Test your basic knowledge |

Renal

Instructions:

Answer 50 questions in 15 minutes.
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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. With what genetic tumor syndrome is RCC associated
Dec - inc - inc
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Dec - dec - dec
Von hippel laundau and gene deletion in chromosome 3

2. What happens in the thin descending loop of henle
Renal artery - interlobar a - interlobular a
Passively reabsorbs water via medullary hypertonicity
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Renal in origin

3. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Men 50 to 70 - inc incidence with smoking and obesity
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
All glomeruli

4. How do you interpret creatinine clearance
Men 50 to 70 - inc incidence with smoking and obesity
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
EPO - endothelial cells of peritubular capillaries

5. What is the formula for the filtered load
GFR x plasma concentration
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Nonspecific
Nephritic syndrome

6. In what disease in FSGS the most common glomerular disease
HIV
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
By 10%
Acute tubular necrosis

7. What is the ddx for respiratory acidosis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Under and under
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

8. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
Radiopaque
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Makes urine less concentrated - impermeable to H20

9. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Principal cells and intercalated cells
Na and volume loss

10. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
Principal cells and intercalated cells
Involves glomeruli and other organs
Dec - inc - inc

11. What is the LM for diabetic glomerulonephropathy
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Dec renal bicarb reabsorption - delayed
White cell casts

12. What is the formula for clearance of a substance per unit time
Von hippel laundau and gene deletion in chromosome 3
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Size and charge

13. What does NEG lead to in the efferent arterioles
20 percent
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Inc GFR and mesangial expansion
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

14. What two cells make up the JGA
Macula densa and JG cells
Podocytes foot processes
Rxn from angiotensinogen to angiontensin I
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

15. What happens to pH - PCO2 and bicarb in metabolic acidosis
Dec - dec - dec
All glomeruli
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Freely filtered and neither absorbed or secreted

16. In renal failure What are the consquence sof Na/H20 retention
RTA type 4 (hyperkalemic)
CHF - pulmonary edema - HTN
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Liver

17. tram track appearance on EM - typ - path - and associated dz
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Growth retardation and developmental delay
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Dialysis cysts

18. Why is the left kidney taken during living donor transplantation
Makes urine less concentrated - impermeable to H20
Negative charge
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
It has a longer renal vein

19. What is a normal filtration fraction
20 percent
Ectopic EPO - ACTH - PTHrP - prolactin
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Liver

20. Which cells sense decreases in Na delivery
RPF/(1- Hct)
Hyperkalemia
Macula densa
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

21. How is extracellular volume measured
Inc plasma osm - dec blood volume
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Dec - dec - NC
Inulin

22. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - dec - dec
NC - inc - inc
LM - nl glomeruli - EM - foot process effacement
Na reabsorption drives H20 reabsorption

23. Defect in collecting ducts ability to excrete H+
NC - inc - inc
RTA type 1 (distal)
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

24. In a metabolic acidosis What additional calculation is necessary and How do you make it
Anion gap = na - (Cl + bicarb)
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Dialysis cysts
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

25. hyaline casts ddx
Medullary cystic disease
Bladder cancer
Nonspecific
Acute - ATN - or chronic - HTN - DM

26. What effect does efferent arteriole cxn have on RPF - GFR and FF
1/4 plasma - and 3/4 interstitial volume
Inc in concentration - not amout - due to water reabsorption
Dialysis cysts
Dec - inc - inc

27. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Diuretics - vomiting - antacid - hyperaldosteronism
Inc in Ca and PO4 absoprtion from the gut
Acute renal failure
NC - inc - inc

28. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Radiopaque
UTI or acute gastroenteritis
Macula densa and JG cells

29. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
Stimulates thirst
Hypervent - immediate
Under and under

30. What happens in the collecting tubules
20 percent
Freely filtered and neither absorbed or secreted
Reabsorb Na in exchange for secreting K and H
Inc - inc - inc

31. What do patients die from ADPKD
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Segmental sclerosis and hylanosis
Complications of chronic kidney disease or HTN
RTA type 4 (hyperkalemic)

32. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Acute pyelonephritis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

33. What happens when PTH is secreted
Liver
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
60% total body water - 40% ICF - 20% ECF

34. What is the formula for secreted
Excreted - filtered
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Macula densa
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

35. What is the formula for reabsorption
Amyloidosis
Filtered - secreted
Phenacetin - smoking - aniline dyes - cyclophosphamide
Inc renal bicarb resabsoprtion - delayed

36. What happens in the early distal convoluted tubule and What does that do to the urine
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Men 50 to 70 - inc incidence with smoking and obesity
Actively reabsorbs NaCl - diluting - makes urine hypotonic

37. In renal failure What acid - base disturbance is most likely
GFR/RPF
Metabolic acidosis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

38. 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
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Medullary cystic disease

39. What is the effect of PTH on the proximal tubule
V x Urine concentration
Dec - inc - dec
Inc in Ca and PO4 absoprtion from the gut
Inhibits Na/phosphate cotransport leading to phosphate excretion

40. Under what circumstances is aldosterone secreted
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Failure of EPO
Poor - days to weeks

41. What does renin do
Macula densa and JG cells
60% total body water - 40% ICF - 20% ECF
Rxn from angiotensinogen to angiontensin I
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

42. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Inc in Ca and PO4 absoprtion from the gut
Hypervent - early high altitude - aspirin ingestion early
ADPKD
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

43. dense deposits on EM - type and association
Inulin
Corticosteroids
Hypokalemia and hypophosphatemic rickets
Type II - C3 nephritic factor

44. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Segmental sclerosis and hylanosis
EPO - endothelial cells of peritubular capillaries
Beta 1
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

45. Where is angiotensinogen made
Liver
Size and charge
Under and under
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

46. What is the genetic etiology of wilms tumor and What is WAGR complex
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Triglycerides
Nonspecific

47. coarse - asymmetric - corticomedullary scarring and blunted calyx
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Chronic pyelonephritis
V x Urine concentration
Inc Ca/Na exchange to inc Ca reabsoprtion

48. What dyslipidemia is most common in renal failure
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
No
Angio I to angio II and inhibits bradykinin
Triglycerides

49. What do casts indicated about hematuria/pyuria
Inc GFR and mesangial expansion
Hypervent - early high altitude - aspirin ingestion early
Dialysis cysts
Renal in origin

50. What is the formula for excretion rate
Chronic pyelonephritis
Carbonic anhydrase
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
V x Urine concentration