Renal 1

Question 1

Sporadic renal cell carcinoma gene deletion

Answer 1

Deletion of VHL gene on chromosome 3p

Associated w/ von Hippel Lindau disease

Question 2

Von Hippel-Lindau

Answer 2

AD

Deletion/mutation of VHL on 3p

• Cerebellar hemangioblastomas
• Clear cell renal carcinomas
• Pheochromocytomas

Question 3

Location of lowest pH in the nephron

Answer 3

Distal tubules

Collecting ducts

Question 4

Tumor lysis syndrome

Answer 4

• Occurs when tumors w/ high cell turnover are treated w/ chemo
• Lysed tumor cells release intracellular ions (K, PO4, uric acid) into serum

Question 5

Complications associated w/ tumor lysis syndrome

Answer 5

Uric acid crystallization => obstructive uropathy & acute renal failure

Why??
Because uric acid has pKa of 5.4 and precipitates in low pHs

Question 6

Prevention of tumor lysis syndrome

Answer 6

• Urine alkalinization
• Hydration
• High urine flow
• High pH

Prevents crystallization and precipitation of uric acid

Question 7

Indwelling catheter UTI

(-) lactose, g(-) rod, (+) oxidase

Answer 7

Pseudomonas aeruginosa

Question 8

Anti-glomerular basement membrane Abs react w/ what?

Answer 8

Type IV collagen

Leads to RPGN, also pulm hemorrhage (hematuria and hemoptysis)

THINK CRESCENTS on LM

Question 9

Post-strep GN leads to what on EM?

Answer 9

Subepithelial immune complex deposition!

Composed of IgG, IgM, and C3

THINK HUMPS

Question 10

Which area of the nephron is ALWAYS impermeable to water? Regardless of vasopressin levels

Answer 10

Ascending loop of henle

Where Na/K/2Cl transport occurs

Question 11

Cancers of people who smoked or with occupation exposure to rubber, plastics, aromatic amine-containing dyes, textiles, leather

Answer 11

Transitional cell carcinoma of the bladder

Question 12

Which structure obstructs ascent of a horseshoe kidney?

Answer 12

Inferior mesenteric artery

Kidney is fused at the poles

Question 13

Chronic transplant rejection cause

Answer 13

Chronic, low grade immune response refractory to immunosuppressants

Question 14

Chronic transplant rejection morphology

Answer 14

• Vascular wall thickening & luminal narrowing
• Interstitial fibrosis & parenchyma atrophy

Presents w/ worsening HTN, progressive ^ serum Cr

Question 15

Renal failure + pulm/upper resp sx…?

Answer 15

Think Wegener’s vasculitis

p-ANCA

Question 16

Pauci-immune RPGN, ANCA, (-) Ig/complement deposition, crescent formation

Answer 16

Microscopic polyangiitis or Granulomatosis w/ polyangiitis (Wegener’s)

Question 17

Left 12th rib overlies which internal organs

Answer 17

Medially:
Parietal pleura

Laterally:
Kidney

Question 18

Antiphospholipid antibody syndrome

Answer 18

• Presence of APA
• Can be secondary to SLE (APA is not present in all pts w/ SLE)
• Elevated aPTT in coag studies
• Leads to venous/arterial thromboembolism => recurrent pregnancy loss
• False (+) for RPR/VDRL

Question 19

What is the filtration fraction?

Answer 19

• Portion of renal plasma flow filtered from the glomerular caps
• GFR:RPF ratio

Question 20

Acute ureteral constriction or obstruction does what to the GFR and FF?

Answer 20

Both are decreased

Question 21

Once you determine a pt has a metabolic alkalosis, what should you look at next?

Answer 21

Urine Chloride

Question 22

Metabolic alkalose w/ low urine Cl is due to…?

Answer 22

• Vomiting/nasogastric aspiration
• Prior diuretic use

Saline responsive

Question 23

Metabolic alkalosis w/ high urine Cl and hypo/euvolemia

Answer 23

• Current diuretic use (saline responsive)

- Bartter & Gitelman syndrome (non-saline)

Question 24

Metabolic alkalosis w/ high urine Cl and hypervolemia?

Answer 24

Excess mineralocorticoid activity

• 1ar hyperaldosteronism
• Cushing
• Ectopic ACTH production

Non-saline responsive

Question 25

Ureter relation to ovarian/gonadal vessels?

Answer 25

Posterior Before true pelvis

Question 26

Ureter relation to common/external iliac a.

Answer 26

Anterior Before true pelvis

Question 27

Ureter relation to internal iliac

Answer 27

Anterior w/in true pelvis

Question 28

Ureter relation to ovarian vessels

Answer 28

Medial w/in true pelvis

Question 29

GO REVIEW RESORPTION/EXCRETION ON A NEPHRON

Answer 29

NOW

Question 30

Where is most of K filtered by glomeruli resorbed back into serum?

Answer 30

Proximal tubule LOH

Question 31

Frequent UTIs and pyelonephritis?

Answer 31

Think Vesicoureteral reflux Pyelo wouldn't occur w/o this

Question 32

How do you determine RPF from RBF?

Answer 32

RPF = RBF * (1-Hct)

Question 33

A good rule of thumb for comparing GFR and serum Cr?

Answer 33

Everytime GFR halves => Cr doubles

Question 34

Where is angiotensin I converted into angiotensin II?

Answer 34

Pulm vasculature

Question 35

Function of Angiotensin II?

Answer 35

Potent vasoconstrictor - in systemic circulation => ^ BP - in efferent arterioles => maintains GFR Also - stimulates adrenal gland => release of aldosterone => Na retention => ^ afterload

Question 36

Foscarnet

Answer 36

- Pyrophosphate analog - Used for ganciclovir-resistant CMV - Chelates calcium => hypomagnesemia & v PTH release => hypocalcemia Seizures!

Question 37

Most common cause of unilateral fetal hydronephrosis

Answer 37

``` Uteropelvic junction (connection site between kidney and ureter) - Due to inadequate canalization ``` Detected in 2nd trimester

Question 38

Significant renal hypoperfusion causes what?

Answer 38

Activation of RAAS system Chronic hypoperfusion => hypertrophy & hyperplasia of afferent arteriole

Question 39

What is located in the afferent arteriole in the kidney?

Answer 39

Modified SM cells (juxtaglomerular cells) => synthesize renin

Question 40

Loop diuretics do what?

Answer 40

- Blocks Na/Cl transport => ^ed Na, Cl, and fluid excretion - Stimulates prostaglandin release => vasodilatory effects => ^ RBF => ^ GFR and drug delivery NSAIDs fuck up that shit b/c of decreased prostaglandins

Question 41

Bethanechol

Answer 41

Muscarinic agonist

Question 42

How does anesthesia affect urinary system?

Answer 42

Post-op urinary retention - Incomplete bladder emptying - decreased micturition reflex - Decreased contractility of bladder detrusos - +/- increased vesical sphincter tone

Question 43

Aldosterone excess leads to what?

Answer 43

- HTN - Hypokalemia - Metabolic alkalosis - Depressed renin Conn syndrome