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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. What serum changes cause a secretion in PTH
Inc GFR and mesangial expansion
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
PH - then PC02
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

2. How does Wilms tumor present
Thickening of glomerular BM
Huge palpable flank mass and hematuria
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inhibits Na/phosphate cotransport leading to phosphate excretion

3. What is the ddx for a respiratory alkalosis
Hyperceullular glomeruli
Hypervent - immediate
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Hypervent - early high altitude - aspirin ingestion early

4. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Bladder cancer
RTA type 1 (distal)
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

5. How What does the glomerular filtration barrier distinguish by
Inc in Ca and PO4 absoprtion from the gut
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Kids - peripheral and periorbital edema - resolves spontaneously
Size and charge

6. What two cells make up the JGA
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Macula densa and JG cells
Proximal tubule - na/glucose co transporter
Simple cysts

7. how does this present in adults and What is the pattern of inheritence
Triglycerides
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
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

8. Why can PAH be used to measure ERPF
Insertion of Na channel on luminal side
Inc GFR and mesangial expansion
Carbonic anhydrase
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

9. What are the main complications of kidney stones
160-200 - 350
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hydronephrosis and pyelonephritis

10. What 3 disease can lead to RPGN
Huge palpable flank mass and hematuria
Inc Ca/Na exchange to inc Ca reabsoprtion
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
<3.5 g /day

11. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Poor - days to weeks
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
V x Urine concentration

12. What is the most common renal malignancy of early childhood
Inc renal bicarb resabsoprtion - delayed
Wilms tumor (ages 2-4)
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Thickening of glomerular BM

13. When is TF/P = 1
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Crescent - moon shape
Solute and water are reabsorbed at the same rate
Modified smooth muscle of afferent arteriole - secrete renin

14. What is the effect of PTH on the proximal tubule
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Renal artery - interlobar a - interlobular a
Inhibits Na/phosphate cotransport leading to phosphate excretion
Membranoproliferative glomerulonephritis

15. Where is angiotensinogen made
Diarrhea - glue - RTA - hyperchloremia
Acute tubular necrosis
No
Liver

16. granular - muddy brown casts - ddx
Reabsorb Na in exchange for secreting K and H
Acute tubular necrosis
Inc in concentration - not amout - due to water reabsorption
LM - nl glomeruli - EM - foot process effacement

17. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
By 10%
CHF - pulmonary edema - HTN
Nephritic syndrome

18. What effect does efferent arteriole cxn have on RPF - GFR and FF
Inc Ca/Na exchange to inc Ca reabsoprtion
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Dec - inc - inc
EPO - endothelial cells of peritubular capillaries

19. Where does renal cell carcinoma originate and What do the cells look like
<3.5 g /day
Stimulates thirst
Renal tubular cells - polygonal clear cells
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

20. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Chronic conditions - multiple myeloma - TB - RA
Nephrotic syndrome
ADPKD
160-200 - 350

21. What does NEG lead to in the efferent arterioles
Inc GFR and mesangial expansion
Diabetic glomerulonephropathy
Corticosteroids
JG cells

22. What is hartnup's disease
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
GFR x plasma concentration
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

23. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
RTA type 1 (distal)
Inulin
Beta 1
Diarrhea - glue - RTA - hyperchloremia

24. In what disease in FSGS the most common glomerular disease
HIV
Eosinphilic casts in tubules
Small kidney - poor prognosis
Involves glomeruli and other organs

25. Focal
Few glomeruli
Solute and water are reabsorbed at the same rate
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

26. In a metabolic acidosis What additional calculation is necessary and How do you make it
Inc plasma osm - dec blood volume
Anion gap = na - (Cl + bicarb)
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Nonspecific

27. What is the formula for filtration fraction
Modified smooth muscle of afferent arteriole - secrete renin
GFR/RPF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Negative charge

28. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc renal bicarb resabsoprtion - delayed
UTI or acute gastroenteritis

29. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Inc GFR and mesangial expansion
NC - dec - dec
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Acute pyelonephritis

30. How are amino acids reabsorbed
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Few glomeruli
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

31. net tubular secretion of x
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
RPF/(1- Hct)
Cx>GFR
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

32. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Nephrotic syndrome
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
NC - dec - dec

33. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Na and volume loss
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Bladder cancer
NC - dec - dec

34. cortical and medullary cysts resulting from long standing dialysis
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Dialysis cysts
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Segmental sclerosis and hylanosis

35. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
To defend GFR

36. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
All glomeruli
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Becomes concentrated and hypertonic
Most of the bicarb - sodium - chloride - and water

37. Who often has diffuse proliferative GN
Reabsorb Na in exchange for secreting K and H
60% total body water - 40% ICF - 20% ECF
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
LM - nl glomeruli - EM - foot process effacement

38. What are the associations with nephrotic syndrome
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Thromboembolism and inc risk of infection
UTI or acute gastroenteritis

39. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Metabolic acidosis
Staghorn calculi - worsened by alkaluria
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hyperceullular glomeruli

40. What is ADPKD also associated with
Cx<GFR
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
PH - then PC02

41. do you see casts in bladder cancer - kidney stones with hematuria
Von hippel laundau and gene deletion in chromosome 3
Proximal tubule - na/glucose co transporter
Medullary cystic disease
No

42. proliferative
Hyperceullular glomeruli
Acute tubular necrosis
Inc
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

43. tram track appearance on EM - typ - path - and associated dz
Small kidney - poor prognosis
NKCC
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Principal cells and intercalated cells

44. What is is Alport's syndrome and what else do you see with it other than renal path
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Transitional cell carcinoma
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Crescent - moon shape

45. What are the LM and EM of minimal change disease
Polycystic liver disease - berry aneurysms - mitral valve prolapse
LM - nl glomeruli - EM - foot process effacement
ANP
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

46. In renal failure with uremia - What are the 5 aspects of uremia
Diarrhea - glue - RTA - hyperchloremia
Intra = HIKIN!
Most of the bicarb - sodium - chloride - and water
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

47. no net secretion or reabsorption of x
Cx = GFR
Hypervent - immediate
Excreted - filtered
Dec - inc - dec

48. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Makes urine less concentrated - impermeable to H20
Cx = GFR

49. What is renal osteodystrophy
Needs to be bilateral
Inulin
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

50. What is the effect of AT II on GFR - FF and Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
By 10%
CHF - pulmonary edema - HTN