Test your basic knowledge |

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 effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Beta 1
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Bladder cancer

2. What is the 60-40-20 rule of body weight
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Size
60% total body water - 40% ICF - 20% ECF
Inc plasma osm - dec blood volume

3. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
Hydronephrosis and pyelonephritis
Anion gap = na - (Cl + bicarb)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

4. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
ANP
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

5. cortical and medullary cysts resulting from long standing dialysis
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dialysis cysts
Acute pyelonephritis

6. What is the most common renal malignancy of early childhood
CHF - pulmonary edema - HTN
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Wilms tumor (ages 2-4)

7. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Dec - inc - inc
Diabetic glomerulonephropathy

8. In renal failure What are the consquence sof Na/H20 retention
Negative charge
CHF - pulmonary edema - HTN
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
NC - dec - dec

9. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
RTA type 4 (hyperkalemic)
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

10. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Simple cysts
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Inc - inc - inc

11. What serum changes cause a secretion in PTH
Dec - dec - dec
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Kids - peripheral and periorbital edema - resolves spontaneously

12. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
Inc in Ca and PO4 absoprtion from the gut
Nephritic syndrome
<3.5 g /day

13. What do you see on LM for focal segmental glomerulosclerosis
Vasocxn - inc BP
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Segmental sclerosis and hylanosis
GFR/RPF

14. What effect does afferent arteriole cxn have on RPF - GFR and FF
Hydronephrosis and pyelonephritis
Transitional cell carcinoma
Inc renal bicarb resabsoprtion - delayed
Dec - dec - NC

15. Which cells sense decreases in Na delivery
Nonspecific
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Macula densa
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

16. Why is there anemia in renal failure
White cell casts
Failure of EPO
Ammonia - buffer for secreted H+
Inc plasma osm - dec blood volume

17. By what percentage does EPRF underestimage true RPF
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
2 ways - base exchanger and between epithelial cells
By 10%

18. What are the effects of AT II on the adrenal gland
Chronic conditions - multiple myeloma - TB - RA
Bladder cancer
Inc - dec - dec
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

19. The fenestrated capillary endothelium constitutes what portion of the barrier
LM - nl glomeruli - EM - foot process effacement
Inc - dec - dec
Size
Dec - inc - inc

20. Why is the left kidney taken during living donor transplantation
Macula densa
Huge palpable flank mass and hematuria
It has a longer renal vein
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

21. RBC casts - ddx
Hypokalemia - risk for Ca containing kidney stones
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Stimulates thirst

22. inc in creatinine and BUN over a period of several days
Acute renal failure
Passively reabsorbs water via medullary hypertonicity
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

23. What is the BUN/Cr ratio in instrinsic renal ARF and why
Inc Ca/Na exchange to inc Ca reabsoprtion
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inhibits Na/phosphate cotransport leading to phosphate excretion

24. Why does Na conc nearly match Osm
Inulin
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Na reabsorption drives H20 reabsorption

25. nonenzymatic glycosylation of GBM - inc permeability and thickening
Diabetic glomerulonephropathy
Cx<GFR
Poor - days to weeks
Solute and water are reabsorbed at the same rate

26. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Renal in origin
Rxn from angiotensinogen to angiontensin I
Inc
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

27. What happens to pH - PCO2 and bicarb in metabolic acidosis
White cell casts
Dec - dec - dec
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Dec - inc - inc

28. What is the effect of AT II on GFR - FF and Na
GFR x plasma concentration
White cell casts
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

29. What are the 3 transporters of the intercalated cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Staghorn calculi - worsened by alkaluria
Anion gap = na - (Cl + bicarb)
Renal tubular cells - polygonal clear cells

30. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Few glomeruli
Acute pyelonephritis
Na and volume loss

31. What is the compensatory response in metabolic acidosis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Hypervent - immediate
Complications of chronic kidney disease or HTN

32. How do calcium stones appear on x ray
Becomes concentrated and hypertonic
Failure of EPO
Radiopaque
160-200 - 350

33. Defect in collecting ducts ability to excrete H+
Needs to be bilateral
Insertion of Na channel on luminal side
RTA type 1 (distal)
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

34. Why can PAH be used to measure ERPF
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Proximal tubule - na/glucose co transporter
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

35. Where does renal cell carcinoma originate and What do the cells look like
Acute pyelonephritis
Renal tubular cells - polygonal clear cells
Crescent - moon shape
Poor - days to weeks

36. What 3 disease can lead to RPGN
Wilms tumor (ages 2-4)
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Growth retardation and developmental delay
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

37. What does LM - EM - IF show in diffuse proliferative GN
PH = pKa + log bicarb/0.03PCO2
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

38. Defect in proximal tubule HCO3 reabsorption
Hydronephrosis and pyelonephritis
RTA type 2 (proximal)
Inhibits Na/phosphate cotransport leading to phosphate excretion
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

39. What therapy does miminal change respond to...
Ectopic EPO - ACTH - PTHrP - prolactin
Corticosteroids
Dialysis cysts
Men 50 to 70 - inc incidence with smoking and obesity

40. What is the formula for secreted
V x Urine concentration
Vasa recta - interlobular v - interlobar v - renal v
Inc plasma osm - dec blood volume
Excreted - filtered

41. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Inc - dec - dec
Under and under
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Medullary cystic disease

42. Bergers' disease - which antibody and What do you see on LM and IF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
UTI or acute gastroenteritis
Thickening of glomerular BM
Passively reabsorbs water via medullary hypertonicity

43. What are the associated paraneoplastic syndromes wth RCC
Ectopic EPO - ACTH - PTHrP - prolactin
Bladder cancer
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Cx = GFR

44. What is the formula for excretion rate
Cx = GFR
NC - dec - dec
Radiopaque
V x Urine concentration

45. What is the ddx for a metabolic acidosis with an inc anion gap
RTA type 4 (hyperkalemic)
<3.5 g /day
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

46. What is a normal filtration fraction
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
20 percent
Diarrhea - glue - RTA - hyperchloremia
Cx = GFR

47. net tubular secretion of x
Cx>GFR
Radiolabelled albumin
Vasocxn - inc BP
Freely filtered and neither absorbed or secreted

48. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Acute tubular necrosis
All glomeruli
60% total body water - 40% ICF - 20% ECF

49. proliferative
Acute renal failure
Inc
Hyperceullular glomeruli
Negative charge

50. What is the net effect of ANP
Diuretics - vomiting - antacid - hyperaldosteronism
Nonspecific
Na and volume loss
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia