Test your basic knowledge |

Renal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. How are amino acids reabsorbed
RTA type 2 (proximal)
ANP
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

2. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
RTA type 2 (proximal)
Men 50 to 70 - inc incidence with smoking and obesity

3. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
1alpha hydroxylase - PTH stimulates it
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

4. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
JG cells
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Inc - dec - dec

5. What is the formula for renal blood flow
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Size
RPF/(1- Hct)
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

6. What is a normal filtration fraction
20 percent
GFR x plasma concentration
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
No

7. How What does the glomerular filtration barrier distinguish by
Inhibits Na/phosphate cotransport leading to phosphate excretion
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Size and charge
UTI or acute gastroenteritis

8. What dyslipidemia is most common in renal failure
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Triglycerides
RPF/(1- Hct)
RTA type 4 (hyperkalemic)

9. What is the pathway to the afferent arteriole
Principal cells and intercalated cells
Renal artery - interlobar a - interlobular a
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

10. acute generalized cortical infarction of both kidneys - dz - causes and associations
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Hyperkalemia
Solute and water are reabsorbed at the same rate

11. What are the associations with RTA type 2
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Hypokalemia and hypophosphatemic rickets
Inc GFR and mesangial expansion

12. What is is Alport's syndrome and what else do you see with it other than renal path
Most of the bicarb - sodium - chloride - and water
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
NKCC
Metabolic acidosis

13. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
Macula densa
EPO - endothelial cells of peritubular capillaries
RPF/(1- Hct)

14. When is glucose reabsorbed and with What transporter
Medullary cystic disease
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
LM - nl glomeruli - EM - foot process effacement
Proximal tubule - na/glucose co transporter

15. What do you see in the urine with acute pyelonephritis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Dec - inc - dec
Radiopaque
White cell casts

16. What is the ddx for metabolic alkalosis with compensation
1/4 plasma - and 3/4 interstitial volume
Na
Hyperkalemia
Diuretics - vomiting - antacid - hyperaldosteronism

17. When is TF/P <1
Solute is reabsorbed more quickly than water
Insertion of Na channel on luminal side
Involves glomeruli and other organs
Macula densa

18. What happens to pH - PCO2 and bicarb in metabolic acidosis
Renal artery - interlobar a - interlobular a
1alpha hydroxylase - PTH stimulates it
Renal in origin
Dec - dec - dec

19. What is the effect of AT II on efferent arterioles
Kids - peripheral and periorbital edema - resolves spontaneously
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Contrict leading to inc FF - preserver renal GFR in low volume states
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

20. What needs to happen for postrenal obstruction to creat ARF
Freely filtered and neither absorbed or secreted
Medullary cystic disease
Ectopic EPO - ACTH - PTHrP - prolactin
Needs to be bilateral

21. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Nephritic syndrome
Diarrhea - glue - RTA - hyperchloremia
Huge palpable flank mass and hematuria
Vasa recta - interlobular v - interlobar v - renal v

22. What does aldosterone do in the collecting tubule
Radiopaque
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Insertion of Na channel on luminal side
Inhibits Na/phosphate cotransport leading to phosphate excretion

23. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Solute is reabsorbed more quickly than water
All glomeruli
Inc in concentration - not amout - due to water reabsorption

24. What does thyroidization of the kidney result in
Rxn from angiotensinogen to angiontensin I
Metabolic acidosis
Eosinphilic casts in tubules
NC - inc - inc

25. What is renal osteodystrophy
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Hypervent - immediate
Inc in concentration - not amout - due to water reabsorption

26. What therapy does miminal change respond to...
Nephritic syndrome
Vasa recta - interlobular v - interlobar v - renal v
Corticosteroids
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

27. What is the formula for filtration fraction
NC - inc - inc
GFR/RPF
Filtered - secreted
Size and charge

28. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
<3.5 g /day
Few glomeruli
Macula densa and JG cells

29. What does US show with medullary cystic disease
Small kidney - poor prognosis
Dec renal bicarb reabsorption - delayed
Staghorn calculi - worsened by alkaluria
NC - dec - dec

30. What can cause oxalate crystals
Advanced renal dz - CRF
Few glomeruli
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Antifreeze - ethyelene glycol or vit C abuse

31. How does RCC spread
Invades IVC and spreads hematogenously
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Type II - C3 nephritic factor
Freely filtered and neither absorbed or secreted

32. What do you see on LM for focal segmental glomerulosclerosis
Hyperkalemia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Segmental sclerosis and hylanosis
PH - then PC02

33. What are the LM and EM of minimal change disease
Liver
LM - nl glomeruli - EM - foot process effacement
Nephritic syndrome
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

34. What effect does efferent arteriole cxn have on RPF - GFR and FF
Renal in origin
Hypokalemia and hypophosphatemic rickets
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Dec - inc - inc

35. Which cells sense decreases in BP
NKCC
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
JG cells
Excreted - filtered

36. What is the ddx for respiratory acidosis
Inc in Ca and PO4 absoprtion from the gut
Crescent - moon shape
Chronic conditions - multiple myeloma - TB - RA
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

37. What is the effect of of PTH on the distal convoluted tubule
Intra = HIKIN!
Involves glomeruli and other organs
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc Ca/Na exchange to inc Ca reabsoprtion

38. Where is ACE made and What are 2 of its fxns
Diuretics - vomiting - antacid - hyperaldosteronism
Radiopaque
Acute pyelonephritis
Angio I to angio II and inhibits bradykinin

39. Why does Na conc nearly match Osm
To defend GFR
Vasa recta - interlobular v - interlobar v - renal v
Hydronephrosis and pyelonephritis
Na reabsorption drives H20 reabsorption

40. What do you see on LM and IF with rapidly progressive GN
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Crescent - moon shape
Makes urine less concentrated - impermeable to H20

41. What are the associations with nephrotic syndrome
ANP
Thromboembolism and inc risk of infection
Thickening of glomerular BM
Radiolabelled albumin

42. What is the net effect of PTH
Failure of EPO
Liver
Inc in Ca and PO4 absoprtion from the gut
Eosinphilic casts in tubules

43. What substance is secreted in response increase atrial pressure
Cx<GFR
ANP
JG cells
Involves only glomeruli

44. By what percentage does EPRF underestimage true RPF
NC - dec - dec
By 10%
GFR x plasma concentration
Crescent - moon shape

45. What are the 3 transporters of the intercalated cells
Dec - dec - dec
Dec - inc - inc
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

46. What is ADPKD also associated with
Proximal tubule - na/glucose co transporter
Simple cysts
Polycystic liver disease - berry aneurysms - mitral valve prolapse
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

47. How do calcium stones appear on x ray
Contrict leading to inc FF - preserver renal GFR in low volume states
Radiopaque
Becomes concentrated and hypertonic
Under and under

48. coarse - asymmetric - corticomedullary scarring and blunted calyx
Liver
Inc plasma osm - dec blood volume
Inc in concentration - not amout - due to water reabsorption
Chronic pyelonephritis

49. How can NSAIDs cause acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Dec - dec - dec
Few glomeruli

50. What is the effect of aldosterone in principal cells
Thickening of glomerular BM
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Inc - dec - dec
Invades IVC and spreads hematogenously