Test your basic knowledge |

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. net tubular secretion of x
Cx>GFR
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Acute - ATN - or chronic - HTN - DM
Growth retardation and developmental delay

2. In what clinical context does Berger's disease often present
Renal in origin
UTI or acute gastroenteritis
2 ways - base exchanger and between epithelial cells
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

3. What is the ddx for a metabolic acidosis with an inc anion gap
Carbonic anhydrase
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Triglycerides
Renal artery - interlobar a - interlobular a

4. What is a normal filtration fraction
20 percent
Corticosteroids
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Amyloidosis

5. in acute cystitis with pyuria - do you see casts
Insertion of Na channel on luminal side
Excreted - filtered
Hydronephrosis and pyelonephritis
No

6. What is the genetic etiology of wilms tumor and What is WAGR complex
GFR/RPF
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
LM - nl glomeruli - EM - foot process effacement

7. What is the formula for renal blood flow
Inc - inc - inc
Radiopaque
RPF/(1- Hct)
RTA type 1 (distal)

8. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Small kidney - poor prognosis
Passively reabsorbs water via medullary hypertonicity
Inc plasma osm - dec blood volume

9. Where is angiotensinogen made
Liver
Failure of EPO
Filtered - secreted
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

10. What is the formula for reabsorption
Membranoproliferative glomerulonephritis
Filtered - secreted
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

11. What does US show with medullary cystic disease
Small kidney - poor prognosis
Acute pyelonephritis
Inc
Hypovent - immediate

12. In renal failure What acid - base disturbance is most likely
Growth retardation and developmental delay
CHF - pulmonary edema - HTN
Metabolic acidosis
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

13. What are the two forms of renal failure and What are examples of each
Involves glomeruli and other organs
Acute - ATN - or chronic - HTN - DM
Ectopic EPO - ACTH - PTHrP - prolactin
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

14. What are the 3 transporters of the intercalated cells
Inc plasma osm - dec blood volume
Size and charge
NC - dec - dec
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

15. What is the formula for excretion rate
Inc - inc - inc
V x Urine concentration
Principal cells and intercalated cells
Under and under

16. 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
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Actively reabsorbs NaCl - diluting - makes urine hypotonic

17. What is the formula for secreted
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Excreted - filtered
Corticosteroids
Dec - inc - dec

18. Under what circumstances is aldosterone secreted
Under and under
Makes urine less concentrated - impermeable to H20
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

19. What is the 60-40-20 rule of body weight
60% total body water - 40% ICF - 20% ECF
RTA type 1 (distal)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Radiopaque

20. What does NEG lead to in the efferent arterioles
Dec - inc - inc
Medullary cystic disease
Inc GFR and mesangial expansion
It has a longer renal vein

21. nonenzymatic glycosylation of GBM - inc permeability and thickening
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Excreted - filtered
Diabetic glomerulonephropathy
2 ways - base exchanger and between epithelial cells

22. What effect does cxn of the ureter have on RPF - GFR and FF
160-200 - 350
Size and charge
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
NC - dec - dec

23. What is the effect of PTH on the proximal tubule
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inc plasma osm - dec blood volume
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

24. What is the ddx for respiratory acidosis
All glomeruli
Intra = HIKIN!
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
By 10%

25. The fenestrated capillary endothelium constitutes what portion of the barrier
Size
EPO - endothelial cells of peritubular capillaries
Hypervent - early high altitude - aspirin ingestion early
Dec - inc - inc

26. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
RPF/(1- Hct)
Failure of EPO
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

27. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Intra = HIKIN!
Principal cells and intercalated cells
ADPKD
Poor - days to weeks

28. What is amyloidosis associated with
Inulin
Chronic conditions - multiple myeloma - TB - RA
It has a longer renal vein
Podocytes foot processes

29. What is the cutoff of proteinuria in nephritic syndrome
CHF - pulmonary edema - HTN
Hypervent - immediate
Dec - inc - dec
<3.5 g /day

30. How is extracellular volume measured
Contrict leading to inc FF - preserver renal GFR in low volume states
Inulin
Hypovent - immediate
It has a longer renal vein

31. proliferative
Cx = GFR
Hyperceullular glomeruli
Hydronephrosis and pyelonephritis
Filtered - secreted

32. What is the BUN/Cr ratio in prerenal azotemia and why?
Inc Ca/Na exchange to inc Ca reabsoprtion
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Cx<GFR

33. What can cause oxalate crystals
LM - nl glomeruli - EM - foot process effacement
Antifreeze - ethyelene glycol or vit C abuse
Freely filtered and neither absorbed or secreted
Inc Ca/Na exchange to inc Ca reabsoprtion

34. What needs to happen for postrenal obstruction to creat ARF
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
NKCC
Needs to be bilateral
<3.5 g /day

35. By what percentage does EPRF underestimage true RPF
By 10%
Complications of chronic kidney disease or HTN
Vasa recta - interlobular v - interlobar v - renal v
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

36. What happens in the collecting tubules
By 10%
Reabsorb Na in exchange for secreting K and H
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec - inc - dec

37. What are the associated paraneoplastic syndromes wth RCC
Carbonic anhydrase
Ectopic EPO - ACTH - PTHrP - prolactin
Dec - dec - dec
Na reabsorption drives H20 reabsorption

38. What are the associations with RTA type 4
160-200 - 350
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Bladder cancer
All glomeruli

39. What cells create the epithelial layer of the glomerular filtration barrier
Few glomeruli
White cell casts
Nonspecific
Podocytes foot processes

40. What is the LM for diabetic glomerulonephropathy
PH - then PC02
PH = pKa + log bicarb/0.03PCO2
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

41. What do you see on LM and IF with rapidly progressive GN
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Crescent - moon shape
Beta 1

42. What happens to urine in the ascending limb
Radiopaque
HIV
Negative charge
Makes urine less concentrated - impermeable to H20

43. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Small kidney - poor prognosis
Under and under
160-200 - 350
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

44. What do you see in the urine with acute pyelonephritis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inc plasma osm - dec blood volume
White cell casts
Renal in origin

45. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
NKCC
Cx<GFR
Hypokalemia and hypophosphatemic rickets

46. inc in creatinine and BUN over a period of several days
Inc in Ca and PO4 absoprtion from the gut
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
Acute renal failure
PH - then PC02

47. What circumstances causes ADH secretion
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inc plasma osm - dec blood volume
Diabetic glomerulonephropathy
Dec renal bicarb reabsorption - delayed

48. What happens to the urine in the descending limb
Solute is reabsorbed more quickly than water
Becomes concentrated and hypertonic
Type II - C3 nephritic factor
RTA type 1 (distal)

49. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Carbonic anhydrase
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Few glomeruli
Ectopic EPO - ACTH - PTHrP - prolactin

50. What are the two kinds of cells in the collecting tubules
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Principal cells and intercalated cells
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS