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Renal

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1. What is the algorithim for acidosis/alkalosis
Advanced renal dz - CRF
Vasa recta - interlobular v - interlobar v - renal v
PH - then PC02
Passively reabsorbs water via medullary hypertonicity

2. secondary glomerular dz
Nonspecific
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Hypervent - immediate
Involves glomeruli and other organs

3. What are the associations with nephrotic syndrome
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Thromboembolism and inc risk of infection
Diabetic glomerulonephropathy
White cell casts

4. What is the second most common kidney stone
Advanced renal dz - CRF
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Hyperkalemia

5. inc in creatinine and BUN over a period of several days
PH = pKa + log bicarb/0.03PCO2
Solute and water are reabsorbed at the same rate
GFR x plasma concentration
Acute renal failure

6. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Inhibits Na/phosphate cotransport leading to phosphate excretion
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Proximal tubule - na/glucose co transporter
20 percent

7. What is the 60-40-20 rule of body weight
Vasa recta - interlobular v - interlobar v - renal v
60% total body water - 40% ICF - 20% ECF
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
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

8. What is lost in nephrotic syndrome resulting what urine and serum changes
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Intra = HIKIN!
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

9. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Radiopaque
NC - inc - inc
JG cells
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

10. What are the associations with RTA type 1
Proximal tubule - na/glucose co transporter
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Chronic pyelonephritis
Hypokalemia - risk for Ca containing kidney stones

11. What is the LM for diabetic glomerulonephropathy
RTA type 4 (hyperkalemic)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Insertion of Na channel on luminal side
Most of the bicarb - sodium - chloride - and water

12. In what disease in FSGS the most common glomerular disease
HIV
Hyperceullular glomeruli
Na reabsorption drives H20 reabsorption
Passively reabsorbs water via medullary hypertonicity

13. What is the ddx for metabolic alkalosis with compensation
Inhibits Na/phosphate cotransport leading to phosphate excretion
Few glomeruli
Diuretics - vomiting - antacid - hyperaldosteronism
<3.5 g /day

14. What are the associations with RTA type 2
RTA type 1 (distal)
Hypokalemia and hypophosphatemic rickets
Diabetic glomerulonephropathy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

15. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Carbonic anhydrase
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Vasocxn - inc BP

16. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Kids - peripheral and periorbital edema - resolves spontaneously
Simple cysts
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Insertion of Na channel on luminal side

17. What are the effects of PTH hormone on the kidney
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
Hypovent - immediate
Passively reabsorbs water via medullary hypertonicity
Dec renal bicarb reabsorption - delayed

18. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
Poor - days to weeks
Dec - dec - dec
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

19. What is ADPKD also associated with
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Nonspecific
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

20. What is the pathway to the afferent arteriole
Chronic conditions - multiple myeloma - TB - RA
Involves glomeruli and other organs
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Renal artery - interlobar a - interlobular a

21. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
<3.5 g /day
Radiolabelled albumin
LM - nl glomeruli - EM - foot process effacement

22. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
LM - nl glomeruli - EM - foot process effacement
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Most of the bicarb - sodium - chloride - and water

23. What is the formula for secreted
Carbonic anhydrase
Small kidney - poor prognosis
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Excreted - filtered

24. What is the purpose of the JGA
To defend GFR
Men 50 to 70 - inc incidence with smoking and obesity
Solute and water are reabsorbed at the same rate
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

25. What is generated and secreted in the proximal tubule
Antifreeze - ethyelene glycol or vit C abuse
Ammonia - buffer for secreted H+
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Inhibits Na/phosphate cotransport leading to phosphate excretion

26. What is the most common renal malignancy of early childhood
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Wilms tumor (ages 2-4)
Dec - dec - dec

27. What percentage of ECF is plasma and What is interstitial volume
Chronic pyelonephritis
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Insertion of Na channel on luminal side
1/4 plasma - and 3/4 interstitial volume

28. What happens in the thin descending loop of henle
Phenacetin - smoking - aniline dyes - cyclophosphamide
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
No
Passively reabsorbs water via medullary hypertonicity

29. What is the BUN/Cr ratio in instrinsic renal ARF and why
Hyperceullular glomeruli
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
CHF - pulmonary edema - HTN
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

30. What does ADH do in the collecting tubule
Ectopic EPO - ACTH - PTHrP - prolactin
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inhibits Na/phosphate cotransport leading to phosphate excretion
Solute is reabsorbed more quickly than water

31. What is the compensatory response in metabolic alkalosis
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Hypovent - immediate
2 ways - base exchanger and between epithelial cells

32. What is is Alport's syndrome and what else do you see with it other than renal path
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Angio I to angio II and inhibits bradykinin
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

33. waxy casts ddx
Medullary cystic disease
Needs to be bilateral
Advanced renal dz - CRF
NKCC

34. What happens to pH - PCO2 and bicarb in metabolic acidosis
Dec - dec - dec
Metabolic acidosis
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute tubular necrosis

35. What is hartnup's disease
Inc renal bicarb resabsoprtion - delayed
White cell casts
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
NKCC

36. What effect does afferent arteriole cxn have on RPF - GFR and FF
Dec - dec - NC
Dec - inc - inc
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

37. What is the ddx for respiratory acidosis
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Triglycerides
Membranoproliferative glomerulonephritis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

38. What is the effect of of PTH on the distal convoluted tubule
Inc Ca/Na exchange to inc Ca reabsoprtion
NC - dec - dec
Thromboembolism and inc risk of infection
Huge palpable flank mass and hematuria

39. What is the ddx for a respiratory alkalosis
Invades IVC and spreads hematogenously
Intra = HIKIN!
Segmental sclerosis and hylanosis
Hypervent - early high altitude - aspirin ingestion early

40. What are the associations with RTA type 4
Solute is reabsorbed less quickly than water or net secretion of substance
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

41. What is the formula for filtration fraction
Metabolic acidosis
GFR/RPF
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
2 ways - base exchanger and between epithelial cells

42. What effect does inc plasma protein concentration have on RPF - GFR - and FF
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
NC - dec - dec
Huge palpable flank mass and hematuria
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

43. In renal failure - what happens to potassium
Hyperkalemia
Hypovent - immediate
Medullary cystic disease
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

44. Why is the left kidney taken during living donor transplantation
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
It has a longer renal vein
Renal tubular cells - polygonal clear cells
Beta 1

45. What are the effects of AT II on vascular smooth muscle
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
2 ways - base exchanger and between epithelial cells
Vasocxn - inc BP
No

46. What is the BUN/Cr ratio in prerenal azotemia and why?
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
ADPKD
Few glomeruli
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

47. proliferative
Excreted - filtered
Hyperceullular glomeruli
RPF/(1- Hct)
Acute - ATN - or chronic - HTN - DM

48. What happens to the urine in the descending limb
2 ways - base exchanger and between epithelial cells
Invades IVC and spreads hematogenously
Becomes concentrated and hypertonic
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

49. What do you see on LM for focal segmental glomerulosclerosis
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Amyloidosis
Modified smooth muscle of afferent arteriole - secrete renin
Segmental sclerosis and hylanosis

50. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
ADPKD
Principal cells and intercalated cells
Hypokalemia - risk for Ca containing kidney stones
Hydronephrosis and pyelonephritis

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Renal

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