Test your basic knowledge |

Renal

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 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
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Diabetic glomerulonephropathy
Hypervent - immediate

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

3. What is the compensatory response in metabolic alkalosis
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
Stimulates thirst
Hypovent - immediate

4. What are the two forms of renal failure and What are examples of each
Na reabsorption drives H20 reabsorption
Hypokalemia and hypophosphatemic rickets
Acute - ATN - or chronic - HTN - DM
Segmental sclerosis and hylanosis

5. What substance is secreted in response increase atrial pressure
All glomeruli
Antifreeze - ethyelene glycol or vit C abuse
160-200 - 350
ANP

6. What is the 60-40-20 rule of body weight
Excreted - filtered
Anion gap = na - (Cl + bicarb)
60% total body water - 40% ICF - 20% ECF
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

7. What effect does efferent arteriole cxn have on RPF - GFR and FF
Dec - inc - inc
Na and volume loss
Von hippel laundau and gene deletion in chromosome 3
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

8. What is the formula for excretion rate
Advanced renal dz - CRF
Thickening of glomerular BM
Triglycerides
V x Urine concentration

9. granular - muddy brown casts - ddx
Acute tubular necrosis
Dec - inc - dec
Inc plasma osm - dec blood volume
To defend GFR

10. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Macula densa and JG cells
Nephritic syndrome
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

11. How does RCC spread
Carbonic anhydrase
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Solute and water are reabsorbed at the same rate
Invades IVC and spreads hematogenously

12. What therapy does miminal change respond to...
Corticosteroids
Involves only glomeruli
Hyperkalemia
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

13. How does RCC manifest clinically
Nonspecific
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
No
Negative charge

14. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
60% total body water - 40% ICF - 20% ECF
GFR x plasma concentration
NC - dec - dec

15. What circumstances causes ADH secretion
Involves glomeruli and other organs
Vasocxn - inc BP
Inc plasma osm - dec blood volume
Filtered - secreted

16. What can cause oxalate crystals
ANP
White cell casts
Antifreeze - ethyelene glycol or vit C abuse
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

17. do you see casts in bladder cancer - kidney stones with hematuria
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Corticosteroids
Hyperkalemia
No

18. What is lost in nephrotic syndrome resulting what urine and serum changes
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
2 ways - base exchanger and between epithelial cells
Type II - C3 nephritic factor
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

19. What serum changes cause a secretion in PTH
Ammonia - buffer for secreted H+
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Becomes concentrated and hypertonic
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

20. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
ADPKD
Transitional cell carcinoma
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

21. 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
Metabolic acidosis
ANP
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

22. What is the effect of AT II on the hypothalamus
JG cells
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Inc - inc - inc
Stimulates thirst

23. What two cells make up the JGA
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Macula densa and JG cells
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

24. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
Vasa recta - interlobular v - interlobar v - renal v
Rxn from angiotensinogen to angiontensin I
Hydronephrosis and pyelonephritis

25. What is the henderson hasselbalch equation
Cx = GFR
Size and charge
PH = pKa + log bicarb/0.03PCO2
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

26. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Thickening of glomerular BM
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inc

27. What do casts indicated about hematuria/pyuria
Renal in origin
Vasocxn - inc BP
Inc in concentration - not amout - due to water reabsorption
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

28. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Invades IVC and spreads hematogenously
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

29. membranous
No
Thickening of glomerular BM
To defend GFR
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

30. Why can PAH be used to measure ERPF
Medullary cystic disease
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Inhibits Na/phosphate cotransport leading to phosphate excretion
Intra = HIKIN!

31. Subendothelial immune complexes with granular IF
Diarrhea - glue - RTA - hyperchloremia
RTA type 4 (hyperkalemic)
Reabsorb Na in exchange for secreting K and H
Membranoproliferative glomerulonephritis

32. How What does the glomerular filtration barrier distinguish by
Size and charge
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
160-200 - 350
Dec - dec - NC

33. What is hartnup's disease
Inhibits Na/phosphate cotransport leading to phosphate excretion
1/4 plasma - and 3/4 interstitial volume
Inc
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

34. inc in creatinine and BUN over a period of several days
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Most of the bicarb - sodium - chloride - and water
Acute renal failure

35. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
160-200 - 350
Growth retardation and developmental delay
No
EPO - endothelial cells of peritubular capillaries

36. What is the purpose of the JGA
20 percent
To defend GFR
Dec - dec - NC
Dec - inc - dec

37. How do struvite stones appear on xray
Radiopaque
Contrict leading to inc FF - preserver renal GFR in low volume states
Antifreeze - ethyelene glycol or vit C abuse
Involves only glomeruli

38. What is the compensatory response in metabolic acidosis
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Hypervent - immediate
<3.5 g /day
NC - dec - dec

39. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Huge palpable flank mass and hematuria
Freely filtered and neither absorbed or secreted
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

40. What are the associations with RTA type 1
60% total body water - 40% ICF - 20% ECF
Hypokalemia - risk for Ca containing kidney stones
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

41. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Acute - ATN - or chronic - HTN - DM
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Transitional cell carcinoma

42. What is the formula for filtration fraction
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
HIV
GFR/RPF
Radiolabelled albumin

43. What are the effects of AT II on vascular smooth muscle
Simple cysts
Crescent - moon shape
Vasocxn - inc BP
Inulin

44. net tubular reabsorption of x
Nephrotic syndrome
Na reabsorption drives H20 reabsorption
Dec - dec - NC
Cx<GFR

45. What is the BUN/Cr ratio in prerenal azotemia and why?
Freely filtered and neither absorbed or secreted
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Size and charge

46. What is is Alport's syndrome and what else do you see with it other than renal path
Transitional cell carcinoma
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Staghorn calculi - worsened by alkaluria

47. By what percentage does EPRF underestimage true RPF
JG cells
Excreted - filtered
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
By 10%

48. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
Dec - inc - dec
Proximal tubule - na/glucose co transporter
Actively reabsorbs NaCl - diluting - makes urine hypotonic

49. What change (lack of) is common in children with renal failure
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Growth retardation and developmental delay
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

50. What is the most common renal malignancy of early childhood
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Na
Needs to be bilateral
Wilms tumor (ages 2-4)