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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 effect does afferent arteriole cxn have on RPF - GFR and FF
Dec - dec - NC
GFR/RPF
Filtered - secreted
Hypokalemia - risk for Ca containing kidney stones

2. How are amino acids reabsorbed
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Reabsorb Na in exchange for secreting K and H
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
NC - dec - dec

3. What is the ddx for respiratory acidosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
GFR x plasma concentration
Hypervent - early high altitude - aspirin ingestion early
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

4. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Acute pyelonephritis
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Size
Anion gap = na - (Cl + bicarb)

5. What is the ddx for metabolic alkalosis with compensation
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Diuretics - vomiting - antacid - hyperaldosteronism
Size
Eosinphilic casts in tubules

6. What is the formula for excretion rate
Inc - dec - dec
Kids - peripheral and periorbital edema - resolves spontaneously
V x Urine concentration
Staghorn calculi - worsened by alkaluria

7. What is the most frequent kind of kidney stone and What are causes that lead to it
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Acute tubular necrosis
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Amyloidosis

8. What is the net effect of ANP
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Kids - peripheral and periorbital edema - resolves spontaneously
Na and volume loss
Rxn from angiotensinogen to angiontensin I

9. What is the pathway to the afferent arteriole
Passively reabsorbs water via medullary hypertonicity
Hyperkalemia
Invades IVC and spreads hematogenously
Renal artery - interlobar a - interlobular a

10. What cells create the epithelial layer of the glomerular filtration barrier
Becomes concentrated and hypertonic
Dec - inc - inc
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Podocytes foot processes

11. Where does renal cell carcinoma originate and What do the cells look like
Hyperceullular glomeruli
PH - then PC02
Antifreeze - ethyelene glycol or vit C abuse
Renal tubular cells - polygonal clear cells

12. What are the LM and EM of minimal change disease
Na and volume loss
Growth retardation and developmental delay
LM - nl glomeruli - EM - foot process effacement
Cx>GFR

13. In what disease in FSGS the most common glomerular disease
Acute pyelonephritis
HIV
Radiolabelled albumin
No

14. Defect in collecting ducts ability to excrete H+
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
RTA type 1 (distal)
Inc - dec - dec

15. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Insertion of Na channel on luminal side
160-200 - 350
Triglycerides
Radiopaque

16. What is generated and secreted in the proximal tubule
Beta 1
Ammonia - buffer for secreted H+
Growth retardation and developmental delay
Hyperkalemia

17. What is the LM for diabetic glomerulonephropathy
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Acute pyelonephritis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

18. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Transitional cell carcinoma
Beta 1
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Cx<GFR

19. What does US show with medullary cystic disease
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Small kidney - poor prognosis
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
ADPKD

20. What substance is secreted in response increase atrial pressure
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
CHF - pulmonary edema - HTN
Solute and water are reabsorbed at the same rate
ANP

21. What effect does efferent arteriole cxn have on RPF - GFR and FF
Chronic conditions - multiple myeloma - TB - RA
Bladder cancer
Phenacetin - smoking - aniline dyes - cyclophosphamide
Dec - inc - inc

22. How What does the glomerular filtration barrier distinguish by
Size and charge
Hypokalemia and hypophosphatemic rickets
Actively reabsorbs NaCl - diluting - makes urine hypotonic
All glomeruli

23. What is the 60-40-20 rule of body weight
Macula densa
60% total body water - 40% ICF - 20% ECF
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

24. What effect does ANP have on GFR
NC - inc - inc
Inc
Transitional cell carcinoma
60% total body water - 40% ICF - 20% ECF

25. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc in concentration - not amout - due to water reabsorption
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Negative charge

26. What is winter's formula and when do you use it
1/4 plasma - and 3/4 interstitial volume
Carbonic anhydrase
Hyperceullular glomeruli
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

27. inc in creatinine and BUN over a period of several days
Vasocxn - inc BP
Acute renal failure
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
1alpha hydroxylase - PTH stimulates it

28. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
No
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Corticosteroids

29. What is renal osteodystrophy
By 10%
Few glomeruli
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
To defend GFR

30. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
NKCC
ANP
Phenacetin - smoking - aniline dyes - cyclophosphamide

31. What is the formula for reabsorption
Cx>GFR
EPO - endothelial cells of peritubular capillaries
Invades IVC and spreads hematogenously
Filtered - secreted

32. Who commonly gets acute post strep GN
JG cells
Small kidney - poor prognosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Kids - peripheral and periorbital edema - resolves spontaneously

33. How do calcium stones appear on x ray
Radiopaque
Thromboembolism and inc risk of infection
Invades IVC and spreads hematogenously
Chronic conditions - multiple myeloma - TB - RA

34. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
NKCC
Corticosteroids

35. 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
It has a longer renal vein
Wilms tumor (ages 2-4)
Angio I to angio II and inhibits bradykinin

36. What are the associations with nephrotic syndrome
Macula densa and JG cells
Thromboembolism and inc risk of infection
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
NC - inc - inc

37. What are the 3 transporters of the intercalated cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Hypokalemia - risk for Ca containing kidney stones
PH = pKa + log bicarb/0.03PCO2
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

38. What 3 things stimulate the release of renin - and Where is it released from
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Needs to be bilateral
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

39. What is the genetic etiology of wilms tumor and What is WAGR complex
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Poor - days to weeks
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Carbonic anhydrase

40. What do macula densa cells sense
Dec renal bicarb reabsorption - delayed
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Stimulates thirst
Na

41. waxy casts ddx
Solute is reabsorbed more quickly than water
Advanced renal dz - CRF
Inhibits Na/phosphate cotransport leading to phosphate excretion
Insertion of Na channel on luminal side

42. What two cells make up the JGA
1/4 plasma - and 3/4 interstitial volume
Macula densa and JG cells
Advanced renal dz - CRF
Cx<GFR

43. What is the least common kidney stone - What causes it and How do you treat it
All glomeruli
Wilms tumor (ages 2-4)
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

44. What is the ddx for a metabolic acidosis with an inc anion gap
It has a longer renal vein
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inhibits Na/phosphate cotransport leading to phosphate excretion

45. What is the effect of AT II on the hypothalamus
PH = pKa + log bicarb/0.03PCO2
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
Makes urine less concentrated - impermeable to H20
Stimulates thirst

46. in acute post strep GN - What do you see on LM - EM and IF

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47. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
60% total body water - 40% ICF - 20% ECF
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Invades IVC and spreads hematogenously

48. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Advanced renal dz - CRF
Hyperceullular glomeruli
Solute is reabsorbed less quickly than water or net secretion of substance
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

49. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Diarrhea - glue - RTA - hyperchloremia
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

50. What 3 disease can lead to RPGN
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
PH - then PC02
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inulin