Test your basic knowledge |

Renal

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Answer 50 questions in 15 minutes.
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1. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
LM - nl glomeruli - EM - foot process effacement
Membranoproliferative glomerulonephritis
Men 50 to 70 - inc incidence with smoking and obesity

2. What is renal osteodystrophy
Invades IVC and spreads hematogenously
Inc
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

3. How do calcium stones appear on x ray
By 10%
Radiopaque
Radiolabelled albumin
Inc GFR and mesangial expansion

4. How does RCC spread
NKCC
Invades IVC and spreads hematogenously
Acute - ATN - or chronic - HTN - DM
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

5. What is the formula for filtration fraction
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
GFR/RPF
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Na

6. What substance is secreted in response increase atrial pressure
Acute pyelonephritis
ANP
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Thickening of glomerular BM

7. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Inc in Ca and PO4 absoprtion from the gut
Kids - peripheral and periorbital edema - resolves spontaneously
Medullary cystic disease
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

8. proliferative
Hyperceullular glomeruli
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Modified smooth muscle of afferent arteriole - secrete renin
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

9. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Under and under
Involves glomeruli and other organs
NC - inc - inc
Cx>GFR

10. What is the pathway from the efferent arteriorle to the renal v
Nephrotic syndrome
Nonspecific
Renal in origin
Vasa recta - interlobular v - interlobar v - renal v

11. What happens in the early distal convoluted tubule and What does that do to the urine
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Radiopaque
Inulin
Diuretics - vomiting - antacid - hyperaldosteronism

12. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Hydronephrosis and pyelonephritis
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Antifreeze - ethyelene glycol or vit C abuse
Involves glomeruli and other organs

13. waxy casts ddx
Advanced renal dz - CRF
Dec - dec - NC
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Kids - peripheral and periorbital edema - resolves spontaneously

14. Defect in collecting ducts ability to excrete H+
Hypovent - immediate
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Reabsorb Na in exchange for secreting K and H
RTA type 1 (distal)

15. secondary glomerular dz
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Involves glomeruli and other organs
RTA type 4 (hyperkalemic)
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

16. What is the formula for clearance of a substance per unit time
Triglycerides
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Von hippel laundau and gene deletion in chromosome 3

17. What is the ddx for respiratory acidosis
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Nephritic syndrome
Angio I to angio II and inhibits bradykinin

18. What is the formula for reabsorption
Metabolic acidosis
Filtered - secreted
RPF/(1- Hct)
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

19. In what clinical context does Berger's disease often present
NC - dec - dec
Inc in concentration - not amout - due to water reabsorption
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
UTI or acute gastroenteritis

20. What is the most common renal malignancy of early childhood
Few glomeruli
Medullary cystic disease
Wilms tumor (ages 2-4)
Macula densa

21. What is the second most common kidney stone
160-200 - 350
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Diabetic glomerulonephropathy
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

22. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
Under and under
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

23. Which cells sense decreases in BP
JG cells
V x Urine concentration
UTI or acute gastroenteritis
Inc

24. diffuse
Phenacetin - smoking - aniline dyes - cyclophosphamide
160-200 - 350
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
All glomeruli

25. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Vasocxn - inc BP
Simple cysts
Hyperceullular glomeruli
RTA type 2 (proximal)

26. What is the most frequent kind of kidney stone and What are causes that lead to it
NC - dec - dec
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Solute is reabsorbed more quickly than water

27. What happens when PTH is secreted
20 percent
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Acute tubular necrosis

28. coarse - asymmetric - corticomedullary scarring and blunted calyx
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Size and charge
Chronic pyelonephritis
Men 50 to 70 - inc incidence with smoking and obesity

29. What are the effects of PTH hormone on the kidney
V x Urine concentration
Macula densa
Hypovent - immediate
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

30. What is the cutoff of proteinuria in nephritic syndrome
<3.5 g /day
Cx<GFR
Simple cysts
Negative charge

31. What is the effect of AT II on GFR - FF and Na
Makes urine less concentrated - impermeable to H20
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
EPO - endothelial cells of peritubular capillaries

32. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
ADPKD
Nonspecific
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

33. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Type II - C3 nephritic factor
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

34. What is hartnup's disease
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
ANP

35. What is winter's formula and when do you use it
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
UTI or acute gastroenteritis
RTA type 1 (distal)

36. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Crescent - moon shape
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Von hippel laundau and gene deletion in chromosome 3

37. Focal
Few glomeruli
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Filtered - secreted
Men 50 to 70 - inc incidence with smoking and obesity

38. do you see casts in bladder cancer - kidney stones with hematuria
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
EPO - endothelial cells of peritubular capillaries
No
Involves glomeruli and other organs

39. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
RPF/(1- Hct)
Complications of chronic kidney disease or HTN
Nephritic syndrome

40. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Bladder cancer
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Huge palpable flank mass and hematuria
160-200 - 350

41. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Podocytes foot processes
Acute pyelonephritis

42. What is the ddx for metabolic alkalosis with compensation
RTA type 1 (distal)
Diuretics - vomiting - antacid - hyperaldosteronism
Inc - inc - inc
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

43. What do patients die from ADPKD
Involves glomeruli and other organs
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Complications of chronic kidney disease or HTN
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

44. In who is RCC most comon
Inhibits Na/phosphate cotransport leading to phosphate excretion
Solute is reabsorbed less quickly than water or net secretion of substance
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Men 50 to 70 - inc incidence with smoking and obesity

45. What two cells make up the JGA
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Solute is reabsorbed more quickly than water
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Macula densa and JG cells

46. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
It has a longer renal vein
Size and charge
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

47. Where is potassium conc. Highest? Intra or extra
Intra = HIKIN!
Triglycerides
Hypervent - immediate
1/4 plasma - and 3/4 interstitial volume

48. How can NSAIDs cause acute renal failure
Invades IVC and spreads hematogenously
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Rxn from angiotensinogen to angiontensin I

49. Why can PAH be used to measure ERPF
Amyloidosis
Makes urine less concentrated - impermeable to H20
Diarrhea - glue - RTA - hyperchloremia
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

50. What is the effect of aldosterone in principal cells
Invades IVC and spreads hematogenously
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Radiopaque
Nephrotic syndrome

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Renal

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