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Renal

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Answer 50 questions in 15 minutes.
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1. WBC casts - ddx
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Chronic conditions - multiple myeloma - TB - RA
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

2. What is the ddx for respiratory acidosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Contrict leading to inc FF - preserver renal GFR in low volume states
Corticosteroids
RTA type 4 (hyperkalemic)

3. Under what circumstances is aldosterone secreted
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Diuretics - vomiting - antacid - hyperaldosteronism
To defend GFR
Makes urine less concentrated - impermeable to H20

4. In renal failure - what happens to potassium
Inc in concentration - not amout - due to water reabsorption
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Poor - days to weeks
Hyperkalemia

5. What are the effects of AT II on the adrenal gland
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
LM - nl glomeruli - EM - foot process effacement

6. Where does renal cell carcinoma originate and What do the cells look like
Inc in concentration - not amout - due to water reabsorption
Inc
Renal tubular cells - polygonal clear cells
Cx = GFR

7. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Passively reabsorbs water via medullary hypertonicity
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Carbonic anhydrase
Makes urine less concentrated - impermeable to H20

8. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Size
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Hydronephrosis and pyelonephritis

9. What is the net effect of ANP
Transitional cell carcinoma
Na and volume loss
Carbonic anhydrase
Polycystic liver disease - berry aneurysms - mitral valve prolapse

10. When is TF/P = 1
LM - nl glomeruli - EM - foot process effacement
To defend GFR
Inc Ca/Na exchange to inc Ca reabsoprtion
Solute and water are reabsorbed at the same rate

11. What is the compensatory response in metabolic alkalosis
PH - then PC02
Hypovent - immediate
Inc
20 percent

12. no net secretion or reabsorption of x
Cx = GFR
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Transitional cell carcinoma
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

13. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Complications of chronic kidney disease or HTN
Nephrotic syndrome
ANP
Diarrhea - glue - RTA - hyperchloremia

14. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Stimulates thirst
Macula densa
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
EPO - endothelial cells of peritubular capillaries

15. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
ANP
RTA type 4 (hyperkalemic)
JG cells
Nephritic syndrome

16. What are the effects of PTH hormone on the kidney
Diabetic glomerulonephropathy
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
Most of the bicarb - sodium - chloride - and water
Acute - ATN - or chronic - HTN - DM

17. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Inc in concentration - not amout - due to water reabsorption
Na and volume loss
Inc plasma osm - dec blood volume

18. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Proximal tubule - na/glucose co transporter
Carbonic anhydrase
Dec - inc - inc

19. What is the formula for clearance of a substance per unit time
Inc
GFR x plasma concentration
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Thromboembolism and inc risk of infection

20. inc in creatinine and BUN over a period of several days
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Acute renal failure
Renal tubular cells - polygonal clear cells
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

21. Why does Na conc nearly match Osm
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Type II - C3 nephritic factor
Makes urine less concentrated - impermeable to H20
Na reabsorption drives H20 reabsorption

22. coarse - asymmetric - corticomedullary scarring and blunted calyx
Phenacetin - smoking - aniline dyes - cyclophosphamide
Needs to be bilateral
JG cells
Chronic pyelonephritis

23. What is the net effect of PTH
Makes urine less concentrated - impermeable to H20
RTA type 4 (hyperkalemic)
Inc in Ca and PO4 absoprtion from the gut
Cx = GFR

24. What do you see on LM for focal segmental glomerulosclerosis
Inc - dec - dec
Segmental sclerosis and hylanosis
Makes urine less concentrated - impermeable to H20
Men 50 to 70 - inc incidence with smoking and obesity

25. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Freely filtered and neither absorbed or secreted
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc - inc - inc

26. What is the formula for renal blood flow
Passively reabsorbs water via medullary hypertonicity
RPF/(1- Hct)
GFR/RPF
Diabetic glomerulonephropathy

27. In who is RCC most comon
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Insertion of Na channel on luminal side
Men 50 to 70 - inc incidence with smoking and obesity

28. What is hartnup's disease
Inc GFR and mesangial expansion
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Renal artery - interlobar a - interlobular a

29. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Makes urine less concentrated - impermeable to H20
Ammonia - buffer for secreted H+

30. In renal failure What acid - base disturbance is most likely
Growth retardation and developmental delay
Metabolic acidosis
Size
PH = pKa + log bicarb/0.03PCO2

31. In what disease in FSGS the most common glomerular disease
Inc renal bicarb resabsoprtion - delayed
HIV
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Insertion of Na channel on luminal side

32. How do struvite stones appear on xray
Radiopaque
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Small kidney - poor prognosis
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

33. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
It has a longer renal vein
Wilms tumor (ages 2-4)
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

34. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Thromboembolism and inc risk of infection
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Proximal tubule - na/glucose co transporter

35. What effect does ANP have on GFR
Dialysis cysts
Acute pyelonephritis
Inc
Dec - dec - dec

36. Where is angiotensinogen made
Liver
Renal tubular cells - polygonal clear cells
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

37. secondary glomerular dz
Involves glomeruli and other organs
GFR/RPF
NC - inc - inc
Insertion of Na channel on luminal side

38. What is ADPKD also associated with
1alpha hydroxylase - PTH stimulates it
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Inc in Ca and PO4 absoprtion from the gut
Inc GFR and mesangial expansion

39. Which cells sense decreases in BP
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
PH - then PC02
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
JG cells

40. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
To defend GFR

41. How does Wilms tumor present
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Huge palpable flank mass and hematuria
Nephritic syndrome
Poor - days to weeks

42. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Acute pyelonephritis
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Polycystic liver disease - berry aneurysms - mitral valve prolapse

43. With what genetic tumor syndrome is RCC associated
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Von hippel laundau and gene deletion in chromosome 3
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
20 percent

44. What is a normal filtration fraction
Bladder cancer
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
20 percent
Inhibits Na/phosphate cotransport leading to phosphate excretion

45. How is extracellular volume measured
Acute pyelonephritis
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inulin

46. Focal
Few glomeruli
Podocytes foot processes
Needs to be bilateral
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

47. What happens in the collecting tubules
Dec - dec - dec
Reabsorb Na in exchange for secreting K and H
Acute - ATN - or chronic - HTN - DM
RPF/(1- Hct)

48. What happens when PTH is secreted
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Small kidney - poor prognosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

49. What cells create the epithelial layer of the glomerular filtration barrier
Podocytes foot processes
Corticosteroids
It has a longer renal vein
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

50. What is the compensatory response in metabolic acidosis
Solute is reabsorbed more quickly than water
Hypervent - immediate
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
PH - then PC02

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Renal

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