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Test your basic knowledge |
Renal
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Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. nonenzymatic glycosylation of GBM - inc permeability and thickening
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Hyperceullular glomeruli
Diuretics - vomiting - antacid - hyperaldosteronism
Diabetic glomerulonephropathy
2. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Von hippel laundau and gene deletion in chromosome 3
Advanced renal dz - CRF
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
3. What is lost in nephrotic syndrome resulting what urine and serum changes
Size
Complications of chronic kidney disease or HTN
Vasocxn - inc BP
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
4. How is extracellular volume measured
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Inulin
Antifreeze - ethyelene glycol or vit C abuse
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
5. What happens to urine in the ascending limb
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Dec renal bicarb reabsorption - delayed
Hypervent - immediate
Makes urine less concentrated - impermeable to H20
6. What is the 3rd most common kidney stone and What causes it
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inc in Ca and PO4 absoprtion from the gut
Wilms tumor (ages 2-4)
7. How does Wilms tumor present
Most of the bicarb - sodium - chloride - and water
Huge palpable flank mass and hematuria
Bladder cancer
Poor - days to weeks
8. The fused basement membrane with heparan sulfate constitutes what portion of the charge
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
UTI or acute gastroenteritis
Solute is reabsorbed more quickly than water
Negative charge
9. What is the effect of AT II on GFR - FF and Na
No
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Wilms tumor (ages 2-4)
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
10. What effect does ANP have on Na in the kidney
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Podocytes foot processes
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Metabolic acidosis
11. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
Chronic pyelonephritis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
160-200 - 350
12. What is the algorithim for acidosis/alkalosis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hypokalemia - risk for Ca containing kidney stones
Na reabsorption drives H20 reabsorption
PH - then PC02
13. Which cells sense decreases in Na delivery
Inc renal calcium reabsorption and dec renal phosphate reabsoprtion - BUT also stimulates the prox tub cells to make 1 -25 (OH)2 vit D which inc intestinal absorption of both Ca and PO4
Macula densa
Diabetic glomerulonephropathy
Corticosteroids
14. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Radiopaque
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Dec renal bicarb reabsorption - delayed
15. diffuse
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
All glomeruli
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
16. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Dec - dec - NC
Men 50 to 70 - inc incidence with smoking and obesity
Medullary cystic disease
17. What is the compensatory response in metabolic alkalosis
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Inc plasma osm - dec blood volume
Hypovent - immediate
Most of the bicarb - sodium - chloride - and water
18. What dyslipidemia is most common in renal failure
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Acute - ATN - or chronic - HTN - DM
RTA type 1 (distal)
Triglycerides
19. How does RCC manifest clinically
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
20. What do you see on LM and IF with rapidly progressive GN
Diuretics - vomiting - antacid - hyperaldosteronism
Crescent - moon shape
Vasocxn - inc BP
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
21. net tubular reabsorption of x
Cx<GFR
Crescent - moon shape
Inc in concentration - not amout - due to water reabsorption
Staghorn calculi - worsened by alkaluria
22. When is TF/P <1
Solute is reabsorbed more quickly than water
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Poor - days to weeks
23. What do you see in the urine with acute pyelonephritis
20 percent
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
White cell casts
24. In what clinical context does Berger's disease often present
Dec - inc - dec
Acute pyelonephritis
Principal cells and intercalated cells
UTI or acute gastroenteritis
25. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
RTA type 4 (hyperkalemic)
Acute tubular necrosis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
26. What happens in the thin descending loop of henle
Passively reabsorbs water via medullary hypertonicity
It has a longer renal vein
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
27. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Membranoproliferative glomerulonephritis
By 10%
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
28. When is TF/P ratio > 1
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Solute is reabsorbed less quickly than water or net secretion of substance
NKCC
Inc GFR and mesangial expansion
29. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
Nephrotic syndrome
Size
1/4 plasma - and 3/4 interstitial volume
30. What is the effect of AT II on the posterior pituitary
RPF/(1- Hct)
It has a longer renal vein
Involves only glomeruli
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
31. What effect does afferent arteriole cxn have on RPF - GFR and FF
PH - then PC02
RPF/(1- Hct)
Antifreeze - ethyelene glycol or vit C abuse
Dec - dec - NC
32. proliferative
Few glomeruli
Hyperceullular glomeruli
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Hypervent - early high altitude - aspirin ingestion early
33. Where is potassium conc. Highest? Intra or extra
Vasocxn - inc BP
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
HIV
Intra = HIKIN!
34. Defect in proximal tubule HCO3 reabsorption
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
RTA type 2 (proximal)
Hyperceullular glomeruli
Makes urine less concentrated - impermeable to H20
35. What is the net effect of PTH
Na reabsorption drives H20 reabsorption
All glomeruli
Inc in Ca and PO4 absoprtion from the gut
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
36. What do macula densa cells sense
Na
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Na and volume loss
Polycystic liver disease - berry aneurysms - mitral valve prolapse
37. What does LM - EM - IF show in diffuse proliferative GN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Involves only glomeruli
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
38. What is the effect of AT II on the hypothalamus
Stimulates thirst
Medullary cystic disease
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Corticosteroids
39. Subendothelial immune complexes with granular IF
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Membranoproliferative glomerulonephritis
Inulin
Dec - dec - NC
40. What is the ddx for respiratory acidosis
Cx<GFR
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
It has a longer renal vein
Von hippel laundau and gene deletion in chromosome 3
41. tram track appearance on EM - typ - path - and associated dz
1alpha hydroxylase - PTH stimulates it
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Metabolic acidosis
Amyloidosis
42. do you see casts in bladder cancer - kidney stones with hematuria
Acute tubular necrosis
No
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
V x Urine concentration
43. What does renin do
Hydronephrosis and pyelonephritis
Inc Ca/Na exchange to inc Ca reabsoprtion
Thickening of glomerular BM
Rxn from angiotensinogen to angiontensin I
44. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
NC - dec - dec
Inc - inc - inc
Hyperceullular glomeruli
Principal cells and intercalated cells
45. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
Inc plasma osm - dec blood volume
Failure of EPO
Radiolabelled albumin
46. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Cx>GFR
Small kidney - poor prognosis
47. What does ADH do in the collecting tubule
Acts on V2 receptors leading to insertion of aquaporins on luminal side
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
48. In what disease in FSGS the most common glomerular disease
Principal cells and intercalated cells
Polycystic liver disease - berry aneurysms - mitral valve prolapse
HIV
GFR x plasma concentration
49. secondary glomerular dz
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Simple cysts
Antifreeze - ethyelene glycol or vit C abuse
Involves glomeruli and other organs
50. in acute cystitis with pyuria - do you see casts
CHF - pulmonary edema - HTN
No
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Wilms tumor (ages 2-4)
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