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Renal

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Answer 50 questions in 15 minutes.
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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. dense deposits on EM - type and association
Nephritic syndrome
Needs to be bilateral
NC - dec - dec
Type II - C3 nephritic factor

2. What happens in the early distal convoluted tubule and What does that do to the urine
Actively reabsorbs NaCl - diluting - makes urine hypotonic
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Vasa recta - interlobular v - interlobar v - renal v
Na and volume loss

3. How do calcium stones appear on x ray
Radiopaque
Crescent - moon shape
Renal artery - interlobar a - interlobular a
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

4. What happens to pH - PCO2 and bicarb in metabolic acidosis
Radiolabelled albumin
Vasocxn - inc BP
Carbonic anhydrase
Dec - dec - dec

5. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Radiopaque
Diarrhea - glue - RTA - hyperchloremia
Phenacetin - smoking - aniline dyes - cyclophosphamide

6. What is the compensatory response in metabolic alkalosis
Diuretics - vomiting - antacid - hyperaldosteronism
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hypovent - immediate
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

7. What are the associated paraneoplastic syndromes wth RCC
Men 50 to 70 - inc incidence with smoking and obesity
Radiolabelled albumin
Ectopic EPO - ACTH - PTHrP - prolactin
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

8. What is the compensatory response in metabolic acidosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
160-200 - 350
Hypervent - immediate
Phenacetin - smoking - aniline dyes - cyclophosphamide

9. What do patients die from ADPKD
Amyloidosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Radiopaque
Complications of chronic kidney disease or HTN

10. How does Wilms tumor present
Huge palpable flank mass and hematuria
GFR x plasma concentration
Na
Needs to be bilateral

11. What is is Alport's syndrome and what else do you see with it other than renal path
Small kidney - poor prognosis
Segmental sclerosis and hylanosis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
It has a longer renal vein

12. How do the ureters course in relation to the uterine artery and ductus deferens
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Solute is reabsorbed more quickly than water
<3.5 g /day
Under and under

13. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Dec - inc - inc
ANP
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

14. proliferative
Hyperceullular glomeruli
Kids - peripheral and periorbital edema - resolves spontaneously
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

15. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Beta 1
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Hypervent - immediate
Simple cysts

16. hyaline casts ddx
Triglycerides
Nonspecific
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
NC - inc - inc

17. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Eosinphilic casts in tubules
Na reabsorption drives H20 reabsorption
Most of the bicarb - sodium - chloride - and water

18. Subendothelial immune complexes with granular IF
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Membranoproliferative glomerulonephritis
Von hippel laundau and gene deletion in chromosome 3
Triglycerides

19. What effect does ANP have on GFR
Filtered - secreted
Intra = HIKIN!
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc

20. waxy casts ddx
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Corticosteroids
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Advanced renal dz - CRF

21. What is the net effect of PTH
Cx = GFR
Beta 1
Inc in Ca and PO4 absoprtion from the gut
Poor - days to weeks

22. In what clinical context does Berger's disease often present
Filtered - secreted
Macula densa and JG cells
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
UTI or acute gastroenteritis

23. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
2 ways - base exchanger and between epithelial cells
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

24. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Rxn from angiotensinogen to angiontensin I
ADPKD
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Size and charge

25. Who often has diffuse proliferative GN
Huge palpable flank mass and hematuria
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Modified smooth muscle of afferent arteriole - secrete renin
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

26. net tubular secretion of x
Involves glomeruli and other organs
Cx>GFR
Na
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

27. What does NEG lead to in the efferent arterioles
Hyperceullular glomeruli
Few glomeruli
Inc GFR and mesangial expansion
Poor - days to weeks

28. in acute cystitis with pyuria - do you see casts
ANP
Hypokalemia and hypophosphatemic rickets
No
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

29. What is the LM for diabetic glomerulonephropathy
Acute renal failure
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
By 10%
Crescent - moon shape

30. When is glucose reabsorbed and with What transporter
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hypokalemia - risk for Ca containing kidney stones
Dec - dec - NC
Proximal tubule - na/glucose co transporter

31. What is the formula for the filtered load
Inc renal bicarb resabsoprtion - delayed
GFR x plasma concentration
Hyperkalemia
Diabetic glomerulonephropathy

32. cortical and medullary cysts resulting from long standing dialysis
It has a longer renal vein
Dialysis cysts
Segmental sclerosis and hylanosis
Vasa recta - interlobular v - interlobar v - renal v

33. What are the two forms of renal failure and What are examples of each
Renal artery - interlobar a - interlobular a
Freely filtered and neither absorbed or secreted
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Acute - ATN - or chronic - HTN - DM

34. Congo - red stain - apple green birefringence
Amyloidosis
Huge palpable flank mass and hematuria
Hypokalemia - risk for Ca containing kidney stones
Stimulates thirst

35. In renal failure What are the consquence sof Na/H20 retention
CHF - pulmonary edema - HTN
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Small kidney - poor prognosis

36. What effect does cxn of the ureter have on RPF - GFR and FF
Hypervent - early high altitude - aspirin ingestion early
Chronic pyelonephritis
Thickening of glomerular BM
NC - dec - dec

37. What is the formula for excretion rate
Under and under
Actively reabsorbs NaCl - diluting - makes urine hypotonic
V x Urine concentration
20 percent

38. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Acute renal failure
Nonspecific
Inc GFR and mesangial expansion

39. What serum changes cause a secretion in PTH
Men 50 to 70 - inc incidence with smoking and obesity
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
NKCC

40. nonenzymatic glycosylation of GBM - inc permeability and thickening
Triglycerides
Contrict leading to inc FF - preserver renal GFR in low volume states
2 ways - base exchanger and between epithelial cells
Diabetic glomerulonephropathy

41. How are amino acids reabsorbed
1/4 plasma - and 3/4 interstitial volume
Renal in origin
Podocytes foot processes
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

42. What does renin do
Podocytes foot processes
Nephrotic syndrome
Rxn from angiotensinogen to angiontensin I
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

43. what happens to pH - PCO2 - and bicarb in respiratory acidosis
By 10%
Segmental sclerosis and hylanosis
Dec - inc - dec
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

44. 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
Anion gap = na - (Cl + bicarb)
Principal cells and intercalated cells
Inc renal bicarb resabsoprtion - delayed

45. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
RPF/(1- Hct)
Inc - dec - dec
Involves glomeruli and other organs

46. When is TF/P <1
Solute is reabsorbed more quickly than water
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

47. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Segmental sclerosis and hylanosis
Diarrhea - glue - RTA - hyperchloremia

48. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Acute - ATN - or chronic - HTN - DM
Negative charge

49. In what disease in FSGS the most common glomerular disease
Vasocxn - inc BP
Cx<GFR
Acute - ATN - or chronic - HTN - DM
HIV

50. The fenestrated capillary endothelium constitutes what portion of the barrier
Contrict leading to inc FF - preserver renal GFR in low volume states
Simple cysts
Size
V x Urine concentration

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Renal

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