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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 is the formula for clearance of a substance per unit time
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Angio I to angio II and inhibits bradykinin
Dec - inc - inc
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

2. RBC casts - ddx
Passively reabsorbs water via medullary hypertonicity
Insertion of Na channel on luminal side
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

3. What does thyroidization of the kidney result in
Hypokalemia and hypophosphatemic rickets
Acute pyelonephritis
Eosinphilic casts in tubules
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

4. What is winter's formula and when do you use it
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc renal bicarb resabsoprtion - delayed
Complications of chronic kidney disease or HTN
Dec - inc - dec

5. What are the effects of AT II on the adrenal gland
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Inc renal bicarb resabsoprtion - delayed
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Diabetic glomerulonephropathy

6. What are the 3 transporters of the intercalated cells
Poor - days to weeks
Size
Most of the bicarb - sodium - chloride - and water
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

7. What are the associated paraneoplastic syndromes wth RCC
Ectopic EPO - ACTH - PTHrP - prolactin
Na and volume loss
Hyperkalemia
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

8. WBC casts - ddx
Na and volume loss
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

9. What is the pathway to the afferent arteriole
Dec - inc - inc
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Men 50 to 70 - inc incidence with smoking and obesity
Renal artery - interlobar a - interlobular a

10. What are the associations with RTA type 4
Under and under
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Hypovent - immediate

11. What is the effect of aldosterone in principal cells
Few glomeruli
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Corticosteroids
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

12. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
PH = pKa + log bicarb/0.03PCO2
NC - dec - dec
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Nephritic syndrome

13. What cells create the epithelial layer of the glomerular filtration barrier
White cell casts
Podocytes foot processes
RTA type 4 (hyperkalemic)
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

14. What is amyloidosis associated with
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Hypokalemia and hypophosphatemic rickets
Chronic conditions - multiple myeloma - TB - RA
1/4 plasma - and 3/4 interstitial volume

15. membranous
Insertion of Na channel on luminal side
Size
Thickening of glomerular BM
Inc GFR and mesangial expansion

16. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Medullary cystic disease
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Thromboembolism and inc risk of infection

17. How does Wilms tumor present
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Reabsorb Na in exchange for secreting K and H
Corticosteroids
Huge palpable flank mass and hematuria

18. How does RCC spread
Invades IVC and spreads hematogenously
Reabsorb Na in exchange for secreting K and H
Excreted - filtered
Inc

19. Focal
Hyperkalemia
Diarrhea - glue - RTA - hyperchloremia
Size and charge
Few glomeruli

20. Why does Na conc nearly match Osm
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Hypervent - early high altitude - aspirin ingestion early
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Na reabsorption drives H20 reabsorption

21. What are the two kinds of cells in the collecting tubules
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Principal cells and intercalated cells
Advanced renal dz - CRF
V x Urine concentration

22. secondary glomerular dz
Angio I to angio II and inhibits bradykinin
Ectopic EPO - ACTH - PTHrP - prolactin
Involves glomeruli and other organs
Diuretics - vomiting - antacid - hyperaldosteronism

23. The fused basement membrane with heparan sulfate constitutes what portion of the charge
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Involves only glomeruli
Negative charge
CHF - pulmonary edema - HTN

24. What do macula densa cells sense
Na
Acute pyelonephritis
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

25. What is the BUN/Cr ratio in prerenal azotemia and why?
Inc - dec - dec
Angio I to angio II and inhibits bradykinin
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

26. What effect does ANP have on GFR
Inc
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
160-200 - 350

27. What is the ddx for a metabolic acidosis with an inc anion gap
Negative charge
RTA type 2 (proximal)
Cx>GFR
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

28. What is the net effect of PTH
Cx<GFR
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inc in Ca and PO4 absoprtion from the gut
Inc plasma osm - dec blood volume

29. In what clinical context does Berger's disease often present
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Inc - inc - inc
UTI or acute gastroenteritis
Dec - inc - dec

30. What is the formula for the filtered load
EPO - endothelial cells of peritubular capillaries
Macula densa and JG cells
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
GFR x plasma concentration

31. What is the algorithim for acidosis/alkalosis
Inhibits Na/phosphate cotransport leading to phosphate excretion
PH - then PC02
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Insertion of Na channel on luminal side

32. granular - muddy brown casts - ddx
Acute tubular necrosis
Cx = GFR
<3.5 g /day
Dec - inc - dec

33. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Inc Ca/Na exchange to inc Ca reabsoprtion
Phenacetin - smoking - aniline dyes - cyclophosphamide
RPF/(1- Hct)

34. In a metabolic acidosis What additional calculation is necessary and How do you make it
Radiopaque
Anion gap = na - (Cl + bicarb)
Crescent - moon shape
Hypokalemia - risk for Ca containing kidney stones

35. hypoaldosteronism or lack of collecting tubule response to aldosteron
Inc Ca/Na exchange to inc Ca reabsoprtion
PH = pKa + log bicarb/0.03PCO2
Angio I to angio II and inhibits bradykinin
RTA type 4 (hyperkalemic)

36. What does ADH do in the collecting tubule
Rxn from angiotensinogen to angiontensin I
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Actively reabsorbs NaCl - diluting - makes urine hypotonic

37. What are the associations with RTA type 1
Beta 1
Inc in concentration - not amout - due to water reabsorption
Hypokalemia - risk for Ca containing kidney stones
Advanced renal dz - CRF

38. What is the effect of AT II on GFR - FF and Na
Insertion of Na channel on luminal side
Radiopaque
Na reabsorption drives H20 reabsorption
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

39. Who commonly gets acute post strep GN
Hydronephrosis and pyelonephritis
Membranoproliferative glomerulonephritis
Kids - peripheral and periorbital edema - resolves spontaneously
Amyloidosis

40. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
20 percent
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Chronic conditions - multiple myeloma - TB - RA
Diarrhea - glue - RTA - hyperchloremia

41. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Segmental sclerosis and hylanosis
Na reabsorption drives H20 reabsorption
Acute renal failure

42. What do patients die from ADPKD
Metabolic acidosis
V x Urine concentration
Complications of chronic kidney disease or HTN
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

43. By what percentage does EPRF underestimage true RPF
By 10%
Simple cysts
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Angio I to angio II and inhibits bradykinin

44. What can cause oxalate crystals
ADPKD
By 10%
Renal in origin
Antifreeze - ethyelene glycol or vit C abuse

45. What is the formula for filtration fraction
GFR/RPF
Failure of EPO
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Hypovent - immediate

46. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Acute renal failure
NC - dec - dec
2 ways - base exchanger and between epithelial cells
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

47. What happens to urine in the ascending limb
LM - nl glomeruli - EM - foot process effacement
Radiopaque
UTI or acute gastroenteritis
Makes urine less concentrated - impermeable to H20

48. no net secretion or reabsorption of x
1/4 plasma - and 3/4 interstitial volume
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Hypervent - early high altitude - aspirin ingestion early
Cx = GFR

49. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Nephrotic syndrome
Nonspecific
V x Urine concentration

50. What are the associations with RTA type 2
Hypervent - immediate
Inulin
Simple cysts
Hypokalemia and hypophosphatemic rickets