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Renal

Instructions:

Answer 50 questions in 15 minutes.
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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 is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Men 50 to 70 - inc incidence with smoking and obesity
Hypokalemia and hypophosphatemic rickets
Inc renal bicarb resabsoprtion - delayed

2. membranous
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
V x Urine concentration
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Thickening of glomerular BM

3. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Inhibits Na/phosphate cotransport leading to phosphate excretion
Type II - C3 nephritic factor
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

4. Congo - red stain - apple green birefringence
NC - dec - dec
Amyloidosis
Negative charge
Makes urine less concentrated - impermeable to H20

5. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Hypokalemia - risk for Ca containing kidney stones
Segmental sclerosis and hylanosis
Involves only glomeruli

6. What is the prognosis of RPGN
Solute and water are reabsorbed at the same rate
PH - then PC02
It has a longer renal vein
Poor - days to weeks

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

8. What are the LM and EM of minimal change disease
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
LM - nl glomeruli - EM - foot process effacement
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
NC - dec - dec

9. proliferative
Podocytes foot processes
ANP
UTI or acute gastroenteritis
Hyperceullular glomeruli

10. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
1alpha hydroxylase - PTH stimulates it
160-200 - 350

11. When is TF/P = 1
Needs to be bilateral
Inc GFR and mesangial expansion
Solute and water are reabsorbed at the same rate
Dec - dec - NC

12. How do struvite stones appear on xray
Bladder cancer
Stimulates thirst
Radiopaque
Men 50 to 70 - inc incidence with smoking and obesity

13. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
Contrict leading to inc FF - preserver renal GFR in low volume states
Liver
Antifreeze - ethyelene glycol or vit C abuse

14. What is the LM for diabetic glomerulonephropathy
Poor - days to weeks
V x Urine concentration
Inhibits Na/phosphate cotransport leading to phosphate excretion
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

15. diffuse
All glomeruli
Advanced renal dz - CRF
Radiopaque
Men 50 to 70 - inc incidence with smoking and obesity

16. What does thyroidization of the kidney result in
Cx<GFR
Acute tubular necrosis
Type II - C3 nephritic factor
Eosinphilic casts in tubules

17. What is the compensatory response in respiratory alkalosis
Hypovent - immediate
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Carbonic anhydrase
Dec renal bicarb reabsorption - delayed

18. What can cause oxalate crystals
Antifreeze - ethyelene glycol or vit C abuse
Thromboembolism and inc risk of infection
Hypovent - immediate
Most of the bicarb - sodium - chloride - and water

19. What is a normal filtration fraction
20 percent
Thromboembolism and inc risk of infection
Angio I to angio II and inhibits bradykinin
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

20. What are the two kinds of cells in the collecting tubules
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
RPF/(1- Hct)
Few glomeruli
Principal cells and intercalated cells

21. What is generated and secreted in the proximal tubule
Inc GFR and mesangial expansion
White cell casts
Ammonia - buffer for secreted H+
Actively reabsorbs NaCl - diluting - makes urine hypotonic

22. What is ADPKD also associated with
NC - dec - dec
Von hippel laundau and gene deletion in chromosome 3
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

23. What is the pathway to the afferent arteriole
Dec - dec - dec
Renal artery - interlobar a - interlobular a
Hyperceullular glomeruli
Hypovent - immediate

24. What is the formula for renal blood flow
Macula densa and JG cells
RPF/(1- Hct)
NC - dec - dec
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

25. How can NSAIDs cause acute renal failure
Size
Most of the bicarb - sodium - chloride - and water
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

26. coarse - asymmetric - corticomedullary scarring and blunted calyx
Carbonic anhydrase
Becomes concentrated and hypertonic
LM - nl glomeruli - EM - foot process effacement
Chronic pyelonephritis

27. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Carbonic anhydrase
Stimulates thirst
Hypervent - early high altitude - aspirin ingestion early

28. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Size
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

29. When is TF/P <1
By 10%
Solute is reabsorbed more quickly than water
Staghorn calculi - worsened by alkaluria
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

30. What is the net effect of PTH
NKCC
Inc in Ca and PO4 absoprtion from the gut
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Cx = GFR

31. net tubular secretion of x
Type II - C3 nephritic factor
Cx>GFR
Principal cells and intercalated cells
Hyperceullular glomeruli

32. Where is potassium conc. Highest? Intra or extra
Renal tubular cells - polygonal clear cells
Metabolic acidosis
Segmental sclerosis and hylanosis
Intra = HIKIN!

33. Under what circumstances is aldosterone secreted
Hypokalemia - risk for Ca containing kidney stones
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Actively reabsorbs NaCl - diluting - makes urine hypotonic

34. What is the most common renal malignancy of early childhood
Wilms tumor (ages 2-4)
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Nonspecific
Cx>GFR

35. What effect does cxn of the ureter have on RPF - GFR and FF
ANP
No
NC - dec - dec
Thromboembolism and inc risk of infection

36. How are amino acids reabsorbed
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc - inc - inc
Wilms tumor (ages 2-4)
Hypokalemia and hypophosphatemic rickets

37. What is the formula for excretion rate
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
V x Urine concentration
Growth retardation and developmental delay
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

38. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Radiopaque
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Wilms tumor (ages 2-4)
Inc plasma osm - dec blood volume

39. What do you see on LM and IF with rapidly progressive GN
Macula densa and JG cells
Crescent - moon shape
Acute - ATN - or chronic - HTN - DM
<3.5 g /day

40. How do you interpret creatinine clearance
Makes urine less concentrated - impermeable to H20
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Hyperceullular glomeruli
Growth retardation and developmental delay

41. What cells create the epithelial layer of the glomerular filtration barrier
Under and under
Podocytes foot processes
Small kidney - poor prognosis
Solute is reabsorbed less quickly than water or net secretion of substance

42. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
No
Hypervent - immediate

43. In a metabolic acidosis What additional calculation is necessary and How do you make it
160-200 - 350
Anion gap = na - (Cl + bicarb)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Nephritic syndrome

44. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Nonspecific
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inc - inc - inc
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

45. What therapy does miminal change respond to...
1/4 plasma - and 3/4 interstitial volume
Dec - dec - NC
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Corticosteroids

46. What do you see on LM for focal segmental glomerulosclerosis
Hydronephrosis and pyelonephritis
Segmental sclerosis and hylanosis
NKCC
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

47. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Principal cells and intercalated 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
Acute tubular necrosis

48. How does Wilms tumor present
CHF - pulmonary edema - HTN
Huge palpable flank mass and hematuria
Nonspecific
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

49. cortical and medullary cysts resulting from long standing dialysis
Chronic conditions - multiple myeloma - TB - RA
Dialysis cysts
Inc in Ca and PO4 absoprtion from the gut
Type II - C3 nephritic factor

50. What are the associations with RTA type 1
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Ectopic EPO - ACTH - PTHrP - prolactin
Hypokalemia - risk for Ca containing kidney stones
Wilms tumor (ages 2-4)