Test your basic knowledge |

Renal

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 is the compensatory response in respiratory alkalosis
GFR x plasma concentration
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Segmental sclerosis and hylanosis
Dec renal bicarb reabsorption - delayed

2. waxy casts ddx
Inc in concentration - not amout - due to water reabsorption
Advanced renal dz - CRF
Dec - dec - NC
Nephrotic syndrome

3. What is the effect of AT II on GFR - FF and Na
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Growth retardation and developmental delay
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

4. Why can inulin be used to calculate GFR?
Inulin
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc plasma osm - dec blood volume
Freely filtered and neither absorbed or secreted

5. What is the BUN/Cr ratio in instrinsic renal ARF and why
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Acute tubular necrosis
Diabetic glomerulonephropathy
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

6. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Medullary cystic disease
Rxn from angiotensinogen to angiontensin I
NC - inc - inc

7. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
NC - inc - inc
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

8. What is the effect of aldosterone in principal cells
Needs to be bilateral
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
PH - then PC02

9. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
LM - nl glomeruli - EM - foot process effacement
Amyloidosis
ADPKD
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

10. What do you see on LM and IF with rapidly progressive GN
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
Crescent - moon shape
Vasa recta - interlobular v - interlobar v - renal v
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

11. What is the prognosis of RPGN
Poor - days to weeks
Kids - peripheral and periorbital edema - resolves spontaneously
Inc
Principal cells and intercalated cells

12. What are the effects of PTH hormone on the kidney
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
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
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Diarrhea - glue - RTA - hyperchloremia

13. What two cells make up the JGA
Na reabsorption drives H20 reabsorption
Macula densa and JG cells
Kids - peripheral and periorbital edema - resolves spontaneously
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

14. The fenestrated capillary endothelium constitutes what portion of the barrier
Complications of chronic kidney disease or HTN
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Size
ADPKD

15. What do you see in the urine with acute pyelonephritis
White cell casts
Hypokalemia - risk for Ca containing kidney stones
Bladder cancer
Amyloidosis

16. Why is there anemia in renal failure
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc in Ca and PO4 absoprtion from the gut
Failure of EPO

17. What can cause oxalate crystals
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Eosinphilic casts in tubules
Metabolic acidosis
Antifreeze - ethyelene glycol or vit C abuse

18. What is the LM for diabetic glomerulonephropathy
Hypovent - immediate
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
LM - nl glomeruli - EM - foot process effacement
Inc in concentration - not amout - due to water reabsorption

19. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Staghorn calculi - worsened by alkaluria
JG cells
Acute pyelonephritis
Macula densa

20. What is the effect of AT II on the posterior pituitary
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Na and volume loss
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Huge palpable flank mass and hematuria

21. In renal failure What are the consquence sof Na/H20 retention
ADPKD
Diabetic glomerulonephropathy
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
CHF - pulmonary edema - HTN

22. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Rxn from angiotensinogen to angiontensin I

23. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Phenacetin - smoking - aniline dyes - cyclophosphamide
Type II - C3 nephritic factor
HIV
Simple cysts

24. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
Macula densa
Eosinphilic casts in tubules
Von hippel laundau and gene deletion in chromosome 3

25. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Size and charge
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Inc - inc - inc

26. What is the pathway from the efferent arteriorle to the renal v
Inc
Vasa recta - interlobular v - interlobar v - renal v
Phenacetin - smoking - aniline dyes - cyclophosphamide
No

27. coarse - asymmetric - corticomedullary scarring and blunted calyx
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Chronic pyelonephritis

28. TCC is associated with problems in your Pee SAC - ??
Nephritic syndrome
Phenacetin - smoking - aniline dyes - cyclophosphamide
Crescent - moon shape
Rxn from angiotensinogen to angiontensin I

29. What happens in the collecting tubules
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Insertion of Na channel on luminal side
Reabsorb Na in exchange for secreting K and H

30. What is the pathway to the afferent arteriole
Renal artery - interlobar a - interlobular a
Crescent - moon shape
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

31. What is the BUN/Cr ratio in prerenal azotemia and why?
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Staghorn calculi - worsened by alkaluria
Proximal tubule - na/glucose co transporter

32. What is generated and secreted in the proximal tubule
20 percent
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Ammonia - buffer for secreted H+
RTA type 2 (proximal)

33. What is the formula for filtration fraction
Inc - inc - inc
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
GFR/RPF
20 percent

34. Who commonly gets acute post strep GN
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Acts on V2 receptors leading to insertion of aquaporins on luminal side
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Kids - peripheral and periorbital edema - resolves spontaneously

35. Where is angiotensinogen made
Inc renal bicarb resabsoprtion - delayed
<3.5 g /day
Liver
Under and under

36. cortical and medullary cysts resulting from long standing dialysis
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Dialysis cysts
Poor - days to weeks
Eosinphilic casts in tubules

37. How What does the glomerular filtration barrier distinguish by
Chronic pyelonephritis
Stimulates thirst
Size and charge
Bladder cancer

38. Where is ACE made and What are 2 of its fxns
Membranoproliferative glomerulonephritis
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Acute - ATN - or chronic - HTN - DM
Angio I to angio II and inhibits bradykinin

39. Which cells sense decreases in Na delivery
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Anion gap = na - (Cl + bicarb)
Macula densa
By 10%

40. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Thromboembolism and inc risk of infection
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Ammonia - buffer for secreted H+
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

41. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
To defend GFR
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

42. in TCC - What does painelss hematuria suggest
Inc - inc - inc
Inc
Bladder cancer
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

43. Under what circumstances is aldosterone secreted
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

44. What is the net effect of PTH
RPF/(1- Hct)
60% total body water - 40% ICF - 20% ECF
Inc in Ca and PO4 absoprtion from the gut
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

45. What is the 3rd most common kidney stone and What causes it
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
RTA type 4 (hyperkalemic)
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
ANP

46. RBC casts - ddx
GFR x plasma concentration
It has a longer renal vein
Excreted - filtered
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

47. What effect does afferent arteriole cxn have on RPF - GFR and FF
Dec - dec - NC
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Cx<GFR
Cx>GFR

48. Why does Na conc nearly match Osm
Growth retardation and developmental delay
Renal artery - interlobar a - interlobular a
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Na reabsorption drives H20 reabsorption

49. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Inc - dec - dec
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Dec - dec - NC

50. do you see casts in bladder cancer - kidney stones with hematuria
Filtered - secreted
NC - dec - dec
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
No