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Test your basic knowledge |
Renal
Start Test
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. What is the effect of PTH on the proximal tubule
UTI or acute gastroenteritis
Inhibits Na/phosphate cotransport leading to phosphate excretion
Hypokalemia and hypophosphatemic rickets
Na reabsorption drives H20 reabsorption
2. Which cells sense decreases in BP
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Freely filtered and neither absorbed or secreted
Radiolabelled albumin
JG cells
3. What are the main causes of membranous GN
Men 50 to 70 - inc incidence with smoking and obesity
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
ADPKD
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
4. no net secretion or reabsorption of x
Cx = GFR
Dec renal bicarb reabsorption - delayed
Von hippel laundau and gene deletion in chromosome 3
To defend GFR
5. What serum changes cause a secretion in PTH
CHF - pulmonary edema - HTN
Dialysis cysts
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Na and volume loss
6. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Kids - peripheral and periorbital edema - resolves spontaneously
Solute is reabsorbed less quickly than water or net secretion of substance
<3.5 g /day
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
7. net tubular reabsorption of x
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Dec renal bicarb reabsorption - delayed
Cx<GFR
Dec - inc - dec
8. What are the associations with RTA type 1
Advanced renal dz - CRF
Excreted - filtered
Hypokalemia - risk for Ca containing kidney stones
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
9. What do you see on LM and IF with rapidly progressive GN
Radiopaque
Crescent - moon shape
Inc in concentration - not amout - due to water reabsorption
Renal in origin
10. What is the pathway from the efferent arteriorle to the renal v
Filtered - secreted
Vasa recta - interlobular v - interlobar v - renal v
Contrict leading to inc FF - preserver renal GFR in low volume states
Angio I to angio II and inhibits bradykinin
11. In a metabolic acidosis What additional calculation is necessary and How do you make it
RTA type 1 (distal)
Anion gap = na - (Cl + bicarb)
Needs to be bilateral
It has a longer renal vein
12. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Hydronephrosis and pyelonephritis
Ectopic EPO - ACTH - PTHrP - prolactin
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Staghorn calculi - worsened by alkaluria
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
Actively reabsorbs NaCl - diluting - makes urine hypotonic
NC - dec - dec
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
14. What is the compensatory response in respiratory alkalosis
Ectopic EPO - ACTH - PTHrP - prolactin
Hypervent - immediate
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Dec renal bicarb reabsorption - delayed
15. What happens to urine in the ascending limb
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Makes urine less concentrated - impermeable to H20
Hypervent - early high altitude - aspirin ingestion early
1/4 plasma - and 3/4 interstitial volume
16. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Inc renal bicarb resabsoprtion - delayed
Diabetic glomerulonephropathy
NC - dec - dec
Na and volume loss
17. What is the formula for the filtered load
GFR x plasma concentration
V x Urine concentration
Membranoproliferative glomerulonephritis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
18. What two cells make up the JGA
Ammonia - buffer for secreted H+
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Macula densa and JG cells
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
19. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
Vasa recta - interlobular v - interlobar v - renal v
PH - then PC02
Medullary cystic disease
20. In renal failure - what happens to potassium
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Solute and water are reabsorbed at the same rate
Men 50 to 70 - inc incidence with smoking and obesity
Hyperkalemia
21. With what genetic tumor syndrome is RCC associated
NC - inc - inc
Von hippel laundau and gene deletion in chromosome 3
Macula densa
Kids - peripheral and periorbital edema - resolves spontaneously
22. Where is ACE made and What are 2 of its fxns
Angio I to angio II and inhibits bradykinin
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
23. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Principal cells and intercalated cells
ADPKD
GFR x plasma concentration
Type II - C3 nephritic factor
24. acute generalized cortical infarction of both kidneys - dz - causes and associations
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Dec renal bicarb reabsorption - delayed
Segmental sclerosis and hylanosis
Radiopaque
25. What effect does cxn of the ureter have on RPF - GFR and FF
Carbonic anhydrase
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
NC - dec - dec
1/4 plasma - and 3/4 interstitial volume
26. What happens to pH - PCO2 and bicarb in metabolic acidosis
Dec - dec - dec
Beta 1
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Men 50 to 70 - inc incidence with smoking and obesity
27. What is winter's formula and when do you use it
Hypokalemia and hypophosphatemic rickets
Von hippel laundau and gene deletion in chromosome 3
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Freely filtered and neither absorbed or secreted
28. What is the algorithim for acidosis/alkalosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
To defend GFR
PH - then PC02
Thromboembolism and inc risk of infection
29. What does NEG lead to in the efferent arterioles
Growth retardation and developmental delay
Na reabsorption drives H20 reabsorption
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc GFR and mesangial expansion
30. waxy casts ddx
Inc - inc - inc
Dec - dec - NC
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Advanced renal dz - CRF
31. What substance is secreted in response increase atrial pressure
ANP
Stimulates thirst
It has a longer renal vein
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
32. How do you interpret creatinine clearance
It has a longer renal vein
Hypokalemia - risk for Ca containing kidney stones
Radiolabelled albumin
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
33. What happens to tubular inulin along the proximal tubule and why
Radiopaque
Inc in concentration - not amout - due to water reabsorption
Chronic pyelonephritis
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
34. Which cells sense decreases in Na delivery
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Macula densa
Dialysis cysts
Renal tubular cells - polygonal clear cells
35. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
Macula densa and JG cells
UTI or acute gastroenteritis
Principal cells and intercalated cells
36. What change (lack of) is common in children with renal failure
Insertion of Na channel on luminal side
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Growth retardation and developmental delay
37. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
NC - inc - inc
NKCC
Carbonic anhydrase
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
38. secondary glomerular dz
Simple cysts
Involves glomeruli and other organs
Negative charge
Na
39. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
V x Urine concentration
<3.5 g /day
Staghorn calculi - worsened by alkaluria
Nephritic syndrome
40. coarse - asymmetric - corticomedullary scarring and blunted calyx
Modified smooth muscle of afferent arteriole - secrete renin
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Acute pyelonephritis
Chronic pyelonephritis
41. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Solute is reabsorbed more quickly than water
All glomeruli
42. net tubular secretion of x
Macula densa
Cx>GFR
Reabsorb Na in exchange for secreting K and H
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
43. What does LM - EM - IF show in diffuse proliferative GN
Inc - dec - dec
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Vasocxn - inc BP
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
44. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Crescent - moon shape
Kids - peripheral and periorbital edema - resolves spontaneously
NKCC
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
45. inc in creatinine and BUN over a period of several days
Solute is reabsorbed less quickly than water or net secretion of substance
Inc plasma osm - dec blood volume
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Acute renal failure
46. What is the effect of AT II on the posterior pituitary
Nephritic syndrome
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Staghorn calculi - worsened by alkaluria
Freely filtered and neither absorbed or secreted
47. What are the associated paraneoplastic syndromes wth RCC
Crescent - moon shape
Ectopic EPO - ACTH - PTHrP - prolactin
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
48. What is the effect of AT II on efferent arterioles
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Contrict leading to inc FF - preserver renal GFR in low volume states
Passively reabsorbs water via medullary hypertonicity
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
49. What effect does dec plasma protein concentration have on RPF - GFR - and FF
All glomeruli
NC - inc - inc
Hyperceullular glomeruli
60% total body water - 40% ICF - 20% ECF
50. How is plasma volume measured
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Reabsorb Na in exchange for secreting K and H
Radiolabelled albumin
Radiopaque