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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. Where is ACE made and What are 2 of its fxns
Becomes concentrated and hypertonic
Angio I to angio II and inhibits bradykinin
Men 50 to 70 - inc incidence with smoking and obesity
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

2. What is winter's formula and when do you use it
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
NKCC
Ammonia - buffer for secreted H+
Size

3. What effect does afferent arteriole cxn have on RPF - GFR and FF
Few glomeruli
Dec - dec - NC
NC - inc - inc
Makes urine less concentrated - impermeable to H20

4. What is the formula for excretion rate
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Chronic pyelonephritis
V x Urine concentration
Growth retardation and developmental delay

5. In renal failure with uremia - What are the 5 aspects of uremia
Involves glomeruli and other organs
It has a longer renal vein
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Podocytes foot processes

6. RBC casts - ddx
Size
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

7. What is the formula for secreted
Excreted - filtered
Insertion of Na channel on luminal side
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
To defend GFR

8. diffuse
Acute tubular necrosis
Vasocxn - inc BP
All glomeruli
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

9. What effect does ANP have on Na in the kidney
Inc GFR and mesangial expansion
Excreted - filtered
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Dec - inc - dec

10. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Anion gap = na - (Cl + bicarb)
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
NC - dec - dec
Radiopaque

11. What does thyroidization of the kidney result in
Principal cells and intercalated cells
Rxn from angiotensinogen to angiontensin I
Eosinphilic casts in tubules
Wilms tumor (ages 2-4)

12. membranous
Intra = HIKIN!
Thickening of glomerular BM
To defend GFR
Chronic pyelonephritis

13. What 3 things stimulate the release of renin - and Where is it released from
Renal artery - interlobar a - interlobular a
Stimulates thirst
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Cx = GFR

14. Where is potassium conc. Highest? Intra or extra
Intra = HIKIN!
Involves glomeruli and other organs
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Dec renal bicarb reabsorption - delayed

15. What is the algorithim for acidosis/alkalosis
Principal cells and intercalated cells
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
PH - then PC02
Stimulates thirst

16. What are the effects of PTH hormone on the kidney
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Nonspecific
Renal tubular cells - polygonal clear cells
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

17. What is the ddx for a metabolic acidosis with an inc anion gap
Hypokalemia - risk for Ca containing kidney stones
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
No

18. What does LM - EM - IF show in diffuse proliferative GN
Complications of chronic kidney disease or HTN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
HIV
Dec - dec - NC

19. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Inc Ca/Na exchange to inc Ca reabsoprtion
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Radiolabelled albumin

20. Why is there anemia in renal failure
Passively reabsorbs water via medullary hypertonicity
Failure of EPO
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Growth retardation and developmental delay

21. How do calcium stones appear on x ray
Corticosteroids
20 percent
Radiopaque
Na and volume loss

22. What cells create the epithelial layer of the glomerular filtration barrier
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Amyloidosis
Na
Podocytes foot processes

23. How is plasma volume measured
Antifreeze - ethyelene glycol or vit C abuse
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Freely filtered and neither absorbed or secreted
Radiolabelled albumin

24. When is TF/P ratio > 1
Transitional cell carcinoma
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
V x Urine concentration
Solute is reabsorbed less quickly than water or net secretion of substance

25. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
No
Anion gap = na - (Cl + bicarb)

26. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Dec - dec - dec
Growth retardation and developmental delay
Inhibits Na/phosphate cotransport leading to phosphate excretion

27. What is the prognosis of RPGN
Na and volume loss
Poor - days to weeks
Size
RPF/(1- Hct)

28. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
PH - then PC02
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Men 50 to 70 - inc incidence with smoking and obesity
Hydronephrosis and pyelonephritis

29. Which cells sense decreases in BP
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
JG cells
Hypervent - immediate
NC - dec - dec

30. How are amino acids reabsorbed
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Hyperkalemia
Hydronephrosis and pyelonephritis

31. What are the associated paraneoplastic syndromes wth RCC
Ectopic EPO - ACTH - PTHrP - prolactin
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Inulin

32. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Complications of chronic kidney disease or HTN
Ammonia - buffer for secreted H+
Diarrhea - glue - RTA - hyperchloremia
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

33. What do casts indicated about hematuria/pyuria
RTA type 2 (proximal)
Type II - C3 nephritic factor
NC - inc - inc
Renal in origin

34. What does aldosterone do in the collecting tubule
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Insertion of Na channel on luminal side
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Radiopaque

35. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
HIV
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
NKCC

36. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
160-200 - 350
Radiopaque
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
ANP

37. no net secretion or reabsorption of x
1alpha hydroxylase - PTH stimulates it
Insertion of Na channel on luminal side
Cx = GFR
Inulin

38. What happens to tubular inulin along the proximal tubule and why
Antifreeze - ethyelene glycol or vit C abuse
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Huge palpable flank mass and hematuria
Inc in concentration - not amout - due to water reabsorption

39. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
Dec renal bicarb reabsorption - delayed
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Complications of chronic kidney disease or HTN

40. Focal
1/4 plasma - and 3/4 interstitial volume
It has a longer renal vein
Few glomeruli
Na

41. What effect does ANP have on GFR
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Huge palpable flank mass and hematuria
Inc
Dec - dec - NC

42. What does ADH do in the collecting tubule
Men 50 to 70 - inc incidence with smoking and obesity
Acts on V2 receptors leading to insertion of aquaporins on luminal side
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Acute renal failure

43. What is the compensatory response in respiratory alkalosis
Dec renal bicarb reabsorption - delayed
Medullary cystic disease
20 percent
It has a longer renal vein

44. in TCC - What does painelss hematuria suggest
Hypervent - early high altitude - aspirin ingestion early
Bladder cancer
Rxn from angiotensinogen to angiontensin I
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

45. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Beta 1
60% total body water - 40% ICF - 20% ECF
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
EPO - endothelial cells of peritubular capillaries

46. What happens in the collecting tubules
Crescent - moon shape
Intra = HIKIN!
Reabsorb Na in exchange for secreting K and H
Polycystic liver disease - berry aneurysms - mitral valve prolapse

47. In what disease in FSGS the most common glomerular disease
Hypokalemia and hypophosphatemic rickets
JG cells
HIV
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

48. cortical and medullary cysts resulting from long standing dialysis
V x Urine concentration
RPF/(1- Hct)
Dialysis cysts
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

49. What effect does efferent arteriole cxn have on RPF - GFR and FF
Dec - inc - inc
Inulin
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Chronic conditions - multiple myeloma - TB - RA

50. What are JG cells and what substance do they secrete
Diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Modified smooth muscle of afferent arteriole - secrete renin
HIV