Chronic renal failure

Question 1

The classification for chronic renal failure consists of the following categories: (1).

Answer 1

1. diminished renal reserve, renal insufficiency, chronic renal failure, and end-stage renal disease

Question 2

In (1) the patients are still asymptomatic and have (2) BUN and creatinine and (3) GFR

Answer 2

1. diminished renal reserve
2. normal
3. 50% decrease in GFR

Question 3

(4) presents with (1) and is found when GFR is (2). These patients can also have (3) from decreased urine concentrating ability.

Answer 3

4. Renal insufficiency
5. azotemia, anemia and hypertension
6. reduced between 50-80% (20-50% of normal)
7. polyuria and nocturia

Question 4

asymptomatic, normal BUN and creatinine, 50% decrease in GFR

Answer 4

diminished renal reserve chronic renal failure

Question 5

azotemia, anemia, hTN, 50-80% decrease in GFR, polyuria, nocturia

Answer 5

renal insufficiency

Question 6

Chronic renal failure is present when GFR has fallen to less than (1)% of normal and the patients have (2).

Answer 6

1. 20%

2. edema, metabolic acidosis and hyperkalemia

Question 7

End-stage renal disease is present when the GFR is less than (1)% of normal.

Answer 7

1. 5%

Question 8

GFR 20-50% of normal

Answer 8

renal insufficiency

Question 9

GFR less than 5% of normal

Answer 9

end stage renal disease

Question 10

GFR less than 20% of normal

Answer 10

chronic renal failure

Question 11

edema, metabolic acidosis, hyperkalemia

Answer 11

chronic renal failure

Question 12

Chronic renal disease has a number of symptoms and findings which include (1)

Answer 12

1. renal osteodystrophy (secondary hyperparathyroidism)

Question 13

Secondary vs. primary hyperparathyroidism
calcium
PTH
phosphate

Answer 13

Secondary hyperparathyroidism with a low serum calcium but elevated PTH. Serum phosphate levels are usually elevated because of decreased phosphate excretion by the kidney whereas in primary hyperparathyroidism, serum phosphate levels are usually decreased and serum calcium is increased

Question 14

In addition, there is less conversion to (1) by the diseased kidney.

Answer 14

1,25 vitamin D (Active vitamin D)

Question 15

End stage renal patients also have (1), a white frost on the skin (from (2), (3) and (4) in part because less (5) is produced by the diseased kidney

Answer 15

1. pericarditis
2. elevated urea
3. hyperkalemia, acidosis
4. anemia
5. erythropoietin

Question 16

There are a number of types of (1) which can lead to renal failure.

Answer 16

1. inherited renal cystic diseases

Question 17

Medullary sponge kidney is not inherited and can lead to (1)

Answer 17

1. nephrolithiasis

Question 18

(1) is a consequence of amorphous undigestible acellular material in the (2).

Answer 18

1. Amyloid nephropathy

2. mesangium or renal tubules

Question 19

(1) is a non-specific term for proteins which have a beta-pleated sheet appearance and are (2) by electron microscopy and stain with (3) by light microscopy.

Answer 19

1. Amyloid
2. fibrillar
3. congo red

Question 20

There are two distinct types of amyloid proteins: the inflammatory type which is composed of (1) which is associated with inflammatory disorders such as (2); and (3) which are produced in the B cell malignancy called (4)

Answer 20

1. serum amyloid A protein
2. rheumatoid arthritis and chronic TB
3. immunoglobulin light chains
4. multiple myeloma.

Question 21

The proteinuria in (1) is non-selective and includes (2) as well as (3)

Answer 21

1. multiple myeloma light chain amyloid
2. globulins
3. albumin.

Question 22

Immunoglobulin light chain amyloid themselves can be directly toxic to (1)

Answer 22

1. renal epithelial cells.

Question 23

A type of light chain protein known as (1) protein combines with the (2) protein under (3) conditions to form large dilated tubular casts of light chains which have a very distinctive appearance; this is sometimes called (4)

Answer 23

1. Bence Jones
2. Tamm-Horsfall
3. acidic
4. light chain cast nephropathy.

Question 24

Another type of chronic renal disease are the renal tubular acidosis disorders. Type I is the (1) form, which is due to (2), so patients have a high urine pH.

Answer 24

1. distal tubule

2. decreased acid secretion

Question 25

There are a number of disorders such as (1) that are associated with distal tubular acidosis.

Answer 25

1. Sjogren’s

Question 26

Type II renal tubular acidosis is the (1) form, which is due to (2)

Answer 26

1. proximal tubule

2. bicarbonate loss in the proximal tubule

Question 27

There are a number of disorders such as (1) that are associated with proximal tubular acidosis.

Answer 27

(1) Fanconi

Question 28

Chronic renal failure can be treated by (1) which uses a kidney machine and specifically defined fluids to remove waste products from the blood.

Answer 28

1. hemodialysis

Question 29

The fastest form of transplant rejection is hyperacute, which occurs within minutes to hours and can be caused by ?

Answer 29

ABO or class I MHC incompatibility.

Question 30

In this case, (1) bind endothelial cells, activate complement and attract neutrophils and platelets which produce cell necrosis, thrombi, and hemorrhage within 12-24 hours.

Answer 30

1. preformed antibodies

refers to hyperacute transplant rejection

Question 31

Acute cellular allograft rejection histologically consists of either a (1) reaction with (2) or a (3) reaction with (4)

Answer 31

1. tubuloinsterstitial
2. tubulitis (inflammation of the tubules)
3. vascular
4. endarteritis.

Question 32

Chronic cellular allograft rejection shows vascular changes of (1) and (2)

Answer 32

1. thickening of peritubular capillary basement membranes

2. mesangial widening of glomeruli.