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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 associations with nephrotic syndrome
Angio I to angio II and inhibits bradykinin
HIV
Advanced renal dz - CRF
Thromboembolism and inc risk of infection

2. What is the formula for renal blood flow
RPF/(1- Hct)
Chronic pyelonephritis
2 ways - base exchanger and between epithelial cells
NC - inc - inc

3. What is is Alport's syndrome and what else do you see with it other than renal path
Rxn from angiotensinogen to angiontensin I
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
PH - then PC02

4. net tubular reabsorption of x
Failure of EPO
Vasa recta - interlobular v - interlobar v - renal v
Cx<GFR
Hyperceullular glomeruli

5. In renal failure - what happens to potassium
Negative charge
Poor - days to weeks
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Hyperkalemia

6. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Makes urine less concentrated - impermeable to H20
Inc GFR and mesangial expansion

7. What is the pathway from the efferent arteriorle to the renal v
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Vasa recta - interlobular v - interlobar v - renal v
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

8. What is the compensatory response in metabolic alkalosis
Transitional cell carcinoma
PH = pKa + log bicarb/0.03PCO2
NC - dec - dec
Hypovent - immediate

9. hyaline casts ddx
Transitional cell carcinoma
Growth retardation and developmental delay
Filtered - secreted
Nonspecific

10. What is the formula for clearance of a substance per unit time
HIV
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Most of the bicarb - sodium - chloride - and water

11. secondary glomerular dz
Involves glomeruli and other organs
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Radiolabelled albumin
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

12. What is hartnup's disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Bladder cancer
Inc - inc - inc
Na

13. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Diabetic glomerulonephropathy
NC - inc - inc
Angio I to angio II and inhibits bradykinin
Dialysis cysts

14. membranous
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Thickening of glomerular BM
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

15. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
Chronic conditions - multiple myeloma - TB - RA
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
160-200 - 350

16. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Von hippel laundau and gene deletion in chromosome 3
Anion gap = na - (Cl + bicarb)
Staghorn calculi - worsened by alkaluria
Acts on V2 receptors leading to insertion of aquaporins on luminal side

17. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
Proximal tubule - na/glucose co transporter
Cx = GFR
Advanced renal dz - CRF

18. Why is the left kidney taken during living donor transplantation
Inc in Ca and PO4 absoprtion from the gut
GFR x plasma concentration
It has a longer renal vein
Inc - dec - dec

19. Defect in collecting ducts ability to excrete H+
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Complications of chronic kidney disease or HTN
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
RTA type 1 (distal)

20. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Complications of chronic kidney disease or HTN
1/4 plasma - and 3/4 interstitial volume
Solute is reabsorbed more quickly than water

21. What is the 3rd most common kidney stone and What causes it
PH = pKa + log bicarb/0.03PCO2
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Nephrotic syndrome
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

22. What does US show with medullary cystic disease
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Phenacetin - smoking - aniline dyes - cyclophosphamide
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Small kidney - poor prognosis

23. What is the ddx for a respiratory alkalosis
Under and under
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Bladder cancer
Hypervent - early high altitude - aspirin ingestion early

24. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
GFR x plasma concentration
Carbonic anhydrase
ANP
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

25. What are the effects of PTH hormone on the kidney
Failure of EPO
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
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Chronic pyelonephritis

26. What substance is secreted in response increase atrial pressure
Chronic pyelonephritis
GFR x plasma concentration
ANP
RTA type 1 (distal)

27. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Cx>GFR
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Stimulates thirst
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

28. What are JG cells and what substance do they secrete
Makes urine less concentrated - impermeable to H20
Modified smooth muscle of afferent arteriole - secrete renin
By 10%
Inc in concentration - not amout - due to water reabsorption

29. What 3 things stimulate the release of renin - and Where is it released from
UTI or acute gastroenteritis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inulin
Reabsorb Na in exchange for secreting K and H

30. How is chlorid reabsorbed in the proximal tubule
Inc
All glomeruli
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
2 ways - base exchanger and between epithelial cells

31. What does NEG lead to in the efferent arterioles
Solute and water are reabsorbed at the same rate
Hypervent - early high altitude - aspirin ingestion early
Inc GFR and mesangial expansion
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

32. In renal failure What are the consquence sof Na/H20 retention
Vasocxn - inc BP
CHF - pulmonary edema - HTN
2 ways - base exchanger and between epithelial cells
Acute - ATN - or chronic - HTN - DM

33. in acute cystitis with pyuria - do you see casts
Dec - inc - dec
No
Principal cells and intercalated cells
Metabolic acidosis

34. What is the effect of PTH on the proximal tubule
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Inhibits Na/phosphate cotransport leading to phosphate excretion
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Contrict leading to inc FF - preserver renal GFR in low volume states

35. How are amino acids reabsorbed
Inc plasma osm - dec blood volume
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
20 percent

36. What is the cutoff of proteinuria in nephritic syndrome
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
<3.5 g /day
Na reabsorption drives H20 reabsorption
Actively reabsorbs NaCl - diluting - makes urine hypotonic

37. TCC is associated with problems in your Pee SAC - ??
Diabetic glomerulonephropathy
Phenacetin - smoking - aniline dyes - cyclophosphamide
Renal in origin
RTA type 1 (distal)

38. What are the associations with RTA type 4
Huge palpable flank mass and hematuria
Size and charge
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

39. When is TF/P = 1
1alpha hydroxylase - PTH stimulates it
ANP
Solute and water are reabsorbed at the same rate
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

40. By what percentage does EPRF underestimage true RPF
Principal cells and intercalated cells
Needs to be bilateral
By 10%
Inc in concentration - not amout - due to water reabsorption

41. Where is ACE made and What are 2 of its fxns
No
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
20 percent
Angio I to angio II and inhibits bradykinin

42. What do macula densa cells sense
Nephrotic syndrome
Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Kids - peripheral and periorbital edema - resolves spontaneously

43. Which cells sense decreases in Na delivery
Medullary cystic disease
Macula densa
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
All glomeruli

44. what happens to pH - PCO2 - and bicarb in respiratory acidosis
NKCC
Dec - inc - dec
Hypokalemia and hypophosphatemic rickets
Kids - peripheral and periorbital edema - resolves spontaneously

45. What is generated and secreted in the proximal tubule
V x Urine concentration
Acute - ATN - or chronic - HTN - DM
Macula densa
Ammonia - buffer for secreted H+

46. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Most of the bicarb - sodium - chloride - and water
Staghorn calculi - worsened by alkaluria
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

47. In renal failure with uremia - What are the 5 aspects of uremia
Von hippel laundau and gene deletion in chromosome 3
Inc - inc - inc
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Growth retardation and developmental delay

48. Congo - red stain - apple green birefringence
Amyloidosis
RTA type 2 (proximal)
LM - nl glomeruli - EM - foot process effacement
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

49. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
Radiopaque
Cx>GFR
Inc

50. Why is there anemia in renal failure
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Inc GFR and mesangial expansion
HIV
Failure of EPO