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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 is the 3rd most common kidney stone and What causes it
Wilms tumor (ages 2-4)
V x Urine concentration
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

2. inc in creatinine and BUN over a period of several days
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Acute renal failure
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Size and charge

3. What is ADPKD also associated with
GFR/RPF
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Under and under

4. What is the prognosis of RPGN
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Poor - days to weeks
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

5. What is the compensatory response in metabolic alkalosis
NKCC
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Hypovent - immediate
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

6. TCC is associated with problems in your Pee SAC - ??
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Solute is reabsorbed less quickly than water or net secretion of substance
Phenacetin - smoking - aniline dyes - cyclophosphamide
Reabsorb Na in exchange for secreting K and H

7. What is the net effect of ANP
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Cx = GFR
Na and volume loss
Proximal tubule - na/glucose co transporter

8. Why does Na conc nearly match Osm
Proximal tubule - na/glucose co transporter
Wilms tumor (ages 2-4)
Na reabsorption drives H20 reabsorption
Membranoproliferative glomerulonephritis

9. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
Phenacetin - smoking - aniline dyes - cyclophosphamide
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Triglycerides

10. Who commonly gets acute post strep GN
Radiopaque
Cx<GFR
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Kids - peripheral and periorbital edema - resolves spontaneously

11. What are the effects of AT II on the adrenal gland
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Membranoproliferative glomerulonephritis
Amyloidosis
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

12. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
V x Urine concentration
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Macula densa

13. What 3 things stimulate the release of renin - and Where is it released from
ADPKD
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
RPF/(1- Hct)
LM - nl glomeruli - EM - foot process effacement

14. What does thyroidization of the kidney result in
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Filtered - secreted
Dec - dec - dec
Eosinphilic casts in tubules

15. What is the formula for reabsorption
Crescent - moon shape
NC - dec - dec
Filtered - secreted
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

16. In renal failure with uremia - What are the 5 aspects of uremia
Membranoproliferative glomerulonephritis
60% total body water - 40% ICF - 20% ECF
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Small kidney - poor prognosis

17. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Inulin
Acute pyelonephritis
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Acute - ATN - or chronic - HTN - DM

18. What is the pathway to the afferent arteriole
Makes urine less concentrated - impermeable to H20
Hyperkalemia
Renal artery - interlobar a - interlobular a
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

19. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Intra = HIKIN!
Amyloidosis
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

20. What is winter's formula and when do you use it
Inc - dec - dec
Macula densa and JG cells
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Simple cysts

21. What is the ddx for a respiratory alkalosis
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Hypervent - early high altitude - aspirin ingestion early
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc Ca/Na exchange to inc Ca reabsoprtion

22. What are the associations with nephrotic syndrome
Antifreeze - ethyelene glycol or vit C abuse
Freely filtered and neither absorbed or secreted
PH - then PC02
Thromboembolism and inc risk of infection

23. What are the 3 transporters of the intercalated cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Inc renal bicarb resabsoprtion - delayed
Acute pyelonephritis
LM - nl glomeruli - EM - foot process effacement

24. RBC casts - ddx
RTA type 2 (proximal)
V x Urine concentration
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Solute and water are reabsorbed at the same rate

25. Who often has diffuse proliferative GN
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Size and charge
CHF - pulmonary edema - HTN

26. When is TF/P = 1
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Solute and water are reabsorbed at the same rate
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Radiopaque

27. What is the algorithim for acidosis/alkalosis
PH - then PC02
No
Acute renal failure
Small kidney - poor prognosis

28. How does RCC spread
Cx = GFR
Cx<GFR
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Invades IVC and spreads hematogenously

29. diffuse
JG cells
All glomeruli
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Dec - dec - dec

30. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
No
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
LM - nl glomeruli - EM - foot process effacement

31. coarse - asymmetric - corticomedullary scarring and blunted calyx
Small kidney - poor prognosis
NC - dec - dec
RPF/(1- Hct)
Chronic pyelonephritis

32. What does aldosterone do in the collecting tubule
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Solute is reabsorbed more quickly than water
Inc Ca/Na exchange to inc Ca reabsoprtion
Insertion of Na channel on luminal side

33. How What does the glomerular filtration barrier distinguish by
Negative charge
Size and charge
Cx = GFR
Nephrotic syndrome

34. What does US show with medullary cystic disease
Needs to be bilateral
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
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

35. dense deposits on EM - type and association
2 ways - base exchanger and between epithelial cells
Type II - C3 nephritic factor
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Huge palpable flank mass and hematuria

36. What are the associated paraneoplastic syndromes wth RCC
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Triglycerides
Ectopic EPO - ACTH - PTHrP - prolactin

37. in acute cystitis with pyuria - do you see casts
No
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
GFR x plasma concentration
2 ways - base exchanger and between epithelial cells

38. What is the formula for excretion rate
V x Urine concentration
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
Acute renal failure

39. What happens to urine in the ascending limb
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Makes urine less concentrated - impermeable to H20
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

40. What effect does ANP have on Na in the kidney
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
NC - dec - dec
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Cx>GFR

41. What happens in the thin descending loop of henle
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Huge palpable flank mass and hematuria
It has a longer renal vein
Passively reabsorbs water via medullary hypertonicity

42. In renal failure What acid - base disturbance is most likely
Acute - ATN - or chronic - HTN - DM
Metabolic acidosis
60% total body water - 40% ICF - 20% ECF
Cx = GFR

43. When is TF/P <1
Intra = HIKIN!
Involves only glomeruli
Solute is reabsorbed more quickly than water
HIV

44. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Polycystic liver disease - berry aneurysms - mitral valve prolapse
NKCC
Medullary cystic disease

45. With what genetic tumor syndrome is RCC associated
NKCC
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Diabetic glomerulonephropathy
Von hippel laundau and gene deletion in chromosome 3

46. Why can inulin be used to calculate GFR?
Dec - inc - dec
Von hippel laundau and gene deletion in chromosome 3
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Freely filtered and neither absorbed or secreted

47. What is the LM for diabetic glomerulonephropathy
EPO - endothelial cells of peritubular capillaries
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Chronic conditions - multiple myeloma - TB - RA
Proximal tubule - na/glucose co transporter

48. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Intra = HIKIN!
Excreted - filtered
Inc - dec - dec
Type II - C3 nephritic factor

49. proliferative
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Complications of chronic kidney disease or HTN
Size
Hyperceullular glomeruli

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

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