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Renal

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Answer 50 questions in 15 minutes.
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1. What is the genetic etiology of wilms tumor and What is WAGR complex
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
RTA type 4 (hyperkalemic)
Acts on V2 receptors leading to insertion of aquaporins on luminal side

2. What happens to the urine in the descending limb
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Becomes concentrated and hypertonic
Podocytes foot processes
It has a longer renal vein

3. Focal
Chronic pyelonephritis
Simple cysts
Few glomeruli
Diabetic glomerulonephropathy

4. What is the LM for diabetic glomerulonephropathy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Bladder cancer
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

5. What is winter's formula and when do you use it
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
PH = pKa + log bicarb/0.03PCO2
Inc - inc - inc
Hypokalemia and hypophosphatemic rickets

6. What dyslipidemia is most common in renal failure
GFR/RPF
Poor - days to weeks
Type II - C3 nephritic factor
Triglycerides

7. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Radiopaque
RTA type 2 (proximal)

8. What is the formula for clearance of a substance per unit time
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Rxn from angiotensinogen to angiontensin I
Podocytes foot processes

9. Why is the left kidney taken during living donor transplantation
RTA type 4 (hyperkalemic)
It has a longer renal vein
Acute - ATN - or chronic - HTN - DM
Advanced renal dz - CRF

10. What are JG cells and what substance do they secrete
NKCC
Modified smooth muscle of afferent arteriole - secrete renin
PH - then PC02
Needs to be bilateral

11. What is the most frequent kind of kidney stone and What are causes that lead to it
Solute and water are reabsorbed at the same rate
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
1/4 plasma - and 3/4 interstitial volume
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

12. What is the ddx for a metabolic acidosis with an inc anion gap
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Nephrotic syndrome
Liver

13. Why is there anemia in renal failure
Renal in origin
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Acute - ATN - or chronic - HTN - DM
Failure of EPO

14. What therapy does miminal change respond to...
No
EPO - endothelial cells of peritubular capillaries
Corticosteroids
Contrict leading to inc FF - preserver renal GFR in low volume states

15. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Inc in concentration - not amout - due to water reabsorption
1alpha hydroxylase - PTH stimulates it
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

16. What is the effect of of PTH on the distal convoluted tubule
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Inc Ca/Na exchange to inc Ca reabsoprtion
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
RTA type 2 (proximal)

17. What do you see on LM for focal segmental glomerulosclerosis
Contrict leading to inc FF - preserver renal GFR in low volume states
Nonspecific
Segmental sclerosis and hylanosis
Makes urine less concentrated - impermeable to H20

18. Why does Na conc nearly match Osm
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Reabsorb Na in exchange for secreting K and H
Cx>GFR
Na reabsorption drives H20 reabsorption

19. How are amino acids reabsorbed
Inulin
Complications of chronic kidney disease or HTN
PH = pKa + log bicarb/0.03PCO2
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

20. What is the compensatory response in metabolic acidosis
Stimulates thirst
Acute pyelonephritis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Hypervent - immediate

21. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
No
No
Excreted - filtered

22. Who often has diffuse proliferative GN
Hyperceullular glomeruli
Passively reabsorbs water via medullary hypertonicity
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

23. What is the ddx for metabolic alkalosis with compensation
Inulin
ADPKD
Diuretics - vomiting - antacid - hyperaldosteronism
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

24. What is hartnup's disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Growth retardation and developmental delay
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Diabetic glomerulonephropathy

25. How does RCC spread
Radiopaque
Wilms tumor (ages 2-4)
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Invades IVC and spreads hematogenously

26. What do casts indicated about hematuria/pyuria
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Type II - C3 nephritic factor
Renal in origin
Inc Ca/Na exchange to inc Ca reabsoprtion

27. What substance is secreted in response increase atrial pressure
Inc in Ca and PO4 absoprtion from the gut
Crescent - moon shape
ANP
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

28. What is ADPKD also associated with
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Excreted - filtered
Radiolabelled albumin
Inc

29. What is the net effect of PTH
V x Urine concentration
Carbonic anhydrase
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inc in Ca and PO4 absoprtion from the gut

30. Which cells sense decreases in Na delivery
Diabetic glomerulonephropathy
Under and under
Macula densa
PH = pKa + log bicarb/0.03PCO2

31. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Nonspecific
Acute pyelonephritis
Invades IVC and spreads hematogenously
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

32. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Ammonia - buffer for secreted H+

33. What is the algorithim for acidosis/alkalosis
Men 50 to 70 - inc incidence with smoking and obesity
Insertion of Na channel on luminal side
PH - then PC02
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

34. Defect in proximal tubule HCO3 reabsorption
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
NKCC
Stimulates thirst
RTA type 2 (proximal)

35. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Vasa recta - interlobular v - interlobar v - renal v
Huge palpable flank mass and hematuria
Makes urine less concentrated - impermeable to H20

36. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Few glomeruli
Wilms tumor (ages 2-4)
Chronic pyelonephritis

37. What happens in the thin descending loop of henle
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Small kidney - poor prognosis
Passively reabsorbs water via medullary hypertonicity
Needs to be bilateral

38. How do struvite stones appear on xray
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Growth retardation and developmental delay
Radiopaque
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

39. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Transitional cell carcinoma

40. With what genetic tumor syndrome is RCC associated
Phenacetin - smoking - aniline dyes - cyclophosphamide
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Von hippel laundau and gene deletion in chromosome 3

41. What is the net effect of ANP
Na and volume loss
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
NC - dec - dec
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

42. nonenzymatic glycosylation of GBM - inc permeability and thickening
ADPKD
Diabetic glomerulonephropathy
Makes urine less concentrated - impermeable to H20
Principal cells and intercalated cells

43. What is the formula for excretion rate
Filtered - secreted
V x Urine concentration
Men 50 to 70 - inc incidence with smoking and obesity
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

44. secondary glomerular dz
Phenacetin - smoking - aniline dyes - cyclophosphamide
Involves glomeruli and other organs
Principal cells and intercalated cells
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

45. What are the effects of AT II on the adrenal gland
Poor - days to weeks
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

46. What is the pathway from the efferent arteriorle to the renal v
Acute tubular necrosis
Na reabsorption drives H20 reabsorption
Vasa recta - interlobular v - interlobar v - renal v
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

47. What does US show with medullary cystic disease
Acute - ATN - or chronic - HTN - DM
Hyperkalemia
Small kidney - poor prognosis
ADPKD

48. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Under and under
Renal artery - interlobar a - interlobular a
Triglycerides

49. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Ectopic EPO - ACTH - PTHrP - prolactin
Vasocxn - inc BP
JG cells

50. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
HIV
Transitional cell carcinoma
Ectopic EPO - ACTH - PTHrP - prolactin

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Renal

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