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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 is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
By 10%
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

2. By what percentage does EPRF underestimage true RPF
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Macula densa and JG cells
By 10%
Bladder cancer

3. How do calcium stones appear on x ray
1/4 plasma - and 3/4 interstitial volume
Radiopaque
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
ADPKD

4. What happens to urine in the ascending limb
Solute is reabsorbed more quickly than water
PH - then PC02
Makes urine less concentrated - impermeable to H20
Dec renal bicarb reabsorption - delayed

5. Defect in collecting ducts ability to excrete H+
GFR/RPF
RTA type 1 (distal)
Inc Ca/Na exchange to inc Ca reabsoprtion
Type II - C3 nephritic factor

6. What are the two forms of renal failure and What are examples of each
Under and under
Acute - ATN - or chronic - HTN - DM
Cx<GFR
Staghorn calculi - worsened by alkaluria

7. In a metabolic acidosis What additional calculation is necessary and How do you make it
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Vasa recta - interlobular v - interlobar v - renal v
Acute tubular necrosis
Anion gap = na - (Cl + bicarb)

8. Under what circumstances is aldosterone secreted
GFR x plasma concentration
Dec renal bicarb reabsorption - delayed
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Few glomeruli

9. What is the henderson hasselbalch equation
Small kidney - poor prognosis
ANP
PH = pKa + log bicarb/0.03PCO2
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

10. What is the 60-40-20 rule of body weight
Huge palpable flank mass and hematuria
60% total body water - 40% ICF - 20% ECF
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Needs to be bilateral

11. cortical and medullary cysts resulting from long standing dialysis
It has a longer renal vein
Dec - inc - dec
Dialysis cysts
Angio I to angio II and inhibits bradykinin

12. What effect does afferent arteriole cxn have on RPF - GFR and FF
Hydronephrosis and pyelonephritis
Inhibits Na/phosphate cotransport leading to phosphate excretion
Dec - dec - NC
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

13. What is generated and secreted in the proximal tubule
Hyperceullular glomeruli
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
UTI or acute gastroenteritis
Ammonia - buffer for secreted H+

14. What do macula densa cells sense
Na
Hypovent - immediate
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

15. What is ADPKD also associated with
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Radiopaque
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

16. How is chlorid reabsorbed in the proximal tubule
Advanced renal dz - CRF
2 ways - base exchanger and between epithelial cells
Inc Ca/Na exchange to inc Ca reabsoprtion
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

17. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inc in Ca and PO4 absoprtion from the gut
Inc GFR and mesangial expansion
Carbonic anhydrase

18. What are the two kinds of cells in the collecting tubules
HIV
Principal cells and intercalated cells
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

19. What substance is secreted in response increase atrial pressure
Freely filtered and neither absorbed or secreted
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
ANP
Na and volume loss

20. How do struvite stones appear on xray
Advanced renal dz - CRF
Corticosteroids
Radiopaque
Anion gap = na - (Cl + bicarb)

21. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Vasa recta - interlobular v - interlobar v - renal v
Na and volume loss
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

22. What is the formula for clearance of a substance per unit time
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

23. Who commonly gets acute post strep GN
Invades IVC and spreads hematogenously
Ammonia - buffer for secreted H+
Kids - peripheral and periorbital edema - resolves spontaneously
Needs to be bilateral

24. In what disease in FSGS the most common glomerular disease
Inulin
Stimulates thirst
Inhibits Na/phosphate cotransport leading to phosphate excretion
HIV

25. What do you see in the urine with acute pyelonephritis
Inc plasma osm - dec blood volume
Amyloidosis
White cell casts
It has a longer renal vein

26. What is the effect of aldosterone in principal cells
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Na
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
UTI or acute gastroenteritis

27. What is the most frequent kind of kidney stone and What are causes that lead to it
Eosinphilic casts in tubules
Na
Vasocxn - inc BP
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

28. When is TF/P <1
Von hippel laundau and gene deletion in chromosome 3
Amyloidosis
Solute is reabsorbed more quickly than water
Anion gap = na - (Cl + bicarb)

29. What are the LM and EM of minimal change disease
LM - nl glomeruli - EM - foot process effacement
Triglycerides
NC - dec - dec
Inc - inc - inc

30. What is the formula for reabsorption
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Liver
Filtered - secreted
Amyloidosis

31. What two cells make up the JGA
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc - inc - inc
Macula densa and JG cells

32. How do you interpret creatinine clearance
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Angio I to angio II and inhibits bradykinin

33. What happens in the thin descending loop of henle
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Passively reabsorbs water via medullary hypertonicity
Hyperceullular glomeruli
Liver

34. Which cells sense decreases in Na delivery
Macula densa
Inc - inc - inc
Na and volume loss
Crescent - moon shape

35. Why can PAH be used to measure ERPF
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Small kidney - poor prognosis
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

36. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Medullary cystic disease
1/4 plasma - and 3/4 interstitial volume
Diarrhea - glue - RTA - hyperchloremia
Dec - inc - dec

37. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Inc - dec - dec
Solute and water are reabsorbed at the same rate
Corticosteroids

38. RBC casts - ddx
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Chronic pyelonephritis
Inc - dec - dec
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

39. What is the compensatory response in metabolic acidosis
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Membranoproliferative glomerulonephritis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Hypervent - immediate

40. What is the formula for secreted
Triglycerides
Filtered - secreted
Chronic conditions - multiple myeloma - TB - RA
Excreted - filtered

41. What is is Alport's syndrome and what else do you see with it other than renal path
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Macula densa
Passively reabsorbs water via medullary hypertonicity

42. hypoaldosteronism or lack of collecting tubule response to aldosteron
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
RTA type 4 (hyperkalemic)
Ectopic EPO - ACTH - PTHrP - prolactin
Excreted - filtered

43. What is the formula for filtration fraction
NKCC
To defend GFR
GFR/RPF
Beta 1

44. What do you see on LM for focal segmental glomerulosclerosis
PH = pKa + log bicarb/0.03PCO2
Intra = HIKIN!
Segmental sclerosis and hylanosis
Acts on V2 receptors leading to insertion of aquaporins on luminal side

45. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Vasocxn - inc BP
Small kidney - poor prognosis
Thickening of glomerular BM

46. What happens to pH - PCO2 and bicarb in metabolic acidosis
Becomes concentrated and hypertonic
V x Urine concentration
Dec - dec - dec
Dec renal bicarb reabsorption - delayed

47. What are the associations with RTA type 4
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Intra = HIKIN!

48. granular - muddy brown casts - ddx
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Acute tubular necrosis
Nephrotic syndrome
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

49. What is the 3rd most common kidney stone and What causes it
No
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

50. What do you see on LM and IF with rapidly progressive GN
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Renal artery - interlobar a - interlobular a
Crescent - moon shape
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation