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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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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. RBC casts - ddx
V x Urine concentration
Needs to be bilateral
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Dec - dec - dec

2. How does RCC spread
Dec renal bicarb reabsorption - delayed
Invades IVC and spreads hematogenously
Stimulates thirst
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

3. What is the ddx for a respiratory alkalosis
NKCC
ANP
Hypervent - early high altitude - aspirin ingestion early
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

4. waxy casts ddx
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Advanced renal dz - CRF
Beta 1
Insertion of Na channel on luminal side

5. Subendothelial immune complexes with granular IF
Small kidney - poor prognosis
160-200 - 350
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Membranoproliferative glomerulonephritis

6. How do the ureters course in relation to the uterine artery and ductus deferens
Thickening of glomerular BM
Under and under
Radiopaque
GFR x plasma concentration

7. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Thromboembolism and inc risk of infection
Carbonic anhydrase
NC - dec - dec
No

8. What effect does afferent arteriole cxn have on RPF - GFR and FF
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Angio I to angio II and inhibits bradykinin
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Dec - dec - NC

9. What do you see on LM and IF with rapidly progressive GN
Dec - dec - dec
PH = pKa + log bicarb/0.03PCO2
Crescent - moon shape
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

10. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Modified smooth muscle of afferent arteriole - secrete renin
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Complications of chronic kidney disease or HTN

11. What is the compensatory response in metabolic acidosis
Hypervent - immediate
Size and charge
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
GFR x plasma concentration

12. Why is there anemia in renal failure
Failure of EPO
EPO - endothelial cells of peritubular capillaries
Invades IVC and spreads hematogenously
Nonspecific

13. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Excreted - filtered
Passively reabsorbs water via medullary hypertonicity
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

14. What two cells make up the JGA
Macula densa and JG cells
Nonspecific
Metabolic acidosis
Hypokalemia and hypophosphatemic rickets

15. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Hydronephrosis and pyelonephritis
Rxn from angiotensinogen to angiontensin I
Kids - peripheral and periorbital edema - resolves spontaneously
Inc - dec - dec

16. What is the formula for the filtered load
GFR x plasma concentration
Beta 1
Invades IVC and spreads hematogenously
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

17. What does the crescent moon shape consist of in RPGN
Dec - dec - dec
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Inc - inc - inc

18. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

19. net tubular secretion of x
GFR x plasma concentration
Cx>GFR
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Dec - inc - inc

20. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
Simple cysts
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Diuretics - vomiting - antacid - hyperaldosteronism

21. Who often has diffuse proliferative GN
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

22. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Na and volume loss
Staghorn calculi - worsened by alkaluria
Diarrhea - glue - RTA - hyperchloremia
It has a longer renal vein

23. inc in creatinine and BUN over a period of several days
Acute renal failure
Antifreeze - ethyelene glycol or vit C abuse
Macula densa
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

24. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
JG cells
Principal cells and intercalated cells

25. What effect does ANP have on GFR
Needs to be bilateral
PH = pKa + log bicarb/0.03PCO2
Inc
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

26. What is the formula for filtration fraction
GFR/RPF
RTA type 1 (distal)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
ADPKD

27. What is the least common kidney stone - What causes it and How do you treat it
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Ectopic EPO - ACTH - PTHrP - prolactin
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Intra = HIKIN!

28. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Inhibits Na/phosphate cotransport leading to phosphate excretion
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

29. What are the effects of AT II on vascular smooth muscle
Radiopaque
LM - nl glomeruli - EM - foot process effacement
Vasocxn - inc BP
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

30. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Advanced renal dz - CRF
160-200 - 350
20 percent
GFR x plasma concentration

31. What does ADH do in the collecting tubule
Bladder cancer
Advanced renal dz - CRF
NC - dec - dec
Acts on V2 receptors leading to insertion of aquaporins on luminal side

32. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
NKCC
Membranoproliferative glomerulonephritis
Metabolic acidosis

33. how does this present in adults and What is the pattern of inheritence
No
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

34. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Acute pyelonephritis

35. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Hyperkalemia
Inc
Eosinphilic casts in tubules
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

36. What is the ddx for metabolic alkalosis with compensation
Reabsorb Na in exchange for secreting K and H
Diuretics - vomiting - antacid - hyperaldosteronism
Inulin
60% total body water - 40% ICF - 20% ECF

37. What is the 3rd most common kidney stone and What causes it
Na
Size and charge
Radiolabelled albumin
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

38. What happens to pH - PCO2 and bicarb in metabolic acidosis
Inc GFR and mesangial expansion
Macula densa
Under and under
Dec - dec - dec

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

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40. proliferative
Solute and water are reabsorbed at the same rate
Hyperceullular glomeruli
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Thickening of glomerular BM

41. Under what circumstances is aldosterone secreted
Makes urine less concentrated - impermeable to H20
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

42. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Intra = HIKIN!
Hyperceullular glomeruli
Size and charge

43. What is the compensatory response in respiratory acidosis
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc renal bicarb resabsoprtion - delayed
All glomeruli
Thickening of glomerular BM

44. What happens to the urine in the descending limb
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Becomes concentrated and hypertonic
Ectopic EPO - ACTH - PTHrP - prolactin
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

45. hyaline casts ddx
Nonspecific
20 percent
Inc Ca/Na exchange to inc Ca reabsoprtion
Von hippel laundau and gene deletion in chromosome 3

46. How is plasma volume measured
Radiolabelled albumin
2 ways - base exchanger and between epithelial cells
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Chronic conditions - multiple myeloma - TB - RA

47. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Inc in concentration - not amout - due to water reabsorption
Negative charge
Hypokalemia and hypophosphatemic rickets
HIV

48. What is the prognosis of RPGN
All glomeruli
Poor - days to weeks
JG cells
Radiopaque

49. What are the main complications of kidney stones
Diarrhea - glue - RTA - hyperchloremia
Inc renal bicarb resabsoprtion - delayed
Hydronephrosis and pyelonephritis
PH - then PC02

50. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Acute - ATN - or chronic - HTN - DM
Carbonic anhydrase
Chronic pyelonephritis
Nephrotic syndrome

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Renal

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