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Renal

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1. In who is RCC most comon
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Men 50 to 70 - inc incidence with smoking and obesity
Inc - inc - inc
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

2. How do the ureters course in relation to the uterine artery and ductus deferens
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Eosinphilic casts in tubules
RTA type 2 (proximal)
Under and under

3. proliferative
Hyperceullular glomeruli
Inc - dec - dec
1alpha hydroxylase - PTH stimulates it
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

4. What are the associations with RTA type 1
Involves glomeruli and other organs
Becomes concentrated and hypertonic
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hypokalemia - risk for Ca containing kidney stones

5. What is generated and secreted in the proximal tubule
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Contrict leading to inc FF - preserver renal GFR in low volume states
Ammonia - buffer for secreted H+
Negative charge

6. What is the ddx for a respiratory alkalosis
Antifreeze - ethyelene glycol or vit C abuse
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Hypervent - early high altitude - aspirin ingestion early
Hyperceullular glomeruli

7. When is TF/P = 1
Metabolic acidosis
Solute and water are reabsorbed at the same rate
Radiolabelled albumin
GFR/RPF

8. Where does renal cell carcinoma originate and What do the cells look like
Renal in origin
Modified smooth muscle of afferent arteriole - secrete renin
Hypervent - early high altitude - aspirin ingestion early
Renal tubular cells - polygonal clear cells

9. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
ANP
Beta 1
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Acute pyelonephritis

10. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Renal artery - interlobar a - interlobular a
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Phenacetin - smoking - aniline dyes - cyclophosphamide

11. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Radiolabelled albumin
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
NC - inc - inc
Inc - dec - dec

12. What happens in the collecting tubules
Principal cells and intercalated cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Reabsorb Na in exchange for secreting K and H
Inc in Ca and PO4 absoprtion from the gut

13. TCC is associated with problems in your Pee SAC - ??
Hypervent - early high altitude - aspirin ingestion early
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
PH - then PC02
Phenacetin - smoking - aniline dyes - cyclophosphamide

14. What do you see in the urine with acute pyelonephritis
Dialysis cysts
NC - inc - inc
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
White cell casts

15. What are the main causes of membranous GN
Na reabsorption drives H20 reabsorption
<3.5 g /day
Principal cells and intercalated cells
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

16. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
Small kidney - poor prognosis
Inc Ca/Na exchange to inc Ca reabsoprtion
Cx = GFR

17. What is the purpose of the JGA
Polycystic liver disease - berry aneurysms - mitral valve prolapse
To defend GFR
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
By 10%

18. What are the two kinds of cells in the collecting tubules
Hypervent - early high altitude - aspirin ingestion early
Principal cells and intercalated cells
Macula densa and JG cells
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

19. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Under and under
RTA type 4 (hyperkalemic)
Carbonic anhydrase

20. How is plasma volume measured
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dec - inc - dec
Radiolabelled albumin
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

21. What is the least common kidney stone - What causes it and How do you treat it
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Carbonic anhydrase
Na reabsorption drives H20 reabsorption
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

22. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
Liver
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Stimulates thirst

23. What is the 60-40-20 rule of body weight
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
NC - inc - inc
60% total body water - 40% ICF - 20% ECF
Poor - days to weeks

24. What effect does afferent arteriole cxn have on RPF - GFR and FF
Vasa recta - interlobular v - interlobar v - renal v
Proximal tubule - na/glucose co transporter
Dec - dec - NC
Inc renal bicarb resabsoprtion - delayed

25. In renal failure What acid - base disturbance is most likely
NC - dec - dec
ADPKD
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Metabolic acidosis

26. What is lost in nephrotic syndrome resulting what urine and serum changes
Involves only glomeruli
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

27. What is the net effect of PTH
Diabetic glomerulonephropathy
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Metabolic acidosis
Inc in Ca and PO4 absoprtion from the gut

28. In renal failure - what happens to potassium
Hyperkalemia
Huge palpable flank mass and hematuria
Involves glomeruli and other organs
Solute is reabsorbed less quickly than water or net secretion of substance

29. When is glucose reabsorbed and with What transporter
NC - dec - dec
Staghorn calculi - worsened by alkaluria
Proximal tubule - na/glucose co transporter
Actively reabsorbs NaCl - diluting - makes urine hypotonic

30. What happens to the urine in the descending limb
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Hypervent - immediate
Becomes concentrated and hypertonic
Inc - dec - dec

31. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

32. What happens in the thin descending loop of henle
Passively reabsorbs water via medullary hypertonicity
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Involves only glomeruli
NC - inc - inc

33. What is the formula for clearance of a substance per unit time
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Hyperceullular glomeruli
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Liver

34. What 3 disease can lead to RPGN
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

35. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
ADPKD
Corticosteroids
Inc renal bicarb resabsoprtion - delayed
Von hippel laundau and gene deletion in chromosome 3

36. What is the prognosis of RPGN
Nephritic syndrome
Growth retardation and developmental delay
Inc - dec - dec
Poor - days to weeks

37. What effect does efferent arteriole cxn have on RPF - GFR and FF
Nonspecific
NC - dec - dec
Dec - inc - inc
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

38. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Acute pyelonephritis
Corticosteroids
Hydronephrosis and pyelonephritis

39. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
GFR/RPF
Hypovent - immediate
Beta 1
Dec - dec - dec

40. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Staghorn calculi - worsened by alkaluria
Vasa recta - interlobular v - interlobar v - renal v
Simple cysts

41. What can cause oxalate crystals
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Na reabsorption drives H20 reabsorption
Antifreeze - ethyelene glycol or vit C abuse
RTA type 1 (distal)

42. In renal failure with uremia - What are the 5 aspects of uremia
Hypovent - immediate
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
By 10%
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

43. What are the associated paraneoplastic syndromes wth RCC
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Needs to be bilateral
Failure of EPO
Ectopic EPO - ACTH - PTHrP - prolactin

44. coarse - asymmetric - corticomedullary scarring and blunted calyx
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Chronic pyelonephritis
Type II - C3 nephritic factor
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

45. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Radiopaque
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

46. With what genetic tumor syndrome is RCC associated
1/4 plasma - and 3/4 interstitial volume
Von hippel laundau and gene deletion in chromosome 3
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Anion gap = na - (Cl + bicarb)

47. What is the most frequent kind of kidney stone and What are causes that lead to it
Beta 1
NKCC
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

48. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
ANP
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
NKCC

49. WBC casts - ddx
No
Size
Hypokalemia - risk for Ca containing kidney stones
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

50. By what percentage does EPRF underestimage true RPF
By 10%
Contrict leading to inc FF - preserver renal GFR in low volume states
Modified smooth muscle of afferent arteriole - secrete renin
Wilms tumor (ages 2-4)

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Renal

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