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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 generated and secreted in the proximal tubule
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Ammonia - buffer for secreted H+
Inc plasma osm - dec blood volume
Hyperkalemia

2. waxy casts ddx
Inhibits Na/phosphate cotransport leading to phosphate excretion
Hypovent - immediate
Acute renal failure
Advanced renal dz - CRF

3. When is TF/P <1
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Solute is reabsorbed more quickly than water

4. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
Inc Ca/Na exchange to inc Ca reabsoprtion
Hydronephrosis and pyelonephritis
Ammonia - buffer for secreted H+

5. What are the 3 transporters of the intercalated cells
Kids - peripheral and periorbital edema - resolves spontaneously
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Bladder cancer
Membranoproliferative glomerulonephritis

6. What 3 disease can lead to RPGN
Phenacetin - smoking - aniline dyes - cyclophosphamide
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Contrict leading to inc FF - preserver renal GFR in low volume states

7. What is the most frequent kind of kidney stone and What are causes that lead to it
Advanced renal dz - CRF
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
<3.5 g /day
Hyperkalemia

8. How are amino acids reabsorbed
RPF/(1- Hct)
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Freely filtered and neither absorbed or secreted

9. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Chronic pyelonephritis
Diarrhea - glue - RTA - hyperchloremia
Inc renal bicarb resabsoprtion - delayed
Hydronephrosis and pyelonephritis

10. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Transitional cell carcinoma
Insertion of Na channel on luminal side
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

11. What is the formula for renal blood flow
Contrict leading to inc FF - preserver renal GFR in low volume states
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
LM - nl glomeruli - EM - foot process effacement
RPF/(1- Hct)

12. Where is potassium conc. Highest? Intra or extra
Poor - days to weeks
Intra = HIKIN!
Proximal tubule - na/glucose co transporter
60% total body water - 40% ICF - 20% ECF

13. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
No
Corticosteroids
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

14. secondary glomerular dz
ADPKD
Involves glomeruli and other organs
Inc GFR and mesangial expansion
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

15. What is the effect of aldosterone in principal cells
Dec - inc - inc
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Under and under

16. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Reabsorb Na in exchange for secreting K and H
Stimulates thirst

17. What are the main complications of kidney stones
Radiopaque
Angio I to angio II and inhibits bradykinin
Hydronephrosis and pyelonephritis
Inc plasma osm - dec blood volume

18. In who is RCC most comon
Liver
Men 50 to 70 - inc incidence with smoking and obesity
Actively reabsorbs NaCl - diluting - makes urine hypotonic
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

19. What effect does ANP have on GFR
Hypokalemia - risk for Ca containing kidney stones
Inc
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

20. What is the second most common kidney stone
Hypokalemia and hypophosphatemic rickets
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

21. Subendothelial immune complexes with granular IF
Diarrhea - glue - RTA - hyperchloremia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
NC - dec - dec
Membranoproliferative glomerulonephritis

22. What do you see in the urine with acute pyelonephritis
Radiolabelled albumin
White cell casts
UTI or acute gastroenteritis
Membranoproliferative glomerulonephritis

23. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Eosinphilic casts in tubules
Involves only glomeruli
Radiolabelled albumin

24. What is the ddx for metabolic alkalosis with compensation
Corticosteroids
Diuretics - vomiting - antacid - hyperaldosteronism
Angio I to angio II and inhibits bradykinin
ADPKD

25. What are the effects of AT II on the adrenal gland
PH = pKa + log bicarb/0.03PCO2
Segmental sclerosis and hylanosis
160-200 - 350
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

26. What is hartnup's disease
Advanced renal dz - CRF
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Involves glomeruli and other organs
Diuretics - vomiting - antacid - hyperaldosteronism

27. What is the cutoff of proteinuria in nephritic syndrome
<3.5 g /day
Solute is reabsorbed more quickly than water
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
RTA type 4 (hyperkalemic)

28. What does US show with medullary cystic disease
Small kidney - poor prognosis
Inc - inc - inc
Acute renal failure
Renal in origin

29. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
NC - dec - dec
Medullary cystic disease
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

30. What is is Alport's syndrome and what else do you see with it other than renal path
Crescent - moon shape
60% total body water - 40% ICF - 20% ECF
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

31. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Beta 1
Hyperceullular glomeruli
Negative charge
Acts on V2 receptors leading to insertion of aquaporins on luminal side

32. how does this present in adults and What is the pattern of inheritence
Hyperceullular glomeruli
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Radiolabelled albumin

33. How does RCC manifest clinically
Podocytes foot processes
ADPKD
Excreted - filtered
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

34. in acute cystitis with pyuria - do you see casts
Beta 1
Anion gap = na - (Cl + bicarb)
No
60% total body water - 40% ICF - 20% ECF

35. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Chronic pyelonephritis
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

36. What two cells make up the JGA
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Macula densa and JG cells
Macula densa

37. The fenestrated capillary endothelium constitutes what portion of the barrier
Size
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
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
RTA type 2 (proximal)

38. What substance is secreted in response increase atrial pressure
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Contrict leading to inc FF - preserver renal GFR in low volume states
ANP
Most of the bicarb - sodium - chloride - and water

39. How do the ureters course in relation to the uterine artery and ductus deferens
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
CHF - pulmonary edema - HTN
Staghorn calculi - worsened by alkaluria
Under and under

40. What are the two kinds of cells in the collecting tubules
Triglycerides
No
Principal cells and intercalated cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

41. What is renal osteodystrophy
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Dialysis cysts
Acute renal failure
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

42. How is chlorid reabsorbed in the proximal tubule
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
By 10%
2 ways - base exchanger and between epithelial cells
Chronic conditions - multiple myeloma - TB - RA

43. RBC casts - ddx
EPO - endothelial cells of peritubular capillaries
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Negative charge

44. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Becomes concentrated and hypertonic
Solute is reabsorbed more quickly than water
Medullary cystic disease
Modified smooth muscle of afferent arteriole - secrete renin

45. nonenzymatic glycosylation of GBM - inc permeability and thickening
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Vasa recta - interlobular v - interlobar v - renal v
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Diabetic glomerulonephropathy

46. What effect does cxn of the ureter have on RPF - GFR and FF
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
NC - dec - dec
ADPKD
Inc in concentration - not amout - due to water reabsorption

47. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Growth retardation and developmental delay
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Amyloidosis

48. WBC casts - ddx
20 percent
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
No

49. What is the ddx for a respiratory alkalosis
Macula densa
Diarrhea - glue - RTA - hyperchloremia
Hypokalemia and hypophosphatemic rickets
Hypervent - early high altitude - aspirin ingestion early

50. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hypokalemia - risk for Ca containing kidney stones
Acute tubular necrosis