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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 therapy does miminal change respond to...
Simple cysts
Corticosteroids
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

2. How do struvite stones appear on xray
160-200 - 350
Radiopaque
RTA type 4 (hyperkalemic)
NC - dec - dec

3. What is the henderson hasselbalch equation
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Phenacetin - smoking - aniline dyes - cyclophosphamide
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
PH = pKa + log bicarb/0.03PCO2

4. What do macula densa cells sense
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hypokalemia - risk for Ca containing kidney stones
NC - inc - inc
Na

5. What is the compensatory response in respiratory alkalosis
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Dec renal bicarb reabsorption - delayed

6. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
Diuretics - vomiting - antacid - hyperaldosteronism
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Inc Ca/Na exchange to inc Ca reabsoprtion

7. how does this present in adults and What is the pattern of inheritence
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
No

8. What is the effect of AT II on the hypothalamus
Intra = HIKIN!
Acute renal failure
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Stimulates thirst

9. What is the compensatory response in metabolic alkalosis
Negative charge
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Hypovent - immediate
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

10. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Crescent - moon shape
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

11. What does renin do
Cx<GFR
Rxn from angiotensinogen to angiontensin I
Beta 1
NC - dec - dec

12. Focal
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Few glomeruli
Thromboembolism and inc risk of infection
Polycystic liver disease - berry aneurysms - mitral valve prolapse

13. nonenzymatic glycosylation of GBM - inc permeability and thickening
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
ADPKD
Diabetic glomerulonephropathy
Na reabsorption drives H20 reabsorption

14. The fenestrated capillary endothelium constitutes what portion of the barrier
Advanced renal dz - CRF
Acute tubular necrosis
V x Urine concentration
Size

15. dense deposits on EM - type and association
Dec - inc - dec
Ectopic EPO - ACTH - PTHrP - prolactin
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Type II - C3 nephritic factor

16. What are the main complications of kidney stones
Hypokalemia and hypophosphatemic rickets
GFR x plasma concentration
Dec renal bicarb reabsorption - delayed
Hydronephrosis and pyelonephritis

17. What are the associated paraneoplastic syndromes wth RCC
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Inulin
Ectopic EPO - ACTH - PTHrP - prolactin
Proximal tubule - na/glucose co transporter

18. What is the pathway to the afferent arteriole
Renal artery - interlobar a - interlobular a
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc in concentration - not amout - due to water reabsorption
Hypokalemia - risk for Ca containing kidney stones

19. What are the two kinds of cells in the collecting tubules
Renal artery - interlobar a - interlobular a
Inc renal bicarb resabsoprtion - delayed
Simple cysts
Principal cells and intercalated cells

20. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
NC - inc - inc
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Liver

21. What happens when PTH is secreted
EPO - endothelial cells of peritubular capillaries
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Thromboembolism and inc risk of infection
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

22. do you see casts in bladder cancer - kidney stones with hematuria
Corticosteroids
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
No
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

23. What cells create the epithelial layer of the glomerular filtration barrier
Podocytes foot processes
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Negative charge
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

24. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Acute pyelonephritis
Cx>GFR
Renal artery - interlobar a - interlobular a
EPO - endothelial cells of peritubular capillaries

25. What effect does efferent arteriole cxn have on RPF - GFR and FF
Insertion of Na channel on luminal side
Hyperceullular glomeruli
Dec - inc - inc
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

26. What effect does cxn of the ureter have on RPF - GFR and FF
UTI or acute gastroenteritis
Complications of chronic kidney disease or HTN
NC - dec - dec
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

27. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Involves glomeruli and other organs
Inc in concentration - not amout - due to water reabsorption
Makes urine less concentrated - impermeable to H20
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

28. How does RCC manifest clinically
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
20 percent
Growth retardation and developmental delay
1alpha hydroxylase - PTH stimulates it

29. What substance is secreted in response increase atrial pressure
Wilms tumor (ages 2-4)
Reabsorb Na in exchange for secreting K and H
ANP
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

30. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Acute - ATN - or chronic - HTN - DM
Kids - peripheral and periorbital edema - resolves spontaneously
Hydronephrosis and pyelonephritis

31. What is the effect of AT II on the posterior pituitary
Advanced renal dz - CRF
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Na reabsorption drives H20 reabsorption
Hyperceullular glomeruli

32. What is the formula for clearance of a substance per unit time
Inc in concentration - not amout - due to water reabsorption
Na reabsorption drives H20 reabsorption
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

33. What is the most frequent kind of kidney stone and What are causes that lead to it
Few glomeruli
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

34. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Size and charge
Poor - days to weeks
Inc - inc - inc

35. What do you see on LM and IF with rapidly progressive GN
Principal cells and intercalated cells
Growth retardation and developmental delay
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Crescent - moon shape

36. What is renal osteodystrophy
Small kidney - poor prognosis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

37. What is the formula for secreted
Acts on V2 receptors leading to insertion of aquaporins on luminal side
ANP
Membranoproliferative glomerulonephritis
Excreted - filtered

38. What is the LM for diabetic glomerulonephropathy
Simple cysts
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

39. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Solute is reabsorbed more quickly than water
Na
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Proximal tubule - na/glucose co transporter

40. What is amyloidosis associated with
Under and under
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
RTA type 2 (proximal)
Chronic conditions - multiple myeloma - TB - RA

41. What are JG cells and what substance do they secrete
Acute renal failure
Podocytes foot processes
160-200 - 350
Modified smooth muscle of afferent arteriole - secrete renin

42. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Most of the bicarb - sodium - chloride - and water
GFR/RPF
60% total body water - 40% ICF - 20% ECF
V x Urine concentration

43. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
Vasa recta - interlobular v - interlobar v - renal v
Macula densa
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

44. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
GFR x plasma concentration
Type II - C3 nephritic factor

45. What is the formula for filtration fraction
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Chronic pyelonephritis
GFR/RPF
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

46. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Dec - inc - inc
1alpha hydroxylase - PTH stimulates it
Inc in Ca and PO4 absoprtion from the gut
To defend GFR

47. What happens in the collecting tubules
Solute is reabsorbed more quickly than water
Dialysis cysts
Reabsorb Na in exchange for secreting K and H
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

48. When is TF/P ratio > 1
Passively reabsorbs water via medullary hypertonicity
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc - inc - inc
Solute is reabsorbed less quickly than water or net secretion of substance

49. What happens to urine in the ascending limb
White cell casts
Makes urine less concentrated - impermeable to H20
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

50. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Type II - C3 nephritic factor
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Ammonia - buffer for secreted H+
Beta 1