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Renal

Instructions:

Answer 50 questions in 15 minutes.
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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. What effect does ANP have on GFR
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inc
Von hippel laundau and gene deletion in chromosome 3
Hypovent - immediate

2. What does LM - EM - IF show in diffuse proliferative GN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
RTA type 1 (distal)
2 ways - base exchanger and between epithelial cells
Liver

3. When is TF/P <1
60% total body water - 40% ICF - 20% ECF
Staghorn calculi - worsened by alkaluria
Solute is reabsorbed more quickly than water
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

4. How does RCC spread
Medullary cystic disease
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inc - dec - dec
Invades IVC and spreads hematogenously

5. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Hydronephrosis and pyelonephritis
Carbonic anhydrase
All glomeruli
NC - dec - dec

6. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Rxn from angiotensinogen to angiontensin I

7. What are the two forms of renal failure and What are examples of each
Acute - ATN - or chronic - HTN - DM
Hypokalemia and hypophosphatemic rickets
Thickening of glomerular BM
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

8. What is the formula for the filtered load
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Type II - C3 nephritic factor
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
GFR x plasma concentration

9. What is the prognosis of RPGN
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Poor - days to weeks
No
Freely filtered and neither absorbed or secreted

10. What is the compensatory response in metabolic acidosis
Cx<GFR
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Acute renal failure
Hypervent - immediate

11. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Amyloidosis

12. What are the effects of AT II on the adrenal gland
Dec - inc - dec
Invades IVC and spreads hematogenously
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Negative charge

13. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Beta 1
GFR x plasma concentration
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

14. In renal failure What acid - base disturbance is most likely
Metabolic acidosis
20 percent
Na
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

15. membranous
Solute is reabsorbed more quickly than water
EPO - endothelial cells of peritubular capillaries
Thickening of glomerular BM
Beta 1

16. What is the pathway to the afferent arteriole
Renal artery - interlobar a - interlobular a
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
NC - dec - dec
RTA type 4 (hyperkalemic)

17. What is the effect of PTH on the proximal tubule
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

18. How does Wilms tumor present
Huge palpable flank mass and hematuria
Excreted - filtered
To defend GFR
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

19. What are the associated paraneoplastic syndromes wth RCC
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Ectopic EPO - ACTH - PTHrP - prolactin
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
1alpha hydroxylase - PTH stimulates it

20. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Ectopic EPO - ACTH - PTHrP - prolactin
Chronic conditions - multiple myeloma - TB - RA
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

21. How do you interpret creatinine clearance
Inc GFR and mesangial expansion
Anion gap = na - (Cl + bicarb)
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Acute pyelonephritis

22. What is the net effect of PTH
Na
Inc in Ca and PO4 absoprtion from the gut
Small kidney - poor prognosis
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

23. What is the ddx for a metabolic acidosis with an inc anion gap
Excreted - filtered
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Involves only glomeruli
Failure of EPO

24. What needs to happen for postrenal obstruction to creat ARF
1/4 plasma - and 3/4 interstitial volume
Needs to be bilateral
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Inc renal bicarb resabsoprtion - delayed

25. In who is RCC most comon
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Men 50 to 70 - inc incidence with smoking and obesity
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Dec - dec - dec

26. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Intra = HIKIN!
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Diarrhea - glue - RTA - hyperchloremia

27. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
By 10%
Type II - C3 nephritic factor
ANP

28. cortical and medullary cysts resulting from long standing dialysis
Negative charge
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Dialysis cysts
Hypovent - immediate

29. do you see casts in bladder cancer - kidney stones with hematuria
No
Dec - inc - inc
RPF/(1- Hct)
Acts on V2 receptors leading to insertion of aquaporins on luminal side

30. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc - dec - dec
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

31. What does NEG lead to in the efferent arterioles
Diarrhea - glue - RTA - hyperchloremia
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Filtered - secreted
Inc GFR and mesangial expansion

32. How do struvite stones appear on xray
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Radiopaque
Men 50 to 70 - inc incidence with smoking and obesity

33. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Inc
Transitional cell carcinoma
1alpha hydroxylase - PTH stimulates it
Inc - dec - dec

34. What is renal osteodystrophy
Size
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Hydronephrosis and pyelonephritis
Few glomeruli

35. In a metabolic acidosis What additional calculation is necessary and How do you make it
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Anion gap = na - (Cl + bicarb)
Hyperkalemia

36. net tubular secretion of x
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Cx>GFR
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
NC - dec - dec

37. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Filtered - secreted
Transitional cell carcinoma
Inulin

38. How do the ureters course in relation to the uterine artery and ductus deferens
Inc - dec - dec
Corticosteroids
Under and under
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

39. coarse - asymmetric - corticomedullary scarring and blunted calyx
Ectopic EPO - ACTH - PTHrP - prolactin
PH - then PC02
Chronic pyelonephritis
Growth retardation and developmental delay

40. Which cells sense decreases in BP
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hypervent - early high altitude - aspirin ingestion early
JG cells
RPF/(1- Hct)

41. What happens in the early distal convoluted tubule and What does that do to the urine
Involves glomeruli and other organs
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Reabsorb Na in exchange for secreting K and H

42. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
LM - nl glomeruli - EM - foot process effacement
ADPKD
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Membranoproliferative glomerulonephritis

43. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
PH = pKa + log bicarb/0.03PCO2
Cx<GFR
Acute pyelonephritis
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

44. In renal failure - what happens to potassium
Hyperkalemia
Principal cells and intercalated cells
1alpha hydroxylase - PTH stimulates it
Hypovent - immediate

45. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Segmental sclerosis and hylanosis
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Staghorn calculi - worsened by alkaluria
20 percent

46. no net secretion or reabsorption of x
Contrict leading to inc FF - preserver renal GFR in low volume states
Inc - inc - inc
Cx = GFR
RPF/(1- Hct)

47. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
NC - dec - dec
Radiopaque

48. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Metabolic acidosis
Macula densa and JG cells
Wilms tumor (ages 2-4)
Simple cysts

49. What is the 3rd most common kidney stone and What causes it
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Involves only glomeruli
Acts on V2 receptors leading to insertion of aquaporins on luminal side

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)
1/4 plasma - and 3/4 interstitial volume
Acute renal failure
2 ways - base exchanger and between epithelial cells