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Renal

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1. granular - muddy brown casts - ddx
RTA type 1 (distal)
Acute tubular necrosis
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
60% total body water - 40% ICF - 20% ECF

2. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Beta 1
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
NKCC
Inhibits Na/phosphate cotransport leading to phosphate excretion

3. What is a normal filtration fraction
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
20 percent
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

4. What 3 things stimulate the release of renin - and Where is it released from
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc in Ca and PO4 absoprtion from the gut
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

5. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Modified smooth muscle of afferent arteriole - secrete renin
No
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

6. 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
Phenacetin - smoking - aniline dyes - cyclophosphamide
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Needs to be bilateral

7. RBC casts - ddx
2 ways - base exchanger and between epithelial cells
Failure of EPO
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

8. What does thyroidization of the kidney result in
Hypokalemia and hypophosphatemic rickets
Metabolic acidosis
LM - nl glomeruli - EM - foot process effacement
Eosinphilic casts in tubules

9. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
PH = pKa + log bicarb/0.03PCO2
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
ADPKD
Cx>GFR

10. What is the compensatory response in metabolic acidosis
Hypervent - immediate
Complications of chronic kidney disease or HTN
Reabsorb Na in exchange for secreting K and H
Chronic conditions - multiple myeloma - TB - RA

11. What is the compensatory response in respiratory alkalosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
By 10%
Dec renal bicarb reabsorption - delayed
Failure of EPO

12. How can NSAIDs cause acute renal failure
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Diarrhea - glue - RTA - hyperchloremia

13. no net secretion or reabsorption of x
Cx = GFR
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Failure of EPO

14. How is plasma volume measured
Hypervent - early high altitude - aspirin ingestion early
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Proximal tubule - na/glucose co transporter
Radiolabelled albumin

15. What does the crescent moon shape consist of in RPGN
Liver
Acute pyelonephritis
Size
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

16. What is the pathway to the afferent arteriole
Inc in concentration - not amout - due to water reabsorption
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Insertion of Na channel on luminal side
Renal artery - interlobar a - interlobular a

17. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Hydronephrosis and pyelonephritis
Podocytes foot processes
Nonspecific

18. What is the ddx for metabolic alkalosis with compensation
Kids - peripheral and periorbital edema - resolves spontaneously
Inc in concentration - not amout - due to water reabsorption
Diuretics - vomiting - antacid - hyperaldosteronism
Huge palpable flank mass and hematuria

19. What happens in the early distal convoluted tubule and What does that do to the urine
Na
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Actively reabsorbs NaCl - diluting - makes urine hypotonic
GFR/RPF

20. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
White cell casts
Hydronephrosis and pyelonephritis
160-200 - 350
Inc - inc - inc

21. What is ADPKD also associated with
Von hippel laundau and gene deletion in chromosome 3
To defend GFR
Polycystic liver disease - berry aneurysms - mitral valve prolapse
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

22. When is glucose reabsorbed and with What transporter
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Proximal tubule - na/glucose co transporter
Beta 1
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

23. What is the algorithim for acidosis/alkalosis
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
PH - then PC02
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

24. How do you interpret creatinine clearance
Dec renal bicarb reabsorption - delayed
Renal tubular cells - polygonal clear cells
Segmental sclerosis and hylanosis
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

25. How What does the glomerular filtration barrier distinguish by
RPF/(1- Hct)
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Size and charge
Reabsorb Na in exchange for secreting K and H

26. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
Dialysis cysts
Metabolic acidosis
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

27. What percentage of ECF is plasma and What is interstitial volume
RTA type 2 (proximal)
1/4 plasma - and 3/4 interstitial volume
Thickening of glomerular BM
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

28. How is chlorid reabsorbed in the proximal tubule
Renal tubular cells - polygonal clear cells
2 ways - base exchanger and between epithelial cells
Chronic pyelonephritis
Staghorn calculi - worsened by alkaluria

29. When is TF/P ratio > 1
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Crescent - moon shape
Solute is reabsorbed less quickly than water or net secretion of substance
UTI or acute gastroenteritis

30. What does NEG lead to in the efferent arterioles
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Angio I to angio II and inhibits bradykinin
Dec renal bicarb reabsorption - delayed
Inc GFR and mesangial expansion

31. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Growth retardation and developmental delay
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
CHF - pulmonary edema - HTN

32. What needs to happen for postrenal obstruction to creat ARF
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Needs to be bilateral

33. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Nephritic syndrome
EPO - endothelial cells of peritubular capillaries
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

34. What is the compensatory response in metabolic alkalosis
GFR x plasma concentration
Hypovent - immediate
V x Urine concentration
PH = pKa + log bicarb/0.03PCO2

35. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Beta 1
Angio I to angio II and inhibits bradykinin
Reabsorb Na in exchange for secreting K and H
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

36. What is the formula for filtration fraction
Diabetic glomerulonephropathy
GFR/RPF
Few glomeruli
Liver

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

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38. In renal failure What acid - base disturbance is most likely
Inc GFR and mesangial expansion
Metabolic acidosis
Cx>GFR
Triglycerides

39. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
Excreted - filtered
Size and charge
Membranoproliferative glomerulonephritis

40. What do you see on LM for focal segmental glomerulosclerosis
Kids - peripheral and periorbital edema - resolves spontaneously
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Membranoproliferative glomerulonephritis
Segmental sclerosis and hylanosis

41. What is the second most common kidney stone
Wilms tumor (ages 2-4)
Inulin
Renal artery - interlobar a - interlobular a
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

42. What is the pathway from the efferent arteriorle to the renal v
Radiopaque
Vasa recta - interlobular v - interlobar v - renal v
Radiopaque
Hydronephrosis and pyelonephritis

43. What does US show with medullary cystic disease
Excreted - filtered
Small kidney - poor prognosis
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
All glomeruli

44. What are the associations with RTA type 1
PH = pKa + log bicarb/0.03PCO2
Inhibits Na/phosphate cotransport leading to phosphate excretion
Vasa recta - interlobular v - interlobar v - renal v
Hypokalemia - risk for Ca containing kidney stones

45. What are the effects of AT II on the adrenal gland
V x Urine concentration
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

46. When is TF/P = 1
Huge palpable flank mass and hematuria
Solute and water are reabsorbed at the same rate
Hypervent - early high altitude - aspirin ingestion early
Nephritic syndrome

47. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Inc renal bicarb resabsoprtion - delayed
Transitional cell carcinoma
Most of the bicarb - sodium - chloride - and water

48. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

49. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
2 ways - base exchanger and between epithelial cells
Acts on V2 receptors leading to insertion of aquaporins on luminal side

50. do you see casts in bladder cancer - kidney stones with hematuria
No
Dec - inc - inc
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
2 ways - base exchanger and between epithelial cells

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Renal

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