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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 do macula densa cells sense
Na
Liver
Most of the bicarb - sodium - chloride - and water
Rxn from angiotensinogen to angiontensin I

2. What substance is secreted in response increase atrial pressure
ANP
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Acute pyelonephritis
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

3. What is the net effect of PTH
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inc in Ca and PO4 absoprtion from the gut
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Excreted - filtered

4. Defect in collecting ducts ability to excrete H+
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
RTA type 1 (distal)
Involves only glomeruli
Size and charge

5. What is the effect of AT II on the hypothalamus
Needs to be bilateral
Diarrhea - glue - RTA - hyperchloremia
Stimulates thirst
Hypokalemia and hypophosphatemic rickets

6. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Inc - dec - dec
Modified smooth muscle of afferent arteriole - secrete renin
ADPKD

7. 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
Stimulates thirst
Macula densa and JG cells
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

8. What therapy does miminal change respond to...
Growth retardation and developmental delay
Corticosteroids
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
60% total body water - 40% ICF - 20% ECF

9. What is the ddx for metabolic alkalosis with compensation
White cell casts
Diuretics - vomiting - antacid - hyperaldosteronism
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Crescent - moon shape

10. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Dec - dec - dec
Phenacetin - smoking - aniline dyes - cyclophosphamide
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

11. How do you interpret creatinine clearance
Phenacetin - smoking - aniline dyes - cyclophosphamide
ANP
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Wilms tumor (ages 2-4)

12. When is TF/P ratio > 1
160-200 - 350
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Solute is reabsorbed less quickly than water or net secretion of substance
Na and volume loss

13. What happens when PTH is secreted
Poor - days to weeks
Filtered - secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Rxn from angiotensinogen to angiontensin I

14. With what genetic tumor syndrome is RCC associated
Most of the bicarb - sodium - chloride - and water
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Von hippel laundau and gene deletion in chromosome 3

15. What 3 things stimulate the release of renin - and Where is it released from
RTA type 2 (proximal)
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Solute is reabsorbed more quickly than water

16. What are the effects of AT II on vascular smooth muscle
Renal artery - interlobar a - interlobular a
Vasocxn - inc BP
Podocytes foot processes
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

17. What is the formula for secreted
Na reabsorption drives H20 reabsorption
Excreted - filtered
NC - dec - dec
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

18. 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
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

19. What does aldosterone do in the collecting tubule
Bladder cancer
LM - nl glomeruli - EM - foot process effacement
It has a longer renal vein
Insertion of Na channel on luminal side

20. What are the associations with nephrotic syndrome
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Thromboembolism and inc risk of infection
Carbonic anhydrase
60% total body water - 40% ICF - 20% ECF

21. What needs to happen for postrenal obstruction to creat ARF
GFR x plasma concentration
Needs to be bilateral
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Involves only glomeruli

22. What effect does cxn of the ureter have on RPF - GFR and FF
Staghorn calculi - worsened by alkaluria
Acute tubular necrosis
Insertion of Na channel on luminal side
NC - dec - dec

23. What is the formula for excretion rate
Diabetic glomerulonephropathy
Macula densa and JG cells
Ammonia - buffer for secreted H+
V x Urine concentration

24. what happens to pH - PCO2 - and bicarb in respiratory acidosis
<3.5 g /day
Diabetic glomerulonephropathy
Hypervent - immediate
Dec - inc - dec

25. coarse - asymmetric - corticomedullary scarring and blunted calyx
White cell casts
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Chronic pyelonephritis
20 percent

26. In a metabolic acidosis What additional calculation is necessary and How do you make it
Hypervent - early high altitude - aspirin ingestion early
Anion gap = na - (Cl + bicarb)
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Chronic conditions - multiple myeloma - TB - RA

27. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Men 50 to 70 - inc incidence with smoking and obesity
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Filtered - secreted

28. What is the most frequent kind of kidney stone and What are causes that lead to it
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
It has a longer renal vein
Renal tubular cells - polygonal clear cells
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

29. nonenzymatic glycosylation of GBM - inc permeability and thickening
Needs to be bilateral
Diabetic glomerulonephropathy
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Renal in origin

30. What is the purpose of the JGA
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
To defend GFR
NC - dec - dec
Intra = HIKIN!

31. What happens in the collecting tubules
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Eosinphilic casts in tubules
RTA type 2 (proximal)
Reabsorb Na in exchange for secreting K and H

32. What are the effects of AT II on the adrenal gland
<3.5 g /day
NC - dec - dec
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

33. In what disease in FSGS the most common glomerular disease
GFR x plasma concentration
HIV
Solute is reabsorbed less quickly than water or net secretion of substance
Triglycerides

34. What is the effect of AT II on the posterior pituitary
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Inc GFR and mesangial expansion
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

35. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dialysis cysts
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Freely filtered and neither absorbed or secreted
PH - then PC02

36. In renal failure - what happens to potassium
Freely filtered and neither absorbed or secreted
Hyperkalemia
NC - inc - inc
Solute is reabsorbed more quickly than water

37. How does RCC spread
Invades IVC and spreads hematogenously
Proximal tubule - na/glucose co transporter
Thickening of glomerular BM
<3.5 g /day

38. How is plasma volume measured
Inc renal bicarb resabsoprtion - delayed
PH - then PC02
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Radiolabelled albumin

39. 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
Advanced renal dz - CRF
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Cx = GFR

40. What are the 3 transporters of the intercalated cells
Liver
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inc renal bicarb resabsoprtion - delayed

41. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Ammonia - buffer for secreted H+
Corticosteroids
Acute pyelonephritis

42. The fenestrated capillary endothelium constitutes what portion of the barrier
Men 50 to 70 - inc incidence with smoking and obesity
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Size
EPO - endothelial cells of peritubular capillaries

43. How is chlorid reabsorbed in the proximal tubule
2 ways - base exchanger and between epithelial cells
Hypokalemia and hypophosphatemic rickets
Needs to be bilateral
Solute is reabsorbed more quickly than water

44. hyaline casts ddx
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
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
Nonspecific
Ectopic EPO - ACTH - PTHrP - prolactin

45. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
EPO - endothelial cells of peritubular capillaries
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
ADPKD
Excreted - filtered

46. What is generated and secreted in the proximal tubule
Small kidney - poor prognosis
Ammonia - buffer for secreted H+
Thickening of glomerular BM
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

47. What circumstances causes ADH secretion
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Renal artery - interlobar a - interlobular a
Inc plasma osm - dec blood volume
Cx<GFR

48. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Acute - ATN - or chronic - HTN - DM
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

49. What is the effect of of PTH on the distal convoluted tubule
Amyloidosis
Bladder cancer
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Inc Ca/Na exchange to inc Ca reabsoprtion

50. Why is there anemia in renal failure
Dec - inc - inc
Failure of EPO
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Angio I to angio II and inhibits bradykinin