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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 ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Hypokalemia - risk for Ca containing kidney stones
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

2. What is is Alport's syndrome and what else do you see with it other than renal path
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dec - dec - dec
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Men 50 to 70 - inc incidence with smoking and obesity

3. What effect does efferent arteriole cxn have on RPF - GFR and FF
Size and charge
Dec - inc - inc
Size
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

4. What does US show with medullary cystic disease
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Angio I to angio II and inhibits bradykinin
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Small kidney - poor prognosis

5. What is the second most common kidney stone
Ectopic EPO - ACTH - PTHrP - prolactin
Dec - inc - inc
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

6. In renal failure What acid - base disturbance is most likely
Diarrhea - glue - RTA - hyperchloremia
Renal in origin
Anion gap = na - (Cl + bicarb)
Metabolic acidosis

7. TCC is associated with problems in your Pee SAC - ??
Amyloidosis
Ectopic EPO - ACTH - PTHrP - prolactin
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Phenacetin - smoking - aniline dyes - cyclophosphamide

8. Which cells sense decreases in Na delivery
Transitional cell carcinoma
Huge palpable flank mass and hematuria
Macula densa
Inc GFR and mesangial expansion

9. What happens to urine in the ascending limb
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Crescent - moon shape
Growth retardation and developmental delay
Makes urine less concentrated - impermeable to H20

10. What is the BUN/Cr ratio in instrinsic renal ARF and why
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
NKCC
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Anion gap = na - (Cl + bicarb)

11. What therapy does miminal change respond to...
Type II - C3 nephritic factor
Corticosteroids
Segmental sclerosis and hylanosis
Staghorn calculi - worsened by alkaluria

12. In a metabolic acidosis What additional calculation is necessary and How do you make it
Inc plasma osm - dec blood volume
Metabolic acidosis
Hypovent - immediate
Anion gap = na - (Cl + bicarb)

13. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
2 ways - base exchanger and between epithelial cells
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Segmental sclerosis and hylanosis
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

14. What substance is secreted in response increase atrial pressure
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
Chronic conditions - multiple myeloma - TB - RA
ANP
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

15. What is the least common kidney stone - What causes it and How do you treat it
Failure of EPO
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Involves glomeruli and other organs
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

16. What is the purpose of the JGA
Acute - ATN - or chronic - HTN - DM
Phenacetin - smoking - aniline dyes - cyclophosphamide
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
To defend GFR

17. secondary glomerular dz
Acute renal failure
Involves glomeruli and other organs
Radiolabelled albumin
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

18. hyaline casts ddx
RTA type 4 (hyperkalemic)
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Nonspecific
NC - dec - dec

19. When is TF/P = 1
Solute and water are reabsorbed at the same rate
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Freely filtered and neither absorbed or secreted
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

20. What is the algorithim for acidosis/alkalosis
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
PH - then PC02
Dec - dec - dec
Failure of EPO

21. In who is RCC most comon
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Complications of chronic kidney disease or HTN
Men 50 to 70 - inc incidence with smoking and obesity
Ectopic EPO - ACTH - PTHrP - prolactin

22. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
1alpha hydroxylase - PTH stimulates it
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Intra = HIKIN!
Type II - C3 nephritic factor

23. What are the LM and EM of minimal change disease
Antifreeze - ethyelene glycol or vit C abuse
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Radiolabelled albumin
LM - nl glomeruli - EM - foot process effacement

24. In what clinical context does Berger's disease often present
Makes urine less concentrated - impermeable to H20
UTI or acute gastroenteritis
Radiolabelled albumin
Amyloidosis

25. What are the 3 transporters of the intercalated cells
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Diuretics - vomiting - antacid - hyperaldosteronism
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

26. Defect in proximal tubule HCO3 reabsorption
Men 50 to 70 - inc incidence with smoking and obesity
RTA type 2 (proximal)
Angio I to angio II and inhibits bradykinin
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

27. What does ADH do in the collecting tubule
Solute is reabsorbed less quickly than water or net secretion of substance
Insertion of Na channel on luminal side
Wilms tumor (ages 2-4)
Acts on V2 receptors leading to insertion of aquaporins on luminal side

28. Where is angiotensinogen made
Triglycerides
Liver
Complications of chronic kidney disease or HTN
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

29. cortical and medullary cysts resulting from long standing dialysis
Eosinphilic casts in tubules
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
No
Dialysis cysts

30. What is the compensatory response in respiratory acidosis
Modified smooth muscle of afferent arteriole - secrete renin
Complications of chronic kidney disease or HTN
Inc renal bicarb resabsoprtion - delayed
Advanced renal dz - CRF

31. What is the net effect of ANP
ADPKD
Inc Ca/Na exchange to inc Ca reabsoprtion
Na and volume loss
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

32. What is the formula for renal blood flow
RPF/(1- Hct)
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Renal tubular cells - polygonal clear cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

33. WBC casts - ddx
Vasocxn - inc BP
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Anion gap = na - (Cl + bicarb)
Proximal tubule - na/glucose co transporter

34. What is the ddx for a respiratory alkalosis
Hypervent - early high altitude - aspirin ingestion early
By 10%
Liver
Diuretics - vomiting - antacid - hyperaldosteronism

35. What happens in the collecting tubules
Becomes concentrated and hypertonic
Reabsorb Na in exchange for secreting K and H
Men 50 to 70 - inc incidence with smoking and obesity
Excreted - filtered

36. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Dec - dec - dec
Acute renal failure

37. What is winter's formula and when do you use it
Hyperceullular glomeruli
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Becomes concentrated and hypertonic
RTA type 4 (hyperkalemic)

38. What two cells make up the JGA
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Intra = HIKIN!
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Macula densa and JG cells

39. What happens in the early distal convoluted tubule and What does that do to the urine
Na reabsorption drives H20 reabsorption
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Rxn from angiotensinogen to angiontensin I
Eosinphilic casts in tubules

40. tram track appearance on EM - typ - path - and associated dz
Kids - peripheral and periorbital edema - resolves spontaneously
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Becomes concentrated and hypertonic

41. coarse - asymmetric - corticomedullary scarring and blunted calyx
Failure of EPO
Beta 1
Chronic pyelonephritis
Ectopic EPO - ACTH - PTHrP - prolactin

42. inc in creatinine and BUN over a period of several days
Acute renal failure
Nephrotic syndrome
Failure of EPO
Stimulates thirst

43. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Most of the bicarb - sodium - chloride - and water
GFR/RPF
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

44. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Hyperkalemia
NC - dec - dec
Negative charge
160-200 - 350

45. What are JG cells and what substance do they secrete
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Under and under
Modified smooth muscle of afferent arteriole - secrete renin

46. In what disease in FSGS the most common glomerular disease
Actively reabsorbs NaCl - diluting - makes urine hypotonic
No
HIV
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

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

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48. Focal
Few glomeruli
Inc - inc - inc
No
Size

49. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Nephritic syndrome
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Intra = HIKIN!

50. What do you see on LM for focal segmental glomerulosclerosis
Inc in concentration - not amout - due to water reabsorption
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
V x Urine concentration
Segmental sclerosis and hylanosis