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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. What is the BUN/Cr ratio in prerenal azotemia and why?
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

2. What is the formula for renal blood flow
Angio I to angio II and inhibits bradykinin
RPF/(1- Hct)
To defend GFR
Anion gap = na - (Cl + bicarb)

3. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
Crescent - moon shape
Failure of EPO
Phenacetin - smoking - aniline dyes - cyclophosphamide

4. What do you see on LM for focal segmental glomerulosclerosis
Transitional cell carcinoma
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Segmental sclerosis and hylanosis
Solute is reabsorbed less quickly than water or net secretion of substance

5. What is the effect of aldosterone in principal cells
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Few glomeruli

6. When is TF/P = 1
Solute and water are reabsorbed at the same rate
EPO - endothelial cells of peritubular capillaries
Nephrotic syndrome
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

7. What is the compensatory response in metabolic alkalosis
By 10%
Crescent - moon shape
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Hypovent - immediate

8. What is the compensatory response in metabolic acidosis
It has a longer renal vein
Podocytes foot processes
Hypervent - immediate
ADPKD

9. granular - muddy brown casts - ddx
Membranoproliferative glomerulonephritis
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Acute tubular necrosis
GFR/RPF

10. What is the compensatory response in respiratory acidosis
Complications of chronic kidney disease or HTN
RTA type 4 (hyperkalemic)
Inc renal bicarb resabsoprtion - delayed
Hypokalemia - risk for Ca containing kidney stones

11. What do you see in the urine with acute pyelonephritis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
White cell casts
No

12. What happens in the collecting tubules
Makes urine less concentrated - impermeable to H20
Reabsorb Na in exchange for secreting K and H
Diabetic glomerulonephropathy
Vasocxn - inc BP

13. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
PH - then PC02
Inc

14. What are the main complications of kidney stones
Most of the bicarb - sodium - chloride - and water
Inulin
Hydronephrosis and pyelonephritis
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

15. In a metabolic acidosis What additional calculation is necessary and How do you make it
Kids - peripheral and periorbital edema - resolves spontaneously
Poor - days to weeks
Needs to be bilateral
Anion gap = na - (Cl + bicarb)

16. What are the effects of AT II on the adrenal gland
Insertion of Na channel on luminal side
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Small kidney - poor prognosis
Men 50 to 70 - inc incidence with smoking and obesity

17. What are the associated paraneoplastic syndromes wth RCC
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Vasocxn - inc BP
Ectopic EPO - ACTH - PTHrP - prolactin
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

18. What are the main causes of membranous GN
Involves only glomeruli
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

19. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
ANP
Inc plasma osm - dec blood volume
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

20. What are the LM and EM of minimal change disease
By 10%
LM - nl glomeruli - EM - foot process effacement
Thickening of glomerular BM
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

21. Where is angiotensinogen made
Insertion of Na channel on luminal side
Liver
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

22. RBC casts - ddx
Cx = GFR
RPF/(1- Hct)
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Thromboembolism and inc risk of infection

23. Focal
Advanced renal dz - CRF
Inc in concentration - not amout - due to water reabsorption
Few glomeruli
To defend GFR

24. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
ANP
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Simple cysts
RPF/(1- Hct)

25. What is winter's formula and when do you use it
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
2 ways - base exchanger and between epithelial cells
60% total body water - 40% ICF - 20% ECF
Inc - inc - inc

26. What is the effect of of PTH on the distal convoluted tubule
NKCC
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Radiopaque
Inc Ca/Na exchange to inc Ca reabsoprtion

27. How What does the glomerular filtration barrier distinguish by
Size and charge
UTI or acute gastroenteritis
Dec - dec - NC
Chronic pyelonephritis

28. What happens to tubular inulin along the proximal tubule and why
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc in concentration - not amout - due to water reabsorption
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Thromboembolism and inc risk of infection

29. What are the two forms of renal failure and What are examples of each
Angio I to angio II and inhibits bradykinin
Complications of chronic kidney disease or HTN
Acute - ATN - or chronic - HTN - DM
Dialysis cysts

30. cortical and medullary cysts resulting from long standing dialysis
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Dialysis cysts
LM - nl glomeruli - EM - foot process effacement
1alpha hydroxylase - PTH stimulates it

31. What is the least common kidney stone - What causes it and How do you treat it
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Solute is reabsorbed more quickly than water
Small kidney - poor prognosis

32. What effect does ANP have on GFR
Principal cells and intercalated cells
Vasocxn - inc BP
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Inc

33. in acute post strep GN - What do you see on LM - EM and IF

34. How do the ureters course in relation to the uterine artery and ductus deferens
Segmental sclerosis and hylanosis
Under and under
GFR x plasma concentration
Simple cysts

35. How does RCC manifest clinically
Phenacetin - smoking - aniline dyes - cyclophosphamide
Inc in concentration - not amout - due to water reabsorption
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Amyloidosis

36. What is a normal filtration fraction
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
20 percent
<3.5 g /day
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

37. Defect in proximal tubule HCO3 reabsorption
Segmental sclerosis and hylanosis
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
RTA type 2 (proximal)
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

38. What happens in the early distal convoluted tubule and What does that do to the urine
Actively reabsorbs NaCl - diluting - makes urine hypotonic
All glomeruli
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Under and under

39. What is the compensatory response in respiratory alkalosis
Dec renal bicarb reabsorption - delayed
Amyloidosis
JG cells
PH = pKa + log bicarb/0.03PCO2

40. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Dec - inc - inc
Medullary cystic disease
Von hippel laundau and gene deletion in chromosome 3
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

41. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
CHF - pulmonary edema - HTN
Proximal tubule - na/glucose co transporter
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

42. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Inc renal bicarb resabsoprtion - delayed
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
160-200 - 350
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

43. What are the effects of PTH hormone on the kidney
White cell casts
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
Diuretics - vomiting - antacid - hyperaldosteronism
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

44. How is chlorid reabsorbed in the proximal tubule
Reabsorb Na in exchange for secreting K and H
2 ways - base exchanger and between epithelial cells
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Type II - C3 nephritic factor

45. How do calcium stones appear on x ray
V x Urine concentration
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Phenacetin - smoking - aniline dyes - cyclophosphamide
Radiopaque

46. What is lost in nephrotic syndrome resulting what urine and serum changes
Small kidney - poor prognosis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Solute is reabsorbed more quickly than water
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

47. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
White cell casts
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Involves only glomeruli

48. What happens to pH - PCO2 and bicarb in metabolic acidosis
RPF/(1- Hct)
Amyloidosis
Dec - dec - dec
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

49. What do casts indicated about hematuria/pyuria
Podocytes foot processes
Staghorn calculi - worsened by alkaluria
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Renal in origin

50. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Hypervent - early high altitude - aspirin ingestion early
<3.5 g /day
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption