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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 is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Size and charge
Men 50 to 70 - inc incidence with smoking and obesity
Triglycerides

2. RBC casts - ddx
Hypovent - immediate
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Dec - dec - dec

3. What are the associations with RTA type 2
Hypokalemia and hypophosphatemic rickets
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Hyperceullular glomeruli
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

4. What effect does cxn of the ureter have on RPF - GFR and FF
Macula densa and JG cells
NC - dec - dec
Acute pyelonephritis
Staghorn calculi - worsened by alkaluria

5. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
No
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

6. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Anion gap = na - (Cl + bicarb)
Beta 1
Ammonia - buffer for secreted H+
Inc - dec - dec

7. inc in creatinine and BUN over a period of several days
Acute renal failure
Size and charge
Invades IVC and spreads hematogenously
160-200 - 350

8. What does the crescent moon shape consist of in RPGN
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Transitional cell carcinoma
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Nephritic syndrome

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

10. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
Reabsorb Na in exchange for secreting K and H
60% total body water - 40% ICF - 20% ECF
Diarrhea - glue - RTA - hyperchloremia

11. What does thyroidization of the kidney result in
Metabolic acidosis
Acute - ATN - or chronic - HTN - DM
Eosinphilic casts in tubules
RPF/(1- Hct)

12. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Contrict leading to inc FF - preserver renal GFR in low volume states
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
ADPKD

13. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
PH = pKa + log bicarb/0.03PCO2
Becomes concentrated and hypertonic
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Inc - inc - inc

14. tram track appearance on EM - typ - path - and associated dz
PH = pKa + log bicarb/0.03PCO2
Inc - inc - inc
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

15. What can cause oxalate crystals
Becomes concentrated and hypertonic
Kids - peripheral and periorbital edema - resolves spontaneously
Antifreeze - ethyelene glycol or vit C abuse
Few glomeruli

16. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Advanced renal dz - CRF
Hypokalemia - risk for Ca containing kidney stones
Transitional cell carcinoma
Na and volume loss

17. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Invades IVC and spreads hematogenously
Needs to be bilateral
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

18. membranous
Thickening of glomerular BM
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
RTA type 4 (hyperkalemic)

19. coarse - asymmetric - corticomedullary scarring and blunted calyx
Inc in Ca and PO4 absoprtion from the gut
Chronic pyelonephritis
EPO - endothelial cells of peritubular capillaries
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

20. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
20 percent
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Bladder cancer

21. How is extracellular volume measured
ADPKD
Under and under
Inulin
Nonspecific

22. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

23. What is the pathway from the efferent arteriorle to the renal v
Ectopic EPO - ACTH - PTHrP - prolactin
Radiopaque
Vasa recta - interlobular v - interlobar v - renal v
Hypokalemia and hypophosphatemic rickets

24. What circumstances causes ADH secretion
Inc plasma osm - dec blood volume
Inc GFR and mesangial expansion
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Diuretics - vomiting - antacid - hyperaldosteronism

25. In who is RCC most comon
All glomeruli
Men 50 to 70 - inc incidence with smoking and obesity
Renal tubular cells - polygonal clear cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

26. How do you interpret creatinine clearance
NC - inc - inc
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Diarrhea - glue - RTA - hyperchloremia
Vasa recta - interlobular v - interlobar v - renal v

27. Why is there anemia in renal failure
Failure of EPO
Passively reabsorbs water via medullary hypertonicity
Poor - days to weeks
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

28. What are the main causes of membranous GN
Cx>GFR
Ammonia - buffer for secreted H+
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Nephrotic syndrome

29. What is is Alport's syndrome and what else do you see with it other than renal path
Corticosteroids
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Rxn from angiotensinogen to angiontensin I
Liver

30. What is the effect of PTH on the proximal tubule
Diuretics - vomiting - antacid - hyperaldosteronism
Inhibits Na/phosphate cotransport leading to phosphate excretion
160-200 - 350
Hyperceullular glomeruli

31. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
Na
Chronic conditions - multiple myeloma - TB - RA
Simple cysts

32. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Complications of chronic kidney disease or HTN
Nephrotic syndrome
Eosinphilic casts in tubules
2 ways - base exchanger and between epithelial cells

33. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - dec - dec
Hydronephrosis and pyelonephritis
Dec - inc - inc
Passively reabsorbs water via medullary hypertonicity

34. secondary glomerular dz
Antifreeze - ethyelene glycol or vit C abuse
Hypovent - immediate
Corticosteroids
Involves glomeruli and other organs

35. What is lost in nephrotic syndrome resulting what urine and serum changes
2 ways - base exchanger and between epithelial cells
Angio I to angio II and inhibits bradykinin
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Most of the bicarb - sodium - chloride - and water

36. What effect does ANP have on GFR
Inc
Chronic conditions - multiple myeloma - TB - RA
Acute renal failure
Polycystic liver disease - berry aneurysms - mitral valve prolapse

37. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
By 10%
Rxn from angiotensinogen to angiontensin I
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

38. What percentage of ECF is plasma and What is interstitial volume
Crescent - moon shape
Triglycerides
NC - dec - dec
1/4 plasma - and 3/4 interstitial volume

39. Where is potassium conc. Highest? Intra or extra
PH = pKa + log bicarb/0.03PCO2
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Intra = HIKIN!

40. What change (lack of) is common in children with renal failure
Under and under
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Radiolabelled albumin
Growth retardation and developmental delay

41. What is the effect of AT II on the posterior pituitary
Amyloidosis
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Acute pyelonephritis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

42. Defect in collecting ducts ability to excrete H+
Corticosteroids
Growth retardation and developmental delay
Insertion of Na channel on luminal side
RTA type 1 (distal)

43. hyaline casts ddx
Triglycerides
Nonspecific
PH = pKa + log bicarb/0.03PCO2
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

44. When is TF/P <1
1alpha hydroxylase - PTH stimulates it
Segmental sclerosis and hylanosis
Eosinphilic casts in tubules
Solute is reabsorbed more quickly than water

45. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Chronic conditions - multiple myeloma - TB - RA
Hypervent - immediate

46. What is ADPKD also associated with
V x Urine concentration
Involves only glomeruli
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Polycystic liver disease - berry aneurysms - mitral valve prolapse

47. Why is the left kidney taken during living donor transplantation
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
CHF - pulmonary edema - HTN
It has a longer renal vein
PH = pKa + log bicarb/0.03PCO2

48. What are the LM and EM of minimal change disease
Principal cells and intercalated cells
LM - nl glomeruli - EM - foot process effacement
ADPKD
Acute pyelonephritis

49. What is the cutoff of proteinuria in nephritic syndrome
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Nephrotic syndrome
<3.5 g /day
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

50. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inc renal bicarb resabsoprtion - delayed
Complications of chronic kidney disease or HTN