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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. What effect does cxn of the ureter have on RPF - GFR and FF
Triglycerides
Kids - peripheral and periorbital edema - resolves spontaneously
NC - dec - dec
Negative charge

2. What is the most common renal malignancy of early childhood
Chronic conditions - multiple myeloma - TB - RA
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Intra = HIKIN!
Wilms tumor (ages 2-4)

3. Which cells sense decreases in Na delivery
Macula densa
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
LM - nl glomeruli - EM - foot process effacement

4. What can cause oxalate crystals
Inhibits Na/phosphate cotransport leading to phosphate excretion
V x Urine concentration
Antifreeze - ethyelene glycol or vit C abuse
Under and under

5. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Negative charge
Cx<GFR
Nephrotic syndrome
Renal artery - interlobar a - interlobular a

6. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Transitional cell carcinoma
UTI or acute gastroenteritis

7. What is the pathway from the efferent arteriorle to the renal v
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Vasa recta - interlobular v - interlobar v - renal v
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

8. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hydronephrosis and pyelonephritis

9. What effect does afferent arteriole cxn have on RPF - GFR and FF
Thromboembolism and inc risk of infection
Corticosteroids
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Dec - dec - NC

10. How What does the glomerular filtration barrier distinguish by
Dec - dec - NC
Size and charge
Chronic pyelonephritis
Inc Ca/Na exchange to inc Ca reabsoprtion

11. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Advanced renal dz - CRF
20 percent
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

12. What is the effect of PTH on the proximal tubule
CHF - pulmonary edema - HTN
Radiopaque
Renal artery - interlobar a - interlobular a
Inhibits Na/phosphate cotransport leading to phosphate excretion

13. Why is there anemia in renal failure
Failure of EPO
RTA type 2 (proximal)
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

14. What is the ddx for respiratory acidosis
Antifreeze - ethyelene glycol or vit C abuse
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
<3.5 g /day

15. tram track appearance on EM - typ - path - and associated dz
RTA type 2 (proximal)
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
HIV

16. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Dec renal bicarb reabsorption - delayed
Inc - dec - dec
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

17. What is winter's formula and when do you use it
Vasocxn - inc BP
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Filtered - secreted
Chronic pyelonephritis

18. waxy casts ddx
RTA type 4 (hyperkalemic)
Invades IVC and spreads hematogenously
Advanced renal dz - CRF
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

19. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Amyloidosis
Nonspecific
Beta 1

20. How do calcium stones appear on x ray
Stimulates thirst
<3.5 g /day
Radiopaque
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

21. diffuse
Ectopic EPO - ACTH - PTHrP - prolactin
Dialysis cysts
All glomeruli
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

22. What do you see on LM and IF with rapidly progressive GN
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Angio I to angio II and inhibits bradykinin
Crescent - moon shape
Vasa recta - interlobular v - interlobar v - renal v

23. What is the LM for diabetic glomerulonephropathy
Na and volume loss
Inc
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Kids - peripheral and periorbital edema - resolves spontaneously

24. What is the net effect of AT II
Growth retardation and developmental delay
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Vasocxn - inc BP

25. What effect does ANP have on GFR
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Proximal tubule - na/glucose co transporter
Ammonia - buffer for secreted H+
Inc

26. What do you see in the urine with acute pyelonephritis
White cell casts
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Inc - inc - inc
Inhibits Na/phosphate cotransport leading to phosphate excretion

27. What is the formula for filtration fraction
Insertion of Na channel on luminal side
Hypervent - early high altitude - aspirin ingestion early
GFR/RPF
Excreted - filtered

28. Defect in proximal tubule HCO3 reabsorption
Inc in Ca and PO4 absoprtion from the gut
Cx = GFR
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
RTA type 2 (proximal)

29. What do macula densa cells sense
Filtered - secreted
Acute - ATN - or chronic - HTN - DM
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Na

30. What is the cutoff of proteinuria in nephritic syndrome
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
<3.5 g /day
Polycystic liver disease - berry aneurysms - mitral valve prolapse

31. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Hyperkalemia
Radiopaque
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

32. What substance is secreted in response increase atrial pressure
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
ANP
Hyperkalemia
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

33. How is extracellular volume measured
Bladder cancer
Acute pyelonephritis
Carbonic anhydrase
Inulin

34. What effect does ANP have on Na in the kidney
Simple cysts
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Hyperkalemia
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

35. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Phenacetin - smoking - aniline dyes - cyclophosphamide
Macula densa and JG cells

36. primary glomerular dz
Inc - inc - inc
Hypokalemia - risk for Ca containing kidney stones
<3.5 g /day
Involves only glomeruli

37. What change (lack of) is common in children with renal failure
GFR/RPF
Growth retardation and developmental delay
Inc
Hypokalemia and hypophosphatemic rickets

38. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
GFR/RPF
Segmental sclerosis and hylanosis
<3.5 g /day

39. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Chronic conditions - multiple myeloma - TB - RA
Hypokalemia - risk for Ca containing kidney stones
Simple cysts
Inc renal bicarb resabsoprtion - delayed

40. Where is ACE made and What are 2 of its fxns
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Angio I to angio II and inhibits bradykinin
EPO - endothelial cells of peritubular capillaries
Principal cells and intercalated cells

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

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42. What effect does efferent arteriole cxn have on RPF - GFR and FF
Inulin
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
2 ways - base exchanger and between epithelial cells
Dec - inc - inc

43. What is the purpose of the JGA
To defend GFR
60% total body water - 40% ICF - 20% ECF
Renal in origin
Dec - dec - NC

44. What do casts indicated about hematuria/pyuria
Radiopaque
Renal in origin
<3.5 g /day
Acute tubular necrosis

45. What two cells make up the JGA
Acute - ATN - or chronic - HTN - DM
Inhibits Na/phosphate cotransport leading to phosphate excretion
Size
Macula densa and JG cells

46. How is plasma volume measured
Von hippel laundau and gene deletion in chromosome 3
Radiolabelled albumin
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Kids - peripheral and periorbital edema - resolves spontaneously

47. What 3 disease can lead to RPGN
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
V x Urine concentration
JG cells

48. When is glucose reabsorbed and with What transporter
Macula densa and JG cells
Triglycerides
Proximal tubule - na/glucose co transporter
Amyloidosis

49. hypoaldosteronism or lack of collecting tubule response to aldosteron
Invades IVC and spreads hematogenously
Type II - C3 nephritic factor
Acts on V2 receptors leading to insertion of aquaporins on luminal side
RTA type 4 (hyperkalemic)

50. What is hartnup's disease
Huge palpable flank mass and hematuria
Hypervent - immediate
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Modified smooth muscle of afferent arteriole - secrete renin