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Renal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What does the crescent moon shape consist of in RPGN
Hyperceullular glomeruli
JG cells
Becomes concentrated and hypertonic
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

2. What are the main causes of membranous GN
Few glomeruli
Inc
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Corticosteroids

3. What is the formula for filtration fraction
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
UTI or acute gastroenteritis
GFR/RPF
RTA type 4 (hyperkalemic)

4. What is a normal filtration fraction
Modified smooth muscle of afferent arteriole - secrete renin
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
20 percent
Hypovent - immediate

5. What dyslipidemia is most common in renal failure
No
Triglycerides
Rxn from angiotensinogen to angiontensin I
Vasa recta - interlobular v - interlobar v - renal v

6. in TCC - What does painelss hematuria suggest
Bladder cancer
Few glomeruli
Excreted - filtered
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

7. What is the pathway to the afferent arteriole
Inc plasma osm - dec blood volume
Renal artery - interlobar a - interlobular a
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
RPF/(1- Hct)

8. What is the henderson hasselbalch equation
Solute is reabsorbed more quickly than water
RTA type 2 (proximal)
PH = pKa + log bicarb/0.03PCO2
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

9. Which cells sense decreases in BP
RTA type 4 (hyperkalemic)
JG cells
Thickening of glomerular BM
Filtered - secreted

10. What are the associations with RTA type 4
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Corticosteroids

11. What is the formula for the filtered load
GFR x plasma concentration
Acute renal failure
Carbonic anhydrase
Advanced renal dz - CRF

12. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
1alpha hydroxylase - PTH stimulates it
Simple cysts
Inc Ca/Na exchange to inc Ca reabsoprtion
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

13. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Hypervent - early high altitude - aspirin ingestion early
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Ammonia - buffer for secreted H+

14. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
GFR/RPF
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
Solute and water are reabsorbed at the same rate

15. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
2 ways - base exchanger and between epithelial cells
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

16. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
Makes urine less concentrated - impermeable to H20
No
Most of the bicarb - sodium - chloride - and water

17. What substance is secreted in response increase atrial pressure
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
ANP
Dec - inc - dec

18. When is TF/P <1
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Hyperceullular glomeruli
Solute is reabsorbed more quickly than water
Small kidney - poor prognosis

19. What effect does ANP have on Na in the kidney
To defend GFR
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Na

20. What is the effect of of PTH on the distal convoluted tubule
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inc Ca/Na exchange to inc Ca reabsoprtion
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Huge palpable flank mass and hematuria

21. 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
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
GFR/RPF

22. granular - muddy brown casts - ddx
Acute pyelonephritis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Acute tubular necrosis
Dec - dec - dec

23. How is extracellular volume measured
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc - dec - dec
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Inulin

24. What is renal osteodystrophy
Medullary cystic disease
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Macula densa and JG cells

25. What two cells make up the JGA
GFR/RPF
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Macula densa and JG cells
Nephritic syndrome

26. What is the effect of PTH on the proximal tubule
Ectopic EPO - ACTH - PTHrP - prolactin
Inhibits Na/phosphate cotransport leading to phosphate excretion
Dec - inc - inc
Liver

27. Where is ACE made and What are 2 of its fxns
Angio I to angio II and inhibits bradykinin
Small kidney - poor prognosis
Complications of chronic kidney disease or HTN
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

28. What are the LM and EM of minimal change disease
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
LM - nl glomeruli - EM - foot process effacement

29. In what disease in FSGS the most common glomerular disease
Medullary cystic disease
HIV
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
1alpha hydroxylase - PTH stimulates it

30. How do calcium stones appear on x ray
Renal in origin
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Phenacetin - smoking - aniline dyes - cyclophosphamide
Radiopaque

31. What effect does cxn of the ureter have on RPF - GFR and FF
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
NC - dec - dec
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Failure of EPO

32. What effect does afferent arteriole cxn have on RPF - GFR and FF
PH - then PC02
Dec - dec - NC
Antifreeze - ethyelene glycol or vit C abuse
Radiopaque

33. What are the main complications of kidney stones
ANP
Hydronephrosis and pyelonephritis
Invades IVC and spreads hematogenously
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

34. what happens to pH - PCO2 - and bicarb in respiratory acidosis
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Dec - inc - dec
Von hippel laundau and gene deletion in chromosome 3
By 10%

35. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Na and volume loss
NKCC
V x Urine concentration
Radiopaque

36. 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
Wilms tumor (ages 2-4)
1/4 plasma - and 3/4 interstitial volume
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

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

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38. What is the effect of AT II on efferent arterioles
HIV
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Contrict leading to inc FF - preserver renal GFR in low volume states
Modified smooth muscle of afferent arteriole - secrete renin

39. What is ADPKD also associated with
Acute - ATN - or chronic - HTN - DM
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Actively reabsorbs NaCl - diluting - makes urine hypotonic
To defend GFR

40. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Wilms tumor (ages 2-4)
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
ANP
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

41. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
All glomeruli
Inc - inc - inc
2 ways - base exchanger and between epithelial cells

42. What is the least common kidney stone - What causes it and How do you treat it
Renal tubular cells - polygonal clear cells
Inc - inc - inc
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Membranoproliferative glomerulonephritis

43. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Staghorn calculi - worsened by alkaluria
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

44. What is the formula for excretion rate
Angio I to angio II and inhibits bradykinin
V x Urine concentration
Ammonia - buffer for secreted H+
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

45. What happens in the thin descending loop of henle
Na and volume loss
Stimulates thirst
Hydronephrosis and pyelonephritis
Passively reabsorbs water via medullary hypertonicity

46. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Ammonia - buffer for secreted H+
Na
Hypervent - immediate

47. What is the compensatory response in respiratory alkalosis
Dialysis cysts
Dec renal bicarb reabsorption - delayed
Filtered - secreted
Dec - inc - dec

48. Defect in collecting ducts ability to excrete H+
ADPKD
Kids - peripheral and periorbital edema - resolves spontaneously
RTA type 1 (distal)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

49. When is TF/P = 1
Solute and water are reabsorbed at the same rate
Contrict leading to inc FF - preserver renal GFR in low volume states
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Staghorn calculi - worsened by alkaluria

50. What effect does ANP have on GFR
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc
Crescent - moon shape
Solute is reabsorbed less quickly than water or net secretion of substance