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Renal

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Answer 50 questions in 15 minutes.
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1. secondary glomerular dz
Involves glomeruli and other organs
Antifreeze - ethyelene glycol or vit C abuse
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Few glomeruli

2. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Insertion of Na channel on luminal side
Inc renal bicarb resabsoprtion - delayed
Dec renal bicarb reabsorption - delayed

3. Who often has diffuse proliferative GN
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
160-200 - 350
Inc - inc - inc
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

4. coarse - asymmetric - corticomedullary scarring and blunted calyx
Na reabsorption drives H20 reabsorption
Dialysis cysts
Chronic pyelonephritis
Most of the bicarb - sodium - chloride - and water

5. How does Wilms tumor present
HIV
Inc
Huge palpable flank mass and hematuria
Stimulates thirst

6. What is the formula for clearance of a substance per unit time
GFR x plasma concentration
Modified smooth muscle of afferent arteriole - secrete renin
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Stimulates thirst

7. What change (lack of) is common in children with renal failure
Acute renal failure
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Growth retardation and developmental delay
Radiopaque

8. What are the associations with RTA type 2
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Hypokalemia and hypophosphatemic rickets
Dec renal bicarb reabsorption - delayed

9. What do casts indicated about hematuria/pyuria
Inc - inc - inc
Size and charge
Diarrhea - glue - RTA - hyperchloremia
Renal in origin

10. What are the effects of PTH hormone on the kidney
Stimulates thirst
NC - inc - inc
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
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

11. What are the two kinds of cells in the collecting tubules
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Principal cells and intercalated cells
Segmental sclerosis and hylanosis

12. What is the second most common kidney stone
Failure of EPO
Hydronephrosis and pyelonephritis
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Renal in origin

13. What happens to the urine in the descending limb
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Thromboembolism and inc risk of infection
Becomes concentrated and hypertonic
RTA type 2 (proximal)

14. cortical and medullary cysts resulting from long standing dialysis
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Dialysis cysts
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

15. diffuse
All glomeruli
Needs to be bilateral
Thromboembolism and inc risk of infection
No

16. How is plasma volume measured
JG cells
Insertion of Na channel on luminal side
Antifreeze - ethyelene glycol or vit C abuse
Radiolabelled albumin

17. What does NEG lead to in the efferent arterioles
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Inc GFR and mesangial expansion
Amyloidosis
ADPKD

18. hyaline casts ddx
Hyperkalemia
Nonspecific
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
V x Urine concentration

19. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Hypervent - immediate
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
RTA type 4 (hyperkalemic)
Diarrhea - glue - RTA - hyperchloremia

20. What can cause oxalate crystals
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Antifreeze - ethyelene glycol or vit C abuse
No
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

21. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
ANP
Macula densa and JG cells
Chronic conditions - multiple myeloma - TB - RA

22. What is the formula for excretion rate
V x Urine concentration
Inc in concentration - not amout - due to water reabsorption
Nonspecific
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

23. What is the pathway to the afferent arteriole
Renal artery - interlobar a - interlobular a
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Macula densa and JG cells
Inc Ca/Na exchange to inc Ca reabsoprtion

24. What is the henderson hasselbalch equation
60% total body water - 40% ICF - 20% ECF
PH = pKa + log bicarb/0.03PCO2
Angio I to angio II and inhibits bradykinin
PH - then PC02

25. By what percentage does EPRF underestimage true RPF
By 10%
Involves only glomeruli
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Hyperceullular glomeruli

26. hypoaldosteronism or lack of collecting tubule response to aldosteron
Hypokalemia - risk for Ca containing kidney stones
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Radiopaque
RTA type 4 (hyperkalemic)

27. inc in creatinine and BUN over a period of several days
Acute renal failure
Makes urine less concentrated - impermeable to H20
Angio I to angio II and inhibits bradykinin
160-200 - 350

28. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Involves glomeruli and other organs
1alpha hydroxylase - PTH stimulates it
Anion gap = na - (Cl + bicarb)

29. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Renal in origin
Advanced renal dz - CRF
Inc in concentration - not amout - due to water reabsorption

30. no net secretion or reabsorption of x
Corticosteroids
Segmental sclerosis and hylanosis
Cx = GFR
Makes urine less concentrated - impermeable to H20

31. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
NC - dec - dec
Principal cells and intercalated cells
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Acute renal failure

32. What is the algorithim for acidosis/alkalosis
RTA type 4 (hyperkalemic)
PH - then PC02
Macula densa and JG cells
Huge palpable flank mass and hematuria

33. What does renin do
HIV
Rxn from angiotensinogen to angiontensin I
Reabsorb Na in exchange for secreting K and H
Inc renal bicarb resabsoprtion - delayed

34. in acute post strep GN - What do you see on LM - EM and IF

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35. What is the effect of AT II on GFR - FF and Na
Solute and water are reabsorbed at the same rate
Acute - ATN - or chronic - HTN - DM
Needs to be bilateral
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

36. What is the genetic etiology of wilms tumor and What is WAGR complex
Crescent - moon shape
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

37. What is ADPKD also associated with
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Macula densa and JG cells
HIV
Hyperkalemia

38. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Cx = GFR
To defend GFR
Renal in origin

39. What is hartnup's disease
Growth retardation and developmental delay
GFR x plasma concentration
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
RPF/(1- Hct)

40. Where is ACE made and What are 2 of its fxns
RPF/(1- Hct)
Small kidney - poor prognosis
Beta 1
Angio I to angio II and inhibits bradykinin

41. What is a normal filtration fraction
<3.5 g /day
1/4 plasma - and 3/4 interstitial volume
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
20 percent

42. What is the formula for secreted
Hypervent - early high altitude - aspirin ingestion early
Excreted - filtered
RTA type 2 (proximal)
Makes urine less concentrated - impermeable to H20

43. proliferative
Kids - peripheral and periorbital edema - resolves spontaneously
Hyperceullular glomeruli
To defend GFR
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

44. What is the compensatory response in respiratory alkalosis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Dec renal bicarb reabsorption - delayed
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
UTI or acute gastroenteritis

45. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Thromboembolism and inc risk of infection
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Most of the bicarb - sodium - chloride - and water
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

46. Defect in collecting ducts ability to excrete H+
Acute - ATN - or chronic - HTN - DM
Renal artery - interlobar a - interlobular a
RTA type 1 (distal)
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

47. How can NSAIDs cause acute renal failure
V x Urine concentration
Solute is reabsorbed less quickly than water or net secretion of substance
EPO - endothelial cells of peritubular capillaries
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

48. How is chlorid reabsorbed in the proximal tubule
2 ways - base exchanger and between epithelial cells
Corticosteroids
Renal tubular cells - polygonal clear cells
Inc Ca/Na exchange to inc Ca reabsoprtion

49. Where does renal cell carcinoma originate and What do the cells look like
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Renal tubular cells - polygonal clear cells
Dec renal bicarb reabsorption - delayed

50. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
NC - dec - dec
EPO - endothelial cells of peritubular capillaries
Renal in origin
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

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Renal

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