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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. membranous
Thickening of glomerular BM
Acute pyelonephritis
Inc in Ca and PO4 absoprtion from the gut
Inc Ca/Na exchange to inc Ca reabsoprtion

2. What is hartnup's disease
Diarrhea - glue - RTA - hyperchloremia
Anion gap = na - (Cl + bicarb)
RTA type 4 (hyperkalemic)
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

3. Why can PAH be used to measure ERPF
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Dec renal bicarb reabsorption - delayed
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

4. What happens in the collecting tubules
Principal cells and intercalated cells
Acute tubular necrosis
Simple cysts
Reabsorb Na in exchange for secreting K and H

5. What substance is secreted in response increase atrial pressure
Most of the bicarb - sodium - chloride - and water
ANP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Radiopaque

6. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Na reabsorption drives H20 reabsorption
160-200 - 350

7. primary glomerular dz
Segmental sclerosis and hylanosis
Involves only glomeruli
Poor - days to weeks
ANP

8. What is the effect of PTH on the proximal tubule
RPF/(1- Hct)
160-200 - 350
Solute and water are reabsorbed at the same rate
Inhibits Na/phosphate cotransport leading to phosphate excretion

9. What do you see on LM and IF with rapidly progressive GN
Vasocxn - inc BP
Crescent - moon shape
Inc in concentration - not amout - due to water reabsorption
Hyperceullular glomeruli

10. In who is RCC most comon
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Chronic conditions - multiple myeloma - TB - RA
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Men 50 to 70 - inc incidence with smoking and obesity

11. What is the henderson hasselbalch equation
Solute is reabsorbed less quickly than water or net secretion of substance
Macula densa
PH = pKa + log bicarb/0.03PCO2
Under and under

12. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Hypokalemia - risk for Ca containing kidney stones
Carbonic anhydrase
Radiolabelled albumin
Inc GFR and mesangial expansion

13. RBC casts - ddx
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Medullary cystic disease

14. granular - muddy brown casts - ddx
Inc in Ca and PO4 absoprtion from the gut
Simple cysts
Acute tubular necrosis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

15. What is the compensatory response in metabolic acidosis
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Hypervent - immediate
Negative charge
Metabolic acidosis

16. Subendothelial immune complexes with granular IF
Hypokalemia and hypophosphatemic rickets
Membranoproliferative glomerulonephritis
Cx>GFR
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

17. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Thickening of glomerular BM
Negative charge
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Most of the bicarb - sodium - chloride - and water

18. What is the effect of AT II on efferent arterioles
Inc GFR and mesangial expansion
Na and volume loss
Dec - dec - NC
Contrict leading to inc FF - preserver renal GFR in low volume states

19. What is the ddx for a respiratory alkalosis
Type II - C3 nephritic factor
Stimulates thirst
Hypervent - early high altitude - aspirin ingestion early
ANP

20. What is the net effect of AT II
Inulin
Acute pyelonephritis
Small kidney - poor prognosis
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

21. What is the effect of AT II on GFR - FF and Na
Excreted - filtered
Ectopic EPO - ACTH - PTHrP - prolactin
Men 50 to 70 - inc incidence with smoking and obesity
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

22. What do macula densa cells sense
Hyperkalemia
Na
HIV
Freely filtered and neither absorbed or secreted

23. What is the least common kidney stone - What causes it and How do you treat it
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
By 10%
White cell casts
Involves glomeruli and other organs

24. How does RCC spread
Invades IVC and spreads hematogenously
Excreted - filtered
Passively reabsorbs water via medullary hypertonicity
Dec renal bicarb reabsorption - delayed

25. What is the compensatory response in metabolic alkalosis
Proximal tubule - na/glucose co transporter
Hypovent - immediate
Chronic conditions - multiple myeloma - TB - RA
Size and charge

26. What is the effect of of PTH on the distal convoluted tubule
Staghorn calculi - worsened by alkaluria
Inc Ca/Na exchange to inc Ca reabsoprtion
Hyperkalemia
Hypervent - early high altitude - aspirin ingestion early

27. cortical and medullary cysts resulting from long standing dialysis
Dialysis cysts
Inc plasma osm - dec blood volume
By 10%
It has a longer renal vein

28. Why does Na conc nearly match Osm
Hypovent - immediate
Vasocxn - inc BP
Na reabsorption drives H20 reabsorption
Contrict leading to inc FF - preserver renal GFR in low volume states

29. secondary glomerular dz
Nephrotic syndrome
Poor - days to weeks
Thromboembolism and inc risk of infection
Involves glomeruli and other organs

30. What is the most common renal malignancy of early childhood
Wilms tumor (ages 2-4)
Metabolic acidosis
Principal cells and intercalated cells
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

31. What is the net effect of PTH
Inc in Ca and PO4 absoprtion from the gut
Hypervent - immediate
Diarrhea - glue - RTA - hyperchloremia
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

32. What is the algorithim for acidosis/alkalosis
PH - then PC02
Cx = GFR
Nephrotic syndrome
Hyperkalemia

33. What is amyloidosis associated with
Amyloidosis
Chronic conditions - multiple myeloma - TB - RA
Antifreeze - ethyelene glycol or vit C abuse
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

34. What does thyroidization of the kidney result in
Inc renal bicarb resabsoprtion - delayed
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Eosinphilic casts in tubules
Nephrotic syndrome

35. What circumstances causes ADH secretion
Triglycerides
Inc plasma osm - dec blood volume
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

36. What effect does efferent arteriole cxn have on RPF - GFR and FF
Most of the bicarb - sodium - chloride - and water
Dec - inc - inc
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Needs to be bilateral

37. What effect does cxn of the ureter have on RPF - GFR and FF
Inc renal bicarb resabsoprtion - delayed
Advanced renal dz - CRF
Intra = HIKIN!
NC - dec - dec

38. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Kids - peripheral and periorbital edema - resolves spontaneously
Diabetic glomerulonephropathy
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

39. In renal failure What are the consquence sof Na/H20 retention
Dec - inc - inc
Acute renal failure
CHF - pulmonary edema - HTN
Staghorn calculi - worsened by alkaluria

40. What happens in the early distal convoluted tubule and What does that do to the urine
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Size and charge
RPF/(1- Hct)
Actively reabsorbs NaCl - diluting - makes urine hypotonic

41. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
NC - dec - dec
LM - nl glomeruli - EM - foot process effacement
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

42. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Dec - inc - dec
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Antifreeze - ethyelene glycol or vit C abuse
Transitional cell carcinoma

43. What are JG cells and what substance do they secrete
Inc GFR and mesangial expansion
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Modified smooth muscle of afferent arteriole - secrete renin
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

44. What is the formula for clearance of a substance per unit time
Inc Ca/Na exchange to inc Ca reabsoprtion
Failure of EPO
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

45. What is the genetic etiology of wilms tumor and What is WAGR complex
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Acute pyelonephritis
Carbonic anhydrase

46. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - dec - dec
Radiolabelled albumin
Dec - inc - dec
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

47. What happens to tubular inulin along the proximal tubule and why
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
RTA type 4 (hyperkalemic)
Inc in concentration - not amout - due to water reabsorption
Diabetic glomerulonephropathy

48. How do the ureters course in relation to the uterine artery and ductus deferens
Chronic conditions - multiple myeloma - TB - RA
Growth retardation and developmental delay
Carbonic anhydrase
Under and under

49. What is the compensatory response in respiratory alkalosis
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Dec renal bicarb reabsorption - delayed
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

50. Which cells sense decreases in Na delivery
Huge palpable flank mass and hematuria
Macula densa
Ectopic EPO - ACTH - PTHrP - prolactin
Diarrhea - glue - RTA - hyperchloremia