Test your basic knowledge |

Renal

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. What is the 3rd most common kidney stone and What causes it
By 10%
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hyperceullular glomeruli
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

2. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
1alpha hydroxylase - PTH stimulates it
No
Hydronephrosis and pyelonephritis
Diarrhea - glue - RTA - hyperchloremia

3. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
GFR/RPF
It has a longer renal vein
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

4. Why is the left kidney taken during living donor transplantation
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
It has a longer renal vein
20 percent
Acute pyelonephritis

5. What is the prognosis of RPGN
All glomeruli
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Dec - inc - dec
Poor - days to weeks

6. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
PH = pKa + log bicarb/0.03PCO2
Inc - inc - inc

7. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Ammonia - buffer for secreted H+
Radiopaque
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

8. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NC - dec - dec
NKCC
PH - then PC02
Na reabsorption drives H20 reabsorption

9. What is generated and secreted in the proximal tubule
Cx = GFR
Ammonia - buffer for secreted H+
No
PH - then PC02

10. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
HIV
1alpha hydroxylase - PTH stimulates it
PH - then PC02
Renal artery - interlobar a - interlobular a

11. What is the pathway from the efferent arteriorle to the renal v
Size and charge
Carbonic anhydrase
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Vasa recta - interlobular v - interlobar v - renal v

12. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
160-200 - 350
Dialysis cysts
Huge palpable flank mass and hematuria

13. How What does the glomerular filtration barrier distinguish by
Size and charge
Inc GFR and mesangial expansion
Crescent - moon shape
Acute - ATN - or chronic - HTN - DM

14. What happens when PTH is secreted
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Small kidney - poor prognosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Size

15. in TCC - What does painelss hematuria suggest
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Bladder cancer
Stimulates thirst

16. What is the effect of of PTH on the distal convoluted tubule
Transitional cell carcinoma
Inc Ca/Na exchange to inc Ca reabsoprtion
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Modified smooth muscle of afferent arteriole - secrete renin

17. Which cells sense decreases in BP
Cx>GFR
Actively reabsorbs NaCl - diluting - makes urine hypotonic
JG cells
Hypovent - immediate

18. How do struvite stones appear on xray
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Hyperceullular glomeruli
Radiopaque
Dec - inc - inc

19. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Renal in origin
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Poor - days to weeks

20. proliferative
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
By 10%
Hyperceullular glomeruli
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

21. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
NC - dec - dec
Invades IVC and spreads hematogenously
Cx>GFR

22. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Failure of EPO
Under and under
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

23. Focal
Nephrotic syndrome
Few glomeruli
Staghorn calculi - worsened by alkaluria
GFR x plasma concentration

24. What substance is secreted in response increase atrial pressure
Nephrotic syndrome
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
ANP
Na

25. waxy casts ddx
Advanced renal dz - CRF
Nephrotic syndrome
Solute and water are reabsorbed at the same rate
Kids - peripheral and periorbital edema - resolves spontaneously

26. What percentage of ECF is plasma and What is interstitial volume
Chronic pyelonephritis
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
1/4 plasma - and 3/4 interstitial volume
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

27. What are the effects of PTH hormone on the kidney
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
Transitional cell carcinoma
Chronic pyelonephritis
Solute is reabsorbed more quickly than water

28. When is TF/P ratio > 1
Beta 1
Solute and water are reabsorbed at the same rate
Solute is reabsorbed less quickly than water or net secretion of substance
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

29. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Renal in origin
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

30. What are the two kinds of cells in the collecting tubules
Solute and water are reabsorbed at the same rate
Failure of EPO
Principal cells and intercalated cells
Huge palpable flank mass and hematuria

31. What does renin do
Rxn from angiotensinogen to angiontensin I
Inc - dec - dec
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

32. Congo - red stain - apple green birefringence
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Amyloidosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
No

33. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
CHF - pulmonary edema - HTN
Diabetic glomerulonephropathy
Staghorn calculi - worsened by alkaluria
Bladder cancer

34. What do casts indicated about hematuria/pyuria
Renal in origin
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Failure of EPO
1alpha hydroxylase - PTH stimulates it

35. What is the ddx for metabolic alkalosis with compensation
20 percent
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Diabetic glomerulonephropathy
Diuretics - vomiting - antacid - hyperaldosteronism

36. With what genetic tumor syndrome is RCC associated
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Nonspecific
Von hippel laundau and gene deletion in chromosome 3
GFR x plasma concentration

37. What is hartnup's disease
Nephritic syndrome
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

38. In renal failure What are the consquence sof Na/H20 retention
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
CHF - pulmonary edema - HTN
Contrict leading to inc FF - preserver renal GFR in low volume states
Insertion of Na channel on luminal side

39. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Inc plasma osm - dec blood volume
Hypervent - early high altitude - aspirin ingestion early

40. What two cells make up the JGA
Macula densa and JG cells
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Transitional cell carcinoma

41. What are the two forms of renal failure and What are examples of each
RTA type 4 (hyperkalemic)
Acute - ATN - or chronic - HTN - DM
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
2 ways - base exchanger and between epithelial cells

42. How is plasma volume measured
Renal tubular cells - polygonal clear cells
GFR/RPF
Nephritic syndrome
Radiolabelled albumin

43. How does RCC manifest clinically
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Huge palpable flank mass and hematuria
Phenacetin - smoking - aniline dyes - cyclophosphamide
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

44. secondary glomerular dz
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Involves glomeruli and other organs
EPO - endothelial cells of peritubular capillaries
No

45. In renal failure - what happens to potassium
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Corticosteroids
Metabolic acidosis
Hyperkalemia

46. What is the second most common kidney stone
Reabsorb Na in exchange for secreting K and H
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Radiolabelled albumin
RTA type 1 (distal)

47. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Renal artery - interlobar a - interlobular a

48. What is the formula for reabsorption
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
JG cells
Chronic conditions - multiple myeloma - TB - RA
Filtered - secreted

49. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
Cx = GFR
Renal in origin
EPO - endothelial cells of peritubular capillaries

50. What are the associations with RTA type 1
ADPKD
Hypokalemia - risk for Ca containing kidney stones
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia