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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 is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
HIV
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

2. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
Cx<GFR
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Dec - inc - inc

3. What is the ddx for a metabolic acidosis with an inc anion gap
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Macula densa
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

4. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Dec renal bicarb reabsorption - delayed
JG cells
RTA type 4 (hyperkalemic)

5. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Triglycerides
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Insertion of Na channel on luminal side

6. What is generated and secreted in the proximal tubule
Diarrhea - glue - RTA - hyperchloremia
Renal artery - interlobar a - interlobular a
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Ammonia - buffer for secreted H+

7. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Men 50 to 70 - inc incidence with smoking and obesity
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

8. What is the LM for diabetic glomerulonephropathy
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Dialysis cysts
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

9. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Hypovent - immediate
Nonspecific
Inc Ca/Na exchange to inc Ca reabsoprtion
Inc - inc - inc

10. Why can inulin be used to calculate GFR?
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Macula densa and JG cells
Bladder cancer
Freely filtered and neither absorbed or secreted

11. What are the associations with nephrotic syndrome
Hypervent - early high altitude - aspirin ingestion early
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Thromboembolism and inc risk of infection
Involves glomeruli and other organs

12. How are amino acids reabsorbed
Most of the bicarb - sodium - chloride - and water
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
RPF/(1- Hct)

13. How do you interpret creatinine clearance
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Dec - dec - NC
Carbonic anhydrase
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

14. In renal failure What acid - base disturbance is most likely
Segmental sclerosis and hylanosis
Metabolic acidosis
It has a longer renal vein
Renal tubular cells - polygonal clear cells

15. cortical and medullary cysts resulting from long standing dialysis
Involves glomeruli and other organs
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dialysis cysts
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

16. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Renal artery - interlobar a - interlobular a
Hyperceullular glomeruli
Na

17. How does RCC manifest clinically
RPF/(1- Hct)
Bladder cancer
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Inulin

18. What is the net effect of ANP
Hyperkalemia
Size and charge
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Na and volume loss

19. Why is the left kidney taken during living donor transplantation
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inc - inc - inc
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
It has a longer renal vein

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

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21. With what genetic tumor syndrome is RCC associated
Involves glomeruli and other organs
Inc - dec - dec
Von hippel laundau and gene deletion in chromosome 3
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

22. What effect does ANP have on Na in the kidney
PH - then PC02
Failure of EPO
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

23. What is the formula for reabsorption
Staghorn calculi - worsened by alkaluria
Filtered - secreted
Dec - inc - dec
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

24. What do macula densa cells sense
Na
Under and under
Thickening of glomerular BM
Poor - days to weeks

25. acute generalized cortical infarction of both kidneys - dz - causes and associations
Inc GFR and mesangial expansion
Cx = GFR
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Dec - dec - dec

26. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Transitional cell carcinoma
Nephritic syndrome
Dec renal bicarb reabsorption - delayed

27. Under what circumstances is aldosterone secreted
Hypovent - immediate
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
LM - nl glomeruli - EM - foot process effacement

28. Which cells sense decreases in Na delivery
Carbonic anhydrase
Macula densa
Needs to be bilateral
Acute tubular necrosis

29. What serum changes cause a secretion in PTH
1alpha hydroxylase - PTH stimulates it
Acute pyelonephritis
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Hypervent - immediate

30. secondary glomerular dz
Involves glomeruli and other organs
No
NC - dec - dec
Dec renal bicarb reabsorption - delayed

31. What is the effect of AT II on the hypothalamus
Stimulates thirst
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
2 ways - base exchanger and between epithelial cells
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

32. What is the effect of AT II on the posterior pituitary
Size and charge
Hyperceullular glomeruli
Needs to be bilateral
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

33. How do struvite stones appear on xray
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
No
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Radiopaque

34. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Dec - dec - NC
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
1alpha hydroxylase - PTH stimulates it
NKCC

35. What effect does ANP have on GFR
Dec - dec - dec
Inc
By 10%
Medullary cystic disease

36. tram track appearance on EM - typ - path - and associated dz
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Transitional cell carcinoma

37. What does ADH do in the collecting tubule
Hypovent - immediate
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc in concentration - not amout - due to water reabsorption

38. Why can PAH be used to measure ERPF
Invades IVC and spreads hematogenously
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

39. Defect in collecting ducts ability to excrete H+
Dec - inc - inc
Acute tubular necrosis
Poor - days to weeks
RTA type 1 (distal)

40. What is the BUN/Cr ratio in prerenal azotemia and why?
Na and volume loss
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Membranoproliferative glomerulonephritis
Hypervent - early high altitude - aspirin ingestion early

41. When is glucose reabsorbed and with What transporter
Radiolabelled albumin
Proximal tubule - na/glucose co transporter
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
ANP

42. What do patients die from ADPKD
RTA type 2 (proximal)
Carbonic anhydrase
Complications of chronic kidney disease or HTN
Radiopaque

43. coarse - asymmetric - corticomedullary scarring and blunted calyx
Chronic pyelonephritis
NKCC
Crescent - moon shape
Hydronephrosis and pyelonephritis

44. do you see casts in bladder cancer - kidney stones with hematuria
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Thromboembolism and inc risk of infection
No
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

45. How is extracellular volume measured
Podocytes foot processes
Dec - dec - NC
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inulin

46. What does NEG lead to in the efferent arterioles
Inc GFR and mesangial expansion
Negative charge
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Nephrotic syndrome

47. In who is RCC most comon
Men 50 to 70 - inc incidence with smoking and obesity
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Bladder cancer
Few glomeruli

48. inc in creatinine and BUN over a period of several days
Acute renal failure
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Insertion of Na channel on luminal side
Crescent - moon shape

49. What are the main causes of membranous GN
Size and charge
Under and under
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

50. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
HIV
LM - nl glomeruli - EM - foot process effacement
All glomeruli
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate