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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. How do the ureters course in relation to the uterine artery and ductus deferens
Diuretics - vomiting - antacid - hyperaldosteronism
Under and under
Nephrotic syndrome
Freely filtered and neither absorbed or secreted

2. What is the net effect of AT II
Transitional cell carcinoma
Macula densa and JG cells
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Vasocxn - inc BP

3. Why is there anemia in renal failure
Failure of EPO
Staghorn calculi - worsened by alkaluria
Inc in concentration - not amout - due to water reabsorption
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

4. What is a normal filtration fraction
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
20 percent
Small kidney - poor prognosis

5. Under what circumstances is aldosterone secreted
GFR x plasma concentration
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Inc in concentration - not amout - due to water reabsorption
Radiopaque

6. Which cells sense decreases in Na delivery
Anion gap = na - (Cl + bicarb)
Macula densa
20 percent
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

7. In what disease in FSGS the most common glomerular disease
HIV
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Hyperkalemia
Makes urine less concentrated - impermeable to H20

8. What do macula densa cells sense
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Na
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
It has a longer renal vein

9. What happens to tubular inulin along the proximal tubule and why
RPF/(1- Hct)
Amyloidosis
It has a longer renal vein
Inc in concentration - not amout - due to water reabsorption

10. How is extracellular volume measured
Inc - inc - inc
160-200 - 350
Inulin
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

11. How is chlorid reabsorbed in the proximal tubule
Diuretics - vomiting - antacid - hyperaldosteronism
2 ways - base exchanger and between epithelial cells
Crescent - moon shape
Cx = GFR

12. What is the cutoff of proteinuria in nephritic syndrome
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
PH - then PC02
Cx>GFR
<3.5 g /day

13. What is the ddx for respiratory acidosis
Simple cysts
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
RTA type 4 (hyperkalemic)
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

14. What is the henderson hasselbalch equation
Hypervent - early high altitude - aspirin ingestion early
PH = pKa + log bicarb/0.03PCO2
Wilms tumor (ages 2-4)
Radiopaque

15. What is the genetic etiology of wilms tumor and What is WAGR complex
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Passively reabsorbs water via medullary hypertonicity
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Cx>GFR

16. What does NEG lead to in the efferent arterioles
Hyperkalemia
Inc GFR and mesangial expansion
Anion gap = na - (Cl + bicarb)
Solute is reabsorbed less quickly than water or net secretion of substance

17. What is the net effect of ANP
Segmental sclerosis and hylanosis
RPF/(1- Hct)
Na and volume loss
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

18. What happens to urine in the ascending limb
Macula densa
Dialysis cysts
Makes urine less concentrated - impermeable to H20
Thromboembolism and inc risk of infection

19. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Von hippel laundau and gene deletion in chromosome 3
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Na

20. What effect does afferent arteriole cxn have on RPF - GFR and FF
It has a longer renal vein
Poor - days to weeks
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Dec - dec - NC

21. What are the associations with RTA type 1
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Huge palpable flank mass and hematuria
Hypokalemia - risk for Ca containing kidney stones
Triglycerides

22. What is the formula for renal blood flow
No
Solute is reabsorbed more quickly than water
Radiolabelled albumin
RPF/(1- Hct)

23. Focal
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Few glomeruli
Dec renal bicarb reabsorption - delayed
Na reabsorption drives H20 reabsorption

24. What is the least common kidney stone - What causes it and How do you treat it
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Complications of chronic kidney disease or HTN
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
1/4 plasma - and 3/4 interstitial volume

25. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Size
Renal artery - interlobar a - interlobular a

26. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Most of the bicarb - sodium - chloride - and water
CHF - pulmonary edema - HTN

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

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28. granular - muddy brown casts - ddx
Acute tubular necrosis
Poor - days to weeks
Wilms tumor (ages 2-4)
Hypervent - early high altitude - aspirin ingestion early

29. do you see casts in bladder cancer - kidney stones with hematuria
Type II - C3 nephritic factor
Cx<GFR
Chronic conditions - multiple myeloma - TB - RA
No

30. Why does Na conc nearly match Osm
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Solute is reabsorbed more quickly than water
Cx>GFR
Na reabsorption drives H20 reabsorption

31. What do you see on LM for focal segmental glomerulosclerosis
Involves glomeruli and other organs
Na reabsorption drives H20 reabsorption
Podocytes foot processes
Segmental sclerosis and hylanosis

32. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Radiolabelled albumin
Transitional cell carcinoma
RTA type 2 (proximal)
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

33. What therapy does miminal change respond to...
Inc - inc - inc
2 ways - base exchanger and between epithelial cells
Corticosteroids
Phenacetin - smoking - aniline dyes - cyclophosphamide

34. What is the formula for filtration fraction
2 ways - base exchanger and between epithelial cells
JG cells
Complications of chronic kidney disease or HTN
GFR/RPF

35. What happens in the early distal convoluted tubule and What does that do to the urine
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
NC - dec - dec
Macula densa

36. What 3 disease can lead to RPGN
Hypervent - early high altitude - aspirin ingestion early
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Acute tubular necrosis
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

37. What circumstances causes ADH secretion
Macula densa
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc plasma osm - dec blood volume

38. What is the effect of AT II on efferent arterioles
Nonspecific
Contrict leading to inc FF - preserver renal GFR in low volume states
Acute renal failure
Radiolabelled albumin

39. What do patients die from ADPKD
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
To defend GFR
Complications of chronic kidney disease or HTN
Segmental sclerosis and hylanosis

40. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Renal artery - interlobar a - interlobular a
Inc - inc - inc
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

41. net tubular secretion of x
Cx>GFR
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Radiopaque
Hypokalemia and hypophosphatemic rickets

42. Where is potassium conc. Highest? Intra or extra
RTA type 4 (hyperkalemic)
NC - dec - dec
Ammonia - buffer for secreted H+
Intra = HIKIN!

43. waxy casts ddx
White cell casts
Involves only glomeruli
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Advanced renal dz - CRF

44. How do you interpret creatinine clearance
White cell casts
All glomeruli
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
RTA type 1 (distal)

45. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Invades IVC and spreads hematogenously
Podocytes foot processes
PH = pKa + log bicarb/0.03PCO2

46. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Ectopic EPO - ACTH - PTHrP - prolactin
Dec - inc - inc
160-200 - 350
No

47. What is the formula for secreted
Inc in Ca and PO4 absoprtion from the gut
Liver
PH = pKa + log bicarb/0.03PCO2
Excreted - filtered

48. What change (lack of) is common in children with renal failure
Antifreeze - ethyelene glycol or vit C abuse
GFR/RPF
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Growth retardation and developmental delay

49. In renal failure What acid - base disturbance is most likely
Phenacetin - smoking - aniline dyes - cyclophosphamide
Metabolic acidosis
Excreted - filtered
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

50. What is the 60-40-20 rule of body weight
PH - then PC02
Segmental sclerosis and hylanosis
60% total body water - 40% ICF - 20% ECF
1alpha hydroxylase - PTH stimulates it