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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. Where is ACE made and What are 2 of its fxns
Angio I to angio II and inhibits bradykinin
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Dec renal bicarb reabsorption - delayed
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

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

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3. Where does renal cell carcinoma originate and What do the cells look like
Beta 1
Vasocxn - inc BP
Nonspecific
Renal tubular cells - polygonal clear cells

4. no net secretion or reabsorption of x
Principal cells and intercalated cells
Cx = GFR
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Bladder cancer

5. in acute cystitis with pyuria - do you see casts
Inc - dec - dec
No
White cell casts
Angio I to angio II and inhibits bradykinin

6. What does LM - EM - IF show in diffuse proliferative GN
V x Urine concentration
Crescent - moon shape
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Hypervent - early high altitude - aspirin ingestion early

7. How What does the glomerular filtration barrier distinguish by
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Becomes concentrated and hypertonic
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Size and charge

8. What is lost in nephrotic syndrome resulting what urine and serum changes
Hypokalemia - risk for Ca containing kidney stones
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Complications of chronic kidney disease or HTN

9. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Size and charge
Amyloidosis
NKCC

10. Who often has diffuse proliferative GN
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
GFR x plasma concentration
Modified smooth muscle of afferent arteriole - secrete renin
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

11. membranous
Most of the bicarb - sodium - chloride - and water
Principal cells and intercalated cells
GFR/RPF
Thickening of glomerular BM

12. What is the most common renal malignancy of early childhood
GFR/RPF
Macula densa
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Wilms tumor (ages 2-4)

13. net tubular secretion of x
Cx>GFR
Proximal tubule - na/glucose co transporter
Anion gap = na - (Cl + bicarb)
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

14. What do you see on LM for focal segmental glomerulosclerosis
Cx>GFR
160-200 - 350
Membranoproliferative glomerulonephritis
Segmental sclerosis and hylanosis

15. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
GFR x plasma concentration
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Macula densa and JG cells

16. What serum changes cause a secretion in PTH
Under and under
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Dec - dec - NC

17. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
By 10%
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

18. What is generated and secreted in the proximal tubule
Dec - inc - dec
Ammonia - buffer for secreted H+
RPF/(1- Hct)
Few glomeruli

19. The fenestrated capillary endothelium constitutes what portion of the barrier
Amyloidosis
Diabetic glomerulonephropathy
Wilms tumor (ages 2-4)
Size

20. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
Involves only glomeruli
Nonspecific
Antifreeze - ethyelene glycol or vit C abuse

21. What do patients die from ADPKD
By 10%
Complications of chronic kidney disease or HTN
RTA type 4 (hyperkalemic)
Triglycerides

22. Which cells sense decreases in Na delivery
Crescent - moon shape
Macula densa
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
20 percent

23. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Triglycerides
Na and volume loss
Podocytes foot processes

24. Congo - red stain - apple green birefringence
Macula densa and JG cells
2 ways - base exchanger and between epithelial cells
Amyloidosis
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

25. What is the cutoff of proteinuria in nephritic syndrome
Dec renal bicarb reabsorption - delayed
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Solute is reabsorbed less quickly than water or net secretion of substance
<3.5 g /day

26. Which cells sense decreases in BP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Dec renal bicarb reabsorption - delayed
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
JG cells

27. What is the compensatory response in respiratory acidosis
Inulin
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Inc renal bicarb resabsoprtion - delayed
Anion gap = na - (Cl + bicarb)

28. With what genetic tumor syndrome is RCC associated
Dec - dec - dec
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Von hippel laundau and gene deletion in chromosome 3
Inc in concentration - not amout - due to water reabsorption

29. What is the genetic etiology of wilms tumor and What is WAGR complex
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Crescent - moon shape
Few glomeruli

30. What does the crescent moon shape consist of in RPGN
Inc - dec - dec
Acute tubular necrosis
Nonspecific
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

31. In renal failure What are the consquence sof Na/H20 retention
Von hippel laundau and gene deletion in chromosome 3
CHF - pulmonary edema - HTN
Na
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

32. Where is potassium conc. Highest? Intra or extra
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Intra = HIKIN!
Filtered - secreted

33. What is the formula for excretion rate
Inc renal bicarb resabsoprtion - delayed
1/4 plasma - and 3/4 interstitial volume
Inc
V x Urine concentration

34. What happens in the collecting tubules
Chronic conditions - multiple myeloma - TB - RA
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Reabsorb Na in exchange for secreting K and H
Beta 1

35. Bergers' disease - which antibody and What do you see on LM and IF
Anion gap = na - (Cl + bicarb)
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

36. What are the associations with nephrotic syndrome
NC - inc - inc
Anion gap = na - (Cl + bicarb)
Thromboembolism and inc risk of infection
Podocytes foot processes

37. What is the ddx for metabolic alkalosis with compensation
Solute and water are reabsorbed at the same rate
Diuretics - vomiting - antacid - hyperaldosteronism
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Modified smooth muscle of afferent arteriole - secrete renin

38. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Chronic conditions - multiple myeloma - TB - RA
Invades IVC and spreads hematogenously
Transitional cell carcinoma
Passively reabsorbs water via medullary hypertonicity

39. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
White cell casts
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Macula densa

40. What is is Alport's syndrome and what else do you see with it other than renal path
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
To defend GFR
Chronic conditions - multiple myeloma - TB - RA

41. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Triglycerides
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Wilms tumor (ages 2-4)
Few glomeruli

42. What is the least common kidney stone - What causes it and How do you treat it
LM - nl glomeruli - EM - foot process effacement
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Von hippel laundau and gene deletion in chromosome 3
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

43. What is the effect of AT II on the hypothalamus
Angio I to angio II and inhibits bradykinin
Stimulates thirst
RTA type 2 (proximal)
Inc - dec - dec

44. How are amino acids reabsorbed
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Hyperkalemia
Transitional cell carcinoma

45. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
NC - dec - dec
LM - nl glomeruli - EM - foot process effacement
Filtered - secreted

46. Defect in collecting ducts ability to excrete H+
Growth retardation and developmental delay
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Size and charge
RTA type 1 (distal)

47. hyaline casts ddx
Nonspecific
Solute is reabsorbed less quickly than water or net secretion of substance
Growth retardation and developmental delay
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

48. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Acute pyelonephritis
ANP
NC - inc - inc

49. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Liver
Eosinphilic casts in tubules
Carbonic anhydrase
Acute renal failure

50. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Solute is reabsorbed more quickly than water
Renal artery - interlobar a - interlobular a
Nephritic syndrome
Metabolic acidosis