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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 a normal filtration fraction
Insertion of Na channel on luminal side
Rxn from angiotensinogen to angiontensin I
20 percent
Dec - inc - inc

2. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hypokalemia - risk for Ca containing kidney stones
Vasa recta - interlobular v - interlobar v - renal v
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

3. How What does the glomerular filtration barrier distinguish by
Beta 1
NC - dec - dec
Size and charge
ADPKD

4. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Dec renal bicarb reabsorption - delayed
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Podocytes foot processes

5. How is plasma volume measured
Nonspecific
Radiolabelled albumin
Von hippel laundau and gene deletion in chromosome 3
Dec renal bicarb reabsorption - delayed

6. How does RCC spread
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
Invades IVC and spreads hematogenously
Dec - dec - dec
NC - dec - dec

7. What happens to urine in the ascending limb
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Makes urine less concentrated - impermeable to H20
Chronic pyelonephritis

8. hyaline casts ddx
GFR x plasma concentration
Type II - C3 nephritic factor
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Nonspecific

9. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Crescent - moon shape
Hyperkalemia
Triglycerides
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

10. What percentage of ECF is plasma and What is interstitial volume
To defend GFR
1/4 plasma - and 3/4 interstitial volume
PH = pKa + log bicarb/0.03PCO2
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

11. Bergers' disease - which antibody and What do you see on LM and IF
Excreted - filtered
JG cells
Nonspecific
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

12. What are the two kinds of cells in the collecting tubules
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Invades IVC and spreads hematogenously
RTA type 4 (hyperkalemic)
Principal cells and intercalated cells

13. In renal failure with uremia - What are the 5 aspects of uremia
Acute - ATN - or chronic - HTN - DM
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Solute and water are reabsorbed at the same rate
Staghorn calculi - worsened by alkaluria

14. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Ammonia - buffer for secreted H+
Nephrotic syndrome
Type II - C3 nephritic factor
Most of the bicarb - sodium - chloride - and water

15. In a metabolic acidosis What additional calculation is necessary and How do you make it
No
60% total body water - 40% ICF - 20% ECF
Anion gap = na - (Cl + bicarb)
Inhibits Na/phosphate cotransport leading to phosphate excretion

16. What effect does ANP have on Na in the kidney
V x Urine concentration
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Dec - dec - dec

17. What does thyroidization of the kidney result in
By 10%
NC - inc - inc
Eosinphilic casts in tubules
White cell casts

18. When is TF/P ratio > 1
Solute is reabsorbed less quickly than water or net secretion of substance
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Angio I to angio II and inhibits bradykinin
Proximal tubule - na/glucose co transporter

19. waxy casts ddx
Renal tubular cells - polygonal clear cells
Anion gap = na - (Cl + bicarb)
RTA type 1 (distal)
Advanced renal dz - CRF

20. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
Cx>GFR
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal tubular cells - polygonal clear cells

21. What is the formula for filtration fraction
Small kidney - poor prognosis
GFR/RPF
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

22. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Huge palpable flank mass and hematuria
Transitional cell carcinoma
GFR/RPF

23. What does US show with medullary cystic disease
Kids - peripheral and periorbital edema - resolves spontaneously
Cx>GFR
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Small kidney - poor prognosis

24. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

25. When is glucose reabsorbed and with What transporter
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Bladder cancer
Proximal tubule - na/glucose co transporter
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

26. dense deposits on EM - type and association
Corticosteroids
Negative charge
Type II - C3 nephritic factor
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

27. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
UTI or acute gastroenteritis
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Na reabsorption drives H20 reabsorption
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

28. granular - muddy brown casts - ddx
V x Urine concentration
Acute tubular necrosis
Makes urine less concentrated - impermeable to H20
Macula densa

29. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Thromboembolism and inc risk of infection
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

30. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc in Ca and PO4 absoprtion from the gut
Excreted - filtered

31. Under what circumstances is aldosterone secreted
Na
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
1alpha hydroxylase - PTH stimulates it

32. no net secretion or reabsorption of x
Cx = GFR
Reabsorb Na in exchange for secreting K and H
Macula densa
Dialysis cysts

33. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Few glomeruli
Inc - dec - dec
No

34. What circumstances causes ADH secretion
RTA type 2 (proximal)
Advanced renal dz - CRF
Inc plasma osm - dec blood volume
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

35. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Chronic conditions - multiple myeloma - TB - RA
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Hypokalemia - risk for Ca containing kidney stones
Dialysis cysts

36. The fenestrated capillary endothelium constitutes what portion of the barrier
Size
Corticosteroids
Hyperceullular glomeruli
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

37. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
Inc GFR and mesangial expansion
Few glomeruli
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

38. What is the cutoff of proteinuria in nephritic syndrome
<3.5 g /day
White cell casts
Dec renal bicarb reabsorption - delayed
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

39. Which cells sense decreases in Na delivery
Na reabsorption drives H20 reabsorption
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Simple cysts
Macula densa

40. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Bladder cancer
ANP
160-200 - 350

41. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inhibits Na/phosphate cotransport leading to phosphate excretion
Beta 1
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

42. coarse - asymmetric - corticomedullary scarring and blunted calyx
Wilms tumor (ages 2-4)
LM - nl glomeruli - EM - foot process effacement
Inc in Ca and PO4 absoprtion from the gut
Chronic pyelonephritis

43. What happens to pH - PCO2 and bicarb in metabolic acidosis
Dec - dec - dec
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 - inc - inc
By 10%

44. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
Rxn from angiotensinogen to angiontensin I
Acute - ATN - or chronic - HTN - DM
Staghorn calculi - worsened by alkaluria

45. What are the two forms of renal failure and What are examples of each
Solute and water are reabsorbed at the same rate
PH - then PC02
Acute - ATN - or chronic - HTN - DM
Contrict leading to inc FF - preserver renal GFR in low volume states

46. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Men 50 to 70 - inc incidence with smoking and obesity
Small kidney - poor prognosis
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Acute pyelonephritis

47. In what clinical context does Berger's disease often present
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc
UTI or acute gastroenteritis
<3.5 g /day

48. What is the compensatory response in respiratory acidosis
Inc in Ca and PO4 absoprtion from the gut
Small kidney - poor prognosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inc renal bicarb resabsoprtion - delayed

49. Where is potassium conc. Highest? Intra or extra
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Intra = HIKIN!
ANP
Filtered - secreted

50. Why does Na conc nearly match Osm
Cx<GFR
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Na reabsorption drives H20 reabsorption
Inc in Ca and PO4 absoprtion from the gut