Test your basic knowledge |

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 is amyloidosis associated with
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Liver
Chronic conditions - multiple myeloma - TB - RA

2. inc in creatinine and BUN over a period of several days
Acute renal failure
By 10%
Solute is reabsorbed more quickly than water
Eosinphilic casts in tubules

3. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
UTI or acute gastroenteritis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

4. What is the most common renal malignancy of early childhood
60% total body water - 40% ICF - 20% ECF
Wilms tumor (ages 2-4)
Angio I to angio II and inhibits bradykinin
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

5. What are the associations with RTA type 4
Nonspecific
To defend GFR
GFR/RPF
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

6. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
1/4 plasma - and 3/4 interstitial volume
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Ectopic EPO - ACTH - PTHrP - prolactin

7. What is the formula for filtration fraction
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
GFR/RPF
Dec - dec - NC
Dec renal bicarb reabsorption - delayed

8. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Simple cysts
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
It has a longer renal vein

9. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Negative charge
Acute tubular necrosis
Acute renal failure

10. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Renal tubular cells - polygonal clear cells
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Cx>GFR

11. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
Liver
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

12. What are the associations with RTA type 2
Hypokalemia and hypophosphatemic rickets
Thromboembolism and inc risk of infection
RTA type 1 (distal)
Anion gap = na - (Cl + bicarb)

13. What is is Alport's syndrome and what else do you see with it other than renal path
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Metabolic acidosis
Makes urine less concentrated - impermeable to H20

14. What is the 3rd most common kidney stone and What causes it
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Size and charge
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Makes urine less concentrated - impermeable to H20

15. What are the associations with nephrotic syndrome
Vasa recta - interlobular v - interlobar v - renal v
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Thromboembolism and inc risk of infection
Dec - inc - inc

16. What is the least common kidney stone - What causes it and How do you treat it
To defend GFR
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Inc plasma osm - dec blood volume
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

17. What serum changes cause a secretion in PTH
Nephritic syndrome
Inc - dec - dec
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Hydronephrosis and pyelonephritis

18. What are the two forms of renal failure and What are examples of each
Acute - ATN - or chronic - HTN - DM
Inc in concentration - not amout - due to water reabsorption
Dec - dec - dec
Inc GFR and mesangial expansion

19. How does Wilms tumor present
Failure of EPO
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
CHF - pulmonary edema - HTN
Huge palpable flank mass and hematuria

20. In renal failure - what happens to potassium
Phenacetin - smoking - aniline dyes - cyclophosphamide
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hyperkalemia
NC - dec - dec

21. What does US show with medullary cystic disease
160-200 - 350
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Small kidney - poor prognosis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

22. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Hypervent - early high altitude - aspirin ingestion early
Becomes concentrated and hypertonic
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Dec - inc - dec

23. What are the main complications of kidney stones
2 ways - base exchanger and between epithelial cells
NKCC
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Hydronephrosis and pyelonephritis

24. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Inc renal bicarb resabsoprtion - delayed
HIV
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

25. What are the two kinds of cells in the collecting tubules
Complications of chronic kidney disease or HTN
Principal cells and intercalated cells
Chronic conditions - multiple myeloma - TB - RA
GFR x plasma concentration

26. What is the ddx for metabolic alkalosis with compensation
Inc plasma osm - dec blood volume
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Diuretics - vomiting - antacid - hyperaldosteronism
RPF/(1- Hct)

27. in TCC - What does painelss hematuria suggest
Solute and water are reabsorbed at the same rate
Cx>GFR
Ectopic EPO - ACTH - PTHrP - prolactin
Bladder cancer

28. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Principal cells and intercalated cells
Renal artery - interlobar a - interlobular a
Beta 1
Radiopaque

29. granular - muddy brown casts - ddx
Acute tubular necrosis
Antifreeze - ethyelene glycol or vit C abuse
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Solute is reabsorbed less quickly than water or net secretion of substance

30. What effect does inc plasma protein concentration have on RPF - GFR - and FF
60% total body water - 40% ICF - 20% ECF
Chronic pyelonephritis
NC - dec - dec
Dec - inc - dec

31. What percentage of ECF is plasma and What is interstitial volume
Ectopic EPO - ACTH - PTHrP - prolactin
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
All glomeruli
1/4 plasma - and 3/4 interstitial volume

32. Why is there anemia in renal failure
Failure of EPO
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Dec - dec - NC

33. What is the compensatory response in metabolic alkalosis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hypovent - immediate
GFR/RPF
Kids - peripheral and periorbital edema - resolves spontaneously

34. By what percentage does EPRF underestimage true RPF
Principal cells and intercalated cells
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
By 10%

35. Where does renal cell carcinoma originate and What do the cells look like
Negative charge
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Renal tubular cells - polygonal clear cells
Amyloidosis

36. How does RCC manifest clinically
Diabetic glomerulonephropathy
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Hypokalemia - risk for Ca containing kidney stones
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

37. What is the formula for reabsorption
1/4 plasma - and 3/4 interstitial volume
Vasocxn - inc BP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Filtered - secreted

38. What is the effect of of PTH on the distal convoluted tubule
Freely filtered and neither absorbed or secreted
Inc Ca/Na exchange to inc Ca reabsoprtion
Involves glomeruli and other organs
Inc GFR and mesangial expansion

39. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Principal cells and intercalated cells
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
RTA type 4 (hyperkalemic)
Involves only glomeruli

40. proliferative
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Hyperceullular glomeruli
Size

41. What can cause oxalate crystals
Few glomeruli
Negative charge
Antifreeze - ethyelene glycol or vit C abuse
RTA type 1 (distal)

42. What is hartnup's disease
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
20 percent
Cx = GFR
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

43. What are the associated paraneoplastic syndromes wth RCC
RTA type 1 (distal)
RTA type 2 (proximal)
Ectopic EPO - ACTH - PTHrP - prolactin
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

44. What is the cutoff of proteinuria in nephritic syndrome
JG cells
2 ways - base exchanger and between epithelial cells
Thickening of glomerular BM
<3.5 g /day

45. What two cells make up the JGA
Inc plasma osm - dec blood volume
Macula densa and JG cells
Freely filtered and neither absorbed or secreted
Acute renal failure

46. How What does the glomerular filtration barrier distinguish by
RTA type 4 (hyperkalemic)
Size and charge
Vasocxn - inc BP
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

47. What is the pathway to the afferent arteriole
Chronic pyelonephritis
Renal artery - interlobar a - interlobular a
Kids - peripheral and periorbital edema - resolves spontaneously
Most of the bicarb - sodium - chloride - and water

48. The fused basement membrane with heparan sulfate constitutes what portion of the charge
20 percent
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Negative charge
Acute - ATN - or chronic - HTN - DM

49. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
RTA type 2 (proximal)
Macula densa and JG cells

50. tram track appearance on EM - typ - path - and associated dz
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
ANP
Intra = HIKIN!
Freely filtered and neither absorbed or secreted