Pathology (First day)

Question 0

What causes the highly negative charge of the GBM?

Answer 0

Heparin sulfate

Question 1

What makes up the backbone of the glomerular basement membrane?

Answer 1

Type IV Collagen monomers

Question 2

What are the three layers to the GBM, starting with the capillaries?

Answer 2

Lamina interna
Lamina densa
Lamina externa

Question 3

What synthesizes the GBM components?

Answer 3

Podocytes

Question 4

What two proteins, if mutated, can lead to nephrotic syndrome?

Answer 4

Nephrin and podocin

Question 5

What cells are indicated in lying down collagen and secrete mediators of inflammation?

Answer 5

Mesangial cells

Question 6

What two characteristics exclude filtration of albumin?

Answer 6

Size, negative charge

Question 7

What is the most common kidney disease, with 5% of the US population having this?

Answer 7

Kidney stones

Question 8

What is oftentimes the root cause of glomerular diseases?

Answer 8

Immune mediation

Question 9

What is oftentimes the root cause of tubulointerstitial kidney disease?

Answer 9

inflammation, toxic/ischemia

Question 10

What is azotemia?

Answer 10

Increase in BUN and creatinine.

Question 11

What is uremia?

Answer 11

Azotemia with clinical symptoms

Question 12

What are common symptoms of uremia?

Answer 12

Pruritis
Anemia
gastroenteritis
pericarditis
peripheral neuropathy

Question 13

What are the basic distinguishing factors of nephrotic and nephritic syndromes?

Answer 13

Nephritic: Blood in urine
Nephrotic: protein in urine

Question 14

What are key findings in nephritic syndrome?

Answer 14

Hematuria
Mild proteinuria
HTN

Question 15

What are key findings in nephrotic syndrome?

Answer 15

Hyperproteinuria (>3.5 gm/day)
Hypoalbuminemia
Edema
Hyperlipidemia
Lipiduria

Question 16

What is the most common cause of acute renal failure?

Answer 16

Acute tubulonecrosis

Question 17

How will someone with a renal tubular defect present to the clinic?

Answer 17

Polyuria
Nocturia
Electrolyte imbalances

Question 18

How will someone with acute renal failure present to the clinic?

Answer 18

Oliguria/anuria

Rapid onset azotemia

Question 19

How will someone present to your clinic with nephrolithiasis?

Answer 19

Renal colic

Hematuria

Question 20

What equation approximates renal clearance?

Answer 20

Urine concentration x Urine flow / Plasma concentration

Question 21

What are some causes of a pre-renal increase in BUN?

Answer 21

Increased Urea synthesis (catabolism, lots of protein)

Decreased renal perfusion (Hypotension, CHF, Renal vein thrombosis)

Question 22

What are renal causes of increased BUN?

Answer 22

Glomerular disease
ATN
Interstitial disease

Question 23

What are some post renal causes of increased BUN?

Answer 23

Anything with flow obstruction

Question 24

What are prerenal causes for increased Creatinine?

Answer 24

``` Increased synthesis (Anabolic roids, car accident, muscle hypertrophy) CHF, Shock ```

Question 25

What is the normal ratio of BUN to Creat?

Answer 25

10-20:1

Question 26

What is the equation for FENa?

Answer 26

(Urine Na x Plasma Cr x 100) / (Urine Cr x Plasma Na)

Question 27

What does a FENa < 1.0% favor in diagnosis? >2.0%?

Answer 27

1%: Prerenal | 2.0: ATN

Question 28

What is the normal protein make-up of urine?

Answer 28

1/3 albumin 1/3 small globulins 1/3 Tamm-Horsfall protein (secreted by tubule cells)

Question 29

What can cause a false positive for proteinuria check in a urine dipstick test?

Answer 29

Alkaline urine Blood in urine Dilute urine

Question 30

What is the most common fusion for horseshoe kidneys?

Answer 30

Lower lobe (90%)

Question 31

What are the key microscopic findings to Cystic Renal Dysplasia?

Answer 31

Undifferentiated mesenchyme/cartilage Immature collecting ducts Variable sized cysts lined by flattened epithelium

Question 32

What is the inheritance pattern of polycystic kidney disease?

Answer 32

Autosomal dominant

Question 33

What are the most common genes affected in polycystic kidney disease?

Answer 33

PKD 1 and PKD 2

Question 34

How may someone with polycystic kidney disease present to the clinic?

Answer 34

Pain and hematuria

Question 35

What other organ is oftentimes affected with cysts in polycystic kidney disease?

Answer 35

Liver

Question 36

What are two other key pathologies common to patients with Polycystic kidney disease?

Answer 36

Berry aneurisms | Mitral valve prolapse