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Renal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Intra = HIKIN!
Renal in origin
Nephrotic syndrome

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
60% total body water - 40% ICF - 20% ECF
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Involves only glomeruli
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

3. What are the 3 transporters of the intercalated cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Renal tubular cells - polygonal clear cells
Hypokalemia and hypophosphatemic rickets
Inc plasma osm - dec blood volume

4. What is the second most common kidney stone
Hypokalemia and hypophosphatemic rickets
Corticosteroids
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Insertion of Na channel on luminal side

5. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Inc Ca/Na exchange to inc Ca reabsoprtion
Growth retardation and developmental delay
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Transitional cell carcinoma

6. What serum changes cause a secretion in PTH
Nephrotic syndrome
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Invades IVC and spreads hematogenously
No

7. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Under and under
UTI or acute gastroenteritis
CHF - pulmonary edema - HTN

8. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Solute and water are reabsorbed at the same rate
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Failure of EPO
Medullary cystic disease

9. How can NSAIDs cause acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Von hippel laundau and gene deletion in chromosome 3
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

10. How do calcium stones appear on x ray
Acute tubular necrosis
Inc GFR and mesangial expansion
Radiopaque
Involves glomeruli and other organs

11. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
NC - dec - dec
Segmental sclerosis and hylanosis
Small kidney - poor prognosis

12. What do patients die from ADPKD
Advanced renal dz - CRF
Complications of chronic kidney disease or HTN
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Vasocxn - inc BP

13. What is ADPKD also associated with
Negative charge
Polycystic liver disease - berry aneurysms - mitral valve prolapse
<3.5 g /day
NC - dec - dec

14. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Nephritic syndrome
Hypovent - immediate
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
Carbonic anhydrase

15. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
To defend GFR
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

16. What can cause oxalate crystals
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Antifreeze - ethyelene glycol or vit C abuse
Renal artery - interlobar a - interlobular a
Solute is reabsorbed more quickly than water

17. What is the cutoff of proteinuria in nephritic syndrome
<3.5 g /day
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Inc GFR and mesangial expansion
RTA type 1 (distal)

18. What are the two forms of renal failure and What are examples of each
Acute - ATN - or chronic - HTN - DM
Hydronephrosis and pyelonephritis
Radiopaque
UTI or acute gastroenteritis

19. primary glomerular dz
Cx = GFR
Inc
Involves only glomeruli
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

20. What is the effect of PTH on the proximal tubule
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Inhibits Na/phosphate cotransport leading to phosphate excretion
Na
Stimulates thirst

21. how does this present in adults and What is the pattern of inheritence
Advanced renal dz - CRF
Proximal tubule - na/glucose co transporter
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

22. nonenzymatic glycosylation of GBM - inc permeability and thickening
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Diabetic glomerulonephropathy
Von hippel laundau and gene deletion in chromosome 3

23. dense deposits on EM - type and association
GFR/RPF
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Type II - C3 nephritic factor
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

24. What is the effect of aldosterone in principal cells
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Solute is reabsorbed more quickly than water
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

25. secondary glomerular dz
Solute is reabsorbed less quickly than water or net secretion of substance
Needs to be bilateral
Involves glomeruli and other organs
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

26. What is the ddx for respiratory acidosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Chronic pyelonephritis
160-200 - 350
Von hippel laundau and gene deletion in chromosome 3

27. membranous
Hyperkalemia
UTI or acute gastroenteritis
Thickening of glomerular BM
Proximal tubule - na/glucose co transporter

28. in TCC - What does painelss hematuria suggest
Bladder cancer
Na reabsorption drives H20 reabsorption
Nonspecific
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

29. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
RPF/(1- Hct)
White cell casts
1alpha hydroxylase - PTH stimulates it

30. What is the purpose of the JGA
Macula densa
To defend GFR
GFR/RPF
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

31. What are the associations with RTA type 2
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Under and under
Bladder cancer
Hypokalemia and hypophosphatemic rickets

32. What is the pathway to the afferent arteriole
Diuretics - vomiting - antacid - hyperaldosteronism
Renal artery - interlobar a - interlobular a
Kids - peripheral and periorbital edema - resolves spontaneously
Dec - dec - NC

33. In what clinical context does Berger's disease often present
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inc plasma osm - dec blood volume
To defend GFR
UTI or acute gastroenteritis

34. What is the LM for diabetic glomerulonephropathy
Inc - dec - dec
Poor - days to weeks
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Corticosteroids

35. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Carbonic anhydrase
Ectopic EPO - ACTH - PTHrP - prolactin
Kids - peripheral and periorbital edema - resolves spontaneously

36. What is the effect of of PTH on the distal convoluted tubule
Inc Ca/Na exchange to inc Ca reabsoprtion
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

37. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Type II - C3 nephritic factor
Involves glomeruli and other organs
Hypovent - immediate

38. What is amyloidosis associated with
Few glomeruli
Chronic conditions - multiple myeloma - TB - RA
Renal in origin
Renal tubular cells - polygonal clear cells

39. What is the formula for reabsorption
Beta 1
Filtered - secreted
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inc plasma osm - dec blood volume

40. Where is ACE made and What are 2 of its fxns
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Angio I to angio II and inhibits bradykinin
Rxn from angiotensinogen to angiontensin I
EPO - endothelial cells of peritubular capillaries

41. How are amino acids reabsorbed
Acute tubular necrosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Insertion of Na channel on luminal side
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

42. What is the algorithim for acidosis/alkalosis
Hyperceullular glomeruli
Inc - dec - dec
Renal tubular cells - polygonal clear cells
PH - then PC02

43. How do you interpret creatinine clearance
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Diarrhea - glue - RTA - hyperchloremia
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

44. What are the associations with RTA type 1
Eosinphilic casts in tubules
Nephritic syndrome
Hypokalemia - risk for Ca containing kidney stones
Liver

45. cortical and medullary cysts resulting from long standing dialysis
Stimulates thirst
Wilms tumor (ages 2-4)
Dialysis cysts
Segmental sclerosis and hylanosis

46. What is the formula for renal blood flow
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
RPF/(1- Hct)
Crescent - moon shape
PH = pKa + log bicarb/0.03PCO2

47. What is the compensatory response in respiratory alkalosis
Liver
Acute tubular necrosis
Vasocxn - inc BP
Dec renal bicarb reabsorption - delayed

48. Where does renal cell carcinoma originate and What do the cells look like
To defend GFR
Size and charge
Needs to be bilateral
Renal tubular cells - polygonal clear cells

49. In what disease in FSGS the most common glomerular disease
LM - nl glomeruli - EM - foot process effacement
Simple cysts
HIV
Inc in concentration - not amout - due to water reabsorption

50. net tubular reabsorption of x
It has a longer renal vein
160-200 - 350
Acute - ATN - or chronic - HTN - DM
Cx<GFR