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Renal

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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 do casts indicated about hematuria/pyuria
Carbonic anhydrase
Hypokalemia and hypophosphatemic rickets
Type II - C3 nephritic factor
Renal in origin

2. What are the main complications of kidney stones
Failure of EPO
Hydronephrosis and pyelonephritis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
1alpha hydroxylase - PTH stimulates it

3. What does LM - EM - IF show in diffuse proliferative GN
Acute tubular necrosis
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
RTA type 4 (hyperkalemic)
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

4. in acute post strep GN - What do you see on LM - EM and IF

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5. Why is there anemia in renal failure
NKCC
Anion gap = na - (Cl + bicarb)
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Failure of EPO

6. When is TF/P ratio > 1
Solute is reabsorbed less quickly than water or net secretion of substance
Radiolabelled albumin
Involves only glomeruli
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

7. What is the formula for reabsorption
Medullary cystic disease
Inc Ca/Na exchange to inc Ca reabsoprtion
To defend GFR
Filtered - secreted

8. In a metabolic acidosis What additional calculation is necessary and How do you make it
Chronic pyelonephritis
HIV
Anion gap = na - (Cl + bicarb)
Na

9. What is the BUN/Cr ratio in prerenal azotemia and why?
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Medullary cystic disease
PH = pKa + log bicarb/0.03PCO2

10. What are the effects of AT II on vascular smooth muscle
Failure of EPO
160-200 - 350
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Vasocxn - inc BP

11. Where does renal cell carcinoma originate and What do the cells look like
LM - nl glomeruli - EM - foot process effacement
Renal tubular cells - polygonal clear cells
Contrict leading to inc FF - preserver renal GFR in low volume states
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

12. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Crescent - moon shape
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

13. How are amino acids reabsorbed
Hypovent - immediate
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

14. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Renal tubular cells - polygonal clear cells
Nephritic syndrome
Nephrotic syndrome
Filtered - secreted

15. What is the net effect of AT II
Phenacetin - smoking - aniline dyes - cyclophosphamide
Hypokalemia and hypophosphatemic rickets
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
1/4 plasma - and 3/4 interstitial volume

16. What is the effect of AT II on the hypothalamus
Failure of EPO
Stimulates thirst
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Involves glomeruli and other organs

17. What two cells make up the JGA
NKCC
Macula densa and JG cells
By 10%
Hypervent - immediate

18. Why can inulin be used to calculate GFR?
1/4 plasma - and 3/4 interstitial volume
Inulin
Small kidney - poor prognosis
Freely filtered and neither absorbed or secreted

19. What is the effect of AT II on efferent arterioles
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Metabolic acidosis
ANP
Contrict leading to inc FF - preserver renal GFR in low volume states

20. What does aldosterone do in the collecting tubule
Crescent - moon shape
Wilms tumor (ages 2-4)
Staghorn calculi - worsened by alkaluria
Insertion of Na channel on luminal side

21. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Growth retardation and developmental delay

22. membranous
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Na
Thickening of glomerular BM
Inc - inc - inc

23. What is the compensatory response in metabolic acidosis
Inc - dec - dec
Needs to be bilateral
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Hypervent - immediate

24. What needs to happen for postrenal obstruction to creat ARF
NC - inc - inc
Inc in Ca and PO4 absoprtion from the gut
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Needs to be bilateral

25. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
RTA type 2 (proximal)
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

26. When is glucose reabsorbed and with What transporter
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Macula densa
Stimulates thirst
Proximal tubule - na/glucose co transporter

27. What happens to the urine in the descending limb
Cx = GFR
Becomes concentrated and hypertonic
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hyperkalemia

28. What is the formula for secreted
Excreted - filtered
Von hippel laundau and gene deletion in chromosome 3
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Thickening of glomerular BM

29. What are JG cells and what substance do they secrete
CHF - pulmonary edema - HTN
Modified smooth muscle of afferent arteriole - secrete renin
1/4 plasma - and 3/4 interstitial volume
Contrict leading to inc FF - preserver renal GFR in low volume states

30. waxy casts ddx
Advanced renal dz - CRF
Inc - dec - dec
Hypervent - immediate
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

31. What is the most frequent kind of kidney stone and What are causes that lead to it
Under and under
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal tubular cells - polygonal clear cells
GFR x plasma concentration

32. What are the associated paraneoplastic syndromes wth RCC
Radiolabelled albumin
Ectopic EPO - ACTH - PTHrP - prolactin
V x Urine concentration
Macula densa and JG cells

33. How is extracellular volume measured
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inulin
Inc in Ca and PO4 absoprtion from the gut

34. What is winter's formula and when do you use it
Amyloidosis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

35. Who often has diffuse proliferative GN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
160-200 - 350
1/4 plasma - and 3/4 interstitial volume
HIV

36. secondary glomerular dz
Involves glomeruli and other organs
Wilms tumor (ages 2-4)
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

37. By what percentage does EPRF underestimage true RPF
By 10%
Beta 1
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Needs to be bilateral

38. acute generalized cortical infarction of both kidneys - dz - causes and associations
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Transitional cell carcinoma
Inc in concentration - not amout - due to water reabsorption
Size and charge

39. do you see casts in bladder cancer - kidney stones with hematuria
Hypokalemia - risk for Ca containing kidney stones
No
Acute - ATN - or chronic - HTN - DM
Freely filtered and neither absorbed or secreted

40. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

41. What does renin do
Rxn from angiotensinogen to angiontensin I
Cx = GFR
Medullary cystic disease
Inc GFR and mesangial expansion

42. tram track appearance on EM - typ - path - and associated dz
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Macula densa
All glomeruli
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

43. no net secretion or reabsorption of x
Vasa recta - interlobular v - interlobar v - renal v
Nonspecific
Cx = GFR
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

44. proliferative
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Hypokalemia - risk for Ca containing kidney stones
Hyperceullular glomeruli
Makes urine less concentrated - impermeable to H20

45. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
ANP
Huge palpable flank mass and hematuria
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
EPO - endothelial cells of peritubular capillaries

46. Subendothelial immune complexes with granular IF
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Membranoproliferative glomerulonephritis
Contrict leading to inc FF - preserver renal GFR in low volume states

47. What therapy does miminal change respond to...
Amyloidosis
Becomes concentrated and hypertonic
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Corticosteroids

48. What are the two forms of renal failure and What are examples of each
Hyperceullular glomeruli
Na and volume loss
Acute - ATN - or chronic - HTN - DM
Involves glomeruli and other organs

49. What is the pathway to the afferent arteriole
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Renal artery - interlobar a - interlobular a
Podocytes foot processes
GFR/RPF

50. What circumstances causes ADH secretion
Vasocxn - inc BP
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inc plasma osm - dec blood volume