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Renal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Which cells sense decreases in BP
JG cells
Huge palpable flank mass and hematuria
Anion gap = na - (Cl + bicarb)
Hyperceullular glomeruli

2. What does NEG lead to in the efferent arterioles
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Growth retardation and developmental delay
Inc GFR and mesangial expansion
Hydronephrosis and pyelonephritis

3. What are JG cells and what substance do they secrete
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Staghorn calculi - worsened by alkaluria
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Modified smooth muscle of afferent arteriole - secrete renin

4. What is a normal filtration fraction
20 percent
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Anion gap = na - (Cl + bicarb)

5. When is TF/P ratio > 1
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Solute is reabsorbed less quickly than water or net secretion of substance
GFR x plasma concentration
Ammonia - buffer for secreted H+

6. What do you see in the urine with acute pyelonephritis
Inc GFR and mesangial expansion
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Medullary cystic disease
White cell casts

7. in acute post strep GN - What do you see on LM - EM and IF

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8. waxy casts ddx
Advanced renal dz - CRF
Proximal tubule - na/glucose co transporter
RTA type 4 (hyperkalemic)
Diuretics - vomiting - antacid - hyperaldosteronism

9. What happens in the early distal convoluted tubule and What does that do to the urine
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Actively reabsorbs NaCl - diluting - makes urine hypotonic
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

10. With what genetic tumor syndrome is RCC associated
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
UTI or acute gastroenteritis
Von hippel laundau and gene deletion in chromosome 3

11. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Failure of EPO
Hydronephrosis and pyelonephritis
Carbonic anhydrase
RTA type 2 (proximal)

12. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Negative charge
ANP
Acute renal failure

13. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Hypovent - immediate
Staghorn calculi - worsened by alkaluria
Anion gap = na - (Cl + bicarb)

14. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
By 10%
Inc in concentration - not amout - due to water reabsorption
Actively reabsorbs NaCl - diluting - makes urine hypotonic

15. Subendothelial immune complexes with granular IF
Macula densa
Membranoproliferative glomerulonephritis
Freely filtered and neither absorbed or secreted
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

16. What do macula densa cells sense
Reabsorb Na in exchange for secreting K and H
Na
All glomeruli
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

17. hypoaldosteronism or lack of collecting tubule response to aldosteron
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Staghorn calculi - worsened by alkaluria
RTA type 4 (hyperkalemic)
It has a longer renal vein

18. In renal failure What are the consquence sof Na/H20 retention
Negative charge
Small kidney - poor prognosis
CHF - pulmonary edema - HTN
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

19. Defect in proximal tubule HCO3 reabsorption
Radiopaque
RTA type 2 (proximal)
<3.5 g /day
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

20. Who often has diffuse proliferative GN
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Beta 1
Chronic conditions - multiple myeloma - TB - RA

21. What needs to happen for postrenal obstruction to creat ARF
Intra = HIKIN!
Principal cells and intercalated cells
Needs to be bilateral
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

22. How do calcium stones appear on x ray
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Radiolabelled albumin
Nephrotic syndrome
Radiopaque

23. When is glucose reabsorbed and with What transporter
Filtered - secreted
Excreted - filtered
Involves only glomeruli
Proximal tubule - na/glucose co transporter

24. What is winter's formula and when do you use it
Dec renal bicarb reabsorption - delayed
Transitional cell carcinoma
Hypokalemia and hypophosphatemic rickets
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

25. In renal failure - what happens to potassium
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
Hypokalemia and hypophosphatemic rickets
Hyperkalemia
Transitional cell carcinoma

26. In a metabolic acidosis What additional calculation is necessary and How do you make it
NC - dec - dec
Segmental sclerosis and hylanosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Anion gap = na - (Cl + bicarb)

27. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
<3.5 g /day
Under and under
Thickening of glomerular BM

28. In renal failure with uremia - What are the 5 aspects of uremia
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Huge palpable flank mass and hematuria
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

29. How does RCC spread
Invades IVC and spreads hematogenously
Modified smooth muscle of afferent arteriole - secrete renin
ANP
Acts on V2 receptors leading to insertion of aquaporins on luminal side

30. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Hypokalemia - risk for Ca containing kidney stones
Staghorn calculi - worsened by alkaluria
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Poor - days to weeks

31. What happens when PTH is secreted
RTA type 4 (hyperkalemic)
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
RTA type 2 (proximal)

32. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Eosinphilic casts in tubules
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

33. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Transitional cell carcinoma
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

34. net tubular secretion of x
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Cx>GFR
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
PH - then PC02

35. What is the 60-40-20 rule of body weight
Eosinphilic casts in tubules
Ectopic EPO - ACTH - PTHrP - prolactin
Small kidney - poor prognosis
60% total body water - 40% ICF - 20% ECF

36. What do you see on LM and IF with rapidly progressive GN
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Contrict leading to inc FF - preserver renal GFR in low volume states
Crescent - moon shape
Eosinphilic casts in tubules

37. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Renal tubular cells - polygonal clear cells
Acute - ATN - or chronic - HTN - DM
Hypervent - early high altitude - aspirin ingestion early

38. What is the ddx for respiratory acidosis
HIV
Kids - peripheral and periorbital edema - resolves spontaneously
ADPKD
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

39. What happens to urine in the ascending limb
Radiolabelled albumin
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Makes urine less concentrated - impermeable to H20
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

40. What is the compensatory response in metabolic alkalosis
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Hypovent - immediate
No
Segmental sclerosis and hylanosis

41. What are the associated paraneoplastic syndromes wth RCC
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Podocytes foot processes
Ectopic EPO - ACTH - PTHrP - prolactin
Principal cells and intercalated cells

42. How do struvite stones appear on xray
UTI or acute gastroenteritis
Radiopaque
Na reabsorption drives H20 reabsorption
Intra = HIKIN!

43. Under what circumstances is aldosterone secreted
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Kids - peripheral and periorbital edema - resolves spontaneously
Crescent - moon shape
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

44. What is the formula for filtration fraction
GFR/RPF
Transitional cell carcinoma
Beta 1
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

45. What does aldosterone do in the collecting tubule
RTA type 4 (hyperkalemic)
Insertion of Na channel on luminal side
Proximal tubule - na/glucose co transporter
Dec - inc - inc

46. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Bladder cancer
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Macula densa and JG cells

47. What is amyloidosis associated with
Nonspecific
Stimulates thirst
Chronic conditions - multiple myeloma - TB - RA
Inhibits Na/phosphate cotransport leading to phosphate excretion

48. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Solute is reabsorbed more quickly than water
Crescent - moon shape
NC - inc - inc
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

49. What does ADH do in the collecting tubule
Antifreeze - ethyelene glycol or vit C abuse
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc renal bicarb resabsoprtion - delayed
Dec - dec - NC

50. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size
Acute tubular necrosis