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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. In what clinical context does Berger's disease often present
RTA type 4 (hyperkalemic)
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
UTI or acute gastroenteritis
Size

2. secondary glomerular dz
Renal in origin
Hypervent - immediate
Involves glomeruli and other organs
Huge palpable flank mass and hematuria

3. What is the net effect of AT II
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
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

4. What is the effect of AT II on efferent arterioles
Advanced renal dz - CRF
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Contrict leading to inc FF - preserver renal GFR in low volume states

5. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Segmental sclerosis and hylanosis
Nonspecific
Renal artery - interlobar a - interlobular a

6. TCC is associated with problems in your Pee SAC - ??
By 10%
Involves only glomeruli
Phenacetin - smoking - aniline dyes - cyclophosphamide
V x Urine concentration

7. Why can PAH be used to measure ERPF
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
LM - nl glomeruli - EM - foot process effacement
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Contrict leading to inc FF - preserver renal GFR in low volume states

8. What is the 3rd most common kidney stone and What causes it
Segmental sclerosis and hylanosis
Size
V x Urine concentration
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

9. How does RCC manifest clinically
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Macula densa
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

10. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Nephrotic syndrome
Bladder cancer
1alpha hydroxylase - PTH stimulates it

11. When is TF/P = 1
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Dec - dec - dec
Solute and water are reabsorbed at the same rate
Most of the bicarb - sodium - chloride - and water

12. no net secretion or reabsorption of x
No
Cx = GFR
Antifreeze - ethyelene glycol or vit C abuse
Cx<GFR

13. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Involves only glomeruli
Men 50 to 70 - inc incidence with smoking and obesity
1alpha hydroxylase - PTH stimulates it
Most of the bicarb - sodium - chloride - and water

14. How is extracellular volume measured
Inulin
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Hypervent - early high altitude - aspirin ingestion early
Podocytes foot processes

15. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Dec - inc - dec
Medullary cystic disease
Inc - inc - inc
Modified smooth muscle of afferent arteriole - secrete renin

16. What percentage of ECF is plasma and What is interstitial volume
PH = pKa + log bicarb/0.03PCO2
1/4 plasma - and 3/4 interstitial volume
ANP
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

17. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Modified smooth muscle of afferent arteriole - secrete renin
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

18. How do struvite stones appear on xray
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Complications of chronic kidney disease or HTN
Radiopaque

19. What is the formula for secreted
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Renal in origin
Excreted - filtered
Acute pyelonephritis

20. What is lost in nephrotic syndrome resulting what urine and serum changes
Liver
Needs to be bilateral
Diarrhea - glue - RTA - hyperchloremia
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

21. What are the main complications of kidney stones
Eosinphilic casts in tubules
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Dec - inc - dec
Hydronephrosis and pyelonephritis

22. cortical and medullary cysts resulting from long standing dialysis
Becomes concentrated and hypertonic
Dialysis cysts
Inc - dec - dec
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

23. What is the ddx for respiratory acidosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Invades IVC and spreads hematogenously
Involves glomeruli and other organs
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

24. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - inc - inc
Carbonic anhydrase
NC - dec - dec
Inc renal bicarb resabsoprtion - delayed

25. do you see casts in bladder cancer - kidney stones with hematuria
Freely filtered and neither absorbed or secreted
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
No

26. What are the main causes of membranous GN
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Reabsorb Na in exchange for secreting K and H
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Ectopic EPO - ACTH - PTHrP - prolactin

27. What therapy does miminal change respond to...
Corticosteroids
Dec renal bicarb reabsorption - delayed
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

28. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
RPF/(1- Hct)
Cx = GFR
Renal tubular cells - polygonal clear cells

29. Why does Na conc nearly match Osm
Kids - peripheral and periorbital edema - resolves spontaneously
Acute tubular necrosis
Na reabsorption drives H20 reabsorption
To defend GFR

30. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
JG cells
2 ways - base exchanger and between epithelial cells

31. What is the formula for filtration fraction
RTA type 2 (proximal)
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
GFR/RPF
Polycystic liver disease - berry aneurysms - mitral valve prolapse

32. How can NSAIDs cause acute renal failure
Na reabsorption drives H20 reabsorption
NC - inc - inc
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
HIV

33. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Carbonic anhydrase
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
NKCC
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

34. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inhibits Na/phosphate cotransport leading to phosphate excretion

35. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Stimulates thirst
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
160-200 - 350

36. Focal
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Few glomeruli
1/4 plasma - and 3/4 interstitial volume

37. Where does renal cell carcinoma originate and What do the cells look like
Needs to be bilateral
Renal tubular cells - polygonal clear cells
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

38. What is the purpose of the JGA
To defend GFR
RTA type 2 (proximal)
Inc in concentration - not amout - due to water reabsorption
Involves glomeruli and other organs

39. What effect does afferent arteriole cxn have on RPF - GFR and FF
Hypokalemia and hypophosphatemic rickets
Dec - dec - NC
Radiopaque
Acute - ATN - or chronic - HTN - DM

40. Who often has diffuse proliferative GN
Chronic conditions - multiple myeloma - TB - RA
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Bladder cancer
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

41. What is the 60-40-20 rule of body weight
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Podocytes foot processes
Carbonic anhydrase
60% total body water - 40% ICF - 20% ECF

42. What effect does ANP have on Na in the kidney
Chronic conditions - multiple myeloma - TB - RA
Failure of EPO
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

43. What is the effect of AT II on GFR - FF and Na
Dec - inc - inc
Transitional cell carcinoma
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Thromboembolism and inc risk of infection

44. diffuse
Reabsorb Na in exchange for secreting K and H
Growth retardation and developmental delay
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
All glomeruli

45. What are the associated paraneoplastic syndromes wth RCC
CHF - pulmonary edema - HTN
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Phenacetin - smoking - aniline dyes - cyclophosphamide
Ectopic EPO - ACTH - PTHrP - prolactin

46. What is the algorithim for acidosis/alkalosis
Radiopaque
Nonspecific
1alpha hydroxylase - PTH stimulates it
PH - then PC02

47. How do you interpret creatinine clearance
ANP
ADPKD
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
NKCC

48. In renal failure What acid - base disturbance is most likely
Metabolic acidosis
Complications of chronic kidney disease or HTN
Freely filtered and neither absorbed or secreted
Inc GFR and mesangial expansion

49. What is the net effect of ANP
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Inc Ca/Na exchange to inc Ca reabsoprtion
Principal cells and intercalated cells
Na and volume loss

50. When is TF/P ratio > 1
Solute is reabsorbed less quickly than water or net secretion of substance
Eosinphilic casts in tubules
Chronic conditions - multiple myeloma - TB - RA
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine