Test your basic knowledge |

Renal

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Staghorn calculi - worsened by alkaluria
Inc - dec - dec

2. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Staghorn calculi - worsened by alkaluria
Thromboembolism and inc risk of infection

3. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Nephrotic syndrome
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

4. Where is ACE made and What are 2 of its fxns
Inc - dec - dec
Wilms tumor (ages 2-4)
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Angio I to angio II and inhibits bradykinin

5. 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
NKCC
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
160-200 - 350

6. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Dec - inc - inc
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

7. waxy casts ddx
Advanced renal dz - CRF
NKCC
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Hydronephrosis and pyelonephritis

8. How is chlorid reabsorbed in the proximal tubule
Hyperceullular glomeruli
Inc
Solute is reabsorbed more quickly than water
2 ways - base exchanger and between epithelial cells

9. What is the effect of aldosterone in principal cells
Negative charge
Few glomeruli
Renal artery - interlobar a - interlobular a
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

10. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Few glomeruli
Needs to be bilateral
NC - inc - inc

11. What is the formula for excretion rate
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Excreted - filtered
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
V x Urine concentration

12. What happens to the urine in the descending limb
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Huge palpable flank mass and hematuria
Becomes concentrated and hypertonic
Amyloidosis

13. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Poor - days to weeks
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Antifreeze - ethyelene glycol or vit C abuse
NC - dec - dec

14. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
Hypokalemia - risk for Ca containing kidney stones
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

15. 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
No
Under and under
1/4 plasma - and 3/4 interstitial volume

16. What are the associated paraneoplastic syndromes wth RCC
Anion gap = na - (Cl + bicarb)
Ectopic EPO - ACTH - PTHrP - prolactin
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

17. What cells create the epithelial layer of the glomerular filtration barrier
Solute is reabsorbed less quickly than water or net secretion of substance
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Podocytes foot processes
Macula densa and JG cells

18. What is the pathway to the afferent arteriole
Inhibits Na/phosphate cotransport leading to phosphate excretion
Kids - peripheral and periorbital edema - resolves spontaneously
Intra = HIKIN!
Renal artery - interlobar a - interlobular a

19. Why is there anemia in renal failure
Advanced renal dz - CRF
Failure of EPO
Size
Makes urine less concentrated - impermeable to H20

20. What does aldosterone do in the collecting tubule
Cx<GFR
1alpha hydroxylase - PTH stimulates it
Insertion of Na channel on luminal side
No

21. What does the crescent moon shape consist of in RPGN
Medullary cystic disease
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
2 ways - base exchanger and between epithelial cells

22. How is plasma volume measured
60% total body water - 40% ICF - 20% ECF
Radiolabelled albumin
Acute - ATN - or chronic - HTN - DM
Transitional cell carcinoma

23. What is the compensatory response in metabolic alkalosis
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Hypovent - immediate
Poor - days to weeks
Diuretics - vomiting - antacid - hyperaldosteronism

24. nonenzymatic glycosylation of GBM - inc permeability and thickening
Hypovent - immediate
Diabetic glomerulonephropathy
Medullary cystic disease
Radiopaque

25. What substance is secreted in response increase atrial pressure
Acute renal failure
Cx<GFR
White cell casts
ANP

26. no net secretion or reabsorption of x
Medullary cystic disease
NC - dec - dec
Kids - peripheral and periorbital edema - resolves spontaneously
Cx = GFR

27. How can NSAIDs cause acute renal failure
Dec - dec - NC
Kids - peripheral and periorbital edema - resolves spontaneously
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Crescent - moon shape

28. diffuse
All glomeruli
GFR/RPF
Segmental sclerosis and hylanosis
Triglycerides

29. What are the LM and EM of minimal change disease
Acute pyelonephritis
LM - nl glomeruli - EM - foot process effacement
Phenacetin - smoking - aniline dyes - cyclophosphamide
Beta 1

30. How does Wilms tumor present
Under and under
Huge palpable flank mass and hematuria
Radiopaque
V x Urine concentration

31. What is a normal filtration fraction
<3.5 g /day
CHF - pulmonary edema - HTN
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
20 percent

32. What is the cutoff of proteinuria in nephritic syndrome
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Transitional cell carcinoma
<3.5 g /day
Thickening of glomerular BM

33. What serum changes cause a secretion in PTH
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Angio I to angio II and inhibits bradykinin

34. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Macula densa
LM - nl glomeruli - EM - foot process effacement

35. The fused basement membrane with heparan sulfate constitutes what portion of the charge
By 10%
Beta 1
Negative charge
Inc in concentration - not amout - due to water reabsorption

36. What is ADPKD also associated with
Dec - dec - NC
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Needs to be bilateral
RTA type 1 (distal)

37. What is the net effect of ANP
Na and volume loss
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Dec renal bicarb reabsorption - delayed

38. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Corticosteroids
NC - dec - dec
Growth retardation and developmental delay
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

39. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inhibits Na/phosphate cotransport leading to phosphate excretion
Actively reabsorbs NaCl - diluting - makes urine hypotonic

40. What are JG cells and what substance do they secrete
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
All glomeruli
Complications of chronic kidney disease or HTN
Modified smooth muscle of afferent arteriole - secrete renin

41. What is the formula for reabsorption
Filtered - secreted
Complications of chronic kidney disease or HTN
No
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

42. What happens to pH - PCO2 and bicarb in metabolic acidosis
Stimulates thirst
Crescent - moon shape
Dec - dec - dec
Na reabsorption drives H20 reabsorption

43. What effect does ANP have on GFR
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Becomes concentrated and hypertonic
1alpha hydroxylase - PTH stimulates it
Inc

44. 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
Invades IVC and spreads hematogenously
Transitional cell carcinoma
Complications of chronic kidney disease or HTN

45. membranous
Thickening of glomerular BM
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Contrict leading to inc FF - preserver renal GFR in low volume states

46. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
Becomes concentrated and hypertonic
Chronic pyelonephritis
Radiopaque

47. What is the compensatory response in respiratory acidosis
Renal tubular cells - polygonal clear cells
Inc renal bicarb resabsoprtion - delayed
Under and under
Hypokalemia and hypophosphatemic rickets

48. WBC casts - ddx
PH = pKa + log bicarb/0.03PCO2
Na
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
LM - nl glomeruli - EM - foot process effacement

49. The fenestrated capillary endothelium constitutes what portion of the barrier
Size
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Antifreeze - ethyelene glycol or vit C abuse
Renal artery - interlobar a - interlobular a

50. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
LM - nl glomeruli - EM - foot process effacement
Na reabsorption drives H20 reabsorption
Type II - C3 nephritic factor