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 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
NC - dec - dec
Macula densa
Von hippel laundau and gene deletion in chromosome 3

2. primary glomerular dz
RTA type 1 (distal)
Inc plasma osm - dec blood volume
Involves only glomeruli
Radiolabelled albumin

3. What is the least common kidney stone - What causes it and How do you treat it
Staghorn calculi - worsened by alkaluria
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

4. granular - muddy brown casts - ddx
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Hypokalemia and hypophosphatemic rickets
Acute tubular necrosis
CHF - pulmonary edema - HTN

5. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Macula densa
Inc - inc - inc
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

6. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Na
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Staghorn calculi - worsened by alkaluria
Ectopic EPO - ACTH - PTHrP - prolactin

7. Which cells sense decreases in BP
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Growth retardation and developmental delay
JG cells
Nephritic syndrome

8. What do patients die from ADPKD
Cx>GFR
Hydronephrosis and pyelonephritis
Complications of chronic kidney disease or HTN
Na reabsorption drives H20 reabsorption

9. diffuse
All glomeruli
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

10. What is amyloidosis associated with
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Chronic conditions - multiple myeloma - TB - RA
Solute and water are reabsorbed at the same rate

11. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
No
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Most of the bicarb - sodium - chloride - and water
Simple cysts

12. How What does the glomerular filtration barrier distinguish by
Size and charge
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
ADPKD
Von hippel laundau and gene deletion in chromosome 3

13. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Vasocxn - inc BP
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
RPF/(1- Hct)

14. What is the most common renal malignancy of early childhood
NC - dec - dec
Ammonia - buffer for secreted H+
Wilms tumor (ages 2-4)
Size

15. What is the henderson hasselbalch equation
Macula densa and JG cells
PH = pKa + log bicarb/0.03PCO2
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Metabolic acidosis

16. What happens in the early distal convoluted tubule and What does that do to the urine
Hyperkalemia
Nonspecific
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

17. Where is potassium conc. Highest? Intra or extra
Intra = HIKIN!
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Dec - dec - NC
Inc

18. What circumstances causes ADH secretion
Inc plasma osm - dec blood volume
Proximal tubule - na/glucose co transporter
Membranoproliferative glomerulonephritis
Reabsorb Na in exchange for secreting K and H

19. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dialysis cysts
Hyperkalemia
Rxn from angiotensinogen to angiontensin I

20. What is a normal filtration fraction
Solute and water are reabsorbed at the same rate
Size
20 percent
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

21. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
1alpha hydroxylase - PTH stimulates it
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Vasa recta - interlobular v - interlobar v - renal v

22. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
To defend GFR
Transitional cell carcinoma
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size and charge

23. What happens when PTH is secreted
V x Urine concentration
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Dec - dec - NC
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

24. What therapy does miminal change respond to...
Corticosteroids
60% total body water - 40% ICF - 20% ECF
Hydronephrosis and pyelonephritis
Cx<GFR

25. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Transitional cell carcinoma
ADPKD
Thickening of glomerular BM

26. What are the two forms of renal failure and What are examples of each
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Acute - ATN - or chronic - HTN - DM
Freely filtered and neither absorbed or secreted
Carbonic anhydrase

27. inc in creatinine and BUN over a period of several days
Most of the bicarb - sodium - chloride - and water
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Acute renal failure
Modified smooth muscle of afferent arteriole - secrete renin

28. What is the net effect of ANP
Liver
Na and volume loss
Hypervent - immediate
Becomes concentrated and hypertonic

29. How do calcium stones appear on x ray
Hyperkalemia
Radiopaque
NC - dec - dec
Freely filtered and neither absorbed or secreted

30. acute generalized cortical infarction of both kidneys - dz - causes and associations
Dialysis cysts
Dec - dec - dec
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

31. RBC casts - ddx
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
1/4 plasma - and 3/4 interstitial volume
Von hippel laundau and gene deletion in chromosome 3
NC - dec - dec

32. Why can PAH be used to measure ERPF
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Cx<GFR
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

33. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Transitional cell carcinoma
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

34. What is the formula for reabsorption
Filtered - secreted
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Hypervent - immediate
Metabolic acidosis

35. Where is ACE made and What are 2 of its fxns
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Angio I to angio II and inhibits bradykinin
It has a longer renal vein
160-200 - 350

36. What two cells make up the JGA
Macula densa and JG cells
20 percent
Angio I to angio II and inhibits bradykinin
Type II - C3 nephritic factor

37. How is plasma volume measured
Radiolabelled albumin
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Na reabsorption drives H20 reabsorption

38. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Most of the bicarb - sodium - chloride - and water

39. In renal failure - what happens to potassium
Medullary cystic disease
Von hippel laundau and gene deletion in chromosome 3
RTA type 2 (proximal)
Hyperkalemia

40. How does RCC manifest clinically
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Thromboembolism and inc risk of infection
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

41. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Vasa recta - interlobular v - interlobar v - renal v
No

42. In renal failure What acid - base disturbance is most likely
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Dec - inc - inc
NC - dec - dec
Metabolic acidosis

43. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
Stimulates thirst
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

44. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Makes urine less concentrated - impermeable to H20
All glomeruli
EPO - endothelial cells of peritubular capillaries
Simple cysts

45. What are the associations with RTA type 4
Freely filtered and neither absorbed or secreted
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Complications of chronic kidney disease or HTN
Filtered - secreted

46. How can NSAIDs cause acute renal failure
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
All glomeruli
NKCC
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

47. What is the formula for secreted
Chronic conditions - multiple myeloma - TB - RA
1alpha hydroxylase - PTH stimulates it
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Excreted - filtered

48. What do macula densa cells sense
NC - dec - dec
Stimulates thirst
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Na

49. What are the main complications of kidney stones
RTA type 4 (hyperkalemic)
Hydronephrosis and pyelonephritis
Radiopaque
No

50. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Macula densa and JG cells
NC - dec - dec
To defend GFR