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Renal

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Answer 50 questions in 15 minutes.
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1. What is the most frequent kind of kidney stone and What are causes that lead to it
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Medullary cystic disease
Reabsorb Na in exchange for secreting K and H
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

2. What happens to pH - PCO2 and bicarb in metabolic acidosis
Advanced renal dz - CRF
Dec - dec - dec
Acute renal failure
GFR/RPF

3. How What does the glomerular filtration barrier distinguish by
Most of the bicarb - sodium - chloride - and water
Modified smooth muscle of afferent arteriole - secrete renin
Size and charge
Hypovent - immediate

4. What do macula densa cells sense
Na
Advanced renal dz - CRF
CHF - pulmonary edema - HTN
Small kidney - poor prognosis

5. net tubular reabsorption of x
Cx<GFR
Vasocxn - inc BP
Medullary cystic disease
Liver

6. What is the net effect of PTH
Antifreeze - ethyelene glycol or vit C abuse
Inc in Ca and PO4 absoprtion from the gut
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
GFR/RPF

7. Who commonly gets acute post strep GN
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
60% total body water - 40% ICF - 20% ECF
Kids - peripheral and periorbital edema - resolves spontaneously
Amyloidosis

8. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
RTA type 4 (hyperkalemic)
Insertion of Na channel on luminal side
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

9. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Carbonic anhydrase
Acute renal failure
Beta 1
Dec - inc - dec

10. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Becomes concentrated and hypertonic
Wilms tumor (ages 2-4)
Diuretics - vomiting - antacid - hyperaldosteronism
Most of the bicarb - sodium - chloride - and water

11. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Na reabsorption drives H20 reabsorption
Eosinphilic casts in tubules

12. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Beta 1
Inc Ca/Na exchange to inc Ca reabsoprtion
EPO - endothelial cells of peritubular capillaries
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

13. What cells create the epithelial layer of the glomerular filtration barrier
EPO - endothelial cells of peritubular capillaries
Vasa recta - interlobular v - interlobar v - renal v
Type II - C3 nephritic factor
Podocytes foot processes

14. Who often has diffuse proliferative GN
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)
Vasocxn - inc BP
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

15. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
ADPKD
Invades IVC and spreads hematogenously
Kids - peripheral and periorbital edema - resolves spontaneously
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

16. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Size and charge
RTA type 2 (proximal)
Simple cysts

17. What is the most common renal malignancy of early childhood
Dec renal bicarb reabsorption - delayed
Inc GFR and mesangial expansion
Wilms tumor (ages 2-4)
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

18. tram track appearance on EM - typ - path - and associated dz
Crescent - moon shape
Nephrotic syndrome
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

19. In what clinical context does Berger's disease often present
Involves glomeruli and other organs
Dialysis cysts
UTI or acute gastroenteritis
Carbonic anhydrase

20. What effect does afferent arteriole cxn have on RPF - GFR and FF
CHF - pulmonary edema - HTN
Amyloidosis
NC - dec - dec
Dec - dec - NC

21. What do you see on LM for focal segmental glomerulosclerosis
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Segmental sclerosis and hylanosis
RTA type 1 (distal)

22. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
Beta 1
Renal in origin
Complications of chronic kidney disease or HTN

23. The fenestrated capillary endothelium constitutes what portion of the barrier
GFR/RPF
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
NKCC
Size

24. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Radiopaque
Hypervent - early high altitude - aspirin ingestion early
No

25. What serum changes cause a secretion in PTH
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Na
Hyperkalemia

26. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
Chronic pyelonephritis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

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

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28. What is the formula for excretion rate
No
V x Urine concentration
Inc plasma osm - dec blood volume
JG cells

29. What 3 things stimulate the release of renin - and Where is it released from
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Amyloidosis

30. What is a normal filtration fraction
RPF/(1- Hct)
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
20 percent
Dec - dec - NC

31. What does US show with medullary cystic disease
Inulin
Excreted - filtered
Small kidney - poor prognosis
Kids - peripheral and periorbital edema - resolves spontaneously

32. What is the effect of aldosterone in principal cells
Huge palpable flank mass and hematuria
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Chronic conditions - multiple myeloma - TB - RA
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

33. What is the formula for filtration fraction
Dec - inc - dec
Staghorn calculi - worsened by alkaluria
GFR/RPF
Invades IVC and spreads hematogenously

34. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Growth retardation and developmental delay
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Macula densa

35. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Podocytes foot processes
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Acute - ATN - or chronic - HTN - DM

36. In a metabolic acidosis What additional calculation is necessary and How do you make it
Anion gap = na - (Cl + bicarb)
Solute and water are reabsorbed at the same rate
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
60% total body water - 40% ICF - 20% ECF

37. In renal failure with uremia - What are the 5 aspects of uremia
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Segmental sclerosis and hylanosis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

38. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Inc - inc - inc
Acts on V2 receptors leading to insertion of aquaporins on luminal side

39. How is extracellular volume measured
Simple cysts
Inulin
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
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

40. What is the purpose of the JGA
To defend GFR
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Staghorn calculi - worsened by alkaluria
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

41. What is the cutoff of proteinuria in nephritic syndrome
Cx>GFR
<3.5 g /day
NC - inc - inc
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

42. What is the formula for the filtered load
Polycystic liver disease - berry aneurysms - mitral valve prolapse
To defend GFR
GFR x plasma concentration
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

43. How is chlorid reabsorbed in the proximal tubule
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Cx = GFR
2 ways - base exchanger and between epithelial cells
Size and charge

44. Where is angiotensinogen made
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Nonspecific
Liver

45. What is the net effect of AT II
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
1alpha hydroxylase - PTH stimulates it
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Antifreeze - ethyelene glycol or vit C abuse

46. What is the net effect of ANP
Na and volume loss
Size and charge
V x Urine concentration
Hydronephrosis and pyelonephritis

47. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Carbonic anhydrase
GFR/RPF
Inc Ca/Na exchange to inc Ca reabsoprtion

48. Why is there anemia in renal failure
RTA type 4 (hyperkalemic)
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
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
Failure of EPO

49. What is the 3rd most common kidney stone and What causes it
Solute is reabsorbed more quickly than water
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Angio I to angio II and inhibits bradykinin
Filtered - secreted

50. In what disease in FSGS the most common glomerular disease
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Radiopaque
HIV
Intra = HIKIN!

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Renal

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