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Renal

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Answer 50 questions in 15 minutes.
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1. What two cells make up the JGA
Macula densa and JG cells
Simple cysts
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

2. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
1alpha hydroxylase - PTH stimulates it
Medullary cystic disease
Carbonic anhydrase
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

3. no net secretion or reabsorption of x
Inc in concentration - not amout - due to water reabsorption
By 10%
Amyloidosis
Cx = GFR

4. What is the net effect of PTH
Becomes concentrated and hypertonic
Inc in Ca and PO4 absoprtion from the gut
NC - dec - dec
Intra = HIKIN!

5. What are the two kinds of cells in the collecting tubules
Makes urine less concentrated - impermeable to H20
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Principal cells and intercalated cells
Radiopaque

6. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
RTA type 4 (hyperkalemic)
Na and volume loss
Acute - ATN - or chronic - HTN - DM

7. How do struvite stones appear on xray
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
No
Radiopaque
Diabetic glomerulonephropathy

8. Which cells sense decreases in Na delivery
Macula densa
160-200 - 350
Na and volume loss
Nephrotic syndrome

9. What is the effect of aldosterone in principal cells
Modified smooth muscle of afferent arteriole - secrete renin
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Radiopaque
CHF - pulmonary edema - HTN

10. What happens to urine in the ascending limb
Dialysis cysts
Inc - inc - inc
Makes urine less concentrated - impermeable to H20
PH = pKa + log bicarb/0.03PCO2

11. dense deposits on EM - type and association
Contrict leading to inc FF - preserver renal GFR in low volume states
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Cx = GFR
Type II - C3 nephritic factor

12. Why does Na conc nearly match Osm
Liver
Na reabsorption drives H20 reabsorption
JG cells
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

13. 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
Medullary cystic disease
Amyloidosis
2 ways - base exchanger and between epithelial cells

14. What happens to pH - PCO2 and bicarb in metabolic acidosis
Cx>GFR
NKCC
Dec - dec - dec
JG cells

15. What does the crescent moon shape consist of in RPGN
Wilms tumor (ages 2-4)
2 ways - base exchanger and between epithelial cells
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
60% total body water - 40% ICF - 20% ECF

16. What is lost in nephrotic syndrome resulting what urine and serum changes
Acute - ATN - or chronic - HTN - DM
Dec - inc - dec
Becomes concentrated and hypertonic
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

17. What do casts indicated about hematuria/pyuria
Ectopic EPO - ACTH - PTHrP - prolactin
Acute pyelonephritis
Diarrhea - glue - RTA - hyperchloremia
Renal in origin

18. tram track appearance on EM - typ - path - and associated dz
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
White cell casts
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Crescent - moon shape

19. What happens in the collecting tubules
Advanced renal dz - CRF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Reabsorb Na in exchange for secreting K and H
Nonspecific

20. What effect does ANP have on Na in the kidney
Freely filtered and neither absorbed or secreted
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Nonspecific
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

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

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22. What does ADH do in the collecting tubule
Acts on V2 receptors leading to insertion of aquaporins on luminal side
PH = pKa + log bicarb/0.03PCO2
All glomeruli
Inc in Ca and PO4 absoprtion from the gut

23. What can cause oxalate crystals
Antifreeze - ethyelene glycol or vit C abuse
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
NKCC
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

24. How are amino acids reabsorbed
No
Inc renal bicarb resabsoprtion - delayed
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

25. What happens to the urine in the descending limb
Solute is reabsorbed less quickly than water or net secretion of substance
Becomes concentrated and hypertonic
Size and charge
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

26. how does this present in adults and What is the pattern of inheritence
Hypokalemia - risk for Ca containing kidney stones
Type II - C3 nephritic factor
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

27. What is the compensatory response in metabolic acidosis
Ectopic EPO - ACTH - PTHrP - prolactin
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hypervent - immediate
Triglycerides

28. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Diuretics - vomiting - antacid - hyperaldosteronism
RTA type 4 (hyperkalemic)
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

29. What are the two forms of renal failure and What are examples of each
Type II - C3 nephritic factor
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Acute - ATN - or chronic - HTN - DM
Radiolabelled albumin

30. What does LM - EM - IF show in diffuse proliferative GN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Cx>GFR
Inc GFR and mesangial expansion
RTA type 2 (proximal)

31. What change (lack of) is common in children with renal failure
NC - inc - inc
<3.5 g /day
Growth retardation and developmental delay
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

32. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Corticosteroids
Radiopaque
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

33. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Beta 1
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Kids - peripheral and periorbital edema - resolves spontaneously

34. In what clinical context does Berger's disease often present
Simple cysts
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
UTI or acute gastroenteritis
Hyperkalemia

35. What do you see on LM and IF with rapidly progressive GN
Few glomeruli
Crescent - moon shape
NC - dec - dec
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

36. Where does renal cell carcinoma originate and What do the cells look like
No
Na
Renal tubular cells - polygonal clear cells
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

37. What effect does efferent arteriole cxn have on RPF - GFR and FF
Modified smooth muscle of afferent arteriole - secrete renin
Passively reabsorbs water via medullary hypertonicity
Dec - inc - inc
RTA type 2 (proximal)

38. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Dec - dec - dec
Renal in origin
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Transitional cell carcinoma

39. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Chronic conditions - multiple myeloma - TB - RA
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
ADPKD
Passively reabsorbs water via medullary hypertonicity

40. How do calcium stones appear on x ray
Acute tubular necrosis
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Radiopaque
Diabetic glomerulonephropathy

41. What is the compensatory response in metabolic alkalosis
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Acute tubular necrosis
Antifreeze - ethyelene glycol or vit C abuse
Hypovent - immediate

42. What are the effects of AT II on vascular smooth muscle
Metabolic acidosis
Rxn from angiotensinogen to angiontensin I
Vasocxn - inc BP
Failure of EPO

43. How does RCC spread
Invades IVC and spreads hematogenously
Rxn from angiotensinogen to angiontensin I
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
160-200 - 350

44. WBC casts - ddx
Inc - dec - dec
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
PH - then PC02

45. In renal failure What are the consquence sof Na/H20 retention
CHF - pulmonary edema - HTN
Medullary cystic disease
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
RTA type 1 (distal)

46. Under what circumstances is aldosterone secreted
Rxn from angiotensinogen to angiontensin I
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Inc in concentration - not amout - due to water reabsorption

47. How does Wilms tumor present
20 percent
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Huge palpable flank mass and hematuria
UTI or acute gastroenteritis

48. How is plasma volume measured
Inc plasma osm - dec blood volume
Solute is reabsorbed less quickly than water or net secretion of substance
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Radiolabelled albumin

49. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - dec - dec
White cell casts
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Metabolic acidosis

50. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Angio I to angio II and inhibits bradykinin
Macula densa and JG cells
Beta 1

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Renal

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