Renal

Question 1

RPF

Answer 1

FF = GFR/RPF
PAH = estimate

Question 2

Filtered load =

Answer 2

FL = GFR * Px

{GFR NOT CLEARANCE!]

Question 3

AA in urine with vs without proline, hydroxyproline, and arginine

Answer 3

With = Fanconi's anemia (NO AA abs in PCT)
without = hartnups (neutral AA only) - pellagra

Question 4

Fanconi anemia s/s and causes

Answer 4

S/s: prox. renal tubular metabolic ACIDosis

Causes: wilsons, tyrosinemia, glycogen storage diseases, expired tetracyclins, tenofovir, multiple myelomas, ischemia, lead poisoning

Question 5

order of renal tubule defects:

Answer 5

fanconi
barters
Gitelman
Liddle - GOF; AD
S.I. mineralocorticoid excess

Question 6

Adrenergic R on JG cells

Answer 6

Beta-1

Question 7

7 effects of Ang-II

Answer 7

Peripheral VC (AT1)
Renal efferent VC
Aldosterone release
ADH release
Thirst
increases PCT Na//H activity (can cause CONTRACTION ALKALOSIS)
Limits reflex bradycardia (via baro-R modulatoin) to maintain BV and BP

Question 8

macula densa pathway: INCREASED NaCl

Answer 8

high NaCl to macula densa (DCT) –> cells swell –> release adenosine –>

1) A1-R: afferent VC
2) A2-R: efferent VD
3) DECREASED JG release of renin

Question 9

protaglandins in the kidney

Answer 9

VD afferent

[block with NSAIDs decreases GFR –> ARF]

Question 10

Hyper vs hypo Mg

Answer 10

HypoMg = tetany, torades, hypokalemia

HyperMg = decreased DTRs, lethargy, hypotension, bradycardia, cardiac arrest, hypocalcemia

Question 11

Normal anion gap (8−12 mEq/L)

Answer 11

HARD-ASS:
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

Question 12

high anion gap (>12)

Answer 12

MUDPILES:
Methanol (formic acid)
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or Isoniazid
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)

Question 13

Type I renal tubular acidosis (distal)

Answer 13

CD, high urine pH

Alpha-intercalated cant secrete H+ → retain H+ and lose K+
high urine pH + increased bone turnover predisposes to stones

Causes:
amphoteraxcin B, analgesic nephropathy, urinary tract obstructions

Question 14

Proximal/Type 2 renal tubular acidosis

Answer 14

PT, low urine pH

Defective PCT HCO3- absorption @BL → cant resorb Na with it (Na/HCO3 cotransport) → Na gets resorbed at CD, so K+ lost

K+ tries to get resorbed in exchange for H+ @ alpha-intercalated (K//H) → acidifies urine despite metabolic acidosis!

Causes:
Fanconi syndrome, CAH inhibitors (acetazolamide)

Question 15

Hyperkalemic (type 4) renal tubular acidosis

Answer 15

Hypoaldosteronism, hyper K+, low pH urine

No aldosterone → save K+ → can’t exchange for H+ out acidemia
High cellular K+ also decreases PCT NH3 synthesis decreasing urine NH4+ levels → acidic urine

Causes:

• hypoaldosteronism (ACE-I, ARB, NSAIDS, DM hyporeninism, adrnal insufficiency, heparin, cyclospirin)
• Aldosterone resistance (K+ sparing diuretics, obstructoin nephropathy, TMP/SMX)

Question 16

granular/muddy brown casts

Answer 16

ATN

Question 17

Waxy casts

Answer 17

ESRD or CRF

Question 18

oval fat bodies

Answer 18

nephrotic syndrome

Question 19

eosinophilic casts

Answer 19

Multiple myelomas (BJP + tammHorsefall)

[eosinoPHIL casts = AIN/TIN; drugs with rash]

Question 20

RBC casts

Answer 20

glomerulonephritis

malignant HTN

Question 21

WBC casts

Answer 21

TIN
acute pyelonephritis
transplant rejection

Question 22

lumpy bumps vs. humps

Answer 22

PSGN - nephritic
lumpy bumpy = IgG, IgM, C3 on GMB and messangium
humps = sub-epi immune complex deposition

Question 23

IgA nephropathy

Answer 23

HSP - nephritic

messangial IgA deposits and proliferation

Question 24

MPGN

Answer 24

nephritic
Type I = subendo = tram tracks = hepB/hepC
Type II = intramembranous = dense deposits = C3 nephritic factor

Question 25

DPGN

Answer 25

nephritic
via SLE (MCCD) or MPGN
wire-loooping capillaries on LM

Question 26

basket-weave

Answer 26

alports

can’t see, pee, hear a bee

Question 27

Epidemiology of nephrotic diease

Answer 27

Black/hispanic = FSGS (heroin, sickle, HIV, obesity, IFN, CKD)
MCD = kids 91’ or 2’ immune stim.)
Membranous nephropathy = white (PLA2-R, HBV, HCV, SLE, solid tumours, NSAIDs, penicillamine)

Question 28

spike and dome

Answer 28

membranous nephropathy - subEPIthelial

capillary and GBM thickening

Question 29

eosinophilic nodular glomerular sclerosis

Answer 29

Kimmelsteil-wilson nodules (diabetic nephropathy)

Question 30

Rx ca-oxalate stones

Answer 30

B6: decreases oxalate production
Citrate: binds Ca++ salts
hydration
thiazides: resorb Ca++

Question 31

Rx RCC

Answer 31

surgery or immunotherapy

[resistant to chemo and radiation]

Question 32

origins: RCC and oncocytoma

Answer 32

RCC = PCT
oncocytoma = CD

Question 33

RF transitional/urothelial CA

Answer 33

Phenacetin (pain med)
Smoking
Aniline dyes (leathers, rubber, textiles)
Cyclophosphamide

Question 34

sterile pyuria with no culture

Answer 34

ghonorrhea or chlamydia (NOT just a UTI)

Question 35

WBC in urine + WBC CASTS!

Answer 35

Acute pyelonephritis
(not just cystitis or UTI b/c of casts)
(cortex, avoids glomeruli/capilaries)

Question 36

throidization of kidney

Answer 36

chronic pyelonephritis

Question 37

Signs of renal failure:

Answer 37

MaD HUNGER

• Metabolic acidosis
• Dyslipidemia (increased TAG)
• Hyperkalemia
• Uremia: encephalopathy, asterixis, platelet dysfunction, pericarditis, functional hypothyroidism
• Na/H2O retention (edema)
• Growth retardation
• EPO failure
• Renal osteodystrophy

Question 38

HTN in ADPKD via

Answer 38

high renin release from giant kidney

Question 39

Medullary cystic disease

Answer 39

inherited
T-I fibrosis –> SHRUNKEN kidneys (seen on US)
can’t concentrate urine