Test your basic knowledge |

Renal

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
JG cells
Reabsorb Na in exchange for secreting K and H
Inc GFR and mesangial expansion

2. What happens to tubular inulin along the proximal tubule and why
Chronic pyelonephritis
Inc in concentration - not amout - due to water reabsorption
Vasa recta - interlobular v - interlobar v - renal v
Acute pyelonephritis

3. What is hartnup's disease
Dec renal bicarb reabsorption - delayed
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Makes urine less concentrated - impermeable to H20

4. What happens to urine in the ascending limb
Segmental sclerosis and hylanosis
Makes urine less concentrated - impermeable to H20
Inulin
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

5. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Renal tubular cells - polygonal clear cells
Modified smooth muscle of afferent arteriole - secrete renin
EPO - endothelial cells of peritubular capillaries

6. What is the most common renal malignancy of early childhood
Proximal tubule - na/glucose co transporter
Antifreeze - ethyelene glycol or vit C abuse
Wilms tumor (ages 2-4)
Renal artery - interlobar a - interlobular a

7. When is TF/P ratio > 1
RPF/(1- Hct)
NKCC
Solute is reabsorbed less quickly than water or net secretion of substance
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

8. What is the effect of AT II on the hypothalamus
Angio I to angio II and inhibits bradykinin
Stimulates thirst
Involves only glomeruli
Polycystic liver disease - berry aneurysms - mitral valve prolapse

9. primary glomerular dz
Reabsorb Na in exchange for secreting K and H
Inc - inc - inc
Few glomeruli
Involves only glomeruli

10. What effect does efferent arteriole cxn have on RPF - GFR and FF
Solute is reabsorbed less quickly than water or net secretion of substance
Beta 1
Dec - inc - inc
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

11. What are the two kinds of cells in the collecting tubules
<3.5 g /day
Principal cells and intercalated cells
NKCC
Bladder cancer

12. What is generated and secreted in the proximal tubule
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Eosinphilic casts in tubules
Makes urine less concentrated - impermeable to H20
Ammonia - buffer for secreted H+

13. In who is RCC most comon
Stimulates thirst
Type II - C3 nephritic factor
Men 50 to 70 - inc incidence with smoking and obesity
Diuretics - vomiting - antacid - hyperaldosteronism

14. How is extracellular volume measured
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Reabsorb Na in exchange for secreting K and H
Type II - C3 nephritic factor
Inulin

15. no net secretion or reabsorption of x
Angio I to angio II and inhibits bradykinin
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Cx = GFR
Advanced renal dz - CRF

16. cortical and medullary cysts resulting from long standing dialysis
Involves glomeruli and other organs
Renal tubular cells - polygonal clear cells
<3.5 g /day
Dialysis cysts

17. What is the purpose of the JGA
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Complications of chronic kidney disease or HTN
To defend GFR

18. In renal failure What acid - base disturbance is most likely
2 ways - base exchanger and between epithelial cells
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Metabolic acidosis
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

19. What is the ddx for respiratory acidosis
Chronic conditions - multiple myeloma - TB - RA
Kids - peripheral and periorbital edema - resolves spontaneously
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Rxn from angiotensinogen to angiontensin I

20. What happens to pH - PCO2 and bicarb in metabolic acidosis
Advanced renal dz - CRF
Radiopaque
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Dec - dec - dec

21. What is the prognosis of RPGN
Poor - days to weeks
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
PH = pKa + log bicarb/0.03PCO2

22. In renal failure with uremia - What are the 5 aspects of uremia
It has a longer renal vein
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Inhibits Na/phosphate cotransport leading to phosphate excretion
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

23. What effect does dec plasma protein concentration have on RPF - GFR - and FF
NC - inc - inc
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Nephritic syndrome

24. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
GFR x plasma concentration
RPF/(1- Hct)
RTA type 2 (proximal)

25. proliferative
GFR x plasma concentration
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Hyperkalemia
Hyperceullular glomeruli

26. What does aldosterone do in the collecting tubule
Inc Ca/Na exchange to inc Ca reabsoprtion
RPF/(1- Hct)
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Insertion of Na channel on luminal side

27. What substance is secreted in response increase atrial pressure
Inc - dec - dec
Proximal tubule - na/glucose co transporter
ANP
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

28. Congo - red stain - apple green birefringence
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Contrict leading to inc FF - preserver renal GFR in low volume states
Amyloidosis
Inc plasma osm - dec blood volume

29. How does Wilms tumor present
Radiopaque
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inc - inc - inc
Huge palpable flank mass and hematuria

30. What is amyloidosis associated with
Hydronephrosis and pyelonephritis
160-200 - 350
Angio I to angio II and inhibits bradykinin
Chronic conditions - multiple myeloma - TB - RA

31. Which cells sense decreases in Na delivery
Dec - inc - inc
Radiopaque
Macula densa
Inc GFR and mesangial expansion

32. What do patients die from ADPKD
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Ectopic EPO - ACTH - PTHrP - prolactin
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Complications of chronic kidney disease or HTN

33. How are amino acids reabsorbed
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Becomes concentrated and hypertonic
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc

34. What is the BUN/Cr ratio in instrinsic renal ARF and why
Cx = GFR
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Corticosteroids
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

35. What does thyroidization of the kidney result in
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Radiopaque
Freely filtered and neither absorbed or secreted
Eosinphilic casts in tubules

36. RBC casts - ddx
Insertion of Na channel on luminal side
RTA type 2 (proximal)
Renal in origin
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

37. What does NEG lead to in the efferent arterioles
Renal in origin
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc GFR and mesangial expansion

38. net tubular reabsorption of x
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Cx<GFR
Small kidney - poor prognosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

39. What needs to happen for postrenal obstruction to creat ARF
Inhibits Na/phosphate cotransport leading to phosphate excretion
Freely filtered and neither absorbed or secreted
Needs to be bilateral
Excreted - filtered

40. What is the effect of AT II on the posterior pituitary
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
GFR x plasma concentration
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

41. What percentage of ECF is plasma and What is interstitial volume
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Membranoproliferative glomerulonephritis
Na
1/4 plasma - and 3/4 interstitial volume

42. What effect does cxn of the ureter have on RPF - GFR and FF
Vasa recta - interlobular v - interlobar v - renal v
Inc in concentration - not amout - due to water reabsorption
NC - dec - dec
<3.5 g /day

43. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Small kidney - poor prognosis
1alpha hydroxylase - PTH stimulates it
<3.5 g /day

44. in acute cystitis with pyuria - do you see casts
No
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Solute is reabsorbed more quickly than water
Von hippel laundau and gene deletion in chromosome 3

45. When is TF/P <1
Solute and water are reabsorbed at the same rate
GFR/RPF
Solute is reabsorbed more quickly than water
Most of the bicarb - sodium - chloride - and water

46. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Na
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Carbonic anhydrase

47. What do you see on LM and IF with rapidly progressive GN
Crescent - moon shape
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Solute is reabsorbed more quickly than water
Involves glomeruli and other organs

48. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Beta 1
Medullary cystic disease
Passively reabsorbs water via medullary hypertonicity
Staghorn calculi - worsened by alkaluria

49. What is the BUN/Cr ratio in prerenal azotemia and why?
Renal artery - interlobar a - interlobular a
Wilms tumor (ages 2-4)
Becomes concentrated and hypertonic
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

50. Why does Na conc nearly match Osm
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Vasa recta - interlobular v - interlobar v - renal v
Solute is reabsorbed more quickly than water
Na reabsorption drives H20 reabsorption