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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 BUN/Cr ratio in instrinsic renal ARF and why
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Solute is reabsorbed more quickly than water

2. How do you interpret creatinine clearance
Reabsorb Na in exchange for secreting K and H
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

3. hyaline casts ddx
Nonspecific
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Segmental sclerosis and hylanosis
Hyperkalemia

4. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Antifreeze - ethyelene glycol or vit C abuse
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
ANP

5. What is the effect of AT II on efferent arterioles
Men 50 to 70 - inc incidence with smoking and obesity
Triglycerides
Contrict leading to inc FF - preserver renal GFR in low volume states
RPF/(1- Hct)

6. In renal failure with uremia - What are the 5 aspects of uremia
Few glomeruli
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
No
Solute is reabsorbed more quickly than water

7. What is the ddx for respiratory acidosis
Proximal tubule - na/glucose co transporter
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Renal in origin
Thickening of glomerular BM

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

9. How is plasma volume measured
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Radiolabelled albumin
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Type II - C3 nephritic factor

10. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
No
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

11. What do you see in the urine with acute pyelonephritis
UTI or acute gastroenteritis
White cell casts
Inc - inc - inc
Modified smooth muscle of afferent arteriole - secrete renin

12. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Poor - days to weeks
JG cells
Modified smooth muscle of afferent arteriole - secrete renin

13. What effect does ANP have on Na in the kidney
To defend GFR
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Principal cells and intercalated cells
Segmental sclerosis and hylanosis

14. What needs to happen for postrenal obstruction to creat ARF
NC - dec - dec
20 percent
Becomes concentrated and hypertonic
Needs to be bilateral

15. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Inc - dec - dec
White cell casts
Thromboembolism and inc risk of infection

16. dense deposits on EM - type and association
Needs to be bilateral
Type II - C3 nephritic factor
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
Inc

17. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Inc GFR and mesangial expansion
No
ADPKD

18. What two cells make up the JGA
Macula densa and JG cells
Bladder cancer
Intra = HIKIN!
Passively reabsorbs water via medullary hypertonicity

19. What are the associated paraneoplastic syndromes wth RCC
Membranoproliferative glomerulonephritis
Ectopic EPO - ACTH - PTHrP - prolactin
Dec renal bicarb reabsorption - delayed
Inc GFR and mesangial expansion

20. What is the 60-40-20 rule of body weight
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
60% total body water - 40% ICF - 20% ECF
White cell casts
Negative charge

21. nonenzymatic glycosylation of GBM - inc permeability and thickening
Freely filtered and neither absorbed or secreted
RTA type 2 (proximal)
White cell casts
Diabetic glomerulonephropathy

22. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
Amyloidosis
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

23. Which cells sense decreases in BP
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
JG cells
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Growth retardation and developmental delay

24. What is hartnup's disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Intra = HIKIN!
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Phenacetin - smoking - aniline dyes - cyclophosphamide

25. What is amyloidosis associated with
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
GFR x plasma concentration
Chronic conditions - multiple myeloma - TB - RA
Membranoproliferative glomerulonephritis

26. What does US show with medullary cystic disease
Small kidney - poor prognosis
HIV
Na reabsorption drives H20 reabsorption
Acute tubular necrosis

27. What circumstances causes ADH secretion
Inc in concentration - not amout - due to water reabsorption
Inc plasma osm - dec blood volume
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

28. How do the ureters course in relation to the uterine artery and ductus deferens
Antifreeze - ethyelene glycol or vit C abuse
Carbonic anhydrase
PH - then PC02
Under and under

29. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Renal artery - interlobar a - interlobular a
Inc renal bicarb resabsoprtion - delayed
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

30. What are the 3 transporters of the intercalated cells
No
PH = pKa + log bicarb/0.03PCO2
Beta 1
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

31. What do casts indicated about hematuria/pyuria
Invades IVC and spreads hematogenously
Radiopaque
Renal in origin
Simple cysts

32. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Inc - dec - dec
Transitional cell carcinoma
Inc in Ca and PO4 absoprtion from the gut
Becomes concentrated and hypertonic

33. What is lost in nephrotic syndrome resulting what urine and serum changes
Rxn from angiotensinogen to angiontensin I
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

34. inc in creatinine and BUN over a period of several days
Insertion of Na channel on luminal side
Diabetic glomerulonephropathy
Acute renal failure
Solute is reabsorbed more quickly than water

35. What is the net effect of PTH
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc in concentration - not amout - due to water reabsorption
Inc in Ca and PO4 absoprtion from the gut
RTA type 2 (proximal)

36. Congo - red stain - apple green birefringence
Hypokalemia - risk for Ca containing kidney stones
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Huge palpable flank mass and hematuria
Amyloidosis

37. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Liver

38. What are the associations with RTA type 1
Na
Hypokalemia - risk for Ca containing kidney stones
Cx>GFR
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

39. What does aldosterone do in the collecting tubule
Metabolic acidosis
Invades IVC and spreads hematogenously
Insertion of Na channel on luminal side
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

40. How can NSAIDs cause acute renal failure
Size and charge
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

41. What is the prognosis of RPGN
Small kidney - poor prognosis
Dec - dec - NC
Poor - days to weeks
Makes urine less concentrated - impermeable to H20

42. What does NEG lead to in the efferent arterioles
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc GFR and mesangial expansion
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

43. What is the compensatory response in respiratory acidosis
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc renal bicarb resabsoprtion - delayed
Complications of chronic kidney disease or HTN

44. What is the effect of aldosterone in principal cells
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

45. What are the associations with nephrotic syndrome
Radiopaque
Freely filtered and neither absorbed or secreted
Thromboembolism and inc risk of infection
Acts on V2 receptors leading to insertion of aquaporins on luminal side

46. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
PH - then PC02
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Diarrhea - glue - RTA - hyperchloremia
Staghorn calculi - worsened by alkaluria

47. What are the two forms of renal failure and What are examples of each
Acute - ATN - or chronic - HTN - DM
Inc in concentration - not amout - due to water reabsorption
Transitional cell carcinoma
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

48. Defect in proximal tubule HCO3 reabsorption
160-200 - 350
RTA type 1 (distal)
RTA type 2 (proximal)
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

49. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Inc
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

50. What is renal osteodystrophy
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Poor - days to weeks
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
No