Renal adaptation

Question 1

Renal responses to various abnormalities

Answer 1

Deficient nephrons
Reduced renal mass
Reduced Nephron function

Question 2

T or F

Deficient nephrons can be seen at birth

Answer 2

T

Question 3

developmental abnormalities like hypoplastic kidney

Answer 3

CAKUT congenital abnormalities of the kidney and urinary tract

Question 4

Low nephrons at birth

Answer 4

Autosomal recessive kidney disease
Urinary tract abnormalities with abnormal kidney
Dysplastic or Hypoplastic kidneys

Question 5

kidney mass below two standard
deviations of age-matched normal or a
combined kidney mass of less than half
normal for the patient age

Answer 5

Dysplastic or hypoplastic kidneys

Question 6

FACTORS CONTIRBUTING TO LOW NEPHRON

Answer 6

Decrease growth in utero
Low birth weight mothers= low birth weight babies
Calorie restrictions
Protein restrictions
Hi-fat intake prone to hypertension and renal fibrosis
Deficiency in Na, Zn, Fe, Vit A
Drugs taken during preg

Question 7

T or F
persistence of hyperglycemia can actually delay the kidney development and decrease in
the number of nephrons developed

Answer 7

T

Question 8

calorie restriction of mothers may predispose their child to _____

Answer 8

albuminuria

Question 9

Protein restriction decreases lifespan by

Answer 9

200mdays

Question 10

Drugs that could contribute to deficient numbers of nephron

Answer 10

Dexamethasone
ACEI and ARBS
Gentamicin
Nsaids

Question 11

This postulates what the kidney does when an
individual is born with deficient number [of
nephrons].

Answer 11

BENNER HYPERFILTRATION HYPOTHESIS

Question 12

becomes maladaptive as it leads to progressive anatomical and functional deterioration of the kidney

Answer 12

BENNER HYPERFILTRATION HYPOTHESIS

Question 13

adaptation in chronic kidney kidney injury

Answer 13

Counterbalance
Hypertrophy
systemic adap:
-potassium
-sodium
-Acid-base homeostasis
-mineral metabolism

Question 14

an attempt on the part of the less injured or uninjured portion of the kidney to take over the work of the more injured portion

Answer 14

Counterbalance

Question 15

growth or compensation due to overstimulation

Answer 15

acquired reserve

Question 16

related to increase in renal blood flow due to dilatation of the renal arterioles due to Nitric oxide production

increased size of the glomeruli and hyperfiltration

Answer 16

Hypertrophy

Question 17

factors implicated in compensated hypertrophy after nephron loss

Answer 17

inc renal blood flow
inc tubular absorption of Na with dec distal delivery and decreased afferent arterial resistance due to adaptive tubuloglomerular feedback
Hepatocyte growth factor
Gluc transporters
Inc renal nerve activity
Insulin like growth factor
Mammalian target of rapamycin signalling pathway activation
Transforming growth factor beta

Question 18

potassium is reabsorbed in the ______ and secretion determined by _____

Answer 18

proximal tubule; distal nephron

Question 19

hyperkalemia promotes potassium secretion by the principal cell of the _______

Answer 19

collecting duct

Question 20

Increases the density and activity of the
basolateral Na-K-ATPase and the
number of Na channels in the apical
membrane of the collecting duct

Answer 20

aldosterone

Question 21

In CKD: positive feedback=

Answer 21

increase distal delivery = increased filtration

Question 22

acid-base metabolism normal:

Answer 22

excrete 1 mEq/kg/day of dietary acid load

Question 23

adaptation to decreased mass (acid-base metab)

Answer 23

Increased H excretion
o Enhanced nephron ammoniagenesis
o Increased distal H ion secretion (RAS and endothelin-1)

Question 24

Mineral-metabolism response

Answer 24

•  Increased  secretion  of  PTH  and
FGF-23
•  Stimulate phosphaturia
•  Reduces  levels  of  Na-phosphate
cotransporter NaPi2a and NaPi2c

Question 25

mineral metabolism Maladaptive response:

Answer 25

•  Downregulation  of  Klotho-fibroblast
growth  factor  I  resulting  to  a
decrease in the ability of FGF-23 to
downregulate PTH production
•  Persistent  elevation  leads  to  soft
tissue  calcification,  left  ventricular
hypertrophy  and  subsequent
increased mortality in CKD.

Question 26

Activation of intrinsic defense mechanisms

to cope with pathologic conditions

Answer 26

PRECONDITIONING

Question 27

renders the organ resistant to subsequent ischemic injury

Answer 27

ISCHEMIC PRECONDITIONING

Question 28

Protection afforded in one vascular bed by
ischemia in another vascular bed in the
same organ or a different organ

Answer 28

remote ischemic preconditioning

Question 29

adenosine

Answer 29

akt (protein kinase b)

Question 30

antioxidants

Answer 30

autophagy

Question 31

bradykinin

Answer 31

dec in genes regulating inflammation

Question 32

extracellular single-related kinase

Answer 32

hypoxia induced factors

Question 33

heat shock proteins

Answer 33

protein kinase c

Question 34

JAK stat pathways

Answer 34

Jun N terminal kinase

Question 35

Mitochondrial connexin

Answer 35

Nitric oxide

Question 36

Opioids

Answer 36

Sirtuin activity

Question 37

Adaptive response to acute injury

Answer 37

Hypoxia
Acute renal success
Tubulogromerular feedback
Hypoxia-induced factor 1 alpha

Question 38

Induces upregulations of genes whose
protein products are involved in energy
metabolism, angiogenesis, and apoptosis

Answer 38

Hypoxia-induced factor 1 alpha

Question 39

ADAPTIVE RESPONSE TO TOXIC INJURY SPECIFIC TO THE PROXIMAL TUBULES

Answer 39

Response of the proximal tubule cells to direct

injury by Diphtheria toxin producing repair with minimal sequela.