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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 is the 60-40-20 rule of body weight
Inc in concentration - not amout - due to water reabsorption
60% total body water - 40% ICF - 20% ECF
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

2. What is the second most common kidney stone
Makes urine less concentrated - impermeable to H20
Radiopaque
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Staghorn calculi - worsened by alkaluria

3. What effect does ANP have on GFR
GFR/RPF
Inc
<3.5 g /day
Inc plasma osm - dec blood volume

4. What do casts indicated about hematuria/pyuria
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal in origin
Makes urine less concentrated - impermeable to H20
NC - dec - dec

5. proliferative
Macula densa and JG cells
Hyperceullular glomeruli
Acute renal failure
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

6. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Inc in Ca and PO4 absoprtion from the gut
Acute pyelonephritis
Radiopaque
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

7. What are the LM and EM of minimal change disease
LM - nl glomeruli - EM - foot process effacement
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inhibits Na/phosphate cotransport leading to phosphate excretion
Growth retardation and developmental delay

8. In who is RCC most comon
Rxn from angiotensinogen to angiontensin I
Men 50 to 70 - inc incidence with smoking and obesity
RPF/(1- Hct)
Excreted - filtered

9. What is the purpose of the JGA
Solute is reabsorbed more quickly than water
Hydronephrosis and pyelonephritis
Acute pyelonephritis
To defend GFR

10. What two cells make up the JGA
Modified smooth muscle of afferent arteriole - secrete renin
Macula densa and JG cells
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Under and under

11. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
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
60% total body water - 40% ICF - 20% ECF
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
1alpha hydroxylase - PTH stimulates it

12. What is the ddx for a metabolic acidosis with an inc anion gap
Dec - dec - NC
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

13. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Inc in Ca and PO4 absoprtion from the gut
Nephritic syndrome
Liver
Hydronephrosis and pyelonephritis

14. What happens to urine in the ascending limb
LM - nl glomeruli - EM - foot process effacement
Macula densa and JG cells
Makes urine less concentrated - impermeable to H20
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

15. With what genetic tumor syndrome is RCC associated
Hypovent - immediate
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Von hippel laundau and gene deletion in chromosome 3

16. granular - muddy brown casts - ddx
Size and charge
Thromboembolism and inc risk of infection
Acute tubular necrosis
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

17. Under what circumstances is aldosterone secreted
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
GFR x plasma concentration

18. diffuse
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Size and charge
RTA type 2 (proximal)
All glomeruli

19. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
ANP

20. What is the least common kidney stone - What causes it and How do you treat it
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
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
Freely filtered and neither absorbed or secreted

21. What is the algorithim for acidosis/alkalosis
PH - then PC02
NC - inc - inc
Na and volume loss
All glomeruli

22. hyaline casts ddx
20 percent
Dec renal bicarb reabsorption - delayed
Nonspecific
Becomes concentrated and hypertonic

23. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Vasa recta - interlobular v - interlobar v - renal v

24. What does NEG lead to in the efferent arterioles
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc
Inc GFR and mesangial expansion

25. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
Acute - ATN - or chronic - HTN - DM
Passively reabsorbs water via medullary hypertonicity
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

26. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Crescent - moon shape
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Renal tubular cells - polygonal clear cells

27. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Hypovent - immediate
Diarrhea - glue - RTA - hyperchloremia
Dialysis cysts

28. When is TF/P <1
Cx>GFR
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Cx = GFR
Solute is reabsorbed more quickly than water

29. How does RCC manifest clinically
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Antifreeze - ethyelene glycol or vit C abuse
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

30. net tubular reabsorption of x
All glomeruli
Dialysis cysts
Cx<GFR
Na and volume loss

31. What happens to tubular inulin along the proximal tubule and why
Transitional cell carcinoma
Inc in concentration - not amout - due to water reabsorption
Diuretics - vomiting - antacid - hyperaldosteronism
Dec - dec - dec

32. TCC is associated with problems in your Pee SAC - ??
White cell casts
Diabetic glomerulonephropathy
HIV
Phenacetin - smoking - aniline dyes - cyclophosphamide

33. dense deposits on EM - type and association
Hypovent - immediate
Simple cysts
Type II - C3 nephritic factor
Inc in Ca and PO4 absoprtion from the gut

34. Who commonly gets acute post strep GN
Macula densa and JG cells
Kids - peripheral and periorbital edema - resolves spontaneously
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Medullary cystic disease

35. primary glomerular dz
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Principal cells and intercalated cells
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Involves only glomeruli

36. What does thyroidization of the kidney result in
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Eosinphilic casts in tubules
Hyperceullular glomeruli
Medullary cystic disease

37. 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
No
Acute renal failure
Vasocxn - inc BP

38. What is the BUN/Cr ratio in prerenal azotemia and why?
Amyloidosis
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Involves glomeruli and other organs

39. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
20 percent
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

40. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
RTA type 4 (hyperkalemic)
Solute is reabsorbed more quickly than water
Bladder cancer
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

41. What serum changes cause a secretion in PTH
Von hippel laundau and gene deletion in chromosome 3
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Involves only glomeruli
Thickening of glomerular BM

42. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Hydronephrosis and pyelonephritis
Contrict leading to inc FF - preserver renal GFR in low volume states
Inc - inc - inc
Chronic pyelonephritis

43. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dec - inc - dec
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Insertion of Na channel on luminal side

44. What is the effect of AT II on GFR - FF and Na
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Beta 1
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inc plasma osm - dec blood volume

45. WBC casts - ddx
Inc - dec - dec
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
ANP

46. How do the ureters course in relation to the uterine artery and ductus deferens
NC - inc - inc
Cx = GFR
Under and under
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

47. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
Carbonic anhydrase
No
PH - then PC02

48. What does LM - EM - IF show in diffuse proliferative GN
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Vasa recta - interlobular v - interlobar v - renal v

49. Defect in collecting ducts ability to excrete H+
Nonspecific
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
RTA type 1 (distal)
60% total body water - 40% ICF - 20% ECF

50. In a metabolic acidosis What additional calculation is necessary and How do you make it
Acute pyelonephritis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Anion gap = na - (Cl + bicarb)