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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. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Hypokalemia - risk for Ca containing kidney stones
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

2. primary glomerular dz
Amyloidosis
Size
Involves only glomeruli
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

3. What is ADPKD also associated with
Solute and water are reabsorbed at the same rate
Size
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Radiolabelled albumin

4. Which cells sense decreases in BP
JG cells
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Size
Growth retardation and developmental delay

5. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Vasocxn - inc BP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

6. How do struvite stones appear on xray
Radiopaque
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Hydronephrosis and pyelonephritis
Dialysis cysts

7. What is hartnup's disease
Hypovent - immediate
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
LM - nl glomeruli - EM - foot process effacement
60% total body water - 40% ICF - 20% ECF

8. Under what circumstances is aldosterone secreted
Small kidney - poor prognosis
Inc - inc - inc
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

9. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Nephritic syndrome
To defend GFR
Carbonic anhydrase
NC - inc - inc

10. What needs to happen for postrenal obstruction to creat ARF
Size and charge
Ammonia - buffer for secreted H+
Needs to be bilateral
Ectopic EPO - ACTH - PTHrP - prolactin

11. Where is potassium conc. Highest? Intra or extra
Intra = HIKIN!
Wilms tumor (ages 2-4)
Size
Radiopaque

12. What is the BUN/Cr ratio in instrinsic renal ARF and why
Reabsorb Na in exchange for secreting K and H
Bladder cancer
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
NC - dec - dec

13. What is the net effect of PTH
Diabetic glomerulonephropathy
Inc in Ca and PO4 absoprtion from the gut
Na
Corticosteroids

14. What is the formula for filtration fraction
GFR/RPF
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
NC - inc - inc

15. What is the purpose of the JGA
Type II - C3 nephritic factor
Phenacetin - smoking - aniline dyes - cyclophosphamide
Solute is reabsorbed less quickly than water or net secretion of substance
To defend GFR

16. membranous
Thickening of glomerular BM
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Medullary cystic disease
ADPKD

17. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Hypervent - early high altitude - aspirin ingestion early
Membranoproliferative glomerulonephritis
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

18. waxy casts ddx
Advanced renal dz - CRF
Men 50 to 70 - inc incidence with smoking and obesity
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Chronic pyelonephritis

19. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
Cx>GFR
Contrict leading to inc FF - preserver renal GFR in low volume states
Rxn from angiotensinogen to angiontensin I

20. What substance is secreted in response increase atrial pressure
NC - dec - dec
Inc - inc - inc
Wilms tumor (ages 2-4)
ANP

21. What is the BUN/Cr ratio in prerenal azotemia and why?
Liver
160-200 - 350
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Angio I to angio II and inhibits bradykinin

22. In what disease in FSGS the most common glomerular disease
HIV
PH - then PC02
Metabolic acidosis
Rxn from angiotensinogen to angiontensin I

23. What is the 60-40-20 rule of body weight
60% total body water - 40% ICF - 20% ECF
Simple cysts
Macula densa and JG cells
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

24. In renal failure What are the consquence sof Na/H20 retention
PH = pKa + log bicarb/0.03PCO2
CHF - pulmonary edema - HTN
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Cx>GFR

25. What cells create the epithelial layer of the glomerular filtration barrier
Diarrhea - glue - RTA - hyperchloremia
Podocytes foot processes
Complications of chronic kidney disease or HTN
Modified smooth muscle of afferent arteriole - secrete renin

26. Who often has diffuse proliferative GN
Dec - dec - dec
RTA type 1 (distal)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
NKCC

27. What effect does ANP have on Na in the kidney
Vasocxn - inc BP
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Carbonic anhydrase
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

28. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Reabsorb Na in exchange for secreting K and H
Beta 1

29. How does Wilms tumor present
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
1/4 plasma - and 3/4 interstitial volume
Huge palpable flank mass and hematuria

30. What does NEG lead to in the efferent arterioles
Carbonic anhydrase
Hyperkalemia
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Inc GFR and mesangial expansion

31. What is the effect of AT II on the hypothalamus
Dec - inc - dec
Proximal tubule - na/glucose co transporter
Stimulates thirst
Macula densa and JG cells

32. proliferative
NC - inc - inc
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hyperceullular glomeruli
PH = pKa + log bicarb/0.03PCO2

33. What is the genetic etiology of wilms tumor and What is WAGR complex
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Invades IVC and spreads hematogenously
Poor - days to weeks
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

34. What is the effect of AT II on efferent arterioles
Beta 1
Contrict leading to inc FF - preserver renal GFR in low volume states
Podocytes foot processes
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

35. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Dec - inc - inc
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Thickening of glomerular BM
Renal tubular cells - polygonal clear cells

36. Who commonly gets acute post strep GN
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Poor - days to weeks
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Kids - peripheral and periorbital edema - resolves spontaneously

37. The fenestrated capillary endothelium constitutes what portion of the barrier
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Excreted - filtered
V x Urine concentration
Size

38. In what clinical context does Berger's disease often present
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Inc in Ca and PO4 absoprtion from the gut
UTI or acute gastroenteritis
1alpha hydroxylase - PTH stimulates it

39. What does ADH do in the collecting tubule
Podocytes foot processes
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Poor - days to weeks
No

40. What happens in the thin descending loop of henle
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
RTA type 1 (distal)
Chronic pyelonephritis
Passively reabsorbs water via medullary hypertonicity

41. What does US show with medullary cystic disease
Small kidney - poor prognosis
Freely filtered and neither absorbed or secreted
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Filtered - secreted

42. What is lost in nephrotic syndrome resulting what urine and serum changes
Medullary cystic disease
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
<3.5 g /day
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

43. How can NSAIDs cause acute renal failure
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Actively reabsorbs NaCl - diluting - makes urine hypotonic
PH - then PC02
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

44. What is the effect of AT II on GFR - FF and Na
Under and under
Radiopaque
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Vasa recta - interlobular v - interlobar v - renal v

45. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
Dialysis cysts
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Advanced renal dz - CRF

46. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Podocytes foot processes

47. diffuse
Thromboembolism and inc risk of infection
No
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
All glomeruli

48. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Acute pyelonephritis
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

49. What change (lack of) is common in children with renal failure
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Growth retardation and developmental delay
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
LM - nl glomeruli - EM - foot process effacement

50. What is the formula for secreted
Few glomeruli
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Excreted - filtered
Hydronephrosis and pyelonephritis