Associations

Question 1

Low ADAMST13

give dx and treatment

Answer 1

Dx: Thrombotic thrombocytopenic purpura (TTP)
Tx: Plasmapheresis

Question 2

Basket-weave and lamellated basement membrane (give dx)

Answer 2

Alport syndrome

Question 3

Brown urine (give dx)

Answer 3

Post-infectious acute glomerulonephritis

Question 4

c-ANCA, PR-3 (give dx, organ systems involved, and key biopsy finding)

Answer 4

Dx: granulomatosis
Organs: Pulmonary-renal
Biopsy: Crescentic

Question 5

CLDN-16 and paracellin-1 mutations

give dx and site of mutation

Answer 5

Dx: Familial Hypomagnesemia with Hypercalcuria

Site of mutation: Thick ascending limb of LoH

Question 6

Coffin lid shape

give dx and preceding circumstances

Answer 6

Dx: struvite kidney stones
Circumstance: usually happens during infection

Question 7

Congo-red staining with apple-green birefringence under polarized light (give dx)

Answer 7

Amyloidosis

Question 8

Crescents of fibrin and plasma proteins such as C3b (give biopsy pattern class)

Answer 8

Rapidly progressive (crescentic) glomerulonephritis

Question 9

Foot process effacement on EM and normal LM/IF (give dx)

Answer 9

Minimal change disease

Question 10

Envelope shape (give dx)

Answer 10

Calcium oxalate kidney stones

Question 11

Eosinophilic nodular glomerulosclerosis (give dx)

Answer 11

Diabetic glomerulonephropathy

Question 12

Kimmelsteil-Wilson nodules (give dx)

Answer 12

Diabetic glomerulonephropathy

Question 13

Prior epstein barr virus infection (give dx)

Answer 13

Membranoproliferative GN

Question 14

Frothy urine (give ddx class)

Answer 14

Nephrotic syndromes

Question 15

Prior group A beta-hemolytic strep infection (give dx and complement levels)

Answer 15

Dx: Acute post-strep GN

Complement level: low

Question 16

Hepatitis C serology (give dx)

Answer 16

Membranoproliferative GN

Question 17

“Humps” on EM (give dx)

Answer 17

Acute-post strep glomerulonephritis

Question 18

IgG, IgM, and C3 deposition on IF (give dx)

Answer 18

acute-post strep glomerulonephritis

Question 19

Intramembranous deposits on EM (give dx)

Answer 19

Membranoproliferative GN (type II)

Question 20

Linear IgG staining on IF (give dx and organ involvement)

Answer 20

Dx: Anti-GbM disease

Organ involvement: lungs (if goodpastures)

Question 21

Low C3/C4 levels (give ddx)

Answer 21

Post-infectious GN, SLE type IV, membranoproliferative GN

Question 22

Prior lymphomas (give dx)

Answer 22

membranoproliferative GN

Question 23

Mesangial cell proliferation, variable proteinuria, hypocomplementemia (give dx)

Answer 23

Membranoproliferative GN

Question 24

Child with periorbital swelling (give dx and tx)

Answer 24

Dx: Minimal change disease
Tx: Corticosteroids

Question 25

RBC casts (give ddx category)

Answer 25

Glomerulonephritis

Question 26

Radiolucent kidney stones (give dx and tx)

Answer 26

Dx: uric acid stones Tx: Alkalinization of urine and allopurinol

Question 27

Rhomboid/rosette shaped kidney stones (give dx and associated illness)

Answer 27

Dx: uric acid stones | Associated illness: gout

Question 28

Segmental sclerosis and hyalinosis in some of the glomeruli (give dx)

Answer 28

focal segmental glomerulosclerosis

Question 29

"spike and dome" pattern of subepithelial deposits along the GBM (give dx)

Answer 29

membranous nephropathy

Question 30

Staghorn calculi (give dx and associated illness)

Answer 30

dx: struvite stone | associated illness: infection with ureas positive bacteria (like proteus)

Question 31

Stones following urease positive bacterial infection (give dx)

Answer 31

struvite stone

Question 32

Starry sky appearance on LM (give dx)

Answer 32

Acute post-strep glomerulonephritis

Question 33

Subepithelial deposits and effacement of foot processes of podocytes (give dx)

Answer 33

Membranous nephropathy

Question 34

Subepithelial deposits on EM + recent history of infection (give dx)

Answer 34

Post-infectious glomerulonephritis

Question 35

Thickened capillary loops and GBM without cellular proliferation (give dx)

Answer 35

Membranous nephropathy

Question 36

Thrombocytopenia (give dx and accompanying symptoms)

Answer 36

Dx: thrombotic thrombocytopenic purpura Symptoms: neuro symptoms, fever, anemia

Question 37

Tram-tracking on silver stain/EM (give dx)

Answer 37

Membranoproliferative GN

Question 38

Waxy casts (give dx)

Answer 38

ESRD/CKD

Question 39

WBCs/eosinophils in urine (give dx and possible common drug association)

Answer 39

Dx: allergic interstitial nephritis Drugs: antibiotics/penicillin

Question 40

WBC casts (give dx)

Answer 40

Acute pyelonephritis

Question 41

Wire looping on LM + deposits everywhere on EM (give dx)

Answer 41

Diffuse proliferative glomerulonephritis

Question 42

Adenosine (made by, target, action, activation signal)

Answer 42

``` Adenosine Made by: macula densa Target: afferent areteriole Action: vasoconstriction Signal: Increased NaCl flow past macula densa ```

Question 43

Aldosterone (made by, target, action, activation signal)

Answer 43

Aldosterone Made by: Adrenals Target: alpha-intercalated, principal cells, DCT Action: increased H+ secretion (H+ ATPase), increased expression of ENaC and Na+ reabsorption Activated by: Angiotensin II

Question 44

Angiotensin II (made by, target, action, activation signal)

Answer 44

Angiotensin II Made by: Liver Target: Hypothalamus, kidney, glomerulus, artery, adrenals Action: increase ADH (hypothalamus), increased aldosterone (adrenals), increased Na+/H+ exchange in PCT (to increase solute delivery and down regulate renin release), efferent arteriole constriction (increase GFR) Activated by: low NaCl, low BP, sympathetic (beta1) activation all via Renin release

Question 45

FGF23 (made by, target, action, activation signal)

Answer 45

``` FGF23 Made by: osteocytes Target: kidney, thyroid Action: decreased vitamin D activation, decreased PTH release, phosphaturia Activated by: hyperphosphatemia ```

Question 46

PTH (made by, target, action, activation signal)

Answer 46

PTH Made by: parathyroid Target: DCT, PCT, bone, GI Action: increase calcium in blood (also via increased vitamin D activation) Activated by: low Ca/Mg or high serum phosphate

Question 47

Renin (made by, target, action, activation signal)

Answer 47

``` Renin Made by: juxtaglomerular cells Target: Angiotensinogen Action: produce angiotensin I Activated by: decreased NaCl, decreased BP, sympathetic activation (beta1) ```

Question 48

Vitamin D (made by, target, action, activation signal)

Answer 48

``` Vitamin D Made by: kidney Target: Intestine Action: Increased absorption Ca, PO4 Activated by: Decreased Ca and PO4 ```

Question 49

Bartter's syndrome mutation (Location, Action, K+, Mg2+, Ca2+, pH)

Answer 49

Bartter's Location: TAL Action: decreased Na/K/2Cl transport, decreased ROMK K+ secretion, or decreased Cl- reabsorption CIC-Kb K+: low (K+ can't be reabsorbed) Mg2+: low (no charge gradient for Mg/Ca) Ca2+: low (high in urine) pH: alkalosis (decreased potassium reabsorption is compensated for by increasing H+ excretion in alpha-intercalated cells)

Question 50

Liddle syndrome mutation (Location, Action, K+, Na+, pH)

Answer 50

Liddle Location: CCD Action: decreased responsiveness to renin and aldosterone, leading to chronic activation of these pathways and hypertension K+: low (to compensate for increased Na+ reabsorption) Na+: high (because of inability to regulate ENaC) pH: alkalosis (to compensate for increase Na+ reabsorption)

Question 51

Loop diuretic (Location, Action, K+, Na+, Mg2+, Ca2+, pH)

Answer 51

``` Loop diuretic Location: LoH Action: inhibit Na/K/2Cl K+: low Na+: low Mg2+: low (no charge gradient) Ca2+: low (no charge gradient) pH: alkalosis (H+ exchanged for K+ to compensate distally in the nephron) ```

Question 52

Thiazide diuretics (Location, Action, K+, Na+, Ca2+, pH)

Answer 52

Thiazide diuretics Location: Apical DCT Action: blocks Na/Cl (favoring Na/Ca exchange) K+: low Na+: low Ca2+: very high (blocking Na/Cl exchange favors Na/Ca exchange) pH: alkalosis (H+ exchange for K+ to compensate distally in the nephron)