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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. How does RCC manifest clinically
Poor - days to weeks
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
2. What happens when PTH is secreted
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Angio I to angio II and inhibits bradykinin
Complications of chronic kidney disease or HTN
3. What happens in the early distal convoluted tubule and What does that do to the urine
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Actively reabsorbs NaCl - diluting - makes urine hypotonic
ANP
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
4. Where is potassium conc. Highest? Intra or extra
Intra = HIKIN!
Acute - ATN - or chronic - HTN - DM
Solute is reabsorbed less quickly than water or net secretion of substance
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
5. What is the formula for excretion rate
ANP
V x Urine concentration
Hypervent - immediate
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
6. dense deposits on EM - type and association
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
Inc
Type II - C3 nephritic factor
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
7. What does NEG lead to in the efferent arterioles
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc GFR and mesangial expansion
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Rxn from angiotensinogen to angiontensin I
8. What effect does efferent arteriole cxn have on RPF - GFR and FF
To defend GFR
Dec - inc - inc
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
9. What is the effect of PTH on the proximal tubule
Reabsorb Na in exchange for secreting K and H
Thickening of glomerular BM
Transitional cell carcinoma
Inhibits Na/phosphate cotransport leading to phosphate excretion
10. By what percentage does EPRF underestimage true RPF
Amyloidosis
No
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
By 10%
11. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Passively reabsorbs water via medullary hypertonicity
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Bladder cancer
Inc plasma osm - dec blood volume
12. What is the formula for secreted
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Needs to be bilateral
Excreted - filtered
13. What effect does afferent arteriole cxn have on RPF - GFR and FF
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Growth retardation and developmental delay
Renal tubular cells - polygonal clear cells
Dec - dec - NC
14. What is the prognosis of RPGN
Most of the bicarb - sodium - chloride - and water
Liver
GFR/RPF
Poor - days to weeks
15. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Inc GFR and mesangial expansion
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Acute tubular necrosis
16. Defect in proximal tubule HCO3 reabsorption
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
RTA type 2 (proximal)
Staghorn calculi - worsened by alkaluria
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
17. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Type II - C3 nephritic factor
Dec - inc - dec
Freely filtered and neither absorbed or secreted
18. What effect does ANP have on Na in the kidney
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Involves only glomeruli
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
NC - dec - dec
19. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
All glomeruli
Macula densa and JG cells
20. What is the compensatory response in respiratory alkalosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Few glomeruli
Renal in origin
Dec renal bicarb reabsorption - delayed
21. What do you see in the urine with acute pyelonephritis
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
White cell casts
Huge palpable flank mass and hematuria
Inc renal bicarb resabsoprtion - delayed
22. What is winter's formula and when do you use it
Angio I to angio II and inhibits bradykinin
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Acute renal failure
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
23. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
Von hippel laundau and gene deletion in chromosome 3
Under and under
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
24. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Diarrhea - glue - RTA - hyperchloremia
Cx = GFR
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
25. What is the ddx for metabolic alkalosis with compensation
No
Involves glomeruli and other organs
PH - then PC02
Diuretics - vomiting - antacid - hyperaldosteronism
26. diffuse
Nephritic syndrome
Inc GFR and mesangial expansion
All glomeruli
Wilms tumor (ages 2-4)
27. What cells create the epithelial layer of the glomerular filtration barrier
Na
Podocytes foot processes
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Growth retardation and developmental delay
28. What effect does cxn of the ureter have on RPF - GFR and FF
Macula densa and JG cells
Kids - peripheral and periorbital edema - resolves spontaneously
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
NC - dec - dec
29. RBC casts - ddx
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Huge palpable flank mass and hematuria
2 ways - base exchanger and between epithelial cells
Inc GFR and mesangial expansion
30. secondary glomerular dz
Hypovent - immediate
Involves glomeruli and other organs
Na reabsorption drives H20 reabsorption
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
31. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Hydronephrosis and pyelonephritis
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Medullary cystic disease
Proximal tubule - na/glucose co transporter
32. What is the effect of AT II on the hypothalamus
CHF - pulmonary edema - HTN
Acute renal failure
Stimulates thirst
Acute - ATN - or chronic - HTN - DM
33. What happens in the thin descending loop of henle
Dec - dec - dec
Passively reabsorbs water via medullary hypertonicity
Becomes concentrated and hypertonic
Inc in Ca and PO4 absoprtion from the gut
34. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
ANP
Inc in concentration - not amout - due to water reabsorption
Carbonic anhydrase
Dec renal bicarb reabsorption - delayed
35. How are amino acids reabsorbed
Acute tubular necrosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
NC - dec - dec
36. In a metabolic acidosis What additional calculation is necessary and How do you make it
Hypervent - early high altitude - aspirin ingestion early
Filtered - secreted
Anion gap = na - (Cl + bicarb)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
37. What do you see on LM and IF with rapidly progressive GN
Thromboembolism and inc risk of infection
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Crescent - moon shape
Under and under
38. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
39. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Solute and water are reabsorbed at the same rate
To defend GFR
Staghorn calculi - worsened by alkaluria
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
40. What is the BUN/Cr ratio in instrinsic renal ARF and why
Vasocxn - inc BP
Metabolic acidosis
CHF - pulmonary edema - HTN
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
41. What is the formula for renal blood flow
No
RPF/(1- Hct)
Eosinphilic casts in tubules
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
42. What is renal osteodystrophy
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Segmental sclerosis and hylanosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Von hippel laundau and gene deletion in chromosome 3
43. Why is there anemia in renal failure
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
All glomeruli
60% total body water - 40% ICF - 20% ECF
Failure of EPO
44. What are the associated paraneoplastic syndromes wth RCC
Inc
Von hippel laundau and gene deletion in chromosome 3
Ectopic EPO - ACTH - PTHrP - prolactin
Contrict leading to inc FF - preserver renal GFR in low volume states
45. cortical and medullary cysts resulting from long standing dialysis
Inc renal bicarb resabsoprtion - delayed
Dialysis cysts
Na
Proximal tubule - na/glucose co transporter
46. What are the associations with nephrotic syndrome
Inc plasma osm - dec blood volume
RTA type 2 (proximal)
Eosinphilic casts in tubules
Thromboembolism and inc risk of infection
47. In renal failure What are the consquence sof Na/H20 retention
NC - dec - dec
CHF - pulmonary edema - HTN
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
48. granular - muddy brown casts - ddx
Medullary cystic disease
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute tubular necrosis
49. In what clinical context does Berger's disease often present
Membranoproliferative glomerulonephritis
UTI or acute gastroenteritis
Ectopic EPO - ACTH - PTHrP - prolactin
Size and charge
50. What is the net effect of PTH
Hydronephrosis and pyelonephritis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc in Ca and PO4 absoprtion from the gut
GFR x plasma concentration
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