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Renal

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Answer 50 questions in 15 minutes.
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1. What effect does ANP have on GFR
Inc
Membranoproliferative glomerulonephritis
Hyperkalemia
Inhibits Na/phosphate cotransport leading to phosphate excretion

2. What is the compensatory response in metabolic acidosis
Hypervent - immediate
Small kidney - poor prognosis
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Ammonia - buffer for secreted H+

3. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
Na
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

4. What dyslipidemia is most common in renal failure
NC - dec - dec
RTA type 2 (proximal)
Triglycerides
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

5. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
White cell casts
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
No

6. Who often has diffuse proliferative GN
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Kids - peripheral and periorbital edema - resolves spontaneously
Huge palpable flank mass and hematuria

7. What percentage of ECF is plasma and What is interstitial volume
NKCC
Involves glomeruli and other organs
Type II - C3 nephritic factor
1/4 plasma - and 3/4 interstitial volume

8. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
RTA type 4 (hyperkalemic)
Nephritic syndrome
Vasocxn - inc BP
Men 50 to 70 - inc incidence with smoking and obesity

9. What is the ddx for a metabolic acidosis with an inc anion gap
Carbonic anhydrase
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

10. What is the effect of of PTH on the distal convoluted tubule
To defend GFR
RTA type 2 (proximal)
Inc Ca/Na exchange to inc Ca reabsoprtion
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

11. How does RCC spread
Invades IVC and spreads hematogenously
RPF/(1- Hct)
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Diuretics - vomiting - antacid - hyperaldosteronism

12. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Makes urine less concentrated - impermeable to H20
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Negative charge

13. What is the formula for clearance of a substance per unit time
Hypokalemia and hypophosphatemic rickets
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

14. What effect does afferent arteriole cxn have on RPF - GFR and FF
NC - dec - dec
Liver
Dec - dec - NC
Dec - dec - dec

15. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Nephrotic syndrome
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

16. What is the effect of PTH on the proximal tubule
Solute and water are reabsorbed at the same rate
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Inhibits Na/phosphate cotransport leading to phosphate excretion
Under and under

17. How do you interpret creatinine clearance
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

18. What is the henderson hasselbalch equation
Acute - ATN - or chronic - HTN - DM
Passively reabsorbs water via medullary hypertonicity
Inc - inc - inc
PH = pKa + log bicarb/0.03PCO2

19. Which cells sense decreases in Na delivery
Macula densa
RTA type 2 (proximal)
Failure of EPO
Involves glomeruli and other organs

20. What are the main complications of kidney stones
Negative charge
Hypovent - immediate
Hydronephrosis and pyelonephritis
Under and under

21. dense deposits on EM - type and association
2 ways - base exchanger and between epithelial cells
Dialysis cysts
Type II - C3 nephritic factor
UTI or acute gastroenteritis

22. What substance is secreted in response increase atrial pressure
Small kidney - poor prognosis
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Chronic conditions - multiple myeloma - TB - RA
ANP

23. What is the formula for renal blood flow
RTA type 1 (distal)
RPF/(1- Hct)
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Phenacetin - smoking - aniline dyes - cyclophosphamide

24. What is the compensatory response in respiratory alkalosis
Dec renal bicarb reabsorption - delayed
Excreted - filtered
Cx<GFR
Inc in Ca and PO4 absoprtion from the gut

25. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Wilms tumor (ages 2-4)
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Proximal tubule - na/glucose co transporter

26. What is is Alport's syndrome and what else do you see with it other than renal path
V x Urine concentration
Bladder cancer
60% total body water - 40% ICF - 20% ECF
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

27. In who is RCC most comon
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inhibits Na/phosphate cotransport leading to phosphate excretion
Men 50 to 70 - inc incidence with smoking and obesity
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

28. Where is angiotensinogen made
Amyloidosis
Acute - ATN - or chronic - HTN - DM
Liver
Renal artery - interlobar a - interlobular a

29. How does RCC manifest clinically
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
EPO - endothelial cells of peritubular capillaries
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

30. The fenestrated capillary endothelium constitutes what portion of the barrier
Intra = HIKIN!
Size
Cx>GFR
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

31. What is the BUN/Cr ratio in prerenal azotemia and why?
By 10%
Inc GFR and mesangial expansion
Insertion of Na channel on luminal side
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

32. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Eosinphilic casts in tubules
Poor - days to weeks

33. waxy casts ddx
Angio I to angio II and inhibits bradykinin
Advanced renal dz - CRF
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

34. What is the 60-40-20 rule of body weight
Transitional cell carcinoma
Polycystic liver disease - berry aneurysms - mitral valve prolapse
PH = pKa + log bicarb/0.03PCO2
60% total body water - 40% ICF - 20% ECF

35. By what percentage does EPRF underestimage true RPF
By 10%
Principal cells and intercalated cells
Liver
Hyperkalemia

36. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
NKCC
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Inc GFR and mesangial expansion

37. How can NSAIDs cause acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Renal artery - interlobar a - interlobular a
HIV
Vasa recta - interlobular v - interlobar v - renal v

38. What is the genetic etiology of wilms tumor and What is WAGR complex
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
PH = pKa + log bicarb/0.03PCO2
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

39. In renal failure What acid - base disturbance is most likely
Metabolic acidosis
Hydronephrosis and pyelonephritis
Dec - dec - NC
RTA type 1 (distal)

40. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
<3.5 g /day

41. What is the compensatory response in respiratory acidosis
Needs to be bilateral
EPO - endothelial cells of peritubular capillaries
Acute tubular necrosis
Inc renal bicarb resabsoprtion - delayed

42. Defect in collecting ducts ability to excrete H+
1/4 plasma - and 3/4 interstitial volume
RTA type 1 (distal)
Freely filtered and neither absorbed or secreted
Triglycerides

43. Where does renal cell carcinoma originate and What do the cells look like
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Renal tubular cells - polygonal clear cells
Inc - dec - dec

44. When is TF/P <1
Solute is reabsorbed more quickly than water
Inc in concentration - not amout - due to water reabsorption
Liver
Complications of chronic kidney disease or HTN

45. 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
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
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

46. What are the main causes of membranous GN
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Antifreeze - ethyelene glycol or vit C abuse

47. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
By 10%
Angio I to angio II and inhibits bradykinin
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Modified smooth muscle of afferent arteriole - secrete renin

48. What happens to tubular inulin along the proximal tubule and why
PH = pKa + log bicarb/0.03PCO2
White cell casts
Inc in concentration - not amout - due to water reabsorption
Intra = HIKIN!

49. What is the formula for excretion rate
V x Urine concentration
Size
Type II - C3 nephritic factor
Von hippel laundau and gene deletion in chromosome 3

50. What do you see on LM and IF with rapidly progressive GN
<3.5 g /day
Crescent - moon shape
Dec - dec - NC
ADPKD

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Renal

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