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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 do you see on LM for focal segmental glomerulosclerosis
No
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Segmental sclerosis and hylanosis

2. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Carbonic anhydrase
Na reabsorption drives H20 reabsorption
Principal cells and intercalated cells
Acute pyelonephritis

3. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Growth retardation and developmental delay
Medullary cystic disease
Passively reabsorbs water via medullary hypertonicity
Hydronephrosis and pyelonephritis

4. Who often has diffuse proliferative GN
Metabolic acidosis
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Transitional cell carcinoma

5. Defect in collecting ducts ability to excrete H+
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Diarrhea - glue - RTA - hyperchloremia
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
RTA type 1 (distal)

6. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Segmental sclerosis and hylanosis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
JG cells
NC - inc - inc

7. What is the formula for reabsorption
Excreted - filtered
Filtered - secreted
Inc
Ectopic EPO - ACTH - PTHrP - prolactin

8. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Wilms tumor (ages 2-4)
Polycystic liver disease - berry aneurysms - mitral valve prolapse
NKCC

9. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Na and volume loss
Nephrotic syndrome
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc - dec - dec

10. What is lost in nephrotic syndrome resulting what urine and serum changes
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Antifreeze - ethyelene glycol or vit C abuse
Eosinphilic casts in tubules

11. What happens in the early distal convoluted tubule and What does that do to the urine
Inc
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Diarrhea - glue - RTA - hyperchloremia
Nephritic syndrome

12. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Nephrotic syndrome
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

13. What is a normal filtration fraction
20 percent
Inc GFR and mesangial expansion
Freely filtered and neither absorbed or secreted
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

14. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Transitional cell carcinoma
Stimulates thirst
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

15. primary glomerular dz
Acute renal failure
Staghorn calculi - worsened by alkaluria
Becomes concentrated and hypertonic
Involves only glomeruli

16. What is the ddx for metabolic alkalosis with compensation
NC - dec - dec
Rxn from angiotensinogen to angiontensin I
Diuretics - vomiting - antacid - hyperaldosteronism
Inc

17. What is the LM for diabetic glomerulonephropathy
Nonspecific
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Rxn from angiotensinogen to angiontensin I

18. What is winter's formula and when do you use it
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc
Angio I to angio II and inhibits bradykinin
Thromboembolism and inc risk of infection

19. What is the compensatory response in metabolic alkalosis
Medullary cystic disease
Metabolic acidosis
Hypovent - immediate
Huge palpable flank mass and hematuria

20. What does the crescent moon shape consist of in RPGN
Angio I to angio II and inhibits bradykinin
Filtered - secreted
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inhibits Na/phosphate cotransport leading to phosphate excretion

21. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Chronic pyelonephritis
PH = pKa + log bicarb/0.03PCO2
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

22. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
CHF - pulmonary edema - HTN
Chronic pyelonephritis
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

23. In renal failure What are the consquence sof Na/H20 retention
Inc in Ca and PO4 absoprtion from the gut
RTA type 4 (hyperkalemic)
CHF - pulmonary edema - HTN
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

24. What is the 60-40-20 rule of body weight
60% total body water - 40% ICF - 20% ECF
Inc Ca/Na exchange to inc Ca reabsoprtion
Nephritic syndrome
Thromboembolism and inc risk of infection

25. What is the effect of AT II on efferent arterioles
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Contrict leading to inc FF - preserver renal GFR in low volume states
UTI or acute gastroenteritis
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

26. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Simple cysts
Under and under

27. Bergers' disease - which antibody and What do you see on LM and IF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Acute pyelonephritis
Antifreeze - ethyelene glycol or vit C abuse
Macula densa

28. What is the algorithim for acidosis/alkalosis
2 ways - base exchanger and between epithelial cells
PH - then PC02
Acute tubular necrosis
Inc in concentration - not amout - due to water reabsorption

29. inc in creatinine and BUN over a period of several days
Acute renal failure
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Intra = HIKIN!

30. What is the effect of AT II on GFR - FF and Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inhibits Na/phosphate cotransport leading to phosphate excretion
JG cells
Corticosteroids

31. What are the 3 transporters of the intercalated cells
Kids - peripheral and periorbital edema - resolves spontaneously
No
Contrict leading to inc FF - preserver renal GFR in low volume states
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

32. What are the main causes of membranous GN
Filtered - secreted
Involves only glomeruli
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inc - inc - inc

33. Why can inulin be used to calculate GFR?
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Freely filtered and neither absorbed or secreted
Dec - dec - dec

34. When is glucose reabsorbed and with What transporter
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Few glomeruli
2 ways - base exchanger and between epithelial cells
Proximal tubule - na/glucose co transporter

35. What are JG cells and what substance do they secrete
Radiolabelled albumin
Simple cysts
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Modified smooth muscle of afferent arteriole - secrete renin

36. Defect in proximal tubule HCO3 reabsorption
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Simple cysts
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
RTA type 2 (proximal)

37. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
Ammonia - buffer for secreted H+
CHF - pulmonary edema - HTN
Inc - inc - inc

38. What is the most common renal malignancy of early childhood
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Anion gap = na - (Cl + bicarb)
UTI or acute gastroenteritis
Wilms tumor (ages 2-4)

39. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Under and under
Nephritic syndrome
Most of the bicarb - sodium - chloride - and water
Na

40. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
PH = pKa + log bicarb/0.03PCO2
Nephritic syndrome
LM - nl glomeruli - EM - foot process effacement

41. What are the two kinds of cells in the collecting tubules
Inulin
Principal cells and intercalated cells
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Medullary cystic disease

42. What are the associations with RTA type 4
Macula densa and JG cells
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Cx = GFR
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

43. Which cells sense decreases in BP
Na
JG cells
CHF - pulmonary edema - HTN
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

44. How is extracellular volume measured
Hypervent - early high altitude - aspirin ingestion early
Inulin
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Vasa recta - interlobular v - interlobar v - renal v

45. RBC casts - ddx
Contrict leading to inc FF - preserver renal GFR in low volume states
Type II - C3 nephritic factor
Inc renal bicarb resabsoprtion - delayed
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

46. What is the compensatory response in respiratory acidosis
Size
Hypokalemia and hypophosphatemic rickets
Inc renal bicarb resabsoprtion - delayed
Poor - days to weeks

47. do you see casts in bladder cancer - kidney stones with hematuria
2 ways - base exchanger and between epithelial cells
Poor - days to weeks
No
PH = pKa + log bicarb/0.03PCO2

48. How does Wilms tumor present
Huge palpable flank mass and hematuria
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Radiopaque

49. What happens to pH - PCO2 and bicarb in metabolic acidosis
Medullary cystic disease
Negative charge
Dec - dec - dec
Transitional cell carcinoma

50. When is TF/P ratio > 1
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Solute is reabsorbed less quickly than water or net secretion of substance
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN