Test your basic knowledge |

Renal

Instructions:

Answer 50 questions in 15 minutes.
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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 do casts indicated about hematuria/pyuria
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Invades IVC and spreads hematogenously
Renal in origin
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

2. When is TF/P <1
Hypokalemia - risk for Ca containing kidney stones
Failure of EPO
Solute is reabsorbed more quickly than water
Hypokalemia and hypophosphatemic rickets

3. The fenestrated capillary endothelium constitutes what portion of the barrier
Liver
Triglycerides
Podocytes foot processes
Size

4. What is hartnup's disease
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Phenacetin - smoking - aniline dyes - cyclophosphamide
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

5. What does NEG lead to in the efferent arterioles
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Size and charge
Poor - days to weeks
Inc GFR and mesangial expansion

6. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
No
Medullary cystic disease
HIV
Simple cysts

7. Subendothelial immune complexes with granular IF
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Membranoproliferative glomerulonephritis

8. In renal failure - what happens to potassium
Inc - inc - inc
Hyperkalemia
Eosinphilic casts in tubules
Acute pyelonephritis

9. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inhibits Na/phosphate cotransport leading to phosphate excretion
Negative charge
1alpha hydroxylase - PTH stimulates it

10. What happens in the collecting tubules
Triglycerides
Reabsorb Na in exchange for secreting K and H
Simple cysts
20 percent

11. How does Wilms tumor present
Huge palpable flank mass and hematuria
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Solute is reabsorbed less quickly than water or net secretion of substance

12. What is a normal filtration fraction
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
20 percent
RPF/(1- Hct)
Radiolabelled albumin

13. Bergers' disease - which antibody and What do you see on LM and IF
Failure of EPO
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Contrict leading to inc FF - preserver renal GFR in low volume states
Principal cells and intercalated cells

14. granular - muddy brown casts - ddx
Acute tubular necrosis
Under and under
NC - dec - dec
Hyperceullular glomeruli

15. coarse - asymmetric - corticomedullary scarring and blunted calyx
Segmental sclerosis and hylanosis
Chronic pyelonephritis
Dialysis cysts
Intra = HIKIN!

16. What is the net effect of AT II
All glomeruli
Type II - C3 nephritic factor
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
1/4 plasma - and 3/4 interstitial volume

17. What are the main causes of membranous GN
To defend GFR
Von hippel laundau and gene deletion in chromosome 3
GFR x plasma concentration
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

18. What is the BUN/Cr ratio in instrinsic renal ARF and why
It has a longer renal vein
Ammonia - buffer for secreted H+
Freely filtered and neither absorbed or secreted
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

19. Defect in collecting ducts ability to excrete H+
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
RTA type 1 (distal)
Hyperceullular glomeruli

20. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
Acute tubular necrosis
Carbonic anhydrase
CHF - pulmonary edema - HTN

21. What substance is secreted in response increase atrial pressure
ANP
Inc
Poor - days to weeks
Huge palpable flank mass and hematuria

22. What does renin do
GFR x plasma concentration
Wilms tumor (ages 2-4)
Rxn from angiotensinogen to angiontensin I
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

23. What are the effects of AT II on the adrenal gland
Na and volume loss
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
2 ways - base exchanger and between epithelial cells
Solute and water are reabsorbed at the same rate

24. What is the ddx for respiratory acidosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
NC - dec - dec

25. What effect does dec plasma protein concentration have on RPF - GFR - and FF
It has a longer renal vein
Filtered - secreted
NC - inc - inc
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

26. How does RCC spread
Hypokalemia - risk for Ca containing kidney stones
Invades IVC and spreads hematogenously
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Makes urine less concentrated - impermeable to H20

27. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Few glomeruli
Hypokalemia - risk for Ca containing kidney stones
Chronic conditions - multiple myeloma - TB - RA

28. What is the formula for reabsorption
PH = pKa + log bicarb/0.03PCO2
Filtered - secreted
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
PH - then PC02

29. Where is potassium conc. Highest? Intra or extra
PH - then PC02
Stimulates thirst
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Intra = HIKIN!

30. What is the prognosis of RPGN
Diabetic glomerulonephropathy
Wilms tumor (ages 2-4)
Involves only glomeruli
Poor - days to weeks

31. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Modified smooth muscle of afferent arteriole - secrete renin
Corticosteroids
Proximal tubule - na/glucose co transporter

32. What are the associations with RTA type 4
Invades IVC and spreads hematogenously
60% total body water - 40% ICF - 20% ECF
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

33. In what clinical context does Berger's disease often present
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
UTI or acute gastroenteritis
Dec - inc - dec
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

34. What does LM - EM - IF show in diffuse proliferative GN
Acute pyelonephritis
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Poor - days to weeks
1/4 plasma - and 3/4 interstitial volume

35. What is the compensatory response in respiratory alkalosis
GFR/RPF
Dec renal bicarb reabsorption - delayed
Cx>GFR
Hydronephrosis and pyelonephritis

36. By what percentage does EPRF underestimage true RPF
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
By 10%
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
1/4 plasma - and 3/4 interstitial volume

37. What is the most common renal malignancy of early childhood
Crescent - moon shape
Diabetic glomerulonephropathy
Radiopaque
Wilms tumor (ages 2-4)

38. In renal failure with uremia - What are the 5 aspects of uremia
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Diarrhea - glue - RTA - hyperchloremia
Antifreeze - ethyelene glycol or vit C abuse
CHF - pulmonary edema - HTN

39. What is the pathway to the afferent arteriole
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Huge palpable flank mass and hematuria
Inc Ca/Na exchange to inc Ca reabsoprtion
Renal artery - interlobar a - interlobular a

40. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Medullary cystic disease
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Negative charge
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

41. Where is angiotensinogen made
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Liver
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Hypokalemia - risk for Ca containing kidney stones

42. net tubular secretion of x
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Radiopaque
Cx>GFR
Macula densa

43. What is the algorithim for acidosis/alkalosis
Growth retardation and developmental delay
Negative charge
PH = pKa + log bicarb/0.03PCO2
PH - then PC02

44. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
Hypokalemia - risk for Ca containing kidney stones
Radiopaque
Dec - inc - dec

45. Why is there anemia in renal failure
Failure of EPO
Na and volume loss
EPO - endothelial cells of peritubular capillaries
Antifreeze - ethyelene glycol or vit C abuse

46. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Chronic conditions - multiple myeloma - TB - RA
Huge palpable flank mass and hematuria
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

47. What is the formula for excretion rate
Beta 1
RTA type 2 (proximal)
V x Urine concentration
Bladder cancer

48. In renal failure What acid - base disturbance is most likely
Metabolic acidosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
UTI or acute gastroenteritis

49. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Needs to be bilateral

50. What is the formula for clearance of a substance per unit time
Hypervent - immediate
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate