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Renal

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1. waxy casts ddx
Advanced renal dz - CRF
Renal tubular cells - polygonal clear cells
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

2. What is the effect of AT II on the posterior pituitary
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Macula densa
60% total body water - 40% ICF - 20% ECF
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

3. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Solute is reabsorbed less quickly than water or net secretion of substance
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

4. What is the effect of aldosterone in principal cells
Radiolabelled albumin
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Principal cells and intercalated cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

5. What is the effect of PTH on the proximal tubule
Hypokalemia and hypophosphatemic rickets
Intra = HIKIN!
Inc GFR and mesangial expansion
Inhibits Na/phosphate cotransport leading to phosphate excretion

6. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Macula densa
GFR/RPF
Acute pyelonephritis

7. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
ADPKD
Cx>GFR
Passively reabsorbs water via medullary hypertonicity

8. What effect does cxn of the ureter have on RPF - GFR and FF
Stimulates thirst
NC - dec - dec
<3.5 g /day
Nonspecific

9. What does thyroidization of the kidney result in
1/4 plasma - and 3/4 interstitial volume
EPO - endothelial cells of peritubular capillaries
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Eosinphilic casts in tubules

10. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
RTA type 1 (distal)
Growth retardation and developmental delay
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

11. What is the formula for reabsorption
Inc in Ca and PO4 absoprtion from the gut
Filtered - secreted
Complications of chronic kidney disease or HTN
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

12. What are the effects of AT II on the adrenal gland
Most of the bicarb - sodium - chloride - and water
Size and charge
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Dec - inc - dec

13. How does RCC manifest clinically
Dec - inc - dec
Cx>GFR
Inc GFR and mesangial expansion
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

14. In renal failure - what happens to potassium
Hypokalemia and hypophosphatemic rickets
NC - inc - inc
Hyperkalemia
Cx<GFR

15. When is TF/P = 1
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
ADPKD
Hypokalemia and hypophosphatemic rickets
Solute and water are reabsorbed at the same rate

16. What does renin do
NC - dec - dec
Makes urine less concentrated - impermeable to H20
Rxn from angiotensinogen to angiontensin I
Acute renal failure

17. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Freely filtered and neither absorbed or secreted
Inc - dec - dec
Growth retardation and developmental delay
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

18. granular - muddy brown casts - ddx
Liver
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Acute tubular necrosis
Failure of EPO

19. What are the two forms of renal failure and What are examples of each
Nonspecific
Rxn from angiotensinogen to angiontensin I
Hyperceullular glomeruli
Acute - ATN - or chronic - HTN - DM

20. tram track appearance on EM - typ - path - and associated dz
Needs to be bilateral
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Dec - inc - inc
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

21. RBC casts - ddx
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Thickening of glomerular BM
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Nonspecific

22. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
CHF - pulmonary edema - HTN
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
RTA type 4 (hyperkalemic)

23. no net secretion or reabsorption of x
Cx = GFR
Reabsorb Na in exchange for secreting K and H
Radiolabelled albumin
RTA type 4 (hyperkalemic)

24. Under what circumstances is aldosterone secreted
NC - inc - inc
Triglycerides
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Radiopaque

25. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Simple cysts
Complications of chronic kidney disease or HTN
Hyperkalemia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

26. How do the ureters course in relation to the uterine artery and ductus deferens
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Under and under
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

27. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
EPO - endothelial cells of peritubular capillaries
Becomes concentrated and hypertonic
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Amyloidosis

28. Where is ACE made and What are 2 of its fxns
Angio I to angio II and inhibits bradykinin
Size and charge
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
RTA type 2 (proximal)

29. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inhibits Na/phosphate cotransport leading to phosphate excretion
Dialysis cysts
Proximal tubule - na/glucose co transporter

30. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Acute renal failure
NC - inc - inc

31. What is the purpose of the JGA
Radiolabelled albumin
Vasocxn - inc BP
To defend GFR
Ectopic EPO - ACTH - PTHrP - prolactin

32. What happens to the urine in the descending limb
Segmental sclerosis and hylanosis
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Dec - inc - dec
Becomes concentrated and hypertonic

33. What is the second most common kidney stone
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Hypokalemia and hypophosphatemic rickets
Failure of EPO

34. What is ADPKD also associated with
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Simple cysts
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Staghorn calculi - worsened by alkaluria

35. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Involves only glomeruli
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Complications of chronic kidney disease or HTN
Dec - inc - inc

36. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Most of the bicarb - sodium - chloride - and water
White cell casts
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Ammonia - buffer for secreted H+

37. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Reabsorb Na in exchange for secreting K and H
Acute pyelonephritis
Hypokalemia - risk for Ca containing kidney stones
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

38. Where does renal cell carcinoma originate and What do the cells look like
Inc plasma osm - dec blood volume
Eosinphilic casts in tubules
Inc
Renal tubular cells - polygonal clear cells

39. What happens in the thin descending loop of henle
Hyperceullular glomeruli
Passively reabsorbs water via medullary hypertonicity
Huge palpable flank mass and hematuria
Rxn from angiotensinogen to angiontensin I

40. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
JG cells
Transitional cell carcinoma
1alpha hydroxylase - PTH stimulates it
Hypokalemia - risk for Ca containing kidney stones

41. What is the ddx for respiratory acidosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Ectopic EPO - ACTH - PTHrP - prolactin
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

42. What do you see on LM for focal segmental glomerulosclerosis
Crescent - moon shape
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Segmental sclerosis and hylanosis
Size

43. How What does the glomerular filtration barrier distinguish by
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Size and charge
It has a longer renal vein

44. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - inc
Principal cells and intercalated cells
Inc - inc - inc
Dec - inc - dec

45. What are the associations with nephrotic syndrome
Hydronephrosis and pyelonephritis
Thromboembolism and inc risk of infection
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Size and charge

46. What is the formula for clearance of a substance per unit time
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
160-200 - 350
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

47. How is extracellular volume measured
Hyperkalemia
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inulin
Inc plasma osm - dec blood volume

48. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Under and under
Carbonic anhydrase
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

49. What is the formula for the filtered load
RTA type 1 (distal)
Proximal tubule - na/glucose co transporter
GFR x plasma concentration
Principal cells and intercalated cells

50. What is the pathway from the efferent arteriorle to the renal v
Macula densa and JG cells
Complications of chronic kidney disease or HTN
Vasa recta - interlobular v - interlobar v - renal v
Renal in origin

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Renal

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