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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. Which cells sense decreases in BP
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
JG cells
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Kids - peripheral and periorbital edema - resolves spontaneously

2. acute generalized cortical infarction of both kidneys - dz - causes and associations
Ammonia - buffer for secreted H+
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Thickening of glomerular BM
Nephrotic syndrome

3. What is the effect of PTH on the proximal tubule
Metabolic acidosis
Corticosteroids
Inhibits Na/phosphate cotransport leading to phosphate excretion
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

4. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
20 percent
LM - nl glomeruli - EM - foot process effacement

5. Where is angiotensinogen made
Antifreeze - ethyelene glycol or vit C abuse
Liver
Failure of EPO
Freely filtered and neither absorbed or secreted

6. What is the 60-40-20 rule of body weight
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
60% total body water - 40% ICF - 20% ECF
Failure of EPO
Membranoproliferative glomerulonephritis

7. What is the net effect of ANP
Na and volume loss
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Antifreeze - ethyelene glycol or vit C abuse
Vasa recta - interlobular v - interlobar v - renal v

8. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Na
Makes urine less concentrated - impermeable to H20
Under and under
Staghorn calculi - worsened by alkaluria

9. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Radiolabelled albumin
Rxn from angiotensinogen to angiontensin I
Hydronephrosis and pyelonephritis

10. What are the effects of PTH hormone on the kidney
20 percent
Diarrhea - glue - RTA - hyperchloremia
Reabsorb Na in exchange for secreting K and H
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

11. Where is potassium conc. Highest? Intra or extra
RTA type 2 (proximal)
Involves only glomeruli
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Intra = HIKIN!

12. Focal
Inc Ca/Na exchange to inc Ca reabsoprtion
Few glomeruli
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Staghorn calculi - worsened by alkaluria

13. With what genetic tumor syndrome is RCC associated
Renal tubular cells - polygonal clear cells
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Von hippel laundau and gene deletion in chromosome 3
Chronic pyelonephritis

14. Who often has diffuse proliferative GN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Under and under
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Hyperkalemia

15. RBC casts - ddx
Solute is reabsorbed more quickly than water
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Crescent - moon shape

16. granular - muddy brown casts - ddx
Acute tubular necrosis
Von hippel laundau and gene deletion in chromosome 3
Renal artery - interlobar a - interlobular a
160-200 - 350

17. hyaline casts ddx
Nonspecific
Solute is reabsorbed more quickly than water
Nephritic syndrome
Acts on V2 receptors leading to insertion of aquaporins on luminal side

18. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Involves only glomeruli
Filtered - secreted
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

19. How do calcium stones appear on x ray
Radiopaque
Hypokalemia - risk for Ca containing kidney stones
Segmental sclerosis and hylanosis
Cx<GFR

20. What are JG cells and what substance do they secrete
Solute and water are reabsorbed at the same rate
Vasocxn - inc BP
Modified smooth muscle of afferent arteriole - secrete renin
Macula densa

21. What happens in the thin descending loop of henle
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Needs to be bilateral
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Passively reabsorbs water via medullary hypertonicity

22. What is the most frequent kind of kidney stone and What are causes that lead to it
Transitional cell carcinoma
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal in origin
Hypervent - early high altitude - aspirin ingestion early

23. In renal failure What are the consquence sof Na/H20 retention
Excreted - filtered
Hypervent - immediate
CHF - pulmonary edema - HTN
Antifreeze - ethyelene glycol or vit C abuse

24. dense deposits on EM - type and association
160-200 - 350
Type II - C3 nephritic factor
Involves only glomeruli
Hypokalemia - risk for Ca containing kidney stones

25. When is TF/P ratio > 1
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Inc plasma osm - dec blood volume
Dec - dec - dec
Solute is reabsorbed less quickly than water or net secretion of substance

26. What is the compensatory response in respiratory alkalosis
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Dec renal bicarb reabsorption - delayed
Na and volume loss
Ammonia - buffer for secreted H+

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

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28. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Renal artery - interlobar a - interlobular a
Beta 1
Poor - days to weeks
Inc - dec - dec

29. What is the henderson hasselbalch equation
Hypervent - early high altitude - aspirin ingestion early
V x Urine concentration
PH = pKa + log bicarb/0.03PCO2
Diarrhea - glue - RTA - hyperchloremia

30. What is the effect of AT II on efferent arterioles
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Nonspecific
Contrict leading to inc FF - preserver renal GFR in low volume states
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

31. What is the compensatory response in metabolic alkalosis
160-200 - 350
Solute is reabsorbed less quickly than water or net secretion of substance
Hypovent - immediate
Wilms tumor (ages 2-4)

32. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Contrict leading to inc FF - preserver renal GFR in low volume states
Phenacetin - smoking - aniline dyes - cyclophosphamide
Radiolabelled albumin
Transitional cell carcinoma

33. In a metabolic acidosis What additional calculation is necessary and How do you make it
Anion gap = na - (Cl + bicarb)
Huge palpable flank mass and hematuria
Advanced renal dz - CRF
Segmental sclerosis and hylanosis

34. nonenzymatic glycosylation of GBM - inc permeability and thickening
Small kidney - poor prognosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Diabetic glomerulonephropathy
Insertion of Na channel on luminal side

35. What do you see in the urine with acute pyelonephritis
White cell casts
RTA type 1 (distal)
Dialysis cysts
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

36. Why is there anemia in renal failure
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Diarrhea - glue - RTA - hyperchloremia
Corticosteroids
Failure of EPO

37. Why does Na conc nearly match Osm
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Na reabsorption drives H20 reabsorption
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Actively reabsorbs NaCl - diluting - makes urine hypotonic

38. What is the algorithim for acidosis/alkalosis
PH - then PC02
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
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

39. What is the least common kidney stone - What causes it and How do you treat it
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
RTA type 4 (hyperkalemic)
Segmental sclerosis and hylanosis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

40. How is chlorid reabsorbed in the proximal tubule
Radiopaque
Ectopic EPO - ACTH - PTHrP - prolactin
2 ways - base exchanger and between epithelial cells
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

41. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Acute renal failure
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

42. proliferative
Hypokalemia and hypophosphatemic rickets
Inulin
Hyperceullular glomeruli
Inc in Ca and PO4 absoprtion from the gut

43. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Crescent - moon shape
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
GFR x plasma concentration

44. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
Reabsorb Na in exchange for secreting K and H
Inhibits Na/phosphate cotransport leading to phosphate excretion
1alpha hydroxylase - PTH stimulates it

45. coarse - asymmetric - corticomedullary scarring and blunted calyx
Chronic pyelonephritis
Na
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
NC - dec - dec

46. What does LM - EM - IF show in diffuse proliferative GN
All glomeruli
160-200 - 350
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Hypokalemia and hypophosphatemic rickets

47. What change (lack of) is common in children with renal failure
<3.5 g /day
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
RTA type 2 (proximal)
Growth retardation and developmental delay

48. What is the net effect of PTH
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Cx<GFR
Inc in Ca and PO4 absoprtion from the gut

49. What effect does cxn of the ureter have on RPF - GFR and FF
V x Urine concentration
NC - dec - dec
Excreted - filtered
Inc - dec - dec

50. What percentage of ECF is plasma and What is interstitial volume
Inhibits Na/phosphate cotransport leading to phosphate excretion
1/4 plasma - and 3/4 interstitial volume
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Macula densa