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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 3 transporters of the intercalated cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Inc in concentration - not amout - due to water reabsorption
Podocytes foot processes
RTA type 2 (proximal)

2. What is the most common renal malignancy of early childhood
Ammonia - buffer for secreted H+
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Solute and water are reabsorbed at the same rate
Wilms tumor (ages 2-4)

3. What does thyroidization of the kidney result in
Inc - inc - inc
Liver
Eosinphilic casts in tubules
160-200 - 350

4. proliferative
Hyperceullular glomeruli
Becomes concentrated and hypertonic
Dec - dec - dec
Cx<GFR

5. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

6. What do you see on LM and IF with rapidly progressive GN
Hyperkalemia
Passively reabsorbs water via medullary hypertonicity
Poor - days to weeks
Crescent - moon shape

7. Which cells sense decreases in BP
JG cells
Modified smooth muscle of afferent arteriole - secrete renin
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Segmental sclerosis and hylanosis

8. What is is Alport's syndrome and what else do you see with it other than renal path
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Nonspecific
Freely filtered and neither absorbed or secreted
20 percent

9. What cells create the epithelial layer of the glomerular filtration barrier
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Podocytes foot processes
Phenacetin - smoking - aniline dyes - cyclophosphamide
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

10. What are the two kinds of cells in the collecting tubules
No
Diuretics - vomiting - antacid - hyperaldosteronism
Principal cells and intercalated cells
Hypovent - immediate

11. How is chlorid reabsorbed in the proximal tubule
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Type II - C3 nephritic factor
2 ways - base exchanger and between epithelial cells
Inc in Ca and PO4 absoprtion from the gut

12. hyaline casts ddx
Nonspecific
Acute renal failure
Needs to be bilateral
Staghorn calculi - worsened by alkaluria

13. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Vasa recta - interlobular v - interlobar v - renal v
Bladder cancer
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

14. What does NEG lead to in the efferent arterioles
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
Inc GFR and mesangial expansion
Na
GFR/RPF

15. Why is the left kidney taken during living donor transplantation
EPO - endothelial cells of peritubular capillaries
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Macula densa and JG cells
It has a longer renal vein

16. Why is there anemia in renal failure
Bladder cancer
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Medullary cystic disease
Failure of EPO

17. What are the associations with RTA type 1
Radiopaque
Chronic conditions - multiple myeloma - TB - RA
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Hypokalemia - risk for Ca containing kidney stones

18. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Beta 1
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

19. What does ADH do in the collecting tubule
UTI or acute gastroenteritis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Acts on V2 receptors leading to insertion of aquaporins on luminal side

20. What is ADPKD also associated with
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Corticosteroids
Ammonia - buffer for secreted H+
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

21. What happens when PTH is secreted
Hydronephrosis and pyelonephritis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

22. What do you see in the urine with acute pyelonephritis
Dec renal bicarb reabsorption - delayed
Membranoproliferative glomerulonephritis
White cell casts
Filtered - secreted

23. What does LM - EM - IF show in diffuse proliferative GN
Size
Solute is reabsorbed more quickly than water
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

24. What do macula densa cells sense
Kids - peripheral and periorbital edema - resolves spontaneously
Hypovent - immediate
Crescent - moon shape
Na

25. Which cells sense decreases in Na delivery
NKCC
Dec - dec - dec
Macula densa
No

26. Who commonly gets acute post strep GN
Kids - peripheral and periorbital edema - resolves spontaneously
Dec - inc - inc
Simple cysts
To defend GFR

27. What does aldosterone do in the collecting tubule
Needs to be bilateral
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Insertion of Na channel on luminal side
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

28. What are the main complications of kidney stones
Anion gap = na - (Cl + bicarb)
RPF/(1- Hct)
Medullary cystic disease
Hydronephrosis and pyelonephritis

29. net tubular secretion of x
Cx>GFR
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Involves glomeruli and other organs
Needs to be bilateral

30. What effect does ANP have on Na in the kidney
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Stimulates thirst
All glomeruli
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

31. 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
Size and charge
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
White cell casts

32. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
CHF - pulmonary edema - HTN
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Chronic conditions - multiple myeloma - TB - RA
Involves only glomeruli

33. What is the effect of AT II on efferent arterioles
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Staghorn calculi - worsened by alkaluria
No
Contrict leading to inc FF - preserver renal GFR in low volume states

34. primary glomerular dz
Staghorn calculi - worsened by alkaluria
Chronic pyelonephritis
Type II - C3 nephritic factor
Involves only glomeruli

35. What is the pathway from the efferent arteriorle to the renal v
Cx = GFR
Vasa recta - interlobular v - interlobar v - renal v
Solute and water are reabsorbed at the same rate
HIV

36. What are the associations with nephrotic syndrome
NC - inc - inc
Thromboembolism and inc risk of infection
ADPKD
Contrict leading to inc FF - preserver renal GFR in low volume states

37. What are the associations with RTA type 2
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Vasa recta - interlobular v - interlobar v - renal v
LM - nl glomeruli - EM - foot process effacement
Hypokalemia and hypophosphatemic rickets

38. TCC is associated with problems in your Pee SAC - ??
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc GFR and mesangial expansion
Phenacetin - smoking - aniline dyes - cyclophosphamide
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

39. What can cause oxalate crystals
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Antifreeze - ethyelene glycol or vit C abuse
Segmental sclerosis and hylanosis
V x Urine concentration

40. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Dec renal bicarb reabsorption - delayed
160-200 - 350
60% total body water - 40% ICF - 20% ECF

41. What effect does ANP have on GFR
Inc
Solute is reabsorbed more quickly than water
NKCC
Diarrhea - glue - RTA - hyperchloremia

42. What is the formula for secreted
Excreted - filtered
Ammonia - buffer for secreted H+
Under and under
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

43. What is the ddx for respiratory acidosis
Involves glomeruli and other organs
Excreted - filtered
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

44. What are the main causes of membranous GN
Na
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
LM - nl glomeruli - EM - foot process effacement
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

45. What is hartnup's disease
To defend GFR
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Involves only glomeruli
Type II - C3 nephritic factor

46. How does RCC manifest clinically
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
<3.5 g /day
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Dialysis cysts

47. What are the effects of PTH hormone on the kidney
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
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
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

48. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Polycystic liver disease - berry aneurysms - mitral valve prolapse
1alpha hydroxylase - PTH stimulates it
Liver

49. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Size
Transitional cell carcinoma

50. What circumstances causes ADH secretion
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Radiopaque
Inc plasma osm - dec blood volume
Hypokalemia and hypophosphatemic rickets