Renal II

Question 1

fanconi syndrome

Answer 1

defect PCT

increased excretion AAs, glucose, HCO3, P

hereditary defect, ischemia, multi myeloma, nephrotoxin, lead poisoning

Question 2

bartter syndrome

Answer 2

reabsorption defect in thick ascending loop henle

auto recessive
-affect Na/K.2Cl cotranspoter

get hypoK, alkalosis and hyperCa

Question 3

gitelman syndrome

Answer 3

defect NaCl reabsorption in DCT

auto rec

hypoK, hypoMg, metabolic alkalosis, hypoCa

Question 4

liddle syndrome

Answer 4

GOF mutation

• increased Na reabsorption in collecting tubule
• ENaC upregulation

auto dom

get HTN, hypoK, metabolic alkalosis, decreased aldosterone

tx - amiloride

Question 5

syndrome apparent mineralocorticoid excess

Answer 5

hereditary deficiency - 11B hydroxysteroid DH

no cortisol > cortisone in mineralocorticosteroid receptor cells

cortisol - act on mineralocorticoid receptor

• HTN, hypoK, metabolic alkalosis
• low serum aldosterone

can get from licorice - block 11B hydroxysteroid DH

Question 6

11B hydroxysteroid DH

Answer 6

conversion of cortisol > cortisone

stop cortisol from acting on mineralocorticoid receptor

Question 7

TF/P

Answer 7

tubular fluid / plasma

greater than 1 - solute reabsorbed less quickly than water
equal to 1 - solute and water same rate
less than 1 - solute reabsorbed faster than water

Question 8

net secretion

Answer 8

PAH

Question 9

stimulus renin release

Answer 9

hypotension - to JG cell
low Na - to macula densa
increased sympathetic - B1

Question 10

ANG II activity

Answer 10

AT1 receptor - vasc smooth m - vasoconstriction

constrict efferent arteriole glomeruli - preserve GFR low volume

aldosterone increase

ADH increase

increased PCT Na/H activity - contraction alkalosis

stimulate hypothalamus - thirst

Question 11

aldosterone K and H effect

Answer 11

principal cells - K channels

a-intercalated cells - H+ ATPase

Question 12

ANP/BNP

Answer 12

response to high volume - HTN

check on RAAS

relax vasc smooth m - cGMP - increased GFR

decreased renin

Question 13

JG apparatus

Answer 13

mesangial cells
JG cells - smooth m of afferent arteriole
macula densa - NaCl sensor - DCT

JG cell - secrete renin

Question 14

stimulus of JG cells

Answer 14

low blood pressure

Beta 1 sympathetic

Question 15

macula densa cells

Answer 15

sense low NaCl to DCT

release adenosine

vasoconstriction

Question 16

EPO

Answer 16

released from kidney

interstitial cells in peritubular cap bed - response to hypoxia

Question 17

1-a hydroxylase

Answer 17

from PCT of kidney

convert 25 vit D to 1,25 vit D

Question 18

NSAID and renal failure

Answer 18

block renal protective PG synthesis

constriction of afferent arteriole and decreased GFR

Question 19

mechanism of ANP

Answer 19

increased GFR
increased Na filtration - no net absorption

result in Na loss and volume loss

Question 20

mechanism of PTH

Answer 20

secreted with low Ca, high P, or low 1,25 vit D

cause increases Ca reabsorption DCT
decreased P reabsorption PCT
increased vit D 1,25 production

and increased Ca and P reabsorption from gut (via vit D)

Question 21

potassium with acidosis

Answer 21

shift K out of cell and H into cell

Question 22

potassium with alkalosis

Answer 22

shift K into cell and H out of cell

Question 23

Na/K ATPase

Answer 23

shift Na out of cell and K out cell

increased with B-agonist and insulin
-get hypoK

decreased with digitalis
-get hyperK

Question 24

hypoK

Answer 24

U wave
flat T waves

arrhythmia
muscle spasm

Question 25

hypoCa

Answer 25

tetany
seizure
QT prolongation

Question 26

hypoMg

Answer 26

tetany
torsades
hypoK

Question 27

hypoP

Answer 27

bone loss, osteomalacia, rickets

Question 28

hyperK

Answer 28

wide QRS
peaked T wave

arrhythmia
muscle weakness

Question 29

hyperCa

Answer 29

stone, bones, groans, thrones, psych overtones

renal stones
bone pain
abdominal pain
urinary frequency
depression, anxiety

Question 30

hyperMg

Answer 30

low DTR
lethargy
bradycardia
hypotension
hypoCa

Question 31

hyperP

Answer 31

renal stone
metastatic calcifications
hypoCa

Question 32

acid base physiology

Answer 32

low pH and low PCO2 - metabolic acidosis

low pH and high PCO2 - respiratory acidosis

Question 33

winters formula

Answer 33

determine predicted PCO2
-suggest mixed acid base disorder

PCO2 = 1.5 [HCO3] + 8 (+/-2)

Question 34

anion gap

Answer 34

anion gap = Na - (Cl + HCO3)

high - MUDPILES
normal - HARDASS

Question 35

MUDPILES

Answer 35

high anion gap metabolic acidosis

methanol
uremia
DKA
propylene glycol
iron tabs or isoniazid
lactic acidosis
ethylene glycol
salicylates

Question 36

HARDASS

Answer 36

nomal anion gap metabolic acidosis

hyperalimentation
addison disease
renal tubular acidosis
diarrhea
acetazolamide
spironolactone
saline infusion

Question 37

metabolic alkalosis with compensation

Answer 37

compensation - hypoventilation

loop/thiazide use
vomiting
antacid use
hyperaldosterone

Question 38

type 1 renal tubular acidosis

Answer 38

urine pH >5.5

defect a-intercalated cells secrete H (collecting duct)
-no HCO3 generated

with hypokalemia

risk of Ca-P kidney stone - bc alkaline urine

cause - amphotericin B, analgesis nephropathy, urinary tract obstruction

Question 39

type 2 renal tubular acidosis

Answer 39

urine pH

Question 40

type 4 renal tubular acidosis

Answer 40

hypoaldosteronism

• hyperK
• decreased NH3 synthesis PCT - more NH4 excretion

low aldosterone - diabetic hyporeninism, ACE I, ARB, NSAID, heparin, cyclosporine, adrenal insufficient

or aldosterone resistance