Renal For Quiz 1

Question 1

Hyponatremia and hypernatremia show problems with what process?

Answer 1

Free water handling

Question 2

What is the typical renal response to hypernatremia (Dehydration)

Answer 2

ADH secretion causing free water retention and hyperosmolar urine.

Question 3

Match the cause with the hyponatremia type:
Hypovolemic———-Excess serum protein
Euvolemic————-Diuretics and volume loss
Hypervolemic———Inappropriate ADH

Answer 3

Hypo - Diuretics
Eu - inappropriate ADH
Hyper - excess protein (from Cirrhosis, nephrotic syndrome, etc)

Question 4

When do you correct for hyponatremia? What can happen if you correct too fast?

Answer 4

Acute hyponatremia with neurological dysfunction. If corrected too fast, permanent neurological damage can occur

Question 5

What pH shifts can lead to hypo and hyper kalemia

Answer 5

Acidosis leads to hypernatremia, alkalosis leads to hyponatremia

Question 6

How is hyperkalemia treated?

Answer 6

Calcium Gluconate to correct EKG changes. Then correction with insulin or k+ binding resin

Question 7

What ekg changes can be found with hypokalemia?

Answer 7

Prolonged QTc

Question 8

How do you calculate anion gap?

Answer 8

Na - (Bicarbonate + Cl)

Question 9

Embryology: What forms the collecting tubules of the kidney?

Answer 9

The uretic bud

Question 10

Embryology: What forms the nephron?

Answer 10

Metanephric blastema

Question 11

What lines perinephric fat?

Answer 11

Gerota’s fascia

Question 12

How can you differentiate proximal and distal tubules histologically?

Answer 12

Proximal tubules have microvilli, so you can see the lumen better in distal

Question 13

What is the GFR cutoff for end stage renal disease?

Answer 13

GFR < 5%

Question 14

What is the difference between nephrotic and nephrotic syndromes?

Answer 14

Nephritic: Hematuria, mild proteinuria, and HTN
Nephrotic: Major proteinuria, hypoalbuminemia (protein wasting), edema, hyperlipidemia, and lipiduria

Question 15

In Acute renal failure, what are lab values and urinary habits you will see?

Answer 15

Oliguria or Andrea, as well as azotemia (increased BUN and Creatinine)

Question 16

What are some causes of acute renal failure?

Answer 16

Obstruction of the urinary ducts or decreased perfusion (due to hypovolemia, sepsis, etc) or intrinsic diseases of the kidney

Question 17

What are some causes of acute kidney injury?

Answer 17

Ischemia and toxic substances

Question 18

What gross anatomical changes accompany Acute kidney injury?

Answer 18

Enlarged kidney, darker medulla, and pale cortex

Question 19

What are casts in the urine?

Answer 19

Anything that packs into the nephron and can later be passed in the urine. In AKI, this is Tamm-Horsfalll protein (a urinary glycoprotein)

Question 20

What are some histological changes in the initiation phase of AKI?

Answer 20

Loss of brush borders, edema of proximal tubules, dilation of distal tubules, ragged endothelium, and leukocytes in the vasa recta

Question 21

What are the progression of phases of AKI and how long does each last

Answer 21

Initiation - few hours - days
Maintenance - around 1 week (66% mortality)
Recovery - around 2 weeks (33% mortality)

Question 22

What are some toxic causes of AKI?

Answer 22

Aminoglycosides
Ethylene Glycol (antifreeze)
NSAIDs
ACE inhibitors
Pb and Hg
IV contrast

Question 23

What is the histological difference between ischemic and nephrotoxic acute kidney injury?

Answer 23

Ischemic has basement membrane involvement (tubulorrhexis), whereas nephrotoxic is often limited to only necrosis of the proximal tubule

Question 24

What are the most common bacterial causes of pyelonephritis?

Answer 24

Same microbes as lower UTI (esp. E.coli)

Question 25

What is the most common cause of chronic pyelonephritis?

Answer 25

Chronic reflux from the bladder to the ureter (associated with shorter inter-wall path of ureter through the bladder)

Question 26

What organ can a kidney look like histologically if the patient has chronic kidney infection?

Answer 26

Thyroid (thyroidization)

Question 27

Which chronic kidney infection causing bacteria can cause xanthogranulomatous pyelonephritis, which can look like a renal cell carcinoma?

Answer 27

Proteus

Question 28

Which cause of chronic pyelonephritis often leads to non-polar scar formation?

Answer 28

Urinary tract obstruction