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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 effects of PTH hormone on the kidney
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
GFR/RPF
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
Na and volume loss

2. The fused basement membrane with heparan sulfate constitutes what portion of the charge
It has a longer renal vein
Negative charge
2 ways - base exchanger and between epithelial cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

3. What is the formula for renal blood flow
Podocytes foot processes
RPF/(1- Hct)
Na and volume loss
Excreted - filtered

4. in acute cystitis with pyuria - do you see casts
Chronic pyelonephritis
Acute renal failure
Renal artery - interlobar a - interlobular a
No

5. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Invades IVC and spreads hematogenously
Hypervent - immediate
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

6. What does the crescent moon shape consist of in RPGN
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
CHF - pulmonary edema - HTN
EPO - endothelial cells of peritubular capillaries
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

7. What is the formula for secreted
Hydronephrosis and pyelonephritis
Excreted - filtered
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc in concentration - not amout - due to water reabsorption

8. What are the LM and EM of minimal change disease
GFR x plasma concentration
Small kidney - poor prognosis
Wilms tumor (ages 2-4)
LM - nl glomeruli - EM - foot process effacement

9. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Von hippel laundau and gene deletion in chromosome 3
Intra = HIKIN!
Acute renal failure

10. What is the compensatory response in metabolic alkalosis
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc renal bicarb resabsoprtion - delayed
Hypovent - immediate
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

11. What needs to happen for postrenal obstruction to creat ARF
It has a longer renal vein
Needs to be bilateral
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Diarrhea - glue - RTA - hyperchloremia

12. What is the effect of AT II on the posterior pituitary
Nonspecific
Rxn from angiotensinogen to angiontensin I
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Insertion of Na channel on luminal side

13. How does RCC manifest clinically
Corticosteroids
Phenacetin - smoking - aniline dyes - cyclophosphamide
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Kids - peripheral and periorbital edema - resolves spontaneously

14. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Carbonic anhydrase

15. Defect in proximal tubule HCO3 reabsorption
Dec - dec - dec
Membranoproliferative glomerulonephritis
RTA type 2 (proximal)
Inc renal bicarb resabsoprtion - delayed

16. What effect does afferent arteriole cxn have on RPF - GFR and FF
Hypokalemia - risk for Ca containing kidney stones
Intra = HIKIN!
Dec - dec - NC
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

17. WBC casts - ddx
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Phenacetin - smoking - aniline dyes - cyclophosphamide

18. How is plasma volume measured
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Size
Vasocxn - inc BP
Radiolabelled albumin

19. primary glomerular dz
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
PH = pKa + log bicarb/0.03PCO2
Size and charge
Involves only glomeruli

20. What are the effects of AT II on vascular smooth muscle
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Vasocxn - inc BP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Na and volume loss

21. no net secretion or reabsorption of x
Metabolic acidosis
1alpha hydroxylase - PTH stimulates it
Cx = GFR
Inulin

22. What is the formula for excretion rate
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
V x Urine concentration
Huge palpable flank mass and hematuria
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

23. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Hyperkalemia
Stimulates thirst
ADPKD
Huge palpable flank mass and hematuria

24. What is the formula for the filtered load
GFR x plasma concentration
Renal tubular cells - polygonal clear cells
Carbonic anhydrase
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

25. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
V x Urine concentration
Acute renal failure
Hypokalemia and hypophosphatemic rickets

26. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Phenacetin - smoking - aniline dyes - cyclophosphamide
Vasocxn - inc BP
Simple cysts
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

27. Where is angiotensinogen made
Invades IVC and spreads hematogenously
RTA type 4 (hyperkalemic)
Liver
Carbonic anhydrase

28. What is the henderson hasselbalch equation
To defend GFR
Inc - dec - dec
Acute pyelonephritis
PH = pKa + log bicarb/0.03PCO2

29. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
No
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

30. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Anion gap = na - (Cl + bicarb)
Inulin
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D

31. Focal
HIV
Growth retardation and developmental delay
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Few glomeruli

32. net tubular reabsorption of x
Nephrotic syndrome
NC - inc - inc
Renal in origin
Cx<GFR

33. Why can PAH be used to measure ERPF
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Vasa recta - interlobular v - interlobar v - renal v
Makes urine less concentrated - impermeable to H20
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

34. What is the compensatory response in metabolic acidosis
Hypovent - immediate
Hypervent - immediate
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

35. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Thromboembolism and inc risk of infection
Hypervent - early high altitude - aspirin ingestion early
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

36. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Phenacetin - smoking - aniline dyes - cyclophosphamide
Filtered - secreted
Nephrotic syndrome
Huge palpable flank mass and hematuria

37. What does NEG lead to in the efferent arterioles
Diarrhea - glue - RTA - hyperchloremia
Inc GFR and mesangial expansion
Acute - ATN - or chronic - HTN - DM
White cell casts

38. Under what circumstances is aldosterone secreted
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
JG cells
Metabolic acidosis

39. What is the formula for filtration fraction
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Antifreeze - ethyelene glycol or vit C abuse
Dec - inc - dec
GFR/RPF

40. How is extracellular volume measured
Renal in origin
Inc in concentration - not amout - due to water reabsorption
Thickening of glomerular BM
Inulin

41. Congo - red stain - apple green birefringence
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
GFR/RPF
Macula densa
Amyloidosis

42. How do calcium stones appear on x ray
White cell casts
Inc
Radiopaque
Invades IVC and spreads hematogenously

43. In who is RCC most comon
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Few glomeruli
Men 50 to 70 - inc incidence with smoking and obesity

44. What cells create the epithelial layer of the glomerular filtration barrier
Thromboembolism and inc risk of infection
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Inc Ca/Na exchange to inc Ca reabsoprtion
Podocytes foot processes

45. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
NC - dec - dec
Advanced renal dz - CRF

46. What is renal osteodystrophy
Renal tubular cells - polygonal clear cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Kids - peripheral and periorbital edema - resolves spontaneously
Hypervent - immediate

47. Why does Na conc nearly match Osm
Nephrotic syndrome
Size
GFR/RPF
Na reabsorption drives H20 reabsorption

48. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
Few glomeruli
HIV
Growth retardation and developmental delay

49. What is the most frequent kind of kidney stone and What are causes that lead to it
Failure of EPO
V x Urine concentration
Macula densa
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

50. How does Wilms tumor present
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Huge palpable flank mass and hematuria
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Segmental sclerosis and hylanosis