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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 are the effects of AT II on the adrenal gland
Solute is reabsorbed less quickly than water or net secretion of substance
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Excreted - filtered
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

2. What is the effect of PTH on the proximal tubule
Inc
Inhibits Na/phosphate cotransport leading to phosphate excretion
Renal tubular cells - polygonal clear cells
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

3. What are the associations with RTA type 4
Wilms tumor (ages 2-4)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

4. What happens to the urine in the descending limb
Growth retardation and developmental delay
Becomes concentrated and hypertonic
Acute - ATN - or chronic - HTN - DM
V x Urine concentration

5. in TCC - What does painelss hematuria suggest
Metabolic acidosis
Solute and water are reabsorbed at the same rate
Acute pyelonephritis
Bladder cancer

6. What is the formula for secreted
NC - dec - dec
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Excreted - filtered
By 10%

7. With what genetic tumor syndrome is RCC associated
Membranoproliferative glomerulonephritis
Inc GFR and mesangial expansion
Von hippel laundau and gene deletion in chromosome 3
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

8. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
Type II - C3 nephritic factor
Membranoproliferative glomerulonephritis
Renal artery - interlobar a - interlobular a

9. What is the genetic etiology of wilms tumor and What is WAGR complex
Hypokalemia and hypophosphatemic rickets
Advanced renal dz - CRF
Inc
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

10. What do patients die from ADPKD
Bladder cancer
Needs to be bilateral
Complications of chronic kidney disease or HTN
1/4 plasma - and 3/4 interstitial volume

11. Subendothelial immune complexes with granular IF
Corticosteroids
Membranoproliferative glomerulonephritis
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Dec - dec - dec

12. What happens in the thin descending loop of henle
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Dialysis cysts
Passively reabsorbs water via medullary hypertonicity

13. What is the ddx for a metabolic acidosis with an inc anion gap
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
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
Renal tubular cells - polygonal clear cells
All glomeruli

14. Where is potassium conc. Highest? Intra or extra
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal artery - interlobar a - interlobular a
PH - then PC02
Intra = HIKIN!

15. What effect does afferent arteriole cxn have on RPF - GFR and FF
Dec - dec - NC
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inc GFR and mesangial expansion
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

16. What cells create the epithelial layer of the glomerular filtration barrier
V x Urine concentration
Podocytes foot processes
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

17. What happens to pH - PCO2 and bicarb in metabolic acidosis
Size and charge
Dec - dec - dec
Solute is reabsorbed more quickly than water
ANP

18. What is the effect of AT II on the posterior pituitary
Thickening of glomerular BM
Staghorn calculi - worsened by alkaluria
Diuretics - vomiting - antacid - hyperaldosteronism
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

19. Bergers' disease - which antibody and What do you see on LM and IF
HIV
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Radiopaque
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

20. In who is RCC most comon
Angio I to angio II and inhibits bradykinin
Men 50 to 70 - inc incidence with smoking and obesity
Freely filtered and neither absorbed or secreted
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

21. What is the ddx for respiratory acidosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
White cell casts
Needs to be bilateral
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

22. How can NSAIDs cause acute renal failure
Hypovent - immediate
Macula densa
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

23. What is a normal filtration fraction
Vasa recta - interlobular v - interlobar v - renal v
Staghorn calculi - worsened by alkaluria
20 percent
Needs to be bilateral

24. What are the associated paraneoplastic syndromes wth RCC
Renal artery - interlobar a - interlobular a
Ectopic EPO - ACTH - PTHrP - prolactin
Thromboembolism and inc risk of infection
Carbonic anhydrase

25. What is the compensatory response in metabolic alkalosis
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hypovent - immediate
Inc - dec - dec
JG cells

26. What effect does cxn of the ureter have on RPF - GFR and FF
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
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
Needs to be bilateral
NC - dec - dec

27. Which cells sense decreases in Na delivery
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Radiopaque
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Macula densa

28. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Involves glomeruli and other organs
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

29. What is the compensatory response in metabolic acidosis
Proximal tubule - na/glucose co transporter
Growth retardation and developmental delay
Hypervent - immediate
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

30. Congo - red stain - apple green birefringence
Vasocxn - inc BP
PH = pKa + log bicarb/0.03PCO2
Amyloidosis
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

31. Why can inulin be used to calculate GFR?
Hypokalemia - risk for Ca containing kidney stones
Freely filtered and neither absorbed or secreted
Macula densa and JG cells
Kids - peripheral and periorbital edema - resolves spontaneously

32. Where is ACE made and What are 2 of its fxns
V x Urine concentration
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Stimulates thirst
Angio I to angio II and inhibits bradykinin

33. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Actively reabsorbs NaCl - diluting - makes urine hypotonic
NC - inc - inc
Angio I to angio II and inhibits bradykinin

34. net tubular reabsorption of x
Size and charge
Cx<GFR
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
20 percent

35. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Polycystic liver disease - berry aneurysms - mitral valve prolapse
NC - dec - dec
20 percent

36. hypoaldosteronism or lack of collecting tubule response to aldosteron
Acute - ATN - or chronic - HTN - DM
Size and charge
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
RTA type 4 (hyperkalemic)

37. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Wilms tumor (ages 2-4)
Crescent - moon shape
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

38. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
Dec renal bicarb reabsorption - delayed
Macula densa
NC - inc - inc

39. What does LM - EM - IF show in diffuse proliferative GN
JG cells
Growth retardation and developmental delay
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Medullary cystic disease

40. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Hyperceullular glomeruli
NC - dec - dec
Poor - days to weeks
Contrict leading to inc FF - preserver renal GFR in low volume states

41. What needs to happen for postrenal obstruction to creat ARF
Bladder cancer
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Needs to be bilateral
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

42. What dyslipidemia is most common in renal failure
Contrict leading to inc FF - preserver renal GFR in low volume states
Angio I to angio II and inhibits bradykinin
Dialysis cysts
Triglycerides

43. in acute cystitis with pyuria - do you see casts
No
Diabetic glomerulonephropathy
60% total body water - 40% ICF - 20% ECF
Hyperkalemia

44. What is the formula for excretion rate
Acute tubular necrosis
V x Urine concentration
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Under and under

45. What does US show with medullary cystic disease
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Men 50 to 70 - inc incidence with smoking and obesity
Small kidney - poor prognosis

46. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
NC - dec - dec
Solute and water are reabsorbed at the same rate
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Renal tubular cells - polygonal clear cells

47. net tubular secretion of x
Cx>GFR
Segmental sclerosis and hylanosis
Inc in concentration - not amout - due to water reabsorption
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

48. What is the LM for diabetic glomerulonephropathy
EPO - endothelial cells of peritubular capillaries
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Cx<GFR

49. What is the compensatory response in respiratory acidosis
Beta 1
Inc renal bicarb resabsoprtion - delayed
Na reabsorption drives H20 reabsorption
White cell casts

50. What is is Alport's syndrome and what else do you see with it other than renal path
Hypervent - early high altitude - aspirin ingestion early
Contrict leading to inc FF - preserver renal GFR in low volume states
Hydronephrosis and pyelonephritis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant