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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Beta 1
ADPKD
Na
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
2. What does aldosterone do in the collecting tubule
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Insertion of Na channel on luminal side
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
3. What is the effect of AT II on GFR - FF and Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Vasa recta - interlobular v - interlobar v - renal v
Ammonia - buffer for secreted H+
NC - dec - dec
4. How does Wilms tumor present
White cell casts
Medullary cystic disease
Cx<GFR
Huge palpable flank mass and hematuria
5. What is the formula for the filtered load
NC - inc - inc
GFR x plasma concentration
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
6. When is TF/P ratio > 1
Dialysis cysts
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Solute is reabsorbed less quickly than water or net secretion of substance
RTA type 1 (distal)
7. In a metabolic acidosis What additional calculation is necessary and How do you make it
Hypovent - immediate
Anion gap = na - (Cl + bicarb)
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
8. What is the effect of of PTH on the distal convoluted tubule
Involves glomeruli and other organs
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Inc Ca/Na exchange to inc Ca reabsoprtion
Cx>GFR
9. How does RCC spread
CHF - pulmonary edema - HTN
Invades IVC and spreads hematogenously
Von hippel laundau and gene deletion in chromosome 3
Cx<GFR
10. What are the main causes of membranous GN
NC - inc - inc
No
Na and volume loss
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
11. What is ADPKD also associated with
Stimulates thirst
Under and under
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Needs to be bilateral
12. What substance is secreted in response increase atrial pressure
NC - dec - dec
Radiopaque
Men 50 to 70 - inc incidence with smoking and obesity
ANP
13. What is the least common kidney stone - What causes it and How do you treat it
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Men 50 to 70 - inc incidence with smoking and obesity
PH - then PC02
14. What are the effects of PTH hormone on the kidney
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Dialysis cysts
NC - dec - dec
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
15. What is the ddx for a respiratory alkalosis
Inc plasma osm - dec blood volume
Hypervent - early high altitude - aspirin ingestion early
RTA type 1 (distal)
Inc
16. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
ADPKD
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Liver
17. What effect does dec plasma protein concentration have on RPF - GFR - and FF
NC - inc - inc
Poor - days to weeks
Ectopic EPO - ACTH - PTHrP - prolactin
Acute renal failure
18. in TCC - What does painelss hematuria suggest
Bladder cancer
Dec - inc - inc
20 percent
Diabetic glomerulonephropathy
19. hypoaldosteronism or lack of collecting tubule response to aldosteron
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Modified smooth muscle of afferent arteriole - secrete renin
RTA type 4 (hyperkalemic)
Actively reabsorbs NaCl - diluting - makes urine hypotonic
20. What are the associations with RTA type 2
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Contrict leading to inc FF - preserver renal GFR in low volume states
Hypokalemia and hypophosphatemic rickets
Passively reabsorbs water via medullary hypertonicity
21. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Transitional cell carcinoma
22. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Segmental sclerosis and hylanosis
Nephrotic syndrome
23. acute generalized cortical infarction of both kidneys - dz - causes and associations
Na
Needs to be bilateral
NC - dec - dec
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
24. What do you see on LM and IF with rapidly progressive GN
Size
2 ways - base exchanger and between epithelial cells
Crescent - moon shape
Antifreeze - ethyelene glycol or vit C abuse
25. What is lost in nephrotic syndrome resulting what urine and serum changes
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
PH - then PC02
Diuretics - vomiting - antacid - hyperaldosteronism
26. In who is RCC most comon
Under and under
Men 50 to 70 - inc incidence with smoking and obesity
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Dec renal bicarb reabsorption - delayed
27. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
JG cells
RTA type 2 (proximal)
ANP
28. What is the 60-40-20 rule of body weight
60% total body water - 40% ICF - 20% ECF
Cx = GFR
GFR x plasma concentration
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
29. What change (lack of) is common in children with renal failure
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
Most of the bicarb - sodium - chloride - and water
Kids - peripheral and periorbital edema - resolves spontaneously
Growth retardation and developmental delay
30. What effect does afferent arteriole cxn have on RPF - GFR and FF
Few glomeruli
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Nonspecific
Dec - dec - NC
31. in acute cystitis with pyuria - do you see casts
Hypokalemia and hypophosphatemic rickets
Size and charge
Chronic pyelonephritis
No
32. What is the net effect of ANP
Kids - peripheral and periorbital edema - resolves spontaneously
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Na and volume loss
RTA type 1 (distal)
33. What are the associations with RTA type 4
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Inc
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
34. What does renin do
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Anion gap = na - (Cl + bicarb)
Rxn from angiotensinogen to angiontensin I
60% total body water - 40% ICF - 20% ECF
35. What is winter's formula and when do you use it
No
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Metabolic acidosis
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
36. membranous
Thickening of glomerular BM
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
37. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
160-200 - 350
Insertion of Na channel on luminal side
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
38. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Simple cysts
Diarrhea - glue - RTA - hyperchloremia
Chronic pyelonephritis
Contrict leading to inc FF - preserver renal GFR in low volume states
39. What can cause oxalate crystals
Needs to be bilateral
Antifreeze - ethyelene glycol or vit C abuse
NC - dec - dec
Triglycerides
40. dense deposits on EM - type and association
Type II - C3 nephritic factor
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Cx = GFR
By 10%
41. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Reabsorb Na in exchange for secreting K and H
JG cells
42. What cells create the epithelial layer of the glomerular filtration barrier
Small kidney - poor prognosis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Podocytes foot processes
Rxn from angiotensinogen to angiontensin I
43. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
RPF/(1- Hct)
44. Why does Na conc nearly match Osm
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
Na reabsorption drives H20 reabsorption
Vasocxn - inc BP
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
45. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Carbonic anhydrase
Renal artery - interlobar a - interlobular a
Principal cells and intercalated cells
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
46. How can NSAIDs cause acute renal failure
Acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Poor - days to weeks
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
47. hyaline casts ddx
Corticosteroids
Freely filtered and neither absorbed or secreted
Dec - inc - inc
Nonspecific
48. Who often has diffuse proliferative GN
Complications of chronic kidney disease or HTN
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Modified smooth muscle of afferent arteriole - secrete renin
49. What is the pathway from the efferent arteriorle to the renal v
Chronic conditions - multiple myeloma - TB - RA
Inc GFR and mesangial expansion
Vasa recta - interlobular v - interlobar v - renal v
Dec - inc - dec
50. RBC casts - ddx
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Polycystic liver disease - berry aneurysms - mitral valve prolapse