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. 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
GFR x plasma concentration
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
2 ways - base exchanger and between epithelial cells

2. What is the formula for reabsorption
Filtered - secreted
Liver
Angio I to angio II and inhibits bradykinin
Rxn from angiotensinogen to angiontensin I

3. 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
Diarrhea - glue - RTA - hyperchloremia
EPO - endothelial cells of peritubular capillaries
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

4. When is TF/P <1
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Macula densa and JG cells
Solute is reabsorbed more quickly than water
Advanced renal dz - CRF

5. What happens to pH - PCO2 and bicarb in metabolic acidosis
Membranoproliferative glomerulonephritis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Invades IVC and spreads hematogenously
Dec - dec - dec

6. What is the net effect of AT II
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Hypokalemia and hypophosphatemic rickets
Nonspecific
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

7. What is renal osteodystrophy
Excreted - filtered
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Filtered - secreted
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

8. What do you see on LM for focal segmental glomerulosclerosis
Under and under
Podocytes foot processes
All glomeruli
Segmental sclerosis and hylanosis

9. Which cells sense decreases in Na delivery
Negative charge
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Macula densa
Modified smooth muscle of afferent arteriole - secrete renin

10. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
To defend GFR
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inc in Ca and PO4 absoprtion from the gut
Radiopaque

11. What is the least common kidney stone - What causes it and How do you treat it
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

12. What is the effect of AT II on GFR - FF and Na
Inc plasma osm - dec blood volume
Crescent - moon shape
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
ANP

13. What happens to tubular inulin along the proximal tubule and why
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Membranoproliferative glomerulonephritis
Acute pyelonephritis
Inc in concentration - not amout - due to water reabsorption

14. Focal
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Few glomeruli
Chronic pyelonephritis
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

15. By what percentage does EPRF underestimage true RPF
White cell casts
Na and volume loss
By 10%
Transitional cell carcinoma

16. How is extracellular volume measured
160-200 - 350
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Medullary cystic disease
Inulin

17. how does this present in adults and What is the pattern of inheritence
Dec - inc - inc
1alpha hydroxylase - PTH stimulates it
Von hippel laundau and gene deletion in chromosome 3
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

18. What do casts indicated about hematuria/pyuria
Inc plasma osm - dec blood volume
Renal in origin
Radiolabelled albumin
Hypervent - immediate

19. Where does renal cell carcinoma originate and What do the cells look like
Hypervent - early high altitude - aspirin ingestion early
Liver
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Renal tubular cells - polygonal clear cells

20. What is lost in nephrotic syndrome resulting what urine and serum changes
Inc
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Failure of EPO
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

21. What is the compensatory response in respiratory alkalosis
Needs to be bilateral
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Dec renal bicarb reabsorption - delayed
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

22. What is the compensatory response in metabolic acidosis
Hypervent - immediate
Angio I to angio II and inhibits bradykinin
Renal in origin
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

23. How is chlorid reabsorbed in the proximal tubule
2 ways - base exchanger and between epithelial cells
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
160-200 - 350

24. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Medullary cystic disease
1alpha hydroxylase - PTH stimulates it
PH = pKa + log bicarb/0.03PCO2
Wilms tumor (ages 2-4)

25. What are the two forms of renal failure and What are examples of each
1alpha hydroxylase - PTH stimulates it
Triglycerides
Reabsorb Na in exchange for secreting K and H
Acute - ATN - or chronic - HTN - DM

26. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
RTA type 1 (distal)
RTA type 4 (hyperkalemic)
Chronic conditions - multiple myeloma - TB - RA

27. What are the associations with nephrotic syndrome
Radiopaque
Thromboembolism and inc risk of infection
RTA type 4 (hyperkalemic)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

28. Why does Na conc nearly match Osm
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Na reabsorption drives H20 reabsorption
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

29. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
Involves glomeruli and other organs
Cx<GFR
CHF - pulmonary edema - HTN

30. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
Nephritic syndrome
Hypervent - early high altitude - aspirin ingestion early
Renal in origin

31. hypoaldosteronism or lack of collecting tubule response to aldosteron
Inc - inc - inc
RTA type 2 (proximal)
RTA type 4 (hyperkalemic)
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

32. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Triglycerides
Na and volume loss
Negative charge

33. diffuse
All glomeruli
NC - dec - dec
Men 50 to 70 - inc incidence with smoking and obesity
Thickening of glomerular BM

34. Bergers' disease - which antibody and What do you see on LM and IF
Acute renal failure
1alpha hydroxylase - PTH stimulates it
GFR/RPF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

35. What is the formula for the filtered load
Negative charge
Dialysis cysts
Medullary cystic disease
GFR x plasma concentration

36. What are the 3 transporters of the intercalated cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Transitional cell carcinoma
Macula densa and JG cells
Kids - peripheral and periorbital edema - resolves spontaneously

37. RBC casts - ddx
Hypervent - early high altitude - aspirin ingestion early
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Medullary cystic disease
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

38. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Anion gap = na - (Cl + bicarb)
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Carbonic anhydrase

39. What does ADH do in the collecting tubule
Hyperkalemia
Most of the bicarb - sodium - chloride - and water
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

40. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Nephrotic syndrome
ADPKD
Negative charge

41. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Thromboembolism and inc risk of infection
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Cx<GFR
Acute pyelonephritis

42. What are the main complications of kidney stones
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Hydronephrosis and pyelonephritis
By 10%
Angio I to angio II and inhibits bradykinin

43. net tubular reabsorption of x
1/4 plasma - and 3/4 interstitial volume
Cx<GFR
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Actively reabsorbs NaCl - diluting - makes urine hypotonic

44. What does thyroidization of the kidney result in
Makes urine less concentrated - impermeable to H20
Eosinphilic casts in tubules
Nephrotic syndrome
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

45. net tubular secretion of x
Membranoproliferative glomerulonephritis
GFR x plasma concentration
Cx>GFR
PH - then PC02

46. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Dec renal bicarb reabsorption - delayed
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
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

47. What is the LM for diabetic glomerulonephropathy
GFR x plasma concentration
White cell casts
Podocytes foot processes
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

48. How does RCC manifest clinically
Nonspecific
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
NC - dec - dec

49. What happens in the early distal convoluted tubule and What does that do to the urine
Corticosteroids
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Acute pyelonephritis
Ectopic EPO - ACTH - PTHrP - prolactin

50. What are the effects of PTH hormone on the kidney
Growth retardation and developmental delay
Hyperceullular glomeruli
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
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles