Test your basic knowledge |

Renal

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. What substance is secreted in response increase atrial pressure
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
ANP
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Triglycerides

2. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
<3.5 g /day
Proximal tubule - na/glucose co transporter

3. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Involves glomeruli and other organs
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

4. waxy casts ddx
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Chronic pyelonephritis
Advanced renal dz - CRF

5. What is the net effect of PTH
Radiopaque
Inc in Ca and PO4 absoprtion from the gut
Hypokalemia and hypophosphatemic rickets
Radiopaque

6. nonenzymatic glycosylation of GBM - inc permeability and thickening
Diabetic glomerulonephropathy
Proximal tubule - na/glucose co transporter
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Triglycerides

7. What is the least common kidney stone - What causes it and How do you treat it
Rxn from angiotensinogen to angiontensin I
Angio I to angio II and inhibits bradykinin
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Liver

8. What change (lack of) is common in children with renal failure
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Growth retardation and developmental delay
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

9. What does the crescent moon shape consist of in RPGN
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Radiolabelled albumin
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Thromboembolism and inc risk of infection

10. Defect in collecting ducts ability to excrete H+
Macula densa and JG cells
Na
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
RTA type 1 (distal)

11. How do calcium stones appear on x ray
Macula densa
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Cx>GFR
Radiopaque

12. What cells create the epithelial layer of the glomerular filtration barrier
Podocytes foot processes
Most of the bicarb - sodium - chloride - and water
Size and charge
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

13. What is the genetic etiology of wilms tumor and What is WAGR complex
Hypervent - early high altitude - aspirin ingestion early
Inc plasma osm - dec blood volume
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Dec renal bicarb reabsorption - delayed

14. What happens in the collecting tubules
Passively reabsorbs water via medullary hypertonicity
Reabsorb Na in exchange for secreting K and H
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
RPF/(1- Hct)

15. granular - muddy brown casts - ddx
20 percent
Under and under
Acute tubular necrosis
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

16. In who is RCC most comon
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Cx = GFR
Men 50 to 70 - inc incidence with smoking and obesity

17. What are the effects of PTH hormone on the kidney
V x Urine concentration
Growth retardation and developmental delay
ANP
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

18. Which cells sense decreases in Na delivery
Hypokalemia and hypophosphatemic rickets
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Macula densa
Radiopaque

19. What is is Alport's syndrome and what else do you see with it other than renal path
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Solute is reabsorbed more quickly than water
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

20. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Macula densa
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
To defend GFR
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

21. What is ADPKD also associated with
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Polycystic liver disease - berry aneurysms - mitral valve prolapse
EPO - endothelial cells of peritubular capillaries
Under and under

22. tram track appearance on EM - typ - path - and associated dz
Contrict leading to inc FF - preserver renal GFR in low volume states
Solute is reabsorbed more quickly than water
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Cx = GFR

23. Why can inulin be used to calculate GFR?
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Diarrhea - glue - RTA - hyperchloremia
Negative charge
Freely filtered and neither absorbed or secreted

24. What therapy does miminal change respond to...
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Size
Corticosteroids
NC - dec - dec

25. What is the formula for clearance of a substance per unit time
V x Urine concentration
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

26. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Vasocxn - inc BP
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
EPO - endothelial cells of peritubular capillaries
Medullary cystic disease

27. What is the effect of of PTH on the distal convoluted tubule
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
PH = pKa + log bicarb/0.03PCO2
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc Ca/Na exchange to inc Ca reabsoprtion

28. How does Wilms tumor present
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Membranoproliferative glomerulonephritis
Huge palpable flank mass and hematuria
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

29. What are the 3 transporters of the intercalated cells
Poor - days to weeks
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Needs to be bilateral
Inc GFR and mesangial expansion

30. What is the effect of aldosterone in principal cells
Radiopaque
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Makes urine less concentrated - impermeable to H20

31. What is the formula for reabsorption
Makes urine less concentrated - impermeable to H20
Filtered - secreted
GFR/RPF
Segmental sclerosis and hylanosis

32. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - dec - dec
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Ectopic EPO - ACTH - PTHrP - prolactin
Proximal tubule - na/glucose co transporter

33. cortical and medullary cysts resulting from long standing dialysis
Insertion of Na channel on luminal side
Intra = HIKIN!
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Dialysis cysts

34. Who often has diffuse proliferative GN
Transitional cell carcinoma
Growth retardation and developmental delay
Complications of chronic kidney disease or HTN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

35. What is the effect of AT II on efferent arterioles
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Crescent - moon shape
Inc GFR and mesangial expansion
Contrict leading to inc FF - preserver renal GFR in low volume states

36. Subendothelial immune complexes with granular IF
V x Urine concentration
Nonspecific
Rxn from angiotensinogen to angiontensin I
Membranoproliferative glomerulonephritis

37. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Triglycerides
GFR/RPF
Nephrotic syndrome
Beta 1

38. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
60% total body water - 40% ICF - 20% ECF

39. How are amino acids reabsorbed
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
ADPKD
Nephrotic syndrome
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

40. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Under and under
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Excreted - filtered

41. inc in creatinine and BUN over a period of several days
Failure of EPO
Antifreeze - ethyelene glycol or vit C abuse
Acute renal failure
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

42. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Solute is reabsorbed more quickly than water
20 percent
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

43. What is amyloidosis associated with
Angio I to angio II and inhibits bradykinin
Principal cells and intercalated cells
Chronic conditions - multiple myeloma - TB - RA
Inc - dec - dec

44. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Nonspecific
Most of the bicarb - sodium - chloride - and water
Excreted - filtered
60% total body water - 40% ICF - 20% ECF

45. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

46. no net secretion or reabsorption of x
Cx = GFR
Rxn from angiotensinogen to angiontensin I
UTI or acute gastroenteritis
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

47. What is lost in nephrotic syndrome resulting what urine and serum changes
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Ammonia - buffer for secreted H+
Hypervent - immediate

48. What is the most common renal malignancy of early childhood
Wilms tumor (ages 2-4)
Thickening of glomerular BM
Inc plasma osm - dec blood volume
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

49. What do macula densa cells sense
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Na

50. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Inc in Ca and PO4 absoprtion from the gut
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Eosinphilic casts in tubules
Dec - inc - dec