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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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. waxy casts ddx
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Diuretics - vomiting - antacid - hyperaldosteronism
Advanced renal dz - CRF
Na reabsorption drives H20 reabsorption
2. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
Chronic conditions - multiple myeloma - TB - RA
Huge palpable flank mass and hematuria
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
3. Which cells sense decreases in Na delivery
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Becomes concentrated and hypertonic
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Macula densa
4. In what disease in FSGS the most common glomerular disease
60% total body water - 40% ICF - 20% ECF
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
HIV
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
5. When is TF/P ratio > 1
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Solute is reabsorbed less quickly than water or net secretion of substance
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
6. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Crescent - moon shape
Negative charge
Dec - inc - inc
1alpha hydroxylase - PTH stimulates it
7. What are the effects of PTH hormone on the kidney
Na and volume loss
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
Ectopic EPO - ACTH - PTHrP - prolactin
Macula densa and JG cells
8. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diuretics - vomiting - antacid - hyperaldosteronism
Inhibits Na/phosphate cotransport leading to phosphate excretion
Metabolic acidosis
Diarrhea - glue - RTA - hyperchloremia
9. What is the prognosis of RPGN
Podocytes foot processes
Hypervent - early high altitude - aspirin ingestion early
No
Poor - days to weeks
10. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Size
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
11. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
By 10%
Inc in Ca and PO4 absoprtion from the gut
12. What is the second most common kidney stone
No
Involves glomeruli and other organs
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
13. diffuse
Hypervent - immediate
Size and charge
Inc in Ca and PO4 absoprtion from the gut
All glomeruli
14. Where is potassium conc. Highest? Intra or extra
Cx>GFR
Intra = HIKIN!
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Ectopic EPO - ACTH - PTHrP - prolactin
15. In renal failure What are the consquence sof Na/H20 retention
CHF - pulmonary edema - HTN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
HIV
Growth retardation and developmental delay
16. What are the LM and EM of minimal change disease
Poor - days to weeks
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Metabolic acidosis
LM - nl glomeruli - EM - foot process effacement
17. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
Hypokalemia - risk for Ca containing kidney stones
Passively reabsorbs water via medullary hypertonicity
Chronic pyelonephritis
18. What 3 things stimulate the release of renin - and Where is it released from
Cx>GFR
RTA type 4 (hyperkalemic)
Invades IVC and spreads hematogenously
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
19. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
RPF/(1- Hct)
UTI or acute gastroenteritis
Men 50 to 70 - inc incidence with smoking and obesity
20. What are JG cells and what substance do they secrete
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Men 50 to 70 - inc incidence with smoking and obesity
Kids - peripheral and periorbital edema - resolves spontaneously
Modified smooth muscle of afferent arteriole - secrete renin
21. What effect does afferent arteriole cxn have on RPF - GFR and FF
Involves only glomeruli
Thromboembolism and inc risk of infection
Hypervent - immediate
Dec - dec - NC
22. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
RTA type 4 (hyperkalemic)
Liver
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
23. nonenzymatic glycosylation of GBM - inc permeability and thickening
Nephritic syndrome
NC - dec - dec
Membranoproliferative glomerulonephritis
Diabetic glomerulonephropathy
24. granular - muddy brown casts - ddx
Vasocxn - inc BP
Dec renal bicarb reabsorption - delayed
2 ways - base exchanger and between epithelial cells
Acute tubular necrosis
25. Why is the left kidney taken during living donor transplantation
ANP
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
It has a longer renal vein
Na reabsorption drives H20 reabsorption
26. What is the 3rd most common kidney stone and What causes it
Needs to be bilateral
Acute tubular necrosis
Ectopic EPO - ACTH - PTHrP - prolactin
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
27. membranous
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Thickening of glomerular BM
It has a longer renal vein
28. What is the henderson hasselbalch equation
Radiopaque
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Diabetic glomerulonephropathy
PH = pKa + log bicarb/0.03PCO2
29. How What does the glomerular filtration barrier distinguish by
Wilms tumor (ages 2-4)
Size and charge
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Vasocxn - inc BP
30. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Inulin
31. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
32. What happens in the early distal convoluted tubule and What does that do to the urine
Carbonic anhydrase
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Acute - ATN - or chronic - HTN - DM
Segmental sclerosis and hylanosis
33. What needs to happen for postrenal obstruction to creat ARF
Inhibits Na/phosphate cotransport leading to phosphate excretion
No
Needs to be bilateral
Intra = HIKIN!
34. How are amino acids reabsorbed
LM - nl glomeruli - EM - foot process effacement
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Renal in origin
35. What effect does dec plasma protein concentration have on RPF - GFR - and FF
NC - inc - inc
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
GFR/RPF
No
36. What happens in the thin descending loop of henle
Beta 1
HIV
ANP
Passively reabsorbs water via medullary hypertonicity
37. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Acts on V2 receptors leading to insertion of aquaporins on luminal side
JG cells
CHF - pulmonary edema - HTN
38. Defect in collecting ducts ability to excrete H+
Thromboembolism and inc risk of infection
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
RTA type 4 (hyperkalemic)
RTA type 1 (distal)
39. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Wilms tumor (ages 2-4)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
ADPKD
60% total body water - 40% ICF - 20% ECF
40. What dyslipidemia is most common in renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Excreted - filtered
<3.5 g /day
Triglycerides
41. 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
Vasocxn - inc BP
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
42. What is the cutoff of proteinuria in nephritic syndrome
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Diarrhea - glue - RTA - hyperchloremia
RTA type 2 (proximal)
<3.5 g /day
43. What happens to pH - PCO2 and bicarb in metabolic acidosis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Dec - dec - dec
PH - then PC02
Intra = HIKIN!
44. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Nonspecific
Most of the bicarb - sodium - chloride - and water
Acute renal failure
No
45. What are the associations with RTA type 1
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Amyloidosis
Renal artery - interlobar a - interlobular a
Hypokalemia - risk for Ca containing kidney stones
46. Why can PAH be used to measure ERPF
HIV
2 ways - base exchanger and between epithelial cells
Vasocxn - inc BP
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
47. What does renin do
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Becomes concentrated and hypertonic
Rxn from angiotensinogen to angiontensin I
Negative charge
48. What is the formula for clearance of a substance per unit time
Negative charge
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
NKCC
49. What is the BUN/Cr ratio in instrinsic renal ARF and why
Huge palpable flank mass and hematuria
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Inc plasma osm - dec blood volume
50. What does NEG lead to in the efferent arterioles
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
No
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc GFR and mesangial expansion
Sorry!:) No result found.
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