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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. How does Wilms tumor present
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Huge palpable flank mass and hematuria
Men 50 to 70 - inc incidence with smoking and obesity
2. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Dec - inc - inc
RTA type 2 (proximal)
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
3. What 3 things stimulate the release of renin - and Where is it released from
GFR x plasma concentration
Involves only glomeruli
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Hypovent - immediate
4. What are the associations with RTA type 2
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Under and under
Hypokalemia and hypophosphatemic rickets
Actively reabsorbs NaCl - diluting - makes urine hypotonic
5. What is the most common renal malignancy of early childhood
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
Wilms tumor (ages 2-4)
Size and charge
Antifreeze - ethyelene glycol or vit C abuse
6. What are the 3 transporters of the intercalated cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Involves only glomeruli
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
7. Where does renal cell carcinoma originate and What do the cells look like
Hypovent - immediate
Under and under
Beta 1
Renal tubular cells - polygonal clear cells
8. What do casts indicated about hematuria/pyuria
Renal in origin
Solute is reabsorbed less quickly than water or net secretion of substance
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Complications of chronic kidney disease or HTN
9. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Nonspecific
Beta 1
EPO - endothelial cells of peritubular capillaries
Acute renal failure
10. What is the formula for renal blood flow
Growth retardation and developmental delay
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
RPF/(1- Hct)
11. Which cells sense decreases in Na delivery
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Bladder cancer
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Macula densa
12. What dyslipidemia is most common in renal failure
Acute pyelonephritis
Inc - dec - dec
Inulin
Triglycerides
13. What effect does cxn of the ureter have on RPF - GFR and FF
RTA type 4 (hyperkalemic)
All glomeruli
NC - dec - dec
Dec - dec - dec
14. In what disease in FSGS the most common glomerular disease
NC - inc - inc
HIV
Membranoproliferative glomerulonephritis
Phenacetin - smoking - aniline dyes - cyclophosphamide
15. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Inc renal bicarb resabsoprtion - delayed
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
16. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Failure of EPO
Nephritic syndrome
17. primary glomerular dz
Involves only glomeruli
Filtered - secreted
NC - dec - dec
160-200 - 350
18. What is ADPKD also associated with
Membranoproliferative glomerulonephritis
Podocytes foot processes
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Von hippel laundau and gene deletion in chromosome 3
19. Which cells sense decreases in BP
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Solute is reabsorbed less quickly than water or net secretion of substance
JG cells
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
20. In renal failure - what happens to potassium
Hyperkalemia
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Hypervent - immediate
Metabolic acidosis
21. Congo - red stain - apple green birefringence
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Amyloidosis
22. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Excreted - filtered
Inc GFR and mesangial expansion
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
23. What is the 60-40-20 rule of body weight
60% total body water - 40% ICF - 20% ECF
By 10%
Phenacetin - smoking - aniline dyes - cyclophosphamide
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
24. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Inc plasma osm - dec blood volume
Liver
RTA type 1 (distal)
Most of the bicarb - sodium - chloride - and water
25. hyaline casts ddx
Eosinphilic casts in tubules
Nonspecific
Transitional cell carcinoma
Radiopaque
26. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Angio I to angio II and inhibits bradykinin
Reabsorb Na in exchange for secreting K and H
Freely filtered and neither absorbed or secreted
27. RBC casts - ddx
NC - dec - dec
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Solute is reabsorbed more quickly than water
28. What is the effect of AT II on the hypothalamus
Macula densa
Antifreeze - ethyelene glycol or vit C abuse
Stimulates thirst
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
29. Why does Na conc nearly match Osm
Hypokalemia - risk for Ca containing kidney stones
Diuretics - vomiting - antacid - hyperaldosteronism
Cx>GFR
Na reabsorption drives H20 reabsorption
30. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Acute tubular necrosis
Rxn from angiotensinogen to angiontensin I
Beta 1
31. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
JG cells
Transitional cell carcinoma
Medullary cystic disease
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
32. What are the associations with nephrotic syndrome
By 10%
Hypokalemia and hypophosphatemic rickets
Thromboembolism and inc risk of infection
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
33. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
Diabetic glomerulonephropathy
60% total body water - 40% ICF - 20% ECF
Most of the bicarb - sodium - chloride - and water
34. net tubular reabsorption of x
Nonspecific
Macula densa
Crescent - moon shape
Cx<GFR
35. What is the effect of AT II on the posterior pituitary
Nonspecific
Inc GFR and mesangial expansion
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Makes urine less concentrated - impermeable to H20
36. What happens when PTH is secreted
Dec - dec - NC
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hypervent - immediate
37. By what percentage does EPRF underestimage true RPF
By 10%
Modified smooth muscle of afferent arteriole - secrete renin
Size and charge
Acute pyelonephritis
38. What is the ddx for a respiratory alkalosis
Hypervent - early high altitude - aspirin ingestion early
Dialysis cysts
Hydronephrosis and pyelonephritis
Acute - ATN - or chronic - HTN - DM
39. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Corticosteroids
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Solute is reabsorbed more quickly than water
40. When is TF/P = 1
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Hyperkalemia
Excreted - filtered
Solute and water are reabsorbed at the same rate
41. What is the ddx for a metabolic acidosis with an inc anion gap
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Amyloidosis
Radiolabelled albumin
Acute pyelonephritis
42. In renal failure What are the consquence sof Na/H20 retention
CHF - pulmonary edema - HTN
Hyperkalemia
Macula densa
Antifreeze - ethyelene glycol or vit C abuse
43. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Huge palpable flank mass and hematuria
Triglycerides
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inc in Ca and PO4 absoprtion from the gut
44. Focal
Dec renal bicarb reabsorption - delayed
Few glomeruli
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Hypervent - early high altitude - aspirin ingestion early
45. What are the main causes of membranous GN
Insertion of Na channel on luminal side
<3.5 g /day
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
46. Where is potassium conc. Highest? Intra or extra
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Metabolic acidosis
Antifreeze - ethyelene glycol or vit C abuse
Intra = HIKIN!
47. What happens in the early distal convoluted tubule and What does that do to the urine
Thickening of glomerular BM
Hydronephrosis and pyelonephritis
Inulin
Actively reabsorbs NaCl - diluting - makes urine hypotonic
48. dense deposits on EM - type and association
Cx<GFR
Type II - C3 nephritic factor
Radiopaque
V x Urine concentration
49. What change (lack of) is common in children with renal failure
Failure of EPO
Dialysis cysts
Chronic conditions - multiple myeloma - TB - RA
Growth retardation and developmental delay
50. What substance is secreted in response increase atrial pressure
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
ANP
NC - dec - dec
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens