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Renal

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Answer 50 questions in 15 minutes.
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1. Why can inulin be used to calculate GFR?
Inc - inc - inc
NC - inc - inc
Freely filtered and neither absorbed or secreted
Solute and water are reabsorbed at the same rate

2. What is the net effect of ANP
Na and volume loss
Radiolabelled albumin
UTI or acute gastroenteritis
GFR x plasma concentration

3. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
60% total body water - 40% ICF - 20% ECF
Inc in concentration - not amout - due to water reabsorption
Simple cysts

4. What is hartnup's disease
Bladder cancer
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Liver
Rxn from angiotensinogen to angiontensin I

5. What is the prognosis of RPGN
Excreted - filtered
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
Poor - days to weeks

6. How do calcium stones appear on x ray
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Radiopaque
Staghorn calculi - worsened by alkaluria
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

7. nonenzymatic glycosylation of GBM - inc permeability and thickening
Size
RTA type 2 (proximal)
Cx = GFR
Diabetic glomerulonephropathy

8. Where is potassium conc. Highest? Intra or extra
Kids - peripheral and periorbital edema - resolves spontaneously
Intra = HIKIN!
Beta 1
Vasa recta - interlobular v - interlobar v - renal v

9. What happens in the thin descending loop of henle
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
ADPKD
Passively reabsorbs water via medullary hypertonicity

10. What are the effects of AT II on vascular smooth muscle
No
Men 50 to 70 - inc incidence with smoking and obesity
Vasocxn - inc BP
Cx<GFR

11. do you see casts in bladder cancer - kidney stones with hematuria
Inc GFR and mesangial expansion
Inc renal bicarb resabsoprtion - delayed
No
Filtered - secreted

12. What happens to urine in the ascending limb
CHF - pulmonary edema - HTN
Cx>GFR
Inc Ca/Na exchange to inc Ca reabsoprtion
Makes urine less concentrated - impermeable to H20

13. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
Intra = HIKIN!
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Eosinphilic casts in tubules

14. In what disease in FSGS the most common glomerular disease
HIV
Cx = GFR
Hydronephrosis and pyelonephritis
V x Urine concentration

15. How does RCC manifest clinically
Ectopic EPO - ACTH - PTHrP - prolactin
Inc
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
ADPKD

16. What is the henderson hasselbalch equation
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
PH = pKa + log bicarb/0.03PCO2
Involves only glomeruli
Size

17. What happens to pH - PCO2 and bicarb in metabolic acidosis
Complications of chronic kidney disease or HTN
Angio I to angio II and inhibits bradykinin
Dec - dec - dec
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

18. What cells create the epithelial layer of the glomerular filtration barrier
Anion gap = na - (Cl + bicarb)
Medullary cystic disease
Radiopaque
Podocytes foot processes

19. In renal failure What acid - base disturbance is most likely
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
JG cells
Hydronephrosis and pyelonephritis
Metabolic acidosis

20. What is the effect of aldosterone in principal cells
Dec - inc - dec
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Rxn from angiotensinogen to angiontensin I
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

21. What are the main complications of kidney stones
Rxn from angiotensinogen to angiontensin I
Hydronephrosis and pyelonephritis
Acts on V2 receptors leading to insertion of aquaporins on luminal side
RTA type 2 (proximal)

22. What do you see on LM for focal segmental glomerulosclerosis
Vasocxn - inc BP
Cx>GFR
Under and under
Segmental sclerosis and hylanosis

23. What is the compensatory response in respiratory acidosis
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
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
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

24. What do macula densa cells sense
Complications of chronic kidney disease or HTN
Carbonic anhydrase
RTA type 4 (hyperkalemic)
Na

25. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Na reabsorption drives H20 reabsorption
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
NC - dec - dec
Renal in origin

26. membranous
Thickening of glomerular BM
Dec - inc - inc
EPO - endothelial cells of peritubular capillaries
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

27. Who often has diffuse proliferative GN
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Wilms tumor (ages 2-4)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

28. How is chlorid reabsorbed in the proximal tubule
2 ways - base exchanger and between epithelial cells
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Amyloidosis
LM - nl glomeruli - EM - foot process effacement

29. How do struvite stones appear on xray
Radiopaque
Type II - C3 nephritic factor
Most of the bicarb - sodium - chloride - and water
Medullary cystic disease

30. 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
Negative charge
Stimulates thirst
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

31. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Dec - inc - inc
Passively reabsorbs water via medullary hypertonicity
Becomes concentrated and hypertonic

32. What are the LM and EM of minimal change disease
Acute pyelonephritis
LM - nl glomeruli - EM - foot process effacement
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
UTI or acute gastroenteritis

33. Why is there anemia in renal failure
Hypokalemia - risk for Ca containing kidney stones
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Failure of EPO
Reabsorb Na in exchange for secreting K and H

34. What is the second most common kidney stone
Transitional cell carcinoma
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Radiopaque
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

35. How can NSAIDs cause acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Hypovent - immediate
Proximal tubule - na/glucose co transporter

36. What effect does ANP have on Na in the kidney
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Renal in origin
1/4 plasma - and 3/4 interstitial volume
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

37. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
JG cells
Hypokalemia - risk for Ca containing kidney stones
1alpha hydroxylase - PTH stimulates it

38. coarse - asymmetric - corticomedullary scarring and blunted calyx
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Chronic pyelonephritis
Inc in Ca and PO4 absoprtion from the gut
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

39. What is the ddx for a respiratory alkalosis
EPO - endothelial cells of peritubular capillaries
Hypervent - early high altitude - aspirin ingestion early
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Hyperkalemia

40. What 3 disease can lead to RPGN
Reabsorb Na in exchange for secreting K and H
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
PH = pKa + log bicarb/0.03PCO2
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

41. What is the ddx for respiratory acidosis
All glomeruli
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Staghorn calculi - worsened by alkaluria
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

42. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Thromboembolism and inc risk of infection
Diabetic glomerulonephropathy
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

43. What is the BUN/Cr ratio in prerenal azotemia and why?
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Hypovent - immediate
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
By 10%

44. How does RCC spread
Modified smooth muscle of afferent arteriole - secrete renin
CHF - pulmonary edema - HTN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Invades IVC and spreads hematogenously

45. With what genetic tumor syndrome is RCC associated
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Inulin
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Von hippel laundau and gene deletion in chromosome 3

46. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Metabolic acidosis
Amyloidosis
Reabsorb Na in exchange for secreting K and H

47. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Radiopaque
Inc in Ca and PO4 absoprtion from the gut
Medullary cystic disease
GFR x plasma concentration

48. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

49. What is a normal filtration fraction
Inc in Ca and PO4 absoprtion from the gut
Becomes concentrated and hypertonic
Ammonia - buffer for secreted H+
20 percent

50. What effect does afferent arteriole cxn have on RPF - GFR and FF
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
GFR x plasma concentration
Dec - dec - NC
Dec - inc - dec

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Renal

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