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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 are the two kinds of cells in the collecting tubules
20 percent
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Principal cells and intercalated cells
Size

2. 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
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Solute is reabsorbed less quickly than water or net secretion of substance
It has a longer renal vein

3. What is winter's formula and when do you use it
Size
Diarrhea - glue - RTA - hyperchloremia
Phenacetin - smoking - aniline dyes - cyclophosphamide
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

4. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Beta 1
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
HIV
Renal tubular cells - polygonal clear cells

5. What is amyloidosis associated with
NC - dec - dec
Chronic conditions - multiple myeloma - TB - RA
PH - then PC02
<3.5 g /day

6. What dyslipidemia is most common in renal failure
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
<3.5 g /day
Triglycerides
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

7. diffuse
All glomeruli
NC - dec - dec
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Solute is reabsorbed more quickly than water

8. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Most of the bicarb - sodium - chloride - and water
Angio I to angio II and inhibits bradykinin

9. 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
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
PH = pKa + log bicarb/0.03PCO2

10. Why is the left kidney taken during living donor transplantation
Anion gap = na - (Cl + bicarb)
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Beta 1
It has a longer renal vein

11. What are the 3 transporters of the intercalated cells
JG cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Na reabsorption drives H20 reabsorption
Dec - inc - dec

12. What is the ddx for respiratory acidosis
Na reabsorption drives H20 reabsorption
<3.5 g /day
Beta 1
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

13. What is ADPKD also associated with
Medullary cystic disease
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Makes urine less concentrated - impermeable to H20
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

14. How is plasma volume measured
Dec - dec - NC
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Radiolabelled albumin
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

15. Why is there anemia in renal failure
Cx = GFR
Failure of EPO
Radiopaque
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

16. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
RTA type 1 (distal)
Dec - inc - inc

17. What is lost in nephrotic syndrome resulting what urine and serum changes
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Diarrhea - glue - RTA - hyperchloremia
Reabsorb Na in exchange for secreting K and H
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

18. How are amino acids reabsorbed
Antifreeze - ethyelene glycol or vit C abuse
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
V x Urine concentration
Principal cells and intercalated cells

19. In what clinical context does Berger's disease often present
Size and charge
UTI or acute gastroenteritis
Hyperceullular glomeruli
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

20. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
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
Radiopaque

21. secondary glomerular dz
Inc in Ca and PO4 absoprtion from the gut
Hyperceullular glomeruli
Na and volume loss
Involves glomeruli and other organs

22. Subendothelial immune complexes with granular IF
Dec - inc - inc
Ammonia - buffer for secreted H+
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Membranoproliferative glomerulonephritis

23. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
EPO - endothelial cells of peritubular capillaries
<3.5 g /day
Na

24. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Filtered - secreted
Radiopaque

25. What is the most common renal malignancy of early childhood
Wilms tumor (ages 2-4)
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

26. What is the ddx for metabolic alkalosis with compensation
Cx>GFR
Small kidney - poor prognosis
Thickening of glomerular BM
Diuretics - vomiting - antacid - hyperaldosteronism

27. What is the ddx for a respiratory alkalosis
Transitional cell carcinoma
Angio I to angio II and inhibits bradykinin
Hypervent - early high altitude - aspirin ingestion early
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

28. What is the compensatory response in metabolic alkalosis
Renal in origin
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
No
Hypovent - immediate

29. What is the LM for diabetic glomerulonephropathy
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

30. What is the effect of AT II on GFR - FF and Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
<3.5 g /day
Inc in Ca and PO4 absoprtion from the gut
Modified smooth muscle of afferent arteriole - secrete renin

31. What is the prognosis of RPGN
Vasocxn - inc BP
Poor - days to weeks
Simple cysts
Men 50 to 70 - inc incidence with smoking and obesity

32. What is the pathway to the afferent arteriole
It has a longer renal vein
Renal artery - interlobar a - interlobular a
Becomes concentrated and hypertonic
Hydronephrosis and pyelonephritis

33. What circumstances causes ADH secretion
Small kidney - poor prognosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Inc plasma osm - dec blood volume
Bladder cancer

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

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35. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Diarrhea - glue - RTA - hyperchloremia
Inc - inc - inc
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

36. What does LM - EM - IF show in diffuse proliferative GN
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Chronic conditions - multiple myeloma - TB - RA
Crescent - moon shape

37. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
CHF - pulmonary edema - HTN
Inulin

38. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
NC - dec - dec
Membranoproliferative glomerulonephritis

39. What is the 60-40-20 rule of body weight
60% total body water - 40% ICF - 20% ECF
Excreted - filtered
Crescent - moon shape
Transitional cell carcinoma

40. Defect in collecting ducts ability to excrete H+
Chronic conditions - multiple myeloma - TB - RA
Macula densa
RTA type 1 (distal)
Complications of chronic kidney disease or HTN

41. What is the henderson hasselbalch equation
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Size
PH = pKa + log bicarb/0.03PCO2

42. What is the compensatory response in metabolic acidosis
Anion gap = na - (Cl + bicarb)
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Hypervent - immediate
Huge palpable flank mass and hematuria

43. In who is RCC most comon
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc plasma osm - dec blood volume
Inc in Ca and PO4 absoprtion from the gut
Men 50 to 70 - inc incidence with smoking and obesity

44. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Renal artery - interlobar a - interlobular a
Intra = HIKIN!
Small kidney - poor prognosis

45. net tubular reabsorption of x
Renal in origin
Intra = HIKIN!
Dialysis cysts
Cx<GFR

46. Where does renal cell carcinoma originate and What do the cells look like
JG cells
Radiolabelled albumin
Diarrhea - glue - RTA - hyperchloremia
Renal tubular cells - polygonal clear cells

47. How is chlorid reabsorbed in the proximal tubule
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
It has a longer renal vein
Transitional cell carcinoma
2 ways - base exchanger and between epithelial cells

48. What can cause oxalate crystals
Antifreeze - ethyelene glycol or vit C abuse
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc GFR and mesangial expansion
Inc - dec - dec

49. How do you interpret creatinine clearance
PH = pKa + log bicarb/0.03PCO2
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Staghorn calculi - worsened by alkaluria

50. What therapy does miminal change respond to...
Nonspecific
Corticosteroids
Na reabsorption drives H20 reabsorption
Diabetic glomerulonephropathy