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Test your basic knowledge |
Renal
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Subject
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health-sciences
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. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
60% total body water - 40% ICF - 20% ECF
Inc plasma osm - dec blood volume
RPF/(1- Hct)
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
2. What is the ddx for metabolic alkalosis with compensation
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
RTA type 1 (distal)
Diuretics - vomiting - antacid - hyperaldosteronism
Ectopic EPO - ACTH - PTHrP - prolactin
3. What is the 60-40-20 rule of body weight
Metabolic acidosis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Vasocxn - inc BP
60% total body water - 40% ICF - 20% ECF
4. What can cause oxalate crystals
Antifreeze - ethyelene glycol or vit C abuse
Simple cysts
By 10%
Inc in Ca and PO4 absoprtion from the gut
5. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
Excreted - filtered
Anion gap = na - (Cl + bicarb)
Type II - C3 nephritic factor
6. What dyslipidemia is most common in renal failure
NC - inc - inc
Amyloidosis
Triglycerides
LM - nl glomeruli - EM - foot process effacement
7. How can NSAIDs cause acute renal failure
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
8. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
NC - dec - dec
Ectopic EPO - ACTH - PTHrP - prolactin
Macula densa
9. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Thickening of glomerular BM
Advanced renal dz - CRF
Macula densa and JG cells
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
10. What is the compensatory response in metabolic alkalosis
Reabsorb Na in exchange for secreting K and H
Hypovent - immediate
Growth retardation and developmental delay
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
11. What is the cutoff of proteinuria in nephritic syndrome
Acute renal failure
<3.5 g /day
ANP
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
12. What is the pathway to the afferent arteriole
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Renal artery - interlobar a - interlobular a
Filtered - secreted
Diarrhea - glue - RTA - hyperchloremia
13. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Insertion of Na channel on luminal side
Wilms tumor (ages 2-4)
14. RBC casts - ddx
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Renal in origin
RTA type 2 (proximal)
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
15. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Cx<GFR
16. What 3 disease can lead to RPGN
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
17. In who is RCC most comon
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Men 50 to 70 - inc incidence with smoking and obesity
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Acute pyelonephritis
18. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Vasa recta - interlobular v - interlobar v - renal v
160-200 - 350
Acts on V2 receptors leading to insertion of aquaporins on luminal side
19. What happens when PTH is secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Simple cysts
Needs to be bilateral
Na and volume loss
20. What happens in the thin descending loop of henle
Passively reabsorbs water via medullary hypertonicity
Inc renal bicarb resabsoprtion - delayed
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
21. Subendothelial immune complexes with granular IF
Cx>GFR
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Membranoproliferative glomerulonephritis
Huge palpable flank mass and hematuria
22. What is the effect of aldosterone in principal cells
Inc - inc - inc
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Medullary cystic disease
23. What is the henderson hasselbalch equation
Angio I to angio II and inhibits bradykinin
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Negative charge
PH = pKa + log bicarb/0.03PCO2
24. TCC is associated with problems in your Pee SAC - ??
1/4 plasma - and 3/4 interstitial volume
Phenacetin - smoking - aniline dyes - cyclophosphamide
Inc renal bicarb resabsoprtion - delayed
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
25. What is the net effect of ANP
Na and volume loss
Radiopaque
Needs to be bilateral
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
26. What do macula densa cells sense
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Na
It has a longer renal vein
27. What are the main causes of membranous GN
Acute - ATN - or chronic - HTN - DM
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Modified smooth muscle of afferent arteriole - secrete renin
Poor - days to weeks
28. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
<3.5 g /day
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Simple cysts
RTA type 2 (proximal)
29. Which cells sense decreases in BP
Complications of chronic kidney disease or HTN
Cx = GFR
JG cells
Beta 1
30. WBC casts - ddx
Becomes concentrated and hypertonic
Staghorn calculi - worsened by alkaluria
NC - dec - dec
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
31. What effect does afferent arteriole cxn have on RPF - GFR and FF
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dec - dec - NC
1alpha hydroxylase - PTH stimulates it
Involves only glomeruli
32. tram track appearance on EM - typ - path - and associated dz
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Anion gap = na - (Cl + bicarb)
Failure of EPO
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
33. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Few glomeruli
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
34. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Renal in origin
Simple cysts
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
35. nonenzymatic glycosylation of GBM - inc permeability and thickening
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Vasa recta - interlobular v - interlobar v - renal v
Failure of EPO
Diabetic glomerulonephropathy
36. What are the two forms of renal failure and What are examples of each
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
GFR/RPF
Acute - ATN - or chronic - HTN - DM
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
37. inc in creatinine and BUN over a period of several days
Acute renal failure
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Chronic pyelonephritis
NC - inc - inc
38. What is the most common renal malignancy of early childhood
GFR/RPF
All glomeruli
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Wilms tumor (ages 2-4)
39. What are the 3 transporters of the intercalated cells
Antifreeze - ethyelene glycol or vit C abuse
RTA type 1 (distal)
<3.5 g /day
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
40. In renal failure What acid - base disturbance is most likely
Corticosteroids
Metabolic acidosis
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
White cell casts
41. What percentage of ECF is plasma and What is interstitial volume
Cx = GFR
Dec - inc - inc
UTI or acute gastroenteritis
1/4 plasma - and 3/4 interstitial volume
42. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Thickening of glomerular BM
PH = pKa + log bicarb/0.03PCO2
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
43. diffuse
All glomeruli
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
60% total body water - 40% ICF - 20% ECF
44. coarse - asymmetric - corticomedullary scarring and blunted calyx
Chronic pyelonephritis
Diabetic glomerulonephropathy
Acute tubular necrosis
NC - dec - dec
45. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Dec - dec - dec
ADPKD
Hypokalemia and hypophosphatemic rickets
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
46. What is the effect of of PTH on the distal convoluted tubule
Stimulates thirst
Inc Ca/Na exchange to inc Ca reabsoprtion
Dec - dec - dec
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
47. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
GFR x plasma concentration
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
PH - then PC02
48. Who commonly gets acute post strep GN
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Nephritic syndrome
Acute tubular necrosis
Kids - peripheral and periorbital edema - resolves spontaneously
49. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Wilms tumor (ages 2-4)
Hypokalemia and hypophosphatemic rickets
50. How does RCC spread
Invades IVC and spreads hematogenously
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Amyloidosis
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