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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 3 transporters of the intercalated cells
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Macula densa and JG cells

2. net tubular secretion of x
Cx>GFR
Bladder cancer
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Macula densa

3. What is the formula for excretion rate
Renal artery - interlobar a - interlobular a
Excreted - filtered
V x Urine concentration
Acute - ATN - or chronic - HTN - DM

4. What is is Alport's syndrome and what else do you see with it other than renal path
Freely filtered and neither absorbed or secreted
Makes urine less concentrated - impermeable to H20
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Amyloidosis

5. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
Vasocxn - inc BP
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Acute renal failure

6. What is the formula for clearance of a substance per unit time
Amyloidosis
EPO - endothelial cells of peritubular capillaries
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc renal bicarb resabsoprtion - delayed

7. What do casts indicated about hematuria/pyuria
Diuretics - vomiting - antacid - hyperaldosteronism
Passively reabsorbs water via medullary hypertonicity
Cx>GFR
Renal in origin

8. Why can inulin be used to calculate GFR?
Dialysis cysts
Involves glomeruli and other organs
Diabetic glomerulonephropathy
Freely filtered and neither absorbed or secreted

9. What happens when PTH is secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hydronephrosis and pyelonephritis
Excreted - filtered

10. What therapy does miminal change respond to...
Corticosteroids
Liver
Beta 1
NKCC

11. What is the genetic etiology of wilms tumor and What is WAGR complex
Few glomeruli
It has a longer renal vein
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

12. What is the effect of AT II on GFR - FF and Na
NC - dec - dec
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
JG cells

13. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
Ammonia - buffer for secreted H+
Proximal tubule - na/glucose co transporter
Antifreeze - ethyelene glycol or vit C abuse

14. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Anion gap = na - (Cl + bicarb)
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

15. Congo - red stain - apple green birefringence
Negative charge
GFR/RPF
Segmental sclerosis and hylanosis
Amyloidosis

16. in TCC - What does painelss hematuria suggest
Phenacetin - smoking - aniline dyes - cyclophosphamide
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Bladder cancer

17. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
1/4 plasma - and 3/4 interstitial volume
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

18. What are the associations with nephrotic syndrome
It has a longer renal vein
Thromboembolism and inc risk of infection
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

19. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
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
Renal artery - interlobar a - interlobular a
Thromboembolism and inc risk of infection

20. What is the pathway to the afferent arteriole
Solute and water are reabsorbed at the same rate
Renal artery - interlobar a - interlobular a
NKCC
No

21. What happens in the early distal convoluted tubule and What does that do to the urine
Stimulates thirst
Actively reabsorbs NaCl - diluting - makes urine hypotonic
All glomeruli
Nephrotic syndrome

22. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Radiopaque
Membranoproliferative glomerulonephritis

23. What 3 things stimulate the release of renin - and Where is it released from
Angio I to angio II and inhibits bradykinin
Membranoproliferative glomerulonephritis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Nephritic syndrome

24. How is extracellular volume measured
Inulin
Solute and water are reabsorbed at the same rate
1/4 plasma - and 3/4 interstitial volume
Invades IVC and spreads hematogenously

25. 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
Diarrhea - glue - RTA - hyperchloremia
Crescent - moon shape
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

26. In renal failure with uremia - What are the 5 aspects of uremia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Anion gap = na - (Cl + bicarb)
Membranoproliferative glomerulonephritis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

27. In renal failure What are the consquence sof Na/H20 retention
Intra = HIKIN!
CHF - pulmonary edema - HTN
Angio I to angio II and inhibits bradykinin
Stimulates thirst

28. acute generalized cortical infarction of both kidneys - dz - causes and associations
Rxn from angiotensinogen to angiontensin I
Filtered - secreted
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

29. granular - muddy brown casts - ddx
Acute tubular necrosis
Under and under
Diuretics - vomiting - antacid - hyperaldosteronism
Polycystic liver disease - berry aneurysms - mitral valve prolapse

30. Bergers' disease - which antibody and What do you see on LM and IF
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Vasa recta - interlobular v - interlobar v - renal v
By 10%
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

31. primary glomerular dz
Involves only glomeruli
Stimulates thirst
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Kids - peripheral and periorbital edema - resolves spontaneously

32. What are the associated paraneoplastic syndromes wth RCC
<3.5 g /day
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Ectopic EPO - ACTH - PTHrP - prolactin

33. cortical and medullary cysts resulting from long standing dialysis
JG cells
Dialysis cysts
Radiopaque
Bladder cancer

34. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Radiopaque
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Contrict leading to inc FF - preserver renal GFR in low volume states
Cx = GFR

35. What is the effect of PTH on the proximal tubule
Diabetic glomerulonephropathy
Inhibits Na/phosphate cotransport leading to phosphate excretion
Radiopaque
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

36. What happens in the thin descending loop of henle
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Na reabsorption drives H20 reabsorption
Passively reabsorbs water via medullary hypertonicity
RTA type 2 (proximal)

37. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
No
Acute pyelonephritis
GFR x plasma concentration

38. The fenestrated capillary endothelium constitutes what portion of the barrier
Failure of EPO
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Size
GFR x plasma concentration

39. What effect does inc plasma protein concentration have on RPF - GFR - and FF
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Hyperceullular glomeruli
Vasa recta - interlobular v - interlobar v - renal v
NC - dec - dec

40. Focal
Few glomeruli
Renal in origin
LM - nl glomeruli - EM - foot process effacement
By 10%

41. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Anion gap = na - (Cl + bicarb)
Modified smooth muscle of afferent arteriole - secrete renin
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

42. In what disease in FSGS the most common glomerular disease
HIV
Under and under
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
NC - inc - inc

43. What are the two kinds of cells in the collecting tubules
All glomeruli
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inc
Principal cells and intercalated cells

44. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Liver
Cx>GFR

45. Where is potassium conc. Highest? Intra or extra
Hydronephrosis and pyelonephritis
Intra = HIKIN!
Von hippel laundau and gene deletion in chromosome 3
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

46. diffuse
All glomeruli
V x Urine concentration
Insertion of Na channel on luminal side
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

47. What is a normal filtration fraction
20 percent
Advanced renal dz - CRF
No
Excreted - filtered

48. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

49. What is amyloidosis associated with
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Needs to be bilateral
Chronic conditions - multiple myeloma - TB - RA
Nonspecific

50. What does renin do
V x Urine concentration
Rxn from angiotensinogen to angiontensin I
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
1alpha hydroxylase - PTH stimulates it