Renal Physiology

Question 1

Most commonrenal developmental disorder

Answer 1

Renal cystic dysplasia

-abnormal differention of renal structures during embryonic period, with cyst formation

Question 2

Are adult polycystic kidney disease unilateral or bilateral?

Answer 2

bilateral

Question 3

• Serous or purulent-filled cysts that destroy parenchyma
• Cysts form from obstructed tubules
• Dull, aching pain in abdomen or back
• Hematuria
• Liver cysts (also common)

Answer 3

Adult polycystic kidney disease

Question 4

• non-functional kidney, bilaterally at birth
• sponge-like
• cysts from collecting ducts
• Autosomal recessive

Answer 4

Childhood polycystic kidney disease

Question 5

Most common infective agents of acute pyelonephritis

Answer 5

gram negative - E.coli**, (also Klebsiella, Enterobacter, pseudomonas, serritia, proteus)

Question 6

Fever, chills, malaise, sudden sharp costovertebral pain

Answer 6

Acute pyelonephritis

Question 7

Complication of acute pyelonephritis seen with diabetics.

-Ischemia + necrosis at renal pyramid tip

Answer 7

Renal papillary necrosis

Question 8

• Scarring involving pelvis and/or calyces leading to papillary blunting and calyceal deformities
• Dialated tubules contain pink, glassy colloid casts (thyroidization)

Answer 8

Chronic pyelonephritis

Question 9

Proteinaceous casts in distal tubules and collecting ducts–> Tamm-Horsfall protein

Answer 9

Acute tubular necrosis

Question 10

Most common cause of acute renal failure

Answer 10

Acute tubular necrosis

Question 11

Causes of Acute Tubular necrosis

Answer 11

-reduction in blood flow that affects the cortex of the kidney

When?: after MI, cardiac arrect, hypotensive shock

Question 12

Is Acute tubular necrosis reversible?

Answer 12

yes

Question 13

Diabetic nephropathy (2 microscopic findings/urinalysis finding)

Answer 13

1. basement membrane thickens and becomes more permeable
2. Nodules in the glomerular tuft (Kimmelsteil-Wilson dx)
3. Proteinuria (massive if >3 gms a day)

Question 14

Vascular changes (2) in diabetic nephropathy

Answer 14

1. Narrowing of lumen (thickening of vessel walls)

2. Ischemia–>papilary necrosis of pyramids, detach and cause ureter obstruction

Question 15

Location of urinary stones (2)

Answer 15

1. renal pelvis

2. Urinary bladder

Question 16

Hematuria, urinary colic, renal colic, flank pain radiating to the groin

Answer 16

urolithiasis

Question 17

Most common urinary stone

Answer 17

Calcium stone (calcium oxalate or calcium phosphate)

causes: hyperparathyroidism, diffuse bone disease

Question 18

Urea splitting bacteria: Proteus causes this type of stone

Answer 18

Struvite

ex. Staghorn calculi (largest type of stones)

Question 19

• Radiolucent stones

- complication of gout or leukemia (hyperuricemia)

Answer 19

Uric Acid stone

Question 20

Stone from inborn error of amino acid metabolism

Answer 20

Cysteine stone

Question 21

Causes of urinary tract obstruction

Answer 21

1. Developmental defect
2. Urinary calculi
3. Pregnancy
4. BPH
5. Prostate cancer
6. Infection/inflammation
7. Uterine prolapse

Question 22

• Dilation of renal pelvis and calyces with progressive atrophy of the kidney due to obstruction to the outflow of urine
• Compress blood supply of kidney (lowers GFR)

Answer 22

Hydronephrosis

Question 23

Hydronephrosis (gross kidney appearance)

Answer 23

enlarged, dilation of pelvis and calyces with interstitial inflammation (latter leads to fibrosis)

Question 24

Which type of bilateral hydronephrosis has inability to concentrate urine (polyuria and nocturia)?

Answer 24

partial hydronephrosis

Question 25

Which type of hydronephrosis does not produce urine (oliguria or anuria?

Answer 25

complete hydronephrosis -irreversible damage

Question 26

Renal cell carcinoma risk factors

Answer 26

-Older men who smoke

Question 27

Which renal cancer arises from either the lower or upper pole?

Answer 27

Renal cell carcinoma

Question 28

Gross appearance of renal cell carcinoma

Answer 28

- nodules, sharply demarcated - upper or lower pole - yellow, bosselated - encapsulated

Question 29

Where does RCC like to metastasize to?

Answer 29

1. lung | 2. bone (hypercalcemia, polycythemia)

Question 30

Classic triad of Renal cell carcinoma

Answer 30

1. Hematuria 2. Dull flank pain 3. Palpable abdominal mass

Question 31

Cuboidal cells with clear or granular cytoplasm, filled with glycogen and lipids are histological features of what?

Answer 31

Renal cell carcinoma

Question 32

Treatment for RCC?

Answer 32

surgery

Question 33

Papillary neoplasms of the renal pelvis that resemble carcinomas of the urinary bladder

Answer 33

Transitional Cell Carcinoma

Question 34

Most common solid kidney tumor in infants/children

Answer 34

Wilms tumor

Question 35

Kidney tumor of childhood that is highly malignant and comprised of blastic or immature cells - palpable - manifests around age 2-4

Answer 35

Wilms tumor

Question 36

Most common type of urinary bladder cancer?

Answer 36

Transitional cell carcinoma

Question 37

Risk factors of urinary bladder cancer

Answer 37

1. Cigarette smoking 2. Azo dyes 3. Rubber industry chemicals 4. Schistosoma haematobium infection (Egypt) [very rare squamous cell CA)

Question 38

Sudden onset _____ may cause fibrinoid necrosis of glomerular capillaries

Answer 38

Hypertension

Question 39

Rapid, reversible deterioration in renal function. Sudden onset, loss of excretory function (oliguria or anuria)

Answer 39

Acute Renal Failure

Question 40

Most common nephrotic syndrome in children

Answer 40

Minimal change disease (Nils Disease)

Question 41

Acute Post-streptococcal glomerulonephritis

Answer 41

- nephritic - hypocomplementemia (gets stuck in the kidney) - immune complexes in basement membrane (humps) - marked hypercellularity of the glomerulus - smoky colored urine, oliguria - Red cells casts in urine - periorbital edema (recurring each morning)

Question 42

- Autoimmune, abo to bm collagen type 4 - injury to lungs - linear deposits in glomerulus - Kidneys don't survive this, will need dialysis/transplant

Answer 42

Good Pasture's Syndrome

Question 43

Fusion of visceral epithelial foot processes complete remission Treatment: steroids

Answer 43

Minimal Change Disease (Nils) Disease

Question 44

Membranous glomerulonephritis

Answer 44

-nephrotic -adults -bm thickening due to immune complexes -granularity of deposits TX: steroids