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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. What therapy does miminal change respond to...
Renal tubular cells - polygonal clear cells
Diabetic glomerulonephropathy
2 ways - base exchanger and between epithelial cells
Corticosteroids
2. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
Bladder cancer
Hypovent - immediate
Inc - dec - dec
3. In renal failure with uremia - What are the 5 aspects of uremia
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Freely filtered and neither absorbed or secreted
Hypokalemia - risk for Ca containing kidney stones
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
4. What are the effects of AT II on vascular smooth muscle
PH = pKa + log bicarb/0.03PCO2
Dec - dec - dec
Solute is reabsorbed less quickly than water or net secretion of substance
Vasocxn - inc BP
5. What is the effect of PTH on the proximal tubule
Becomes concentrated and hypertonic
Inhibits Na/phosphate cotransport leading to phosphate excretion
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
6. What is the compensatory response in metabolic alkalosis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Hypovent - immediate
Freely filtered and neither absorbed or secreted
Hypervent - early high altitude - aspirin ingestion early
7. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Medullary cystic disease
Complications of chronic kidney disease or HTN
Chronic pyelonephritis
8. What effect does afferent arteriole cxn have on RPF - GFR and FF
Makes urine less concentrated - impermeable to H20
60% total body water - 40% ICF - 20% ECF
Dec - dec - NC
Transitional cell carcinoma
9. Why can PAH be used to measure ERPF
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Needs to be bilateral
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Cx<GFR
10. When is glucose reabsorbed and with What transporter
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Proximal tubule - na/glucose co transporter
Phenacetin - smoking - aniline dyes - cyclophosphamide
Invades IVC and spreads hematogenously
11. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
JG cells
Inulin
Transitional cell carcinoma
12. RBC casts - ddx
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc renal calcium reabsorption and dec renal phosphate reabsoprtion - BUT also stimulates the prox tub cells to make 1 -25 (OH)2 vit D which inc intestinal absorption of both Ca and PO4
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Inulin
13. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Vasocxn - inc BP
V x Urine concentration
JG cells
Nephrotic syndrome
14. Which cells sense decreases in Na delivery
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Macula densa
Metabolic acidosis
1/4 plasma - and 3/4 interstitial volume
15. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
RTA type 1 (distal)
1alpha hydroxylase - PTH stimulates it
Hypovent - immediate
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
16. What is the formula for excretion rate
Segmental sclerosis and hylanosis
ANP
V x Urine concentration
GFR/RPF
17. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
<3.5 g /day
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Medullary cystic disease
18. What does LM - EM - IF show in diffuse proliferative GN
Cx = GFR
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hypovent - immediate
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
19. What 3 disease can lead to RPGN
ANP
Involves only glomeruli
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Acute renal failure
20. TCC is associated with problems in your Pee SAC - ??
Hyperceullular glomeruli
Staghorn calculi - worsened by alkaluria
Filtered - secreted
Phenacetin - smoking - aniline dyes - cyclophosphamide
21. How is plasma volume measured
Cx = GFR
Liver
Radiolabelled albumin
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
22. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
GFR x plasma concentration
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
23. What does US show with medullary cystic disease
Complications of chronic kidney disease or HTN
PH - then PC02
NC - dec - dec
Small kidney - poor prognosis
24. Congo - red stain - apple green birefringence
Inc in concentration - not amout - due to water reabsorption
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Podocytes foot processes
Amyloidosis
25. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
Acute - ATN - or chronic - HTN - DM
Solute is reabsorbed less quickly than water or net secretion of substance
Dec renal bicarb reabsorption - delayed
26. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
Cx<GFR
Beta 1
Na and volume loss
27. What are the associations with RTA type 2
Solute and water are reabsorbed at the same rate
Hypokalemia and hypophosphatemic rickets
Kids - peripheral and periorbital edema - resolves spontaneously
Segmental sclerosis and hylanosis
28. What happens in the thin descending loop of henle
Reabsorb Na in exchange for secreting K and H
Passively reabsorbs water via medullary hypertonicity
Hyperkalemia
Negative charge
29. What is the least common kidney stone - What causes it and How do you treat it
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inc plasma osm - dec blood volume
RTA type 1 (distal)
30. How is chlorid reabsorbed in the proximal tubule
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Hypovent - immediate
2 ways - base exchanger and between epithelial cells
Polycystic liver disease - berry aneurysms - mitral valve prolapse
31. What effect does efferent arteriole cxn have on RPF - GFR and FF
Freely filtered and neither absorbed or secreted
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Dec - inc - inc
Most of the bicarb - sodium - chloride - and water
32. What are the main complications of kidney stones
Beta 1
Metabolic acidosis
Hydronephrosis and pyelonephritis
Medullary cystic disease
33. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
It has a longer renal vein
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
EPO - endothelial cells of peritubular capillaries
Ectopic EPO - ACTH - PTHrP - prolactin
34. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
Small kidney - poor prognosis
Filtered - secreted
UTI or acute gastroenteritis
35. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Advanced renal dz - CRF
Staghorn calculi - worsened by alkaluria
Becomes concentrated and hypertonic
36. In renal failure What acid - base disturbance is most likely
Inhibits Na/phosphate cotransport leading to phosphate excretion
Metabolic acidosis
Anion gap = na - (Cl + bicarb)
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
37. Who often has diffuse proliferative GN
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
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
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
38. Who commonly gets acute post strep GN
Inhibits Na/phosphate cotransport leading to phosphate excretion
Chronic conditions - multiple myeloma - TB - RA
Kids - peripheral and periorbital edema - resolves spontaneously
Reabsorb Na in exchange for secreting K and H
39. waxy casts ddx
Metabolic acidosis
Advanced renal dz - CRF
Contrict leading to inc FF - preserver renal GFR in low volume states
Dialysis cysts
40. How do the ureters course in relation to the uterine artery and ductus deferens
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Wilms tumor (ages 2-4)
PH = pKa + log bicarb/0.03PCO2
Under and under
41. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Type II - C3 nephritic factor
Solute is reabsorbed less quickly than water or net secretion of substance
Radiopaque
NC - inc - inc
42. What is the effect of AT II on GFR - FF and Na
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hydronephrosis and pyelonephritis
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Kids - peripheral and periorbital edema - resolves spontaneously
43. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Dec renal bicarb reabsorption - delayed
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Carbonic anhydrase
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
44. What is the formula for clearance of a substance per unit time
Type II - C3 nephritic factor
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Diarrhea - glue - RTA - hyperchloremia
Inhibits Na/phosphate cotransport leading to phosphate excretion
45. What do you see on LM and IF with rapidly progressive GN
EPO - endothelial cells of peritubular capillaries
Crescent - moon shape
Medullary cystic disease
Insertion of Na channel on luminal side
46. What happens to tubular inulin along the proximal tubule and why
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Na reabsorption drives H20 reabsorption
Inc in concentration - not amout - due to water reabsorption
Acute - ATN - or chronic - HTN - DM
47. In what clinical context does Berger's disease often present
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
UTI or acute gastroenteritis
V x Urine concentration
No
48. What is the effect of AT II on the hypothalamus
Kids - peripheral and periorbital edema - resolves spontaneously
Principal cells and intercalated cells
Na and volume loss
Stimulates thirst
49. How What does the glomerular filtration barrier distinguish by
Dec renal bicarb reabsorption - delayed
Size and charge
60% total body water - 40% ICF - 20% ECF
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
50. What is the genetic etiology of wilms tumor and What is WAGR complex
Cx<GFR
Cx = GFR
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation