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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. What does LM - EM - IF show in diffuse proliferative GN
Carbonic anhydrase
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Acute pyelonephritis

2. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Carbonic anhydrase
Renal tubular cells - polygonal clear cells
Simple cysts
Few glomeruli

3. What do casts indicated about hematuria/pyuria
Hyperkalemia
Invades IVC and spreads hematogenously
Liver
Renal in origin

4. Bergers' disease - which antibody and What do you see on LM and IF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Needs to be bilateral
Polycystic liver disease - berry aneurysms - mitral valve prolapse

5. What is the formula for renal blood flow
RPF/(1- Hct)
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Dec renal bicarb reabsorption - delayed

6. In renal failure - what happens to potassium
Dec - dec - NC
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Hyperkalemia

7. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Phenacetin - smoking - aniline dyes - cyclophosphamide
Reabsorb Na in exchange for secreting K and H
Diarrhea - glue - RTA - hyperchloremia

8. inc in creatinine and BUN over a period of several days
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Eosinphilic casts in tubules
Hypervent - early high altitude - aspirin ingestion early
Acute renal failure

9. What is the 3rd most common kidney stone and What causes it
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hypokalemia and hypophosphatemic rickets
Cx>GFR

10. What is the compensatory response in metabolic acidosis
Bladder cancer
Solute is reabsorbed more quickly than water
Hypervent - immediate
NC - inc - inc

11. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
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
Anion gap = na - (Cl + bicarb)
Crescent - moon shape

12. What therapy does miminal change respond to...
JG cells
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Corticosteroids
Cx>GFR

13. How do calcium stones appear on x ray
PH = pKa + log bicarb/0.03PCO2
Wilms tumor (ages 2-4)
Radiopaque
Antifreeze - ethyelene glycol or vit C abuse

14. How does RCC manifest clinically
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
No
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Dec - dec - dec

15. proliferative
Vasa recta - interlobular v - interlobar v - renal v
Dec - inc - dec
Hyperceullular glomeruli
White cell casts

16. What effect does efferent arteriole cxn have on RPF - GFR and FF
Phenacetin - smoking - aniline dyes - cyclophosphamide
Dec - inc - inc
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Wilms tumor (ages 2-4)

17. What is the formula for excretion rate
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
V x Urine concentration
Metabolic acidosis
Acute - ATN - or chronic - HTN - DM

18. What are the associated paraneoplastic syndromes wth RCC
Ectopic EPO - ACTH - PTHrP - prolactin
UTI or acute gastroenteritis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

19. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
Inc plasma osm - dec blood volume
Inc
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

20. How is extracellular volume measured
Dec renal bicarb reabsorption - delayed
Segmental sclerosis and hylanosis
Inc GFR and mesangial expansion
Inulin

21. What is the net effect of AT II
Simple cysts
Most of the bicarb - sodium - chloride - and water
Contrict leading to inc FF - preserver renal GFR in low volume states
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

22. What is the henderson hasselbalch equation
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Hypervent - immediate
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
PH = pKa + log bicarb/0.03PCO2

23. In renal failure What are the consquence sof Na/H20 retention
Ammonia - buffer for secreted H+
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
CHF - pulmonary edema - HTN
Inc renal bicarb resabsoprtion - delayed

24. What is the ddx for metabolic alkalosis with compensation
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Antifreeze - ethyelene glycol or vit C abuse
Diuretics - vomiting - antacid - hyperaldosteronism
Corticosteroids

25. Who commonly gets acute post strep GN
Nephritic syndrome
Renal artery - interlobar a - interlobular a
Nonspecific
Kids - peripheral and periorbital edema - resolves spontaneously

26. What substance is secreted in response increase atrial pressure
Solute and water are reabsorbed at the same rate
Inhibits Na/phosphate cotransport leading to phosphate excretion
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
ANP

27. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Diarrhea - glue - RTA - hyperchloremia
Carbonic anhydrase
Dec - inc - inc
ANP

28. When is TF/P = 1
Solute and water are reabsorbed at the same rate
Few glomeruli
Inc in concentration - not amout - due to water reabsorption
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

29. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Hypervent - immediate
ADPKD

30. tram track appearance on EM - typ - path - and associated dz
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Medullary cystic disease
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

31. What are the associations with RTA type 2
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
2 ways - base exchanger and between epithelial cells
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Hypokalemia and hypophosphatemic rickets

32. nonenzymatic glycosylation of GBM - inc permeability and thickening
Dec renal bicarb reabsorption - delayed
RPF/(1- Hct)
Diabetic glomerulonephropathy
Dec - inc - inc

33. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Type II - C3 nephritic factor
V x Urine concentration

34. waxy casts ddx
NC - dec - dec
Invades IVC and spreads hematogenously
Advanced renal dz - CRF
Inc GFR and mesangial expansion

35. What happens when PTH is secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

36. What is renal osteodystrophy
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Rxn from angiotensinogen to angiontensin I
LM - nl glomeruli - EM - foot process effacement

37. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Wilms tumor (ages 2-4)
Acute pyelonephritis
All glomeruli
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

38. When is TF/P <1
Solute is reabsorbed more quickly than water
Diabetic glomerulonephropathy
Acute tubular necrosis
Filtered - secreted

39. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Chronic pyelonephritis
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Vasa recta - interlobular v - interlobar v - renal v
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

40. What needs to happen for postrenal obstruction to creat ARF
Ammonia - buffer for secreted H+
Negative charge
Solute and water are reabsorbed at the same rate
Needs to be bilateral

41. What does NEG lead to in the efferent arterioles
HIV
Inc GFR and mesangial expansion
Dec renal bicarb reabsorption - delayed
Metabolic acidosis

42. 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
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inc - dec - dec
Needs to be bilateral

43. 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
Renal tubular cells - polygonal clear cells
White cell casts
Hypokalemia and hypophosphatemic rickets

44. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Amyloidosis
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
NC - inc - inc
Acute renal failure

45. What 3 disease can lead to RPGN
Corticosteroids
Segmental sclerosis and hylanosis
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
V x Urine concentration

46. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
NC - inc - inc

47. What is the effect of AT II on efferent arterioles
Kids - peripheral and periorbital edema - resolves spontaneously
Na reabsorption drives H20 reabsorption
Most of the bicarb - sodium - chloride - and water
Contrict leading to inc FF - preserver renal GFR in low volume states

48. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
No

49. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
ADPKD
Renal in origin
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

50. When is glucose reabsorbed and with What transporter
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Proximal tubule - na/glucose co transporter
Crescent - moon shape
CHF - pulmonary edema - HTN