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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 are the LM and EM of minimal change disease
LM - nl glomeruli - EM - foot process effacement
Cx>GFR
Hyperceullular glomeruli
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

2. What circumstances causes ADH secretion
Dec - dec - NC
Inc plasma osm - dec blood volume
Proximal tubule - na/glucose co transporter
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

3. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Segmental sclerosis and hylanosis
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
GFR x plasma concentration

4. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Dec - dec - dec
Nephrotic syndrome
Insertion of Na channel on luminal side
Macula densa

5. diffuse
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Needs to be bilateral
RTA type 4 (hyperkalemic)
All glomeruli

6. What serum changes cause a secretion in PTH
Invades IVC and spreads hematogenously
Poor - days to weeks
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
JG cells

7. What is the prognosis of RPGN
Involves only glomeruli
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Poor - days to weeks
20 percent

8. net tubular secretion of x
Cx>GFR
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
No
By 10%

9. What does aldosterone do in the collecting tubule
Nephrotic syndrome
2 ways - base exchanger and between epithelial cells
Solute and water are reabsorbed at the same rate
Insertion of Na channel on luminal side

10. What does NEG lead to in the efferent arterioles
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Small kidney - poor prognosis
Inc GFR and mesangial expansion
Beta 1

11. What needs to happen for postrenal obstruction to creat ARF
Inc - dec - dec
Poor - days to weeks
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Needs to be bilateral

12. What happens in the early distal convoluted tubule and What does that do to the urine
Thickening of glomerular BM
Renal tubular cells - polygonal clear cells
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

13. What effect does afferent arteriole cxn have on RPF - GFR and FF
Dec - dec - NC
Radiolabelled albumin
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Insertion of Na channel on luminal side

14. What is the ddx for metabolic alkalosis with compensation
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Hypokalemia and hypophosphatemic rickets
Diuretics - vomiting - antacid - hyperaldosteronism

15. How are amino acids reabsorbed
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Excreted - filtered
Nephritic syndrome

16. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Corticosteroids
1/4 plasma - and 3/4 interstitial volume
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

17. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
Solute is reabsorbed less quickly than water or net secretion of substance
Acute tubular necrosis
ADPKD

18. What is the compensatory response in metabolic alkalosis
Cx<GFR
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Hypovent - immediate
Men 50 to 70 - inc incidence with smoking and obesity

19. hyaline casts ddx
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Nonspecific
Dec - dec - NC

20. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
NC - inc - inc
Inc plasma osm - dec blood volume
Inc in concentration - not amout - due to water reabsorption
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

21. What is the effect of PTH on the proximal tubule
Liver
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Podocytes foot processes
Inhibits Na/phosphate cotransport leading to phosphate excretion

22. coarse - asymmetric - corticomedullary scarring and blunted calyx
Macula densa
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Chronic pyelonephritis
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

23. What happens to the urine in the descending limb
Inc Ca/Na exchange to inc Ca reabsoprtion
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Becomes concentrated and hypertonic
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

24. What percentage of ECF is plasma and What is interstitial volume
Solute and water are reabsorbed at the same rate
Huge palpable flank mass and hematuria
1/4 plasma - and 3/4 interstitial volume
Dialysis cysts

25. What is winter's formula and when do you use it
Von hippel laundau and gene deletion in chromosome 3
No
Dec - dec - dec
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

26. What is generated and secreted in the proximal tubule
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
RTA type 4 (hyperkalemic)
Ammonia - buffer for secreted H+
RTA type 1 (distal)

27. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Few glomeruli
Beta 1
RTA type 1 (distal)
NC - dec - dec

28. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Triglycerides
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
1alpha hydroxylase - PTH stimulates it
White cell casts

29. What are the two forms of renal failure and What are examples of each
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute - ATN - or chronic - HTN - DM
Radiolabelled albumin

30. Under what circumstances is aldosterone secreted
Dialysis cysts
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

31. What are the effects of AT II on the adrenal gland
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Membranoproliferative glomerulonephritis
Eosinphilic casts in tubules

32. What is the genetic etiology of wilms tumor and What is WAGR complex
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
<3.5 g /day

33. proliferative
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Ectopic EPO - ACTH - PTHrP - prolactin
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Hyperceullular glomeruli

34. how does this present in adults and What is the pattern of inheritence
Acute - ATN - or chronic - HTN - DM
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Staghorn calculi - worsened by alkaluria
Failure of EPO

35. RBC casts - ddx
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
No
Renal tubular cells - polygonal clear cells
Hydronephrosis and pyelonephritis

36. What is hartnup's disease
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Freely filtered and neither absorbed or secreted

37. What is the least common kidney stone - What causes it and How do you treat it
Negative charge
Hypokalemia - risk for Ca containing kidney stones
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

38. In renal failure with uremia - What are the 5 aspects of uremia
Makes urine less concentrated - impermeable to H20
Inc plasma osm - dec blood volume
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

39. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
NC - inc - inc
Inc GFR and mesangial expansion
Diarrhea - glue - RTA - hyperchloremia

40. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
160-200 - 350
Staghorn calculi - worsened by alkaluria
Radiopaque

41. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
RTA type 4 (hyperkalemic)
PH = pKa + log bicarb/0.03PCO2
Type II - C3 nephritic factor

42. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Thromboembolism and inc risk of infection
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Hypovent - immediate
Carbonic anhydrase

43. Where does renal cell carcinoma originate and What do the cells look like
HIV
Renal tubular cells - polygonal clear cells
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

44. What is amyloidosis associated with
Nonspecific
Chronic conditions - multiple myeloma - TB - RA
Anion gap = na - (Cl + bicarb)
1alpha hydroxylase - PTH stimulates it

45. What is the pathway to the afferent arteriole
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Modified smooth muscle of afferent arteriole - secrete renin
Renal artery - interlobar a - interlobular a
20 percent

46. What are the effects of PTH hormone on the kidney
No
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
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

47. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
Renal artery - interlobar a - interlobular a
UTI or acute gastroenteritis
Invades IVC and spreads hematogenously

48. Congo - red stain - apple green birefringence
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Bladder cancer
Acute - ATN - or chronic - HTN - DM
Amyloidosis

49. Which cells sense decreases in BP
CHF - pulmonary edema - HTN
Solute is reabsorbed less quickly than water or net secretion of substance
JG cells
Inc renal bicarb resabsoprtion - delayed

50. What is the formula for filtration fraction
Radiolabelled albumin
LM - nl glomeruli - EM - foot process effacement
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
GFR/RPF