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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 does LM - EM - IF show in diffuse proliferative GN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Podocytes foot processes
Few glomeruli
2. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Liver
Acute pyelonephritis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
3. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Diabetic glomerulonephropathy
EPO - endothelial cells of peritubular capillaries
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
4. How is chlorid reabsorbed in the proximal tubule
2 ways - base exchanger and between epithelial cells
Nephritic syndrome
Radiopaque
Solute is reabsorbed more quickly than water
5. dense deposits on EM - type and association
Inc GFR and mesangial expansion
Triglycerides
Poor - days to weeks
Type II - C3 nephritic factor
6. In renal failure What acid - base disturbance is most likely
Corticosteroids
RTA type 4 (hyperkalemic)
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Metabolic acidosis
7. What is the algorithim for acidosis/alkalosis
Cx>GFR
PH - then PC02
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
8. What is winter's formula and when do you use it
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Chronic conditions - multiple myeloma - TB - RA
Transitional cell carcinoma
9. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
GFR/RPF
Most of the bicarb - sodium - chloride - and water
Segmental sclerosis and hylanosis
10. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
CHF - pulmonary edema - HTN
Size and charge
Metabolic acidosis
Inc - dec - dec
11. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Growth retardation and developmental delay
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Ammonia - buffer for secreted H+
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
12. What does US show with medullary cystic disease
Small kidney - poor prognosis
20 percent
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
ADPKD
13. What is the ddx for respiratory acidosis
Podocytes foot processes
Advanced renal dz - CRF
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
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
14. 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
Dec renal bicarb reabsorption - delayed
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
15. proliferative
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Hyperceullular glomeruli
Chronic conditions - multiple myeloma - TB - RA
16. What effect does inc plasma protein concentration have on RPF - GFR - and FF
All glomeruli
Rxn from angiotensinogen to angiontensin I
NC - dec - dec
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
17. What is the effect of of PTH on the distal convoluted tubule
Chronic conditions - multiple myeloma - TB - RA
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Inc Ca/Na exchange to inc Ca reabsoprtion
18. What are the 3 transporters of the intercalated cells
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc in Ca and PO4 absoprtion from the gut
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
19. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Amyloidosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
20. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
Nonspecific
Ammonia - buffer for secreted H+
Rxn from angiotensinogen to angiontensin I
21. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
No
Most of the bicarb - sodium - chloride - and water
Transitional cell carcinoma
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
22. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Acute pyelonephritis
RTA type 4 (hyperkalemic)
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
All glomeruli
23. When is glucose reabsorbed and with What transporter
NC - dec - dec
Proximal tubule - na/glucose co transporter
Na
Invades IVC and spreads hematogenously
24. nonenzymatic glycosylation of GBM - inc permeability and thickening
Contrict leading to inc FF - preserver renal GFR in low volume states
UTI or acute gastroenteritis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Diabetic glomerulonephropathy
25. What is the compensatory response in metabolic alkalosis
Radiopaque
Vasocxn - inc BP
Segmental sclerosis and hylanosis
Hypovent - immediate
26. What is amyloidosis associated with
Inc plasma osm - dec blood volume
Hypovent - immediate
Macula densa and JG cells
Chronic conditions - multiple myeloma - TB - RA
27. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
RTA type 4 (hyperkalemic)
20 percent
Poor - days to weeks
ADPKD
28. What happens to urine in the ascending limb
NC - inc - inc
Makes urine less concentrated - impermeable to H20
Amyloidosis
Filtered - secreted
29. What percentage of ECF is plasma and What is interstitial volume
Phenacetin - smoking - aniline dyes - cyclophosphamide
NC - inc - inc
1/4 plasma - and 3/4 interstitial volume
White cell casts
30. What effect does ANP have on Na in the kidney
Vasocxn - inc BP
Reabsorb Na in exchange for secreting K and H
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Growth retardation and developmental delay
31. Congo - red stain - apple green birefringence
Simple cysts
Amyloidosis
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Na and volume loss
32. What does NEG lead to in the efferent arterioles
CHF - pulmonary edema - HTN
Proximal tubule - na/glucose co transporter
PH - then PC02
Inc GFR and mesangial expansion
33. What dyslipidemia is most common in renal failure
Advanced renal dz - CRF
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Triglycerides
34. secondary glomerular dz
Thickening of glomerular BM
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Involves glomeruli and other organs
35. TCC is associated with problems in your Pee SAC - ??
20 percent
RTA type 2 (proximal)
Podocytes foot processes
Phenacetin - smoking - aniline dyes - cyclophosphamide
36. What effect does efferent arteriole cxn have on RPF - GFR and FF
Dec - inc - inc
Hypervent - early high altitude - aspirin ingestion early
Negative charge
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
37. In renal failure - what happens to potassium
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Medullary cystic disease
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Hyperkalemia
38. How do you interpret creatinine clearance
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Dec - dec - NC
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
39. What is the ddx for a respiratory alkalosis
Inc - dec - dec
Advanced renal dz - CRF
Hypervent - early high altitude - aspirin ingestion early
Filtered - secreted
40. How does RCC spread
Invades IVC and spreads hematogenously
Chronic conditions - multiple myeloma - TB - RA
Proximal tubule - na/glucose co transporter
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
41. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
White cell casts
Amyloidosis
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
42. What do you see on LM and IF with rapidly progressive GN
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Hyperkalemia
1/4 plasma - and 3/4 interstitial volume
Crescent - moon shape
43. In a metabolic acidosis What additional calculation is necessary and How do you make it
Anion gap = na - (Cl + bicarb)
By 10%
Hypokalemia - risk for Ca containing kidney stones
Von hippel laundau and gene deletion in chromosome 3
44. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Nephrotic syndrome
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
45. Who often has diffuse proliferative GN
Hypokalemia and hypophosphatemic rickets
Solute is reabsorbed less quickly than water or net secretion of substance
Insertion of Na channel on luminal side
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
46. Focal
GFR x plasma concentration
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Beta 1
Few glomeruli
47. hyaline casts ddx
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Nonspecific
Involves only glomeruli
Renal artery - interlobar a - interlobular a
48. How can NSAIDs cause acute renal failure
NC - inc - inc
Transitional cell carcinoma
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Simple cysts
49. What is the effect of AT II on the posterior pituitary
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Hypervent - immediate
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
To defend GFR
50. What are the associations with RTA type 1
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Inc GFR and mesangial expansion
Nephrotic syndrome
Hypokalemia - risk for Ca containing kidney stones