Chandy Renal Flashcards
A 37-year-old female has been on a high potassium diet for the past 3 weeks. She is found to have a urine potassium concentration that is higher than her plasma potassium concentration. Which of the following best describes the percentage of potassium remaining in her tubular fluid as it flows through the nephron?
Select one:
a. 5
b. 4
c. 3
d. 1
e. 2
D
A 52-year-old man with end-stage renal disease presents to his renal clinic with a hemoglobin level of 8g/dL, a decreased red blood cell count and a decreased absolute reticulocyte count of <25,000 cells/µl. His WBC count is normal (11,000/ µl) and the differential is normal. Iron staining of a bone marrow aspirate shows macrophages positive for iron and fewer RBCs. Which of the following is the most likely cause for this patient’s condition?
Select one:
a. Low erythropoietin.
b. An overdose of a chemotherapeutic drug.
c. Fanconi’s anemia.
d. Aplastic anemia.
e. Iron deficiency.
A
A 55-year-old woman with diabetes is undergoing renal function tests. Her glomerular filtration rate is determined by inulin clearance to be 100 mL/min, while her GFR determined by creatinine clearance is determined to be 125 mL/min. Which mechanism most likely explains the difference between the two GFR estimates?
Select one:
a. Creatinine is not filtered by the glomerulus.
b. Inulin is reabsorbed in the proximal tubule.
c. Creatinine is reabsorbed in the proximal convoluted tubule.
d. Creatinine is reabsorbed in the descending loop of Henle.
e. Creatinine is filtered by the glomerulus and some is secreted in the tubule.
E
A UCI MS1 is developing drugs to increase renal blood flow. Which of the following mechanisms would she have to target in order to most effectively increase renal blood flow?
Select one:
a. Stimulation of angiotensin II receptors
b. Stimulation of angiotensin II receptors plus opening of stretch-activated calcium channels in the vascular smooth muscle cells.
c. Stimulation of angiotensin II receptors and alpha-adrenergic receptors in the kidney
d. Stimulation of renal dopamine and bradykinin receptors
e. Stimulation of sympathetic alpha adrenergic receptors
D
A 16-year-old girl with Liddle’s syndrome presents with hypertension, hypervolemia, and hypokalemia, but low levels of renin and aldosterone. Her clinical condition is reversed by administration of a diuretic, which acts by blocking epithelial sodium channels. Which of the following is the major defect in Liddle’s syndrome?
Select one:
a. An inability of the distal nephron to secrete hydrogen
b. An inability of the distal nephron to concentrate urine
c. Increased sodium reabsorption by the proximal tubules
d. An inability of the distal nephron to secrete potassium ion
e. Increased sodium reabsorption by the distal nephron
E
A 16-year-old girl with Liddle’s syndrome presents with hypertension, hypervolemia, and hypokalemia, but low levels of renin and aldosterone. Her clinical condition is reversed by administration of a diuretic, which acts by blocking epithelial sodium channels. Which of the following is the major defect in Liddle’s syndrome?
Select one:
a. An inability of the distal nephron to secrete potassium ion
b. An inability of the distal nephron to secrete hydrogen
c. An inability of the distal nephron to concentrate urine
d. Increased sodium reabsorption by the proximal tubules
e. Increased sodium reabsorption by the distal nephron
E
Referring to the image, where A = afferent arteriole and B = efferent arteriole, which ONE of the following most accurately reflects the actions of angiotensin II and prostaglandins on the glomerular filtration rate (GFR) and renal plasma flow (RPF) in a dehydrated patient?
Select one:
a. . Angiotensin II vasoconstricts A; prostaglandins vasodilate B; there is an overall increase in GFR and decrease in RPF.
b. Angiotensin II vasoconstricts B; prostaglandins vasodilate A; there is an overall increase in GFR and decrease in RPF.
c. Angiotensin II vasodilates B; prostaglandins vasoconstrict A; there is an overall decrease in GFR and increase in RPF
d. Angiotensin II vasoconstricts B; prostaglandins vasodilate A; there is an overall decrease in GFR and increase in RPF.
e. Angiotensin II vasoconstricts A; prostaglandins vasodilate B; there is an overall decrease in GFR and increase in RPF.
B
A 26-year-old woman’s laboratory results are presented below.
Serum Sodium: 135 mEq/L
Serum Glucose: 90 mg/dL
Blood Urea Nitrogen: 30 mg/dL
Which of the following is the approximate plasma osmolarity of this patient?
Select one:
a. 270 mOsm/Kg
b. 250 mOsm/Kg
c. 280 mOsm/Kg
d. 290 mOsm/Kg
e. 260 mOsm/Kg
D
An 18-year-old male presents with muscle weakness, cramps, and tetany. Blood pressure is normal and no edema is present. Laboratory analysis reveals hypokalemic alkalosis, hyperaldosteronism, and high plasma renin activity, diagnostic of Bartter’s syndrome.
Which ONE of the following statements about renin is true?
Select one:
a. It is secreted by cells of the proximal tubule
b. Its secretion is stimulated by increased mean renal arterial pressure
c. It converts angiotensin I to angiotensin II
d. It converts angiotensinogen to angiotensin I
e. Its secretion leads to loss of sodium and water from plasma
D
An investigator develops a novel and potent inhibitor of SGLT2 and SGLT1, which affects glucose handling by the kidney. In a healthy volunteer receiving this drug, glucose clearance will approximate the clearance of which ONE of the following?
Select one:
a. Urea
b. Sodium
c. Inulin
d. Para-amino hippuric acid
e. Creatinine
C
A 68-year-old woman presents with hypertension and oliguria. A CT of the abdomen reveals a hypoplastic left kidney.
Laboratory data show the following:
- Renal artery PAH plasma concentration: 0.06 mg/mL
- Renal vein PAH plasma concentration: 0.006 mg/mL
- Urinary PAH: 22 mg/mL
- Urine Flow: 1.5 mL/min
- Hematocrit: 43%
Which ONE of the following is her estimated renal plasma flow?
Select one:
a. 775 mL/min
b. 475 mL/min
c. 700 mL/min
d. 550 mL/min
e. 625 mL/min
D
Anti-diuretic hormone (ADH) exerts its effects on the collecting ducts of the kidney. Which ONE of the following best characterizes ADH activity, as depicted in the image?
Select one:
a. Binds at F and activates Gs-mediated cAMP cascade
b. Binds at F and activates Gi-mediated cAMP cascade
c. Stimulates D
d. Binds and blocks C
e. Binds and blocks A
A
A 43-year-old woman with familial renal hypouricemia was administered para-amino-hippuric acid intravenously. In the image below, which of the segments of the nephron is the para-amino-hippuric acid concentration the lowest?
Select one:
a. A
b. D
c. F
d. B
e. C
f. E
A
A previously healthy 16-year-old boy developed acute renal failure following a track race at the CIF championships held in Cerritos. Several hours after the run, he expressed pain in the loins with nausea and vomiting. After 3 sessions of hemodialysis, he was referred to UCIMC. On admission, serum creatinine was elevated to 2.3 mg/dl. After recovery from acute renal failure (ARF), hypouricemia (0.7 mg/dl) became evident in the patient and it remained low. Uric acid clearance studies revealed the following: Urine Volume = 1 mL/min; Urine Uric Acid 36 mg/dL.
Which ONE of the following is this patient’s renal uric acid clearance?
Select one:
a. 6 mL/min
b. 40 mL/min
c. 12 mL/min
d. 24 mL/min
e. 50 mL/min
E
A 47 year-old man presents with polyuria and polydipsia for the past 4 months. His past history shows that he fell off a ladder and hit his head (head trauma) just before the onset of these symptoms. Physical examination: no specific findings. Lab findings: plasma osmolality >300 mOsm/kg and urine osmolality <600 mOsm/kg. You decide to perform a water deprivation test to assess water conservancy. In the figure shown below, which segment of the nephron is normally impermeable to water?
Select one:
a. B
b. A
c. F
d. D
e. E
f. C
D
A 58-year-old missionary traveling in Ecuador is brought into a local hospital with diarrhea and vomiting for the past 24 hours. He has not been able to take much fluids during this period. His mucus membranes are dry. His blood pressure is 84/58 mmHg.
Which of the following changes in renal plasma flow, glomerular filtration rate and filtration fraction do you expect in this patient?
Select one:
a. Renal plasma flow ↓↓, Glomerular filtration rate ↑, Filtration Fraction↓
b. Renal plasma flow ↓↓, Glomerular filtration rate ↓, Filtration Fraction ↓
c. Renal plasma flow ↓↓, Glomerular filtration rate ↓, Filtration Fraction ↑
d. Renal plasma flow ↓, Glomerular filtration rate ↑, Filtration Fraction ↑
e. Renal plasma flow ↑, Glomerular filtration rate ↑, Filtration Fraction ↓
C
A 32-year-old man complaining of fatigue and muscle weakness is seen by his physician. Blood reveals a serum glucose level of 325 mg/dL and serum creatinine of 1.0 mg/dL.
Results of a 24-hour urine analysis are as follows:
•Total volume: 5L
•Total glucose: 375g
•Total creatinine: 2.4g
Which ONE of the following is the patient’s approximate glomerular filtration rate?
Select one:
a. 210 mL/min
b. 130 mL/min
c. 170 mL/min
d. 90 mL/min
e. 250 mL/min
C
A decrease in the concentration of NaCl in the intraluminal fluid causes the juxtaglomerular apparatus to release which ONE of the following hormones?
Select one:
a. Adenosine
b. ADH
c. Angiotensinogen
d. Renin
e. Aldosterone
D
Angiotensin II stimulates the sodium-hydrogen exchanger in the proximal tubule. How does this affect the handling of bicarbonate and H+ in the proximal tubule?
Select one:
a. Net bicarbonate reabsorption no effect, net H+ reabsorption no effect.
b. Net bicarbonate reabsorption no effect, net H+ reabsorption increased.
c. Net bicarbonate reabsorption increased, net H+ reabsorption no effect.
d. Net bicarbonate reabsorption decreased, net H+ reabsorption decreased.
e. Net bicarbonate reabsorption increased, net H+ reabsorption increased.
C
Substance X is freely filtered by the glomerulus and completely reabsorbed in the tubules. A healthy volunteer is administered substance X.
Laboratory vaules
Inulin clearance: 100 mg/min
PAH Clearance: 480 mg/min
Plasma concentration of substance X: 0.6 mg/mL
Tubular reabsorption of substance X: 40 mg/min
What is the expected excretion rate for substance X in this healthy volunteer?
Select one:
a. 0 mg/min
b. 60 mg/min
c. 40 mg/min
d. 80 mg/min
e. 20 mg/min
f. 100 mg/min
E
A 65-year-old man with uncontrolled Type-2 diabetes mellitus has polyuria (5 L/day) and serum glucose of 550 mg/dL). However, his urine glucose concentration (<100 mM) is much lower than expected. The graph below illustrates the relationship between plasma glucose concentration and renal glucose reabsorption for this patient. The glomerular filtration rate (GFR) is 100 mL/min. Which ONE of the following is the Tmax for glucose?
Select one:
a. 300 mg/min
b. 100 mg/min
c. 200 mg/min
d. 400 mg/min
e. 500 mg/min
E
A patient receiving a diuretic that targets the distal convoluted tubule is placed on a low sodium diet. The patient’s sodium excretion follows the pattern shown below. Which ONE of the following explains the changes in urine sodium in this patient?
Select one:
a. Raised sodium reabsorption in the proximal convoluted and proximal straight tubules
b. Elevated sodium reabsorption in the distal convoluted tubule
c. Reduced ADH-dependent water reabsorption in the collecting duct
d. Diminshed sodium Excretion in the Collecting Duct
e. Reduced Sodium Excretion in the Loop of Henle
A
A UCI medical student decides to climb Ishinca & Tocllaraju peaks in the Peruvian Andes (>15,000 feet). To prevent mountain sickness, she takes acetazolamide. Where in the nephron does this drug act (see image below)?
Select one:
a. E
b. A
c. B
d. F
e. C
f. D
C
Following 12 hours of water deprivation, where in the image below would urine with 100 mOsm/L osmolarity be detected?
Select one:
a. C
b. D
c. B
d. E
e. F
f. A
D
A 78-year-old woman with a history of morbid obesity, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney disease (serum creatinine 2.0 mg/dL) presents with worsening dyspnea. Her ECG shows no acute ischemic changes; her chest radiograph reveals chronic emphysematous changes with mild bilateral infiltrates. Her lung examination is notable for diffuse wheezing, and she has chronic lower extremity edema. Her amino-terminal pro-B-type natriuretic peptide ( NT-proBNP) level is 5500 pg/mL (upper limit of normal is <1800 pg/mL for age >75 years). In which two parts of the nephron shown in the image below does ANP decrease sodium reabsorption?
Select one:
a. A and F
b. C and E
c. C and F
d. D and F
e. B and E
f. B and C
A
The ratios for Tubular Fluid Concentration / Plasma Ultrafiltrate for several compounds are shown in the figure below. Which of the following substances are likely to produce lines 1 and 4?
Select one:
a. Urea and Glucose
b. Inulin and bicarbonate
c. Inulin and Creatinine
d. Inulin and Amino acids
e. Bicarbonate and Glucose
B
The graph below shows the relationship between renal blood flow and glomerular filtration rate in a healthy individual. Assuming a hematocrit of 43% (0.43), what is the best estimate of the filtration fraction at a mean arterial pressure of 180 mm Hg?
Select one:
a. 0.5
b. 0.15
c. 0.3
d. 0.9
e. 0.7
B
A 67-year-old woman with osteoporosis is given a diuretic to treat her hypertension. This particular diuretic has the adverse effect of limiting calcium excretion by the kidney. Referring to the image below, where along the nephron does this drug act?
Select one:
a. A
b. B
c. E
d. F
e. D
f. C
C
A 63-year-old hospitalized woman becomes oliguric and confused. Her blood glucose is found to be only 48 mg/dL. An intravenous bolus of 50% dextrose is administered followed by a continuous infusion of 10% dextrose/saline. In the diagram below, where does most of the glucose that is filtered through the glomerulus undergo reabsorption?
Select one:
a. D
b. F
c. C
d. A
e. E
f. B
F
