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Renal

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Answer 50 questions in 15 minutes.
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1. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Poor - days to weeks
Few glomeruli
Cx<GFR

2. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
By 10%
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Anion gap = na - (Cl + bicarb)
Inhibits Na/phosphate cotransport leading to phosphate excretion

3. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Bladder cancer
Medullary cystic disease
RTA type 2 (proximal)
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

4. What is the ddx for a respiratory alkalosis
Acute renal failure
Diuretics - vomiting - antacid - hyperaldosteronism
Hypervent - early high altitude - aspirin ingestion early
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

5. What does US show with medullary cystic disease
HIV
Inhibits Na/phosphate cotransport leading to phosphate excretion
Small kidney - poor prognosis
To defend GFR

6. What is the formula for filtration fraction
GFR/RPF
Cx = GFR
Nonspecific
NC - dec - dec

7. How What does the glomerular filtration barrier distinguish by
Size and charge
Ectopic EPO - ACTH - PTHrP - prolactin
Hypervent - early high altitude - aspirin ingestion early
Dec - dec - NC

8. in acute cystitis with pyuria - do you see casts
No
Becomes concentrated and hypertonic
Inc in concentration - not amout - due to water reabsorption
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

9. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Hypokalemia - risk for Ca containing kidney stones
Insertion of Na channel on luminal side
Bladder cancer
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

10. What is a normal filtration fraction
Acute renal failure
1alpha hydroxylase - PTH stimulates it
20 percent
Hyperceullular glomeruli

11. By what percentage does EPRF underestimage true RPF
By 10%
Wilms tumor (ages 2-4)
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Diabetic glomerulonephropathy

12. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
Solute and water are reabsorbed at the same rate
Bladder cancer
No

13. What is the effect of AT II on GFR - FF and Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inc - inc - inc
Poor - days to weeks
Involves only glomeruli

14. How does RCC spread
GFR/RPF
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Invades IVC and spreads hematogenously
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

15. What is the most common renal malignancy of early childhood
White cell casts
Wilms tumor (ages 2-4)
Inc renal bicarb resabsoprtion - delayed
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

16. What is the formula for renal blood flow
RPF/(1- Hct)
Inc - inc - inc
Dec - inc - inc
Inulin

17. What is the net effect of AT II
Type II - C3 nephritic factor
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Acute renal failure
Size

18. What is the 60-40-20 rule of body weight
Hypokalemia and hypophosphatemic rickets
Involves only glomeruli
60% total body water - 40% ICF - 20% ECF
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

19. What is the effect of AT II on efferent arterioles
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Simple cysts
Radiopaque
Contrict leading to inc FF - preserver renal GFR in low volume states

20. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
160-200 - 350
Amyloidosis
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

21. How are amino acids reabsorbed
Thromboembolism and inc risk of infection
Acute tubular necrosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Membranoproliferative glomerulonephritis

22. What is the compensatory response in metabolic acidosis
Huge palpable flank mass and hematuria
Renal tubular cells - polygonal clear cells
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Hypervent - immediate

23. What does ADH do in the collecting tubule
Size and charge
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
ANP

24. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Involves glomeruli and other organs

25. How can NSAIDs cause acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Huge palpable flank mass and hematuria
Insertion of Na channel on luminal side
Nonspecific

26. Why can PAH be used to measure ERPF
All glomeruli
RTA type 4 (hyperkalemic)
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Eosinphilic casts in tubules

27. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Excreted - filtered
RPF/(1- Hct)
NKCC

28. What does LM - EM - IF show in diffuse proliferative GN
Negative charge
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
CHF - pulmonary edema - HTN
Acute pyelonephritis

29. What is the formula for the filtered load
Hydronephrosis and pyelonephritis
NKCC
Inulin
GFR x plasma concentration

30. Defect in proximal tubule HCO3 reabsorption
HIV
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Rxn from angiotensinogen to angiontensin I
RTA type 2 (proximal)

31. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
Cx = GFR
Few glomeruli
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

32. What is the effect of of PTH on the distal convoluted tubule
Size and charge
Inc Ca/Na exchange to inc Ca reabsoprtion
LM - nl glomeruli - EM - foot process effacement
JG cells

33. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
1alpha hydroxylase - PTH stimulates it
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Radiolabelled albumin

34. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Cx<GFR
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

35. What are the two kinds of cells in the collecting tubules
Vasa recta - interlobular v - interlobar v - renal v
PH - then PC02
60% total body water - 40% ICF - 20% ECF
Principal cells and intercalated cells

36. How is plasma volume measured
Cx<GFR
HIV
ADPKD
Radiolabelled albumin

37. What needs to happen for postrenal obstruction to creat ARF
Staghorn calculi - worsened by alkaluria
Needs to be bilateral
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Principal cells and intercalated cells

38. What is the purpose of the JGA
To defend GFR
No
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Hypervent - immediate

39. What dyslipidemia is most common in renal failure
Inc plasma osm - dec blood volume
Growth retardation and developmental delay
RTA type 4 (hyperkalemic)
Triglycerides

40. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
ANP
Inc GFR and mesangial expansion
Diarrhea - glue - RTA - hyperchloremia
Podocytes foot processes

41. Which cells sense decreases in BP
Carbonic anhydrase
JG cells
Inc - inc - inc
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

42. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
Freely filtered and neither absorbed or secreted
Thromboembolism and inc risk of infection
Carbonic anhydrase

43. What effect does ANP have on GFR
Inc
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
ANP
RTA type 2 (proximal)

44. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Phenacetin - smoking - aniline dyes - cyclophosphamide
Wilms tumor (ages 2-4)
Hypokalemia and hypophosphatemic rickets
Beta 1

45. What circumstances causes ADH secretion
Inc plasma osm - dec blood volume
By 10%
Angio I to angio II and inhibits bradykinin
Kids - peripheral and periorbital edema - resolves spontaneously

46. In renal failure What are the consquence sof Na/H20 retention
Angio I to angio II and inhibits bradykinin
CHF - pulmonary edema - HTN
Inc - inc - inc
Inhibits Na/phosphate cotransport leading to phosphate excretion

47. nonenzymatic glycosylation of GBM - inc permeability and thickening
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Radiopaque
Diabetic glomerulonephropathy
Small kidney - poor prognosis

48. coarse - asymmetric - corticomedullary scarring and blunted calyx
Chronic pyelonephritis
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Phenacetin - smoking - aniline dyes - cyclophosphamide
HIV

49. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Phenacetin - smoking - aniline dyes - cyclophosphamide
Nephrotic syndrome
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
PH - then PC02

50. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
160-200 - 350
Involves only glomeruli
Solute and water are reabsorbed at the same rate

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Renal

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