Renal UWorld 2

Question 0

What is renal angiomyolipoma, what is it associated with?

Answer 0

Benign tumor made of blood vessels, smooth muscle, fat. Bilateral associated with tuberous sclerosis

Question 1

Filtration/absorption/secretion pattern of inulin and mannitol

Answer 1

Freely filtered, neither resorbed nor secreted

Inulin can be used to calculate GFR

Question 2

IF for postsreptococcal glomerular nephritis

Answer 2

granular deposits of IgM, IgG, C3 in mesangium and basement membranes - “starry sky”

Question 3

Embryonic kidney development: pronephros, mesonephros, metanephros

Answer 3

Pronephros is a very primative structure arising from cephalic portion of nephrogenic cord, degnerates

Mesonephros forms midportion of nephrogenic cord, functions as kidney for first trimester then becomes Wolffian ducts

Metanephros: true kidney. Formation of ureteric bud from caudal end of mesonephric duct - ureter, pelvises, calyces, collecting ducts (collecting system). Metanephric mesenchyme - interacts with uteric to differentiate and form glomerulus through DCT.

Question 4

Post strep glomerulonephritis: EM findings

Answer 4

electron dense deposites on epithelial side of basement membrane, composed of immune complexes

Question 5

Addition of ___ to standard CHF therapy improves morbidity and mortality.

Answer 5

Spironolactone

Question 6

Selective proteinuria

Answer 6

Albumin loss, but minimal loss of bulkier proteins like IgG and macroglobulin

Question 7

Acyclovir nephrotoxicity

Answer 7

Excreted in urine. When concentration gets high in collecting duct, it crystallizes and can cause renal tubular damage. Prevented with adequate hydration

Question 8

Acute post-strep glomerulonephritis - damage is mediated by:

Answer 8

Immune complexes deposited in subepithelial glomerulus (lumpy bumpy)

Question 9

common side effects of ACE-Is

Answer 9

Cough, hyperkalemia, decreased GFR (increased Cr), angioedema

Question 10

Constricting ureters ___ GFR and ___ Filtration Fraction

Answer 10

decreases, decreases

Question 11

Method for diagnosing diabetic nephropathy

Answer 11

Albumin in urine

Question 12

Visual impairment in HIV patient is most commonly due to:

Answer 12

CMV induced retinitis. Tx is ganciclovir, foscarnet, cidofovir

Question 13

Foscarnet toxicity

Answer 13

Hypocalcemia (chelates calcium), hypomagnesemia (promotes nephrotoxic renal Mg wasting)

Question 14

Calculate filtration fraction

Answer 14

FF = GFR/RPF

GFR is clearance of Cr or inulin
RPF is PAH clearance

Question 15

Calculate clearance of substance

Answer 15

Cl = urine conc x urine flow rate / plasma conc

Question 16

What part of the nephron is normally impermeable to water

Answer 16

ascending loop of henle

Question 17

End stage renal disease relation to renal osteodystrophy

Answer 17

Hypocalcemia and secondary hyperparathyroidism

ESRD causes decreased formation of active VD –> decreased intestinal Ca absorption –> low calcium (leads to 2ndary hyperparathyroid)

ESRD causes phosphate retention, high serum phosphate also causes hypocalcemia and leads to secondary hyperparathyroidism

Question 18

Hysterectomies and pelvic surgeries can harm what/cause what

Answer 18

Harm to ureters leads to hydronephrosis

Question 19

Hydronephrosis

Answer 19

Distention/dilation of renal pelvis and calyces usually be urinary tract obstruction. Leads to compression atrophy of cortex and medulla

Question 20

Clearance of digoxin

Answer 20

renal

Question 21

Angiotensin II preferentially contracts

Answer 21

efferent arterioles

Question 22

Acute rejection: time, mediators, treatment

Answer 22

within first 6 months

Can be antibody or cell mediated (lymphocytic infiltration)

Treat with anti-CD3 antibodies, which inhibit T-lymphocytes

Question 23

What is the most important complication during recovery phase of acute tubular necrosis?

Answer 23

Hypokalemia. Also decreased Mg, PO4, and Ca

Question 24

Complications during maintenance phase of acute tubular necrosis

Answer 24

Hyperkalemia, metabolic acidosis (retention of H and anions)

Question 25

Henoch-Schonlein purpura classic triad, who does it affect, what is it mediated by?

Answer 25

Most common childhood vasculitis, often follows URI, IgA mediated

1) Skin: palpable purpura on buttocks/legs
2) Arthralgias
3) GI: abdominal pain, melena, multiple lesions

Question 26

Young child with generalized edema and massive proteinuria after URI has:

Answer 26

Minimal change disease

Question 27

Minimal change disease: LM, IF, EM findings

Answer 27

LM: normal
IF: -
EM: foot process effacement

Selective albuminuria

Question 28

Every time GFR halves, serum Cr

Answer 28

Doubles

Question 29

Which enzyme in DNA synthesis catalyzes the formation of RNA strands in bacteria?

Answer 29

Primase, a RNA polymerase that synthesizes short RNA primers

Question 30

diabetic nephropathy starts with:

Answer 30

hyperfiltration

Question 31

Classic morphologic features of diabetic nephropathy. What drugs may slow progression?

Answer 31

K-W nodes
Diffuse glomerulosclerosis
Hylaine arteriosclerosis

Tx with ACE-I/ARBs