Renal

Question 1

What do the trocar and cannula pierce in a suprapubic cystostomy?

Answer 1

Aponeurosis of the abdominal wall muscles, layers of the superficial fascia, transversalis fascia, and extraperitoneal fat

Question 2

What tumors are associated with VHL?

Answer 2

Renal cell carcinoma, cerebellar hemangioblastomas, pheochromocytomas

Question 3

What are the clinical features of Fabry disease (alpha galactosidase A deficiency)?

Answer 3

neuropathic pain, hypohidrosis, angiokeratomas, telangiectasias. cerebrovascular and cardiac diseases, renal failure

Question 4

From what amino acid is ammonium produced in the Kidney?

Answer 4

Renal metabolism of Glutamine. Seen in chronic acidosis

Question 5

What issue is necessary for acute pyelonephritis?

Answer 5

Some form of vesicoureteral reflux

Question 6

Where is PAH actively secreted? Reabsorbed?

Answer 6

In the proximal tubule. It is not reabsorbed anywhere

Question 7

What is an essential pathologic step in the development of glomerular crescents?

Answer 7

Deposition of fibrin in Bowman’s space. Crescents consist of proliferated glomerular parietal cells, monocytes, and macrophages, as well as fibrin

Question 8

Where are juxtaglomerular cells located?

Answer 8

They are modified smooth muscle cells in the wall of the afferent arteriole

Question 9

What animal is a reservoir for schistosoma Haematobium?

Answer 9

freshwater snail- infect the water

Question 10

What is acyclovir induced nephrotoxicity and how can it be avoided?

Answer 10

Acyclovir concentration in the collecting ducts exceeds solubility and causes crystallization, leading to crystalluria and tubular damage.
Prevented with hydration

Question 11

What are the symptoms of acute hemolytic transfusion reaction

Answer 11

fever and chills, hypotension, dyspnea, chest/back pain, and hemoglobinuria

Question 12

What can you use to estimate GFR and RPF?

Answer 12

Clearance of creatinine and PAH.

GFR/RPF=FF

Question 13

Which renal drugs are associated with ototoxicity?

Answer 13

Loop diuretics

Question 14

What are the symptoms of digoxin toxicity? Why does the dose need to be adjusted in the elderly?

Answer 14

1- visual changes and gastrointestinal disturbances

2- Age-related reduction in renal clearnace

Question 15

Where are the kidneys normally located in a mature adult?

Answer 15

T12-L3

Question 16

Discuss the etiology and morphology of hyperacute, acute, and chronic transplant rejection

Answer 16

Hyperacute- preformed Abs against graft–> arterial fibrinoid necrosis, capillary thrombotic occlussion, and gross mottling and cyanosis
Acute- Humoral: C4d, neutrophils, necrotizing vasculitis; Cellular: Lymphocytic infiltrate and endotheliitis
Chronic- vascular wall thickening, luminal narrowing, interstitial fibrosis, and parenchyma atrophy

Question 17

What happens to the bladder in MS pts with an upper motor neuron lesion?

Answer 17

Spastic bladder- hypertonia. Loss of descending inhibitory control

Question 18

Besides adding aquaporin channels to the cortical collecting duct, what other action does vasopressin have on the nephrons?

Answer 18

Activates urea transports in the medullary collecting duct to maintain hypertonicity

Question 19

What is the most common cause of unilateral fetal hydronephrosis?

Answer 19

UPJ issue

Question 20

What is the most common cause of bilateral fetal hydronephrosis?

Answer 20

posterior urethral valves

Question 21

What effect do beta blockers have on Renin release?

Answer 21

They block it, because the juxtaglomerular cells which release renin have Beta 1 receptors.

Question 22

Where in the nephron is most of the water reabsorbed?

Answer 22

Proximal tubule

Question 23

What is Henoch Schonlein purpura and what are the symptoms?

Answer 23

IgA IMMUNE COMPLEX mediated vasculitis. Presents with palpable purpura, arthralgias, abdominal pain, and hematuria.

Question 24

What is the most important poor prognostic factor for PSGN?

Answer 24

increased age

Question 25

What effect does BPH have on the kidneys?

Answer 25

Hydronephrosis- the renal parenchyma becomes scarred and atrophic

Question 26

What electrolyte changes are noted with the use of foscarnet?

Answer 26

Hypocalcemia (chelating, also reduction of release of PTH) and hypomagnesemia (increased renal wasting). Both of these electrolyte disturbances promote seizures

Question 27

What is the formula for excretion of substance A?

Answer 27

(GFR/Inulin clearance) x (Plasma Concentration of substance A)

Question 28

How is FF calculated?

Answer 28

GFR/RPF

Question 29

What is cystinuria, how does it present, and what tests can be used for diagnosis?

Answer 29

Autosomal recessive disorder affecting the dibasic amino acid (cysteine, ornithine, lysine, and arginine) transporter in the proximal tubule. Presents with cystine stones. Diagnosed if hexagonal crystals are seen in the urine or by sodium-cyanide nitroprusside test (red-purple color change)
Treatment: hydration and urinary alkalinization (acetazolamide)

Question 30

Describe the stages of ATN

Answer 30

1. Initiation: ~36 hours with only slight oliguria
2. Maintenance: oliguria, fluid overload, and electrolyte abnormalities. tubular epithelial necrosis, denudation of basement membrane, and necrotic casts. 1-2 weeks
3. Recovery: Re-epithelization of tubules, GFR recovers quickly, but epithelium is not fully ready, so can lead to polyuria

Question 31

What symptoms and labs are suggestive of multiple myeloma?

Answer 31

anemia, bone pain, hypercalcemia (osteolysis by tumor cells), renal insufficiency, elevated proteins, and electrophoresis showing monoclonal immunoglobulin band. The hypercalciuria and light chaincast nephropathy lead to progressive renal failure

Question 32

What causes urge incontinence in patients with MS?

Answer 32

Spinal cord lesions above the sacral region lead to loss of higher center control of micturition (pons and cerebral cortex) —> detrusor hyperreflexia