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Test your basic knowledge |
Renal
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Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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. In a metabolic acidosis What additional calculation is necessary and How do you make it
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
NC - dec - dec
Anion gap = na - (Cl + bicarb)
2. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
Complications of chronic kidney disease or HTN
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Stimulates thirst
3. What is the most common renal malignancy of early childhood
Chronic conditions - multiple myeloma - TB - RA
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Wilms tumor (ages 2-4)
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
4. granular - muddy brown casts - ddx
NC - dec - dec
Stimulates thirst
Invades IVC and spreads hematogenously
Acute tubular necrosis
5. 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
Acute pyelonephritis
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc Ca/Na exchange to inc Ca reabsoprtion
6. hyaline casts ddx
Nonspecific
EPO - endothelial cells of peritubular capillaries
PH = pKa + log bicarb/0.03PCO2
NC - dec - dec
7. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Cx>GFR
Inulin
To defend GFR
8. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Inc - dec - dec
Principal cells and intercalated cells
RTA type 2 (proximal)
NC - inc - inc
9. What is the net effect of AT II
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Nephritic syndrome
10. What is the BUN/Cr ratio in prerenal azotemia and why?
Renal artery - interlobar a - interlobular a
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
RTA type 4 (hyperkalemic)
Na and volume loss
11. What does LM - EM - IF show in diffuse proliferative GN
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Medullary cystic disease
12. inc in creatinine and BUN over a period of several days
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Excreted - filtered
Acute renal failure
Acute pyelonephritis
13. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Advanced renal dz - CRF
Inc - inc - inc
Cx<GFR
Podocytes foot processes
14. By what percentage does EPRF underestimage true RPF
Hypokalemia and hypophosphatemic rickets
Hyperkalemia
By 10%
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
15. What is winter's formula and when do you use it
Kids - peripheral and periorbital edema - resolves spontaneously
Negative charge
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Chronic conditions - multiple myeloma - TB - RA
16. What is the formula for the filtered load
Na
Hypokalemia and hypophosphatemic rickets
GFR x plasma concentration
Macula densa
17. Where is potassium conc. Highest? Intra or extra
Ammonia - buffer for secreted H+
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Membranoproliferative glomerulonephritis
Intra = HIKIN!
18. diffuse
All glomeruli
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Insertion of Na channel on luminal side
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
19. Who commonly gets acute post strep GN
UTI or acute gastroenteritis
Na reabsorption drives H20 reabsorption
Becomes concentrated and hypertonic
Kids - peripheral and periorbital edema - resolves spontaneously
20. What happens in the early distal convoluted tubule and What does that do to the urine
Inhibits Na/phosphate cotransport leading to phosphate excretion
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
V x Urine concentration
Actively reabsorbs NaCl - diluting - makes urine hypotonic
21. What are the main causes of membranous GN
Inhibits Na/phosphate cotransport leading to phosphate excretion
Renal artery - interlobar a - interlobular a
LM - nl glomeruli - EM - foot process effacement
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
22. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Na reabsorption drives H20 reabsorption
NC - dec - dec
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
23. What does ADH do in the collecting tubule
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Acts on V2 receptors leading to insertion of aquaporins on luminal side
RTA type 4 (hyperkalemic)
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
24. Why can inulin be used to calculate GFR?
Involves glomeruli and other organs
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Freely filtered and neither absorbed or secreted
RTA type 1 (distal)
25. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Solute and water are reabsorbed at the same rate
Inc in concentration - not amout - due to water reabsorption
26. What is the net effect of ANP
Inc in concentration - not amout - due to water reabsorption
Inc - dec - dec
Medullary cystic disease
Na and volume loss
27. How is chlorid reabsorbed in the proximal tubule
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
2 ways - base exchanger and between epithelial cells
Polycystic liver disease - berry aneurysms - mitral valve prolapse
<3.5 g /day
28. In renal failure - what happens to potassium
Hyperkalemia
Thickening of glomerular BM
RTA type 4 (hyperkalemic)
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
29. What does US show with medullary cystic disease
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Small kidney - poor prognosis
Becomes concentrated and hypertonic
30. What are the effects of AT II on the adrenal gland
Cx = GFR
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Stimulates thirst
Podocytes foot processes
31. net tubular reabsorption of x
Radiopaque
Cx<GFR
Eosinphilic casts in tubules
Dialysis cysts
32. What happens to pH - PCO2 and bicarb in metabolic acidosis
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Dec - dec - dec
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
33. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Reabsorb Na in exchange for secreting K and H
RPF/(1- Hct)
34. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Liver
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hydronephrosis and pyelonephritis
35. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Wilms tumor (ages 2-4)
Inc in Ca and PO4 absoprtion from the gut
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Needs to be bilateral
36. Focal
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Few glomeruli
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Cx>GFR
37. Which cells sense decreases in BP
ANP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
HIV
JG cells
38. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
160-200 - 350
Nephrotic syndrome
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Metabolic acidosis
39. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
1alpha hydroxylase - PTH stimulates it
Radiopaque
40. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Beta 1
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Anion gap = na - (Cl + bicarb)
Na reabsorption drives H20 reabsorption
41. How What does the glomerular filtration barrier distinguish by
Size and charge
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Radiopaque
It has a longer renal vein
42. What are JG cells and what substance do they secrete
Insertion of Na channel on luminal side
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Modified smooth muscle of afferent arteriole - secrete renin
Membranoproliferative glomerulonephritis
43. What is hartnup's disease
Small kidney - poor prognosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Crescent - moon shape
44. What is lost in nephrotic syndrome resulting what urine and serum changes
Small kidney - poor prognosis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
<3.5 g /day
ANP
45. What happens when PTH is secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Contrict leading to inc FF - preserver renal GFR in low volume states
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Na reabsorption drives H20 reabsorption
46. What are the effects of AT II on vascular smooth muscle
Acute tubular necrosis
Becomes concentrated and hypertonic
Transitional cell carcinoma
Vasocxn - inc BP
47. In renal failure What acid - base disturbance is most likely
Metabolic acidosis
ANP
Becomes concentrated and hypertonic
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
48. What does the crescent moon shape consist of in RPGN
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
V x Urine concentration
49. How do struvite stones appear on xray
Involves only glomeruli
Reabsorb Na in exchange for secreting K and H
Crescent - moon shape
Radiopaque
50. Under what circumstances is aldosterone secreted
Inc plasma osm - dec blood volume
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Hypokalemia and hypophosphatemic rickets
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