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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
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 is the algorithim for acidosis/alkalosis
Inc in Ca and PO4 absoprtion from the gut
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
PH - then PC02
Radiopaque
2. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Nonspecific
Solute and water are reabsorbed at the same rate
Liver
3. The fenestrated capillary endothelium constitutes what portion of the barrier
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
60% total body water - 40% ICF - 20% ECF
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Size
4. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
60% total body water - 40% ICF - 20% ECF
Wilms tumor (ages 2-4)
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
NKCC
5. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
Inc - dec - dec
Excreted - filtered
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
6. What happens to urine in the ascending limb
Solute is reabsorbed less quickly than water or net secretion of substance
Hypervent - early high altitude - aspirin ingestion early
Dec - inc - dec
Makes urine less concentrated - impermeable to H20
7. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Renal tubular cells - polygonal clear cells
GFR/RPF
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
8. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
ANP
Inc Ca/Na exchange to inc Ca reabsoprtion
Growth retardation and developmental delay
9. What does US show with medullary cystic disease
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Inc GFR and mesangial expansion
Small kidney - poor prognosis
10. What effect does ANP have on GFR
Inc - inc - inc
ANP
Hypervent - immediate
Inc
11. What is the effect of aldosterone in principal cells
Phenacetin - smoking - aniline dyes - cyclophosphamide
Advanced renal dz - CRF
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Eosinphilic casts in tubules
12. How is plasma volume measured
Under and under
Nephrotic syndrome
Radiolabelled albumin
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
13. What is the BUN/Cr ratio in prerenal azotemia and why?
2 ways - base exchanger and between epithelial cells
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Hypokalemia and hypophosphatemic rickets
Diarrhea - glue - RTA - hyperchloremia
14. What is the henderson hasselbalch equation
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
PH = pKa + log bicarb/0.03PCO2
By 10%
RTA type 1 (distal)
15. What are the main causes of membranous GN
Principal cells and intercalated cells
Inc in Ca and PO4 absoprtion from the gut
ANP
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
16. What is the formula for clearance of a substance per unit time
To defend GFR
Inc - dec - dec
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Diarrhea - glue - RTA - hyperchloremia
17. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Inc in Ca and PO4 absoprtion from the gut
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Dec - inc - dec
CHF - pulmonary edema - HTN
18. What needs to happen for postrenal obstruction to creat ARF
All glomeruli
Inc
Renal in origin
Needs to be bilateral
19. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Inc in concentration - not amout - due to water reabsorption
Modified smooth muscle of afferent arteriole - secrete renin
Carbonic anhydrase
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
20. in TCC - What does painelss hematuria suggest
1alpha hydroxylase - PTH stimulates it
Macula densa and JG cells
Bladder cancer
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
21. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
Becomes concentrated and hypertonic
Diabetic glomerulonephropathy
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
22. What happens in the early distal convoluted tubule and What does that do to the urine
Staghorn calculi - worsened by alkaluria
White cell casts
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Renal artery - interlobar a - interlobular a
23. What does LM - EM - IF show in diffuse proliferative GN
Few glomeruli
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
24. Where is potassium conc. Highest? Intra or extra
Hydronephrosis and pyelonephritis
Na
Intra = HIKIN!
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
25. When is glucose reabsorbed and with What transporter
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Solute and water are reabsorbed at the same rate
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Proximal tubule - na/glucose co transporter
26. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Eosinphilic casts in tubules
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Segmental sclerosis and hylanosis
27. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Kids - peripheral and periorbital edema - resolves spontaneously
28. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
Diuretics - vomiting - antacid - hyperaldosteronism
Solute is reabsorbed more quickly than water
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
29. What does thyroidization of the kidney result in
By 10%
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Eosinphilic casts in tubules
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
30. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
Growth retardation and developmental delay
Contrict leading to inc FF - preserver renal GFR in low volume states
Inc plasma osm - dec blood volume
31. In renal failure - what happens to potassium
Simple cysts
Involves only glomeruli
Type II - C3 nephritic factor
Hyperkalemia
32. When is TF/P = 1
Filtered - secreted
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Solute and water are reabsorbed at the same rate
Small kidney - poor prognosis
33. membranous
Thickening of glomerular BM
Kids - peripheral and periorbital edema - resolves spontaneously
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Na
34. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Segmental sclerosis and hylanosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Beta 1
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
35. How can NSAIDs cause acute renal failure
Polycystic liver disease - berry aneurysms - mitral valve prolapse
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Involves only glomeruli
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
36. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Poor - days to weeks
Vasa recta - interlobular v - interlobar v - renal v
Few glomeruli
NC - dec - dec
37. What circumstances causes ADH secretion
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Inc plasma osm - dec blood volume
Inc GFR and mesangial expansion
GFR x plasma concentration
38. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Acute renal failure
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Beta 1
Acute pyelonephritis
39. dense deposits on EM - type and association
Type II - C3 nephritic factor
Size and charge
Radiolabelled albumin
Freely filtered and neither absorbed or secreted
40. How do you interpret creatinine clearance
Segmental sclerosis and hylanosis
Eosinphilic casts in tubules
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Staghorn calculi - worsened by alkaluria
41. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Involves glomeruli and other organs
Nonspecific
Nephritic syndrome
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
42. Where is ACE made and What are 2 of its fxns
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Size and charge
Angio I to angio II and inhibits bradykinin
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
43. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
NKCC
Hypervent - immediate
Involves only glomeruli
1alpha hydroxylase - PTH stimulates it
44. What does ADH do in the collecting tubule
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Renal tubular cells - polygonal clear cells
Diarrhea - glue - RTA - hyperchloremia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
45. What do macula densa cells sense
Na
Dialysis cysts
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
46. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Anion gap = na - (Cl + bicarb)
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Negative charge
47. What is the prognosis of RPGN
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Poor - days to weeks
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Proximal tubule - na/glucose co transporter
48. What do you see on LM and IF with rapidly progressive GN
Amyloidosis
Crescent - moon shape
Proximal tubule - na/glucose co transporter
Eosinphilic casts in tubules
49. Which cells sense decreases in Na delivery
Acute pyelonephritis
Macula densa
Proximal tubule - na/glucose co transporter
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
50. When is TF/P <1
Solute is reabsorbed more quickly than water
EPO - endothelial cells of peritubular capillaries
Carbonic anhydrase
Proximal tubule - na/glucose co transporter