Chapter 11 - Renal Toxicology Flashcards Preview

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Flashcards in Chapter 11 - Renal Toxicology Deck (47):
0

The kidney is involved in all of the following metabolic processes except...

A. Phase 1 biotransformation

B. synthesis of aldosterone

C. Synthesis of renin

D. Synthesis of erythropoietin

B. synthesis of aldosterone

1

A toxicant transported to the kidney via the blood will haave the highest delivery rate to the renal...

A. Medulla

B. Cortex

C. Papilla

D. None of the above

B. Cortex

2

Which of the following is least likely to pass through the glomerulus?

A. Polycationic molecules

B. inulin

C. Polyanionic macromolecules

D. Neutral macromolecules

C. Polyanionic macromolecules

3

The portion of the proximal tubule that is characterized by a tall brush border and a well developed vascular lysosomal system is...

A. S1

B. S2

C. S3

D. S4

A. S1

4

The portion of the proximal tubule that is noted for catabolism, high apical transport of glutathione, and high gamma-glutamyl transpeptidase is...

A. S1

B. S2

C. S3

D. S4

C. S3

5

Analgesic nephropathy is due to long-term use of the combination of...

A. NSAIDs and acetaminophen

B. acetaminophen and opiates

C. Opiates and NSAIDs

D. Tramadol and acetominophen

A. NSAIDs and acetaminophen

6

NSAID use is asso w/...

A. Renal allograph rejection

B. Interstitial nephritis

C. Renal cell carcinoma

D. All of the above

B. Interstitial nephritis

7

A process that plays a role in aminoglycoside proximal tubule nephrotoxicity is...

A. Deposition of immune complexes

B. Free radical formation

C. Decrease in cellular calcium

D. Phospholipidosis

D. Phospholipidosis

8

A process that plays a key role in the nephrotoxicity of halogenated hydrocarbons is...

A. Selective transport

B. tubular secretion

C. Renal vasoconstrictor

D. Biotransformation

D. Biotransformation

9

One mechanism for the renal toxicity of cyclosporin is thought to be increased production of...

A. Thromboxane

B. Vasodilatory prostaglandins

C. Endorphins

D. Aldosterone

A. Thromboxane

10

In the presence of superoxide, nitric oxide can be converted to which radical implicated in renal ischemia/reperfusion injury?

A. Nitric oxide radical

B. nitrogen anion

C. Peroxinitrite anion

D. Nitrogen dioxide anion

C. Peroxinitrite anion

11

If a nephrotoxicant's primary mechanism of action is ATP depletion...

A. Apoptosis will dominate oncosis at all toxicant concentrations

B. Oncosis may be the main cause of death with limited apoptosis

C. Oncosis will never occur

D. None of the above

B. Oncosis may be the main cause of death with limited apoptosis

12

A test to measure renal blood flow in humans is...

A. Insulin clearance

B. creatine clearance

C. Serum cystatin C

D. None of the above

D. None of the above

13

Binding to renal sulfhydral groups is thought to play a role in the renal toxicity of...

A. Metals

B. fluoride ion

C. Aminoglycosides

D. Hydrogen sukfide

A. Metals

14

An increase in urinary excretions of alkaline phosphatase and gamma glutamyl transpeptidase suggests damage to...

A. Glomuerulus

B. Collecting duct

C. Afferent anteriole

D. Brush border

D. Brush border

15

A drug that interacts with sterols and causes the distal tubular epithelium to leak water and ions is...

A. Methoyflurane

B. Amphotericin B

C. Fentanyl

D. Acetominophen

B. Amphotericin B

16

A test to evaluate glucosuria in the presence of normal serum glucose would be...

A. Urine pH

B. 24 h excretion of albumin

C. 24 h excretion of B2 microglobulin

D. Urine creatinine

C. 24 h excretion of B2 microglobulin

17

A characteristic of renal glomerular injury is...

A. Albuminuria

B. White cell casts

C. Uric acid crystals on urinanalysis

D. Amino acids in the urine

A. Albuminuria

18

Serum creatinine is not a very sensitive indicator of renal function because...

A. It increases in liver disease

B. about 50% of renal function has to be lost before it will rise

C. It decreases with exercise

D. All of the above

B. about 50% of renal function has to be lost before it will rise

19

BUN can be increased in all of the following except...

A. Dehydration

B. Hypovolemia

C. Protein catabolism

D. Immediately post-dialysis

D. Immediately post-dialysis

20

ACE inhibitors will most likely precipitate acute renal failure in patients with...

A. Congestive heart failure

B. Systolic hypertension

C. Bilateral renal artery stenosis

D. Mitral stenosis

C. Bilateral renal artery stenosis

21

Immune complexes characteristically cause injury to the...

A. Proximal tubule

B. loop of Henle

C. Glomerulus

D. Collecting duct

C. Glomerulus

22

Changes in charge selectivity of the renal glomerulus secondary to toxicants are due to...

A. Decrease in positively charged sites

B. Decrease in negatively charged sites

C. Increase in positively charged sites

D. Increase in negatively charged sites

B. Decrease in negatively charged sites

23

All of the following are important in selective proximal tubular toxicity of many toxicants except...

A. Plasma level of bilirubin

B. Cellular level of CYP450

C. Cellular level of cysteine B lyase

D. Selective cellular transport

C. Cellular energetics

D. Mitochondrial function

A. Plasma level of bilirubin

24

Ischemic injury to the proximal tubule can be precipitated by toxicants that interfere with all of the following except...

A. Permeability of the collecting duct to water

B. Renal blood flow

C. Cellular energetics

D. Mitochondrial function

A. Permeability of the collecting duct to water

25

A compensatory response to renal injury that may be maladaptive over time is...

A. Increased vasopressin secretion

B. Decreased renin secretion

C. Decreased renal blood flow

D. Increase in glomerular pressure

D. Increase in glomerular pressure

26

Factors that are presumed to play a role in the pathogenesis of chronic renal failure include all of the following except...

A. Growth factor promoters and inhibitors

B. DNA adduct formation

C. Lipid accumulation

D. ECM deposition

B. DNA adduct formation

27

The kidney is susceptible to toxic injury for all of the following reasons except...

A. The processes involved in forming dilute urine are also involved in concentrating toxicants in tubular fluid

B. Any toxicant in the systemic circulation will be delivered to the kidney

C. A nontoxic conc of a toxicant in the circulation can reach toxic conc in kidney

D. Insoluble chemicals may precipitate out and cause tubular obstruction

A. The processes involved in forming dilute urine are also involved in concentrating toxicants in tubular fluid

28

High circulating conc of renal vasoconstrictor hormones are normally counterbalanced by...

A. Thromboxane

B. Prostaglandins

C. Aldosterone

D. Vasopressin

B. Prostaglandins

29

All of the following mechanisms can decrease GFR except...

A. Increased glomerular hydrostatic pressure

B. Afferent arteriolar concstriction

C. Back leakage of glomerular filtrate

D. Obstructing tubular casts

A. Increased glomerular hydrostatic pressure

30

Following toxic damage to the kidney, casts obstructing the tubular lumen are composed primarily of...

A. Neutrophils and macrophages

B. red cells and white cells

C. Basophils and plasma cells

D. Necrotic and viable tubular cells

D. Necrotic and viable tubular cells

31

Following a toxic insult to tubular epithelial cells, the reparative and adaptive response is believed to be derived primarily from...

A. Bone marrow-derived cells

B. Surviving tubular epithelial cells

C. Dedifferentiating capillary endothelial cells

D. Migration and redifferentiation of adrenal cortical cells

B. Surviving tubular epithelial cells

32

As a compensatory process, uninjured renal cells following nephrotic exposure can undergo all of the following except...

A. Hypertrophy

B. Apoptosis

C. Adaptation

D. Proliferation

B. Apoptosis

33

Cellular adaptation responses to toxicant-induced renal injury include the induction of all of the following except...

A. Metallothionein

B. Heat shock proteins

C. Glucose-regulated proteins

D. BRCA1

D. BRCA1

34

In a normal healthy individual, a substance that is filtered by the kidney and completely reabsorbed without any excretion is...

A. Creatinine

B. Urea

C. Glucose

D. Sodium

C. Glucose

35

The portion of the nephron with a high Na/K ATPase activity and low oxygen supply is...

A. Glomerulus

B. medullary-thick ascending limb of the loop of Henle

C. S3 segment of proximal tubule

D. Collecting duct

B. medullary-thick ascending limb of the loop of Henle

36

Agents that interfere with vasopressin synthesis, secretion or action can impair which of the following the most?

A. Glomerular filtration

B. renal bicarbonate excretion

C. Renal sodium excretion

D. Renal concentrating ability

D. Renal concentrating ability

37

Prerenal factors that can cause a decrease in GFR include all of the following except...

A. Glomerulonephritis

B. congestive heart failure

C. Dehydration

D. Pre-glomerular vasoconstriction

A. Glomerulonephritis

38

Postrenal factors that can cause a decrease in GFR include all of the following except...

A. Ureter calculi

B. Renal tubular cell injury

C. Extrinsic ureter compression

D. Bladder outlet obstruction

B. Renal tubular cell injury

39

The toxicity of cisplatin is thought to be due to...

A. The release of ammonia

B. The plutonium ion

C. Its conversion to the trans isomer

D. The geometry of the complex or metabolite

D. The geometry of the complex or metabolite

40

A radioactive agent with a low incidence of nephrotoxicity would have which of the following properties?

A. Nonionic at physiologic pH

B. High osmolarity

C. Presence of iodine

D. High protein binding

A. Nonionic at physiologic pH

41

Principal cells and intercalated cells are located in a 2:1 ratio in the...

A. Proximal tubule

B. cortical collecting duct

C. Loop of Henle

D. Distal tubule

B. cortical collecting duct

42

The juxtaglomerular apparatus is involved in the secretion of...

A. Angiotensin 1

B. Aldosterone

C. Renin

D. Vitamin D

C. Renin

43

The most common site of renal injury is...

A. Glomerulus

B. proximal tubule

C. Loop of Henle

D. Collecting duct

B. proximal tubule

44

Which of the following is true of the mecuric ion?

A. It is more neurotoxic than organic mercury

B. It preferentially binds to amino groups over sulfhydral groups

C. Chelation therapy is of no benefit

D. The S3 segment of the proximal tubule is the initial site of toxicity

D. The S3 segment of the proximal tubule is the initial site of toxicity

45

All of the following are true of the renal glomerulus except...

A. 20% of blood flow entering the glomerulus is filtered

B. filtration of cationic mcls are restricted more than anionic

C. Toxicants can affect charge barrier and allow for the urinary excretion of formally restricted mcls

D. Filtration of macromolecules is generally inversely proportional to MW

B. filtration of cationic mcls are restricted more than anionic

46

Which of the following is the correct toxicant-target organ pair?

A. penicillamine-glomerulus

B. immune cmplxs-collecting duct

C. Analgesic mixtures-proximal tubule

D. Heavy metals-loop of Henle

A. penicillamine-glomerulus