Renal

Question 1

Serum antibodies to PLA2R

Answer 1

Major antigen in the pathogenesis of Idiopathic membranous nephropathy

Question 2

How do the kidneys compensate for metabolic acidosis?

Answer 2

1. Excrete excess H+
2. recycle bicarbonate (inc in carbonic anhydrase action)
3. Excrete titratable acids (H2PO4, NH4+)

Question 3

Where does renal cell carcinoma originate?

Answer 3

epithelial cells of proximal renal tubules

Question 4

Where in the nephron is PAH concentration the lowest?

Answer 4

Bowman’s space- PAH is actively secreted in proximal tubules

Question 5

In the absence of ADH, where is tubular fluid most dilute? Most concentrated?

Answer 5

Dilute: collecting ducts
Concentrated: junction between descending and ascending loop of Henle

Question 6

Side effects of ACE inhibitors

Answer 6

1. decreased GFR (because you’re blocking constriction of efferent arteriole and decreasing glomerular pressure)
2. hyperkalemia
3. cough
4. Angioedema (rare, but life threatening)

Question 7

Formula for filtration fraction

Answer 7

FF= GFR/RPF

Question 8

Selective proteinuria

Answer 8

ex: MCD

Albumin is lost, but more bulky proteins are retained (Igs and macroglobulin)

Question 9

Lab findings in DKA

Answer 9

low pH, low serum bicarbonate, low PaCO2

Question 10

What factor most effects prognosis in PSGN?

Answer 10

Age, most kids recover, while only 60% of adults do

Question 11

Glomerular cresents on light microscopy
Absence of deposits on immunoflourescence
Elevated serum c-ANCA

Answer 11

GPA

Question 12

How does ureteral obstruction effect GFR and filtration fraction

Answer 12

Decreases GFR and FF

Question 13

Gross hematuria in elderly man

History or smoking or occupational exposure to plastics/aromatic dyes/textiles

Answer 13

Transitional cell carcinoma

Question 14

Which parts of the nephron are most susceptible to ischemic damage?

Answer 14

Medullary structures: Proximal tubules and TAL of Loop of Henle
Proximal more so because it needs ATP for active transport of ions.

Question 15

Glomerular histology:
flattening of epithelial cells
loss of brush border in proximal tubular cells
cell necrosis and denudation fo tubular basement membrane

Answer 15

Acute tubular necrosis

Question 16

Muddy brown casts in urin

Answer 16

Acute Tubular Necrosis

Question 17

Easy fatigability
constipation
back pain
azotemia
elderly patient
eosinophilic casts in lumen

Answer 17

Myeloma Kidney

Casts of Bence-Jones protein

Question 18

Best method for screening for diabetic nephropathy

Answer 18

screen for microalbuminuria (30-300 mg/day)

Question 19

Which diseases put patients at extra risk for renal papillary necrosis?

Answer 19

Sickle cell disease (or trait)
DM
analgesic nephropathy
Severe obstructive pyelonephritis