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Renal

Instructions:

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 is the net effect of PTH
Growth retardation and developmental delay
Inc in Ca and PO4 absoprtion from the gut
Most of the bicarb - sodium - chloride - and water
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

2. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Dec - dec - NC
Freely filtered and neither absorbed or secreted
NKCC
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

3. What is the most frequent kind of kidney stone and What are causes that lead to it
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Rxn from angiotensinogen to angiontensin I
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

4. What is the ddx for a metabolic acidosis with an inc anion gap
Anion gap = na - (Cl + bicarb)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Cx<GFR
Dec - dec - NC

5. What is the compensatory response in metabolic alkalosis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Principal cells and intercalated cells
Hypovent - immediate

6. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
It has a longer renal vein
Inc - dec - dec

7. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Inhibits Na/phosphate cotransport leading to phosphate excretion
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Bladder cancer

8. What effect does dec plasma protein concentration have on RPF - GFR - and FF
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
NC - inc - inc
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Macula densa and JG cells

9. Congo - red stain - apple green birefringence
Solute is reabsorbed less quickly than water or net secretion of substance
Hydronephrosis and pyelonephritis
Beta 1
Amyloidosis

10. What is the pathway from the efferent arteriorle to the renal v
Makes urine less concentrated - impermeable to H20
Vasa recta - interlobular v - interlobar v - renal v
Filtered - secreted
GFR/RPF

11. What is the algorithim for acidosis/alkalosis
Liver
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
PH - then PC02
NKCC

12. The fenestrated capillary endothelium constitutes what portion of the barrier
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Involves glomeruli and other organs
Size
Acute tubular necrosis

13. What are the 3 transporters of the intercalated cells
NKCC
Principal cells and intercalated cells
Diuretics - vomiting - antacid - hyperaldosteronism
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

14. do you see casts in bladder cancer - kidney stones with hematuria
No
Rxn from angiotensinogen to angiontensin I
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Passively reabsorbs water via medullary hypertonicity

15. What circumstances causes ADH secretion
Huge palpable flank mass and hematuria
Inc plasma osm - dec blood volume
Poor - days to weeks
Most of the bicarb - sodium - chloride - and water

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

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17. Where is ACE made and What are 2 of its fxns
Wilms tumor (ages 2-4)
Angio I to angio II and inhibits bradykinin
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

18. What 3 disease can lead to RPGN
ANP
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
2 ways - base exchanger and between epithelial cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

19. How is plasma volume measured
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Vasocxn - inc BP
Reabsorb Na in exchange for secreting K and H
Radiolabelled albumin

20. What are the main causes of membranous GN
Hyperceullular glomeruli
Excreted - filtered
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Acts on V2 receptors leading to insertion of aquaporins on luminal side

21. acute generalized cortical infarction of both kidneys - dz - causes and associations
Needs to be bilateral
White cell casts
Small kidney - poor prognosis
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

22. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Diarrhea - glue - RTA - hyperchloremia
RTA type 2 (proximal)
Acute tubular necrosis

23. What are the two forms of renal failure and What are examples of each
Acute - ATN - or chronic - HTN - DM
Liver
JG cells
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

24. waxy casts ddx
No
Hypovent - immediate
Advanced renal dz - CRF
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

25. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Na reabsorption drives H20 reabsorption
RTA type 4 (hyperkalemic)
Dec - inc - dec
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

26. What does the crescent moon shape consist of in RPGN
Hydronephrosis and pyelonephritis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Poor - days to weeks
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

27. tram track appearance on EM - typ - path - and associated dz
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

28. What effect does cxn of the ureter have on RPF - GFR and FF
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
NC - dec - dec
Transitional cell carcinoma
Acute renal failure

29. What are the LM and EM of minimal change disease
Von hippel laundau and gene deletion in chromosome 3
LM - nl glomeruli - EM - foot process effacement
Amyloidosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

30. What effect does afferent arteriole cxn have on RPF - GFR and FF
Nonspecific
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Dec - dec - NC
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

31. What does aldosterone do in the collecting tubule
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Insertion of Na channel on luminal side
Corticosteroids

32. nonenzymatic glycosylation of GBM - inc permeability and thickening
ADPKD
PH - then PC02
Diabetic glomerulonephropathy
Cx = GFR

33. Where does renal cell carcinoma originate and What do the cells look like
Inc - dec - dec
Renal tubular cells - polygonal clear cells
160-200 - 350
Most of the bicarb - sodium - chloride - and water

34. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
All glomeruli

35. RBC casts - ddx
Hypokalemia and hypophosphatemic rickets
Negative charge
Proximal tubule - na/glucose co transporter
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

36. What do you see in the urine with acute pyelonephritis
Inc renal bicarb resabsoprtion - delayed
Corticosteroids
White cell casts
GFR/RPF

37. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Corticosteroids
Huge palpable flank mass and hematuria

38. What is ADPKD also associated with
Crescent - moon shape
1alpha hydroxylase - PTH stimulates it
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Bladder cancer

39. What are the associated paraneoplastic syndromes wth RCC
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Ectopic EPO - ACTH - PTHrP - prolactin

40. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
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

41. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Acute pyelonephritis
Kids - peripheral and periorbital edema - resolves spontaneously
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

42. What is the second most common kidney stone
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Dialysis cysts
Ectopic EPO - ACTH - PTHrP - prolactin
Excreted - filtered

43. What is the net effect of AT II
Advanced renal dz - CRF
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

44. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Most of the bicarb - sodium - chloride - and water
Inc in Ca and PO4 absoprtion from the gut
PH = pKa + log bicarb/0.03PCO2

45. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Diarrhea - glue - RTA - hyperchloremia
Ectopic EPO - ACTH - PTHrP - prolactin

46. What is hartnup's disease
GFR x plasma concentration
By 10%
160-200 - 350
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

47. What cells create the epithelial layer of the glomerular filtration barrier
Inc Ca/Na exchange to inc Ca reabsoprtion
Stimulates thirst
Podocytes foot processes
Hypervent - early high altitude - aspirin ingestion early

48. When is TF/P = 1
Principal cells and intercalated cells
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Solute and water are reabsorbed at the same rate
Stimulates thirst

49. What is the compensatory response in respiratory alkalosis
Dec renal bicarb reabsorption - delayed
LM - nl glomeruli - EM - foot process effacement
Hyperceullular glomeruli
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

50. What is the formula for secreted
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Excreted - filtered
Transitional cell carcinoma
Hyperkalemia