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Renal

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Answer 50 questions in 15 minutes.
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1. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Reabsorb Na in exchange for secreting K and H
RPF/(1- Hct)
Triglycerides

2. In renal failure What acid - base disturbance is most likely
Metabolic acidosis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Dialysis cysts
1alpha hydroxylase - PTH stimulates it

3. In who is RCC most comon
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Men 50 to 70 - inc incidence with smoking and obesity
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
2 ways - base exchanger and between epithelial cells

4. What is the ddx for metabolic alkalosis with compensation
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Segmental sclerosis and hylanosis
Rxn from angiotensinogen to angiontensin I
Diuretics - vomiting - antacid - hyperaldosteronism

5. How What does the glomerular filtration barrier distinguish by
Size and charge
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
No
Hydronephrosis and pyelonephritis

6. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Thromboembolism and inc risk of infection
Transitional cell carcinoma
RTA type 4 (hyperkalemic)

7. What is the second most common kidney stone
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Hyperceullular glomeruli
Type II - C3 nephritic factor
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

8. What dyslipidemia is most common in renal failure
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Triglycerides
Solute and water are reabsorbed at the same rate
HIV

9. Where is potassium conc. Highest? Intra or extra
PH = pKa + log bicarb/0.03PCO2
Intra = HIKIN!
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Solute is reabsorbed less quickly than water or net secretion of substance

10. What do patients die from ADPKD
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Na
Complications of chronic kidney disease or HTN
Acute - ATN - or chronic - HTN - DM

11. What is the compensatory response in respiratory alkalosis
Acts on V2 receptors leading to insertion of aquaporins on luminal side
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Dec renal bicarb reabsorption - delayed
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

12. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
All glomeruli

13. What needs to happen for postrenal obstruction to creat ARF
Phenacetin - smoking - aniline dyes - cyclophosphamide
Needs to be bilateral
Dec - inc - dec
Hyperceullular glomeruli

14. What are the effects of AT II on the adrenal gland
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Cx>GFR
Renal artery - interlobar a - interlobular a
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

15. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
1/4 plasma - and 3/4 interstitial volume
ADPKD
Inc in concentration - not amout - due to water reabsorption
Carbonic anhydrase

16. proliferative
Hyperceullular glomeruli
No
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inulin

17. What circumstances causes ADH secretion
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc plasma osm - dec blood volume

18. What is the most common renal malignancy of early childhood
Acute renal failure
Radiopaque
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Wilms tumor (ages 2-4)

19. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Ammonia - buffer for secreted H+
Size
Medullary cystic disease
Radiopaque

20. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Dec - dec - dec
Nephrotic syndrome
Medullary cystic disease

21. What are the effects of AT II on vascular smooth muscle
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Inc - dec - dec
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Vasocxn - inc BP

22. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
Becomes concentrated and hypertonic
Hypokalemia - risk for Ca containing kidney stones
Ammonia - buffer for secreted H+

23. dense deposits on EM - type and association
Inc
Acute pyelonephritis
Carbonic anhydrase
Type II - C3 nephritic factor

24. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Inulin
Simple cysts
Renal in origin

25. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

26. What does ADH do in the collecting tubule
Acute tubular necrosis
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Hydronephrosis and pyelonephritis
Huge palpable flank mass and hematuria

27. What can cause oxalate crystals
Diarrhea - glue - RTA - hyperchloremia
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Antifreeze - ethyelene glycol or vit C abuse

28. What do you see in the urine with acute pyelonephritis
LM - nl glomeruli - EM - foot process effacement
Cx>GFR
White cell casts
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

29. In renal failure with uremia - What are the 5 aspects of uremia
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
To defend GFR
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

30. What is the ddx for a metabolic acidosis with an inc anion gap
Radiolabelled albumin
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

31. What is the formula for clearance of a substance per unit time
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - 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
Radiopaque
Needs to be bilateral

32. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
Cx<GFR
HIV
Ammonia - buffer for secreted H+

33. What two cells make up the JGA
Macula densa and JG cells
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
JG cells
Corticosteroids

34. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Renal tubular cells - polygonal clear cells

35. coarse - asymmetric - corticomedullary scarring and blunted calyx
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Macula densa and JG cells
Chronic pyelonephritis
Nephritic syndrome

36. granular - muddy brown casts - ddx
Modified smooth muscle of afferent arteriole - secrete renin
Acute tubular necrosis
CHF - pulmonary edema - HTN
ADPKD

37. What are the LM and EM of minimal change disease
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Filtered - secreted
Diabetic glomerulonephropathy
LM - nl glomeruli - EM - foot process effacement

38. in acute cystitis with pyuria - do you see casts
No
Acute pyelonephritis
Inc renal bicarb resabsoprtion - delayed
Cx>GFR

39. What is the effect of of PTH on the distal convoluted tubule
Huge palpable flank mass and hematuria
Complications of chronic kidney disease or HTN
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute tubular necrosis

40. What happens in the collecting tubules
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Reabsorb Na in exchange for secreting K and H
Involves only glomeruli

41. When is TF/P = 1
NC - inc - inc
It has a longer renal vein
Solute and water are reabsorbed at the same rate
Renal artery - interlobar a - interlobular a

42. How is extracellular volume measured
Hypervent - early high altitude - aspirin ingestion early
Inulin
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

43. What effect does cxn of the ureter have on RPF - GFR and FF
Growth retardation and developmental delay
Insertion of Na channel on luminal side
Ammonia - buffer for secreted H+
NC - dec - dec

44. diffuse
All glomeruli
NC - dec - dec
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

45. What is ADPKD also associated with
Polycystic liver disease - berry aneurysms - mitral valve prolapse
It has a longer renal vein
Insertion of Na channel on luminal side
Inc GFR and mesangial expansion

46. Defect in collecting ducts ability to excrete H+
ANP
RTA type 1 (distal)
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Staghorn calculi - worsened by alkaluria

47. What is the formula for renal blood flow
RPF/(1- Hct)
Makes urine less concentrated - impermeable to H20
Inc in Ca and PO4 absoprtion from the gut
Hypervent - immediate

48. How are amino acids reabsorbed
Macula densa
Diarrhea - glue - RTA - hyperchloremia
Ectopic EPO - ACTH - PTHrP - prolactin
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

49. What is the purpose of the JGA
Size
Inulin
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
To defend GFR

50. Why can inulin be used to calculate GFR?
Under and under
Freely filtered and neither absorbed or secreted
All glomeruli
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

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Renal

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