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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 algorithim for acidosis/alkalosis
PH - then PC02
Thickening of glomerular BM
Men 50 to 70 - inc incidence with smoking and obesity
Negative charge

2. What therapy does miminal change respond to...
Na reabsorption drives H20 reabsorption
Corticosteroids
Under and under
Freely filtered and neither absorbed or secreted

3. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
Insertion of Na channel on luminal side
Cx>GFR
Hypovent - immediate

4. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Eosinphilic casts in tubules

5. What are the associations with nephrotic syndrome
NC - inc - inc
Involves only glomeruli
Thromboembolism and inc risk of infection
Vasa recta - interlobular v - interlobar v - renal v

6. What needs to happen for postrenal obstruction to creat ARF
Thickening of glomerular BM
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Acute renal failure
Needs to be bilateral

7. How are amino acids reabsorbed
Von hippel laundau and gene deletion in chromosome 3
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
It has a longer renal vein

8. What are the LM and EM of minimal change disease
Intra = HIKIN!
EPO - endothelial cells of peritubular capillaries
Hypervent - immediate
LM - nl glomeruli - EM - foot process effacement

9. What is the effect of PTH on the proximal tubule
Inc renal bicarb resabsoprtion - delayed
Inhibits Na/phosphate cotransport leading to phosphate excretion
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Wilms tumor (ages 2-4)

10. What is the 60-40-20 rule of body weight
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Principal cells and intercalated cells
60% total body water - 40% ICF - 20% ECF

11. inc in creatinine and BUN over a period of several days
Inulin
Acute renal failure
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Freely filtered and neither absorbed or secreted

12. What is the compensatory response in respiratory alkalosis
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Dec renal bicarb reabsorption - delayed
GFR x plasma concentration
Membranoproliferative glomerulonephritis

13. What is generated and secreted in the proximal tubule
NC - dec - dec
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Ammonia - buffer for secreted H+

14. What effect does afferent arteriole cxn have on RPF - GFR and FF
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Dec - dec - NC
Triglycerides

15. primary glomerular dz
1alpha hydroxylase - PTH stimulates it
Membranoproliferative glomerulonephritis
Involves only glomeruli
Hyperkalemia

16. Who often has diffuse proliferative GN
Modified smooth muscle of afferent arteriole - secrete renin
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Poor - days to weeks
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

17. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
LM - nl glomeruli - EM - foot process effacement
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Solute is reabsorbed less quickly than water or net secretion of substance

18. How can NSAIDs cause acute renal failure
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Dialysis cysts
Becomes concentrated and hypertonic
Carbonic anhydrase

19. What are JG cells and what substance do they secrete
RTA type 4 (hyperkalemic)
GFR/RPF
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Modified smooth muscle of afferent arteriole - secrete renin

20. What substance is secreted in response increase atrial pressure
Ammonia - buffer for secreted H+
Phenacetin - smoking - aniline dyes - cyclophosphamide
ANP
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

21. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Dec - dec - NC
No
NC - inc - inc
Amyloidosis

22. no net secretion or reabsorption of x
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Staghorn calculi - worsened by alkaluria
Cx = GFR

23. nonenzymatic glycosylation of GBM - inc permeability and thickening
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Diabetic glomerulonephropathy
20 percent
NKCC

24. In what clinical context does Berger's disease often present
Most of the bicarb - sodium - chloride - and water
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
UTI or acute gastroenteritis

25. What happens to tubular inulin along the proximal tubule and why
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Na and volume loss
Inc in concentration - not amout - due to water reabsorption
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

26. What circumstances causes ADH secretion
Dec - dec - NC
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc plasma osm - dec blood volume
Dec - dec - dec

27. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Makes urine less concentrated - impermeable to H20
Wilms tumor (ages 2-4)
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

28. What are the main complications of kidney stones
RTA type 4 (hyperkalemic)
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hydronephrosis and pyelonephritis

29. What is the second most common kidney stone
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

30. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
UTI or acute gastroenteritis
Vasocxn - inc BP
Invades IVC and spreads hematogenously

31. Under what circumstances is aldosterone secreted
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Makes urine less concentrated - impermeable to H20
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Vasocxn - inc BP

32. How does RCC manifest clinically
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Vasocxn - inc BP
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

33. 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
Huge palpable flank mass and hematuria
Liver
Corticosteroids

34. When is TF/P = 1
Stimulates thirst
Inc in Ca and PO4 absoprtion from the gut
UTI or acute gastroenteritis
Solute and water are reabsorbed at the same rate

35. net tubular reabsorption of x
Cx<GFR
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Inc Ca/Na exchange to inc Ca reabsoprtion
Triglycerides

36. What do macula densa cells sense
UTI or acute gastroenteritis
Na
Na reabsorption drives H20 reabsorption
Hypovent - immediate

37. hyaline casts ddx
To defend GFR
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Nonspecific
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

38. What do you see in the urine with acute pyelonephritis
Inc renal bicarb resabsoprtion - delayed
Inhibits Na/phosphate cotransport leading to phosphate excretion
ADPKD
White cell casts

39. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
Inc GFR and mesangial expansion
Complications of chronic kidney disease or HTN
Reabsorb Na in exchange for secreting K and H

40. What cells create the epithelial layer of the glomerular filtration barrier
Podocytes foot processes
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Diuretics - vomiting - antacid - hyperaldosteronism
Acute - ATN - or chronic - HTN - DM

41. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
Crescent - moon shape
Inhibits Na/phosphate cotransport leading to phosphate excretion
Solute is reabsorbed less quickly than water or net secretion of substance

42. What effect does efferent arteriole cxn have on RPF - GFR and FF
Needs to be bilateral
Actively reabsorbs NaCl - diluting - makes urine hypotonic
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Dec - inc - inc

43. What is the formula for secreted
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Excreted - filtered
Passively reabsorbs water via medullary hypertonicity
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

44. How is chlorid reabsorbed in the proximal tubule
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
2 ways - base exchanger and between epithelial cells
Anion gap = na - (Cl + bicarb)
Negative charge

45. What is the formula for filtration fraction
Actively reabsorbs NaCl - diluting - makes urine hypotonic
GFR/RPF
Men 50 to 70 - inc incidence with smoking and obesity
Advanced renal dz - CRF

46. do you see casts in bladder cancer - kidney stones with hematuria
LM - nl glomeruli - EM - foot process effacement
No
Solute is reabsorbed more quickly than water
Bladder cancer

47. What serum changes cause a secretion in PTH
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Size and charge
NC - dec - dec
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

48. Who commonly gets acute post strep GN
Principal cells and intercalated cells
2 ways - base exchanger and between epithelial cells
Kids - peripheral and periorbital edema - resolves spontaneously
White cell casts

49. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
GFR x plasma concentration
Diarrhea - glue - RTA - hyperchloremia
HIV

50. What is the net effect of ANP
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Acute tubular necrosis
HIV
Na and volume loss