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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. How is chlorid reabsorbed in the proximal tubule
Under and under
2 ways - base exchanger and between epithelial cells
Medullary cystic disease
Inc Ca/Na exchange to inc Ca reabsoprtion

2. What two cells make up the JGA
Small kidney - poor prognosis
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Macula densa and JG cells
Negative charge

3. What is the formula for the filtered load
GFR x plasma concentration
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Macula densa and JG cells
Na reabsorption drives H20 reabsorption

4. inc in creatinine and BUN over a period of several days
It has a longer renal vein
160-200 - 350
Acute renal failure
Amyloidosis

5. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
Renal in origin
Vasocxn - inc BP
Macula densa and JG cells

6. What is the cutoff of proteinuria in nephritic syndrome
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
<3.5 g /day
No
Dec - inc - dec

7. granular - muddy brown casts - ddx
Dialysis cysts
Acute tubular necrosis
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
V x Urine concentration

8. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Anion gap = na - (Cl + bicarb)
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

9. How is plasma volume measured
Radiolabelled albumin
Filtered - secreted
Small kidney - poor prognosis
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

10. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Hypervent - immediate
Insertion of Na channel on luminal side

11. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
JG cells
20 percent

12. membranous
Intra = HIKIN!
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Thickening of glomerular BM

13. What is the henderson hasselbalch equation
Invades IVC and spreads hematogenously
PH = pKa + log bicarb/0.03PCO2
Chronic pyelonephritis
Radiopaque

14. What is the formula for reabsorption
Cx<GFR
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Filtered - secreted
Few glomeruli

15. WBC casts - ddx
Cx = GFR
NC - dec - dec
RTA type 4 (hyperkalemic)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

16. What happens in the collecting tubules
Passively reabsorbs water via medullary hypertonicity
Reabsorb Na in exchange for secreting K and H
Dec - dec - NC
Hypovent - immediate

17. What 3 disease can lead to RPGN
Bladder cancer
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute tubular necrosis
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

18. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
GFR x plasma concentration
Chronic conditions - multiple myeloma - TB - RA
ANP

19. RBC casts - ddx
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
GFR/RPF
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Huge palpable flank mass and hematuria

20. nonenzymatic glycosylation of GBM - inc permeability and thickening
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Diabetic glomerulonephropathy
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

21. Where is angiotensinogen made
Liver
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
All glomeruli

22. What is the BUN/Cr ratio in instrinsic renal ARF and why
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Rxn from angiotensinogen to angiontensin I
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
RTA type 2 (proximal)

23. What does ADH do in the collecting tubule
LM - nl glomeruli - EM - foot process effacement
Invades IVC and spreads hematogenously
Hypovent - immediate
Acts on V2 receptors leading to insertion of aquaporins on luminal side

24. What do you see on LM and IF with rapidly progressive GN
NC - dec - dec
Crescent - moon shape
Renal tubular cells - polygonal clear cells
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

25. What is hartnup's disease
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Principal cells and intercalated cells

26. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Renal in origin
It has a longer renal vein
By 10%
Diarrhea - glue - RTA - hyperchloremia

27. What are the two forms of renal failure and What are examples of each
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Na reabsorption drives H20 reabsorption
Na and volume loss
Acute - ATN - or chronic - HTN - DM

28. What happens to the urine in the descending limb
GFR/RPF
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Becomes concentrated and hypertonic
Thickening of glomerular BM

29. By what percentage does EPRF underestimage true RPF
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
By 10%
60% total body water - 40% ICF - 20% ECF
Dec renal bicarb reabsorption - delayed

30. primary glomerular dz
Dec - dec - dec
GFR/RPF
Involves only glomeruli
Simple cysts

31. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Vasa recta - interlobular v - interlobar v - renal v
Amyloidosis
RTA type 2 (proximal)

32. What is the formula for renal blood flow
Most of the bicarb - sodium - chloride - and water
No
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
RPF/(1- Hct)

33. What happens to tubular inulin along the proximal tubule and why
NC - dec - dec
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc in concentration - not amout - due to water reabsorption
Solute is reabsorbed less quickly than water or net secretion of substance

34. Congo - red stain - apple green birefringence
Diarrhea - glue - RTA - hyperchloremia
Amyloidosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
RTA type 2 (proximal)

35. 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
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Inc in concentration - not amout - due to water reabsorption
White cell casts

36. acute generalized cortical infarction of both kidneys - dz - causes and associations
Makes urine less concentrated - impermeable to H20
HIV
Dec - inc - dec
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

37. tram track appearance on EM - typ - path - and associated dz
Diarrhea - glue - RTA - hyperchloremia
Filtered - secreted
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
RPF/(1- Hct)

38. What effect does cxn of the ureter have on RPF - GFR and FF
Diuretics - vomiting - antacid - hyperaldosteronism
2 ways - base exchanger and between epithelial cells
NC - dec - dec
Reabsorb Na in exchange for secreting K and H

39. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Inc in concentration - not amout - due to water reabsorption

40. What do macula densa cells sense
Na
Beta 1
2 ways - base exchanger and between epithelial cells
Invades IVC and spreads hematogenously

41. What is the net effect of ANP
Few glomeruli
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Na and volume loss

42. What does thyroidization of the kidney result in
Anion gap = na - (Cl + bicarb)
Hydronephrosis and pyelonephritis
Eosinphilic casts in tubules
<3.5 g /day

43. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Excreted - filtered
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Acute renal failure

44. Why can PAH be used to measure ERPF
Bladder cancer
Rxn from angiotensinogen to angiontensin I
Solute and water are reabsorbed at the same rate
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

45. What do you see on LM for focal segmental glomerulosclerosis
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Transitional cell carcinoma
Size and charge
Segmental sclerosis and hylanosis

46. dense deposits on EM - type and association
Type II - C3 nephritic factor
1alpha hydroxylase - PTH stimulates it
Thromboembolism and inc risk of infection
Hypervent - immediate

47. 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
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Freely filtered and neither absorbed or secreted
LM - nl glomeruli - EM - foot process effacement

48. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
Radiolabelled albumin
CHF - pulmonary edema - HTN
Negative charge

49. What happens in the thin descending loop of henle
Inc renal bicarb resabsoprtion - delayed
Passively reabsorbs water via medullary hypertonicity
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
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

50. What is the BUN/Cr ratio in prerenal azotemia and why?
Inc plasma osm - dec blood volume
Filtered - secreted
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption