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Renal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Involves only glomeruli
1alpha hydroxylase - PTH stimulates it
Proximal tubule - na/glucose co transporter

2. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
Failure of EPO
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

3. tram track appearance on EM - typ - path - and associated dz
<3.5 g /day
Cx>GFR
Macula densa and JG cells
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

4. What do you see in the urine with acute pyelonephritis
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Thromboembolism and inc risk of infection
Von hippel laundau and gene deletion in chromosome 3
White cell casts

5. Where is angiotensinogen made
RTA type 2 (proximal)
PH = pKa + log bicarb/0.03PCO2
Dec - inc - inc
Liver

6. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Acute pyelonephritis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

7. Why is there anemia in renal failure
Failure of EPO
Needs to be bilateral
Acute pyelonephritis
Inc in Ca and PO4 absoprtion from the gut

8. What is the algorithim for acidosis/alkalosis
Eosinphilic casts in tubules
20 percent
Reabsorb Na in exchange for secreting K and H
PH - then PC02

9. With what genetic tumor syndrome is RCC associated
Wilms tumor (ages 2-4)
Von hippel laundau and gene deletion in chromosome 3
Acute renal failure
RTA type 4 (hyperkalemic)

10. What serum changes cause a secretion in PTH
RTA type 2 (proximal)
Hypokalemia and hypophosphatemic rickets
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc renal bicarb resabsoprtion - delayed

11. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Hypovent - immediate
Kids - peripheral and periorbital edema - resolves spontaneously
160-200 - 350

12. What does renin do
Rxn from angiotensinogen to angiontensin I
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Growth retardation and developmental delay

13. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
160-200 - 350
PH = pKa + log bicarb/0.03PCO2
Beta 1
Diabetic glomerulonephropathy

14. What is the effect of AT II on the hypothalamus
Von hippel laundau and gene deletion in chromosome 3
Corticosteroids
Phenacetin - smoking - aniline dyes - cyclophosphamide
Stimulates thirst

15. What 3 disease can lead to RPGN
Membranoproliferative glomerulonephritis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Most of the bicarb - sodium - chloride - and water
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

16. What is the formula for filtration fraction
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
GFR/RPF
Intra = HIKIN!
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

17. How does RCC manifest clinically
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Ammonia - buffer for secreted H+
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Radiopaque

18. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
Carbonic anhydrase
Negative charge
Wilms tumor (ages 2-4)

19. What are the LM and EM of minimal change disease
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
LM - nl glomeruli - EM - foot process effacement
Nephritic syndrome

20. What is generated and secreted in the proximal tubule
Staghorn calculi - worsened by alkaluria
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Ammonia - buffer for secreted H+
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

21. When is TF/P <1
Membranoproliferative glomerulonephritis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
RTA type 1 (distal)
Solute is reabsorbed more quickly than water

22. What is the formula for the filtered load
GFR x plasma concentration
RPF/(1- Hct)
Type II - C3 nephritic factor
PH - then PC02

23. What is the formula for clearance of a substance per unit time
Inc GFR and mesangial expansion
Inc in Ca and PO4 absoprtion from the gut
Inc renal bicarb resabsoprtion - delayed
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

24. How do struvite stones appear on xray
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Radiopaque
GFR/RPF
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

25. 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
Nephritic syndrome
Ammonia - buffer for secreted H+
Beta 1

26. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Anion gap = na - (Cl + bicarb)
Transitional cell carcinoma
60% total body water - 40% ICF - 20% ECF

27. granular - muddy brown casts - ddx
Ammonia - buffer for secreted H+
Acute tubular necrosis
Involves only glomeruli
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

28. In renal failure - what happens to potassium
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Contrict leading to inc FF - preserver renal GFR in low volume states
Hyperkalemia

29. Congo - red stain - apple green birefringence
Chronic conditions - multiple myeloma - TB - RA
Renal tubular cells - polygonal clear cells
ANP
Amyloidosis

30. How does RCC spread
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc GFR and mesangial expansion
Invades IVC and spreads hematogenously

31. primary glomerular dz
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Involves only glomeruli
NC - dec - dec
Simple cysts

32. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Modified smooth muscle of afferent arteriole - secrete renin
ADPKD
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

33. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
Dialysis cysts
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Antifreeze - ethyelene glycol or vit C abuse

34. In renal failure with uremia - What are the 5 aspects of uremia
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Inc Ca/Na exchange to inc Ca reabsoprtion
Wilms tumor (ages 2-4)
White cell casts

35. What therapy does miminal change respond to...
Diabetic glomerulonephropathy
Ammonia - buffer for secreted H+
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Corticosteroids

36. What is the purpose of the JGA
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Chronic conditions - multiple myeloma - TB - RA
To defend GFR
Inc in Ca and PO4 absoprtion from the gut

37. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Passively reabsorbs water via medullary hypertonicity
Hypervent - immediate

38. What are the two forms of renal failure and What are examples of each
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Dialysis cysts
Acute - ATN - or chronic - HTN - DM
Segmental sclerosis and hylanosis

39. When is TF/P = 1
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Solute and water are reabsorbed at the same rate
Inhibits Na/phosphate cotransport leading to phosphate excretion
NC - dec - dec

40. What happens in the collecting tubules
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Reabsorb Na in exchange for secreting K and H
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Small kidney - poor prognosis

41. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
PH = pKa + log bicarb/0.03PCO2
Makes urine less concentrated - impermeable to H20
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
RTA type 4 (hyperkalemic)

42. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Poor - days to weeks

43. What cells create the epithelial layer of the glomerular filtration barrier
RTA type 4 (hyperkalemic)
Podocytes foot processes
Renal artery - interlobar a - interlobular a
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

44. What are the main causes of membranous GN
Dec - dec - NC
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

45. What happens when PTH is secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
NC - inc - inc
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Dec renal bicarb reabsorption - delayed

46. What do you see on LM for focal segmental glomerulosclerosis
Phenacetin - smoking - aniline dyes - cyclophosphamide
Modified smooth muscle of afferent arteriole - secrete renin
JG cells
Segmental sclerosis and hylanosis

47. What is amyloidosis associated with
Hypokalemia and hypophosphatemic rickets
Chronic conditions - multiple myeloma - TB - RA
Anion gap = na - (Cl + bicarb)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

48. When is glucose reabsorbed and with What transporter
All glomeruli
Dec renal bicarb reabsorption - delayed
Failure of EPO
Proximal tubule - na/glucose co transporter

49. How is extracellular volume measured
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Advanced renal dz - CRF
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Inulin

50. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Acute - ATN - or chronic - HTN - DM
60% total body water - 40% ICF - 20% ECF
1alpha hydroxylase - PTH stimulates it
Vasocxn - inc BP