Renal

Question 1

What signs and symptoms lead the doctor to directly assume that Michael has gout?

blood work that showed an increased concentration of uric acid in Michael’s blood
hot and red joints accompanied by pain
a distinctive coloration in Michael’s urine
pain in the joints

Answer 1

hot and red joints accompanied by pain

Question 2

Which of the following statements best describes the pathophysiology of gout?

crystallization of uric acid leading to activation of the inflammatory response within the joints
high levels of uric acid in the urine leading to crystallization and kidney stone formation
excessive filtration of uric acid at the glomerulus leading to a significant drop of plasma uric acid levels
None of the listed options explains the pathophysiology of gout.

Answer 2

crystallization of uric acid leading to activation of the inflammatory response within the joints

Question 3

How is urate (the anionic form of uric acid) handled by the kidney under normal conditions?

net secretion
neither secreted nor reabsorbed
net reabsorption

Answer 3

net secretion

Question 4

If administering a uricosuric agent enhances urate excretion, what might be the mechanism of action of this drug?

To competitively inhibit the transporter for uric acid.
To compete for the same transporter as uric acid.
To destroy the channels that transport urate.
To stimulate the cells of the proximal convoluted tubule that secrete urate to work faster.

Answer 4

To compete for the same transporter as uric acid.

Question 5

The kidneys function to produce hormones, excrete wastes, regulate blood pressure, and maintain ion balance. Which of the following is another function of the kidneys?

Regulate osmolarity
Maintain blood glucose
Produce red blood cells
Generate body heat

Answer 5

Regulate osmolarity

Question 6

The functional unit of the kidney is the __________.

juxtaglomerular apparatus
renal corpuscle
loop of Henle
nephron

Answer 6

nephron

Question 7

A runner drank a lot of water during a race. What is the expected path of the extra filtered water molecules?

Afferent arteriole, glomerulus, nephron tubule, collecting duct
Efferent arteriole, glomerulus, afferent arteriole, peritubular capillaries
Afferent arteriole, glomerulus, nephron tubule, peritubular capillaries
Afferent arteriole, glomerulus, efferent arteriole, peritubular capillaries

Answer 7

Afferent arteriole, glomerulus, nephron tubule, collecting duct

Question 8

Put the following in order from where urine is produced to where it exits the body:
Urethra
Urinary bladder
Nephron
Ureter

4, 2, 1, 3
1, 2, 3, 4
2, 3, 4, 1
3, 4, 2, 1

Answer 8

3, 4, 2, 1

Question 9

Blood leaves the glomerulus through which vessel?

Afferent arteriole
Efferent arteriole
Peritubular capillaries
Vasa recta

Answer 9

Efferent arteriole

Question 10

A patient has a problem in her vasa recta. Where do you predict there could be problems with transport between the blood and the nephron tubule?

Loop of Henle
Distal tubule
Bowman’s capsule
Proximal tubule

Answer 10

Loop of Henle

Question 11

Approximately how much liquid moves through the kidneys of an adult during a 24-hour period?

1.5 liters
18 liters
54 liters
180 liters

Answer 11

180 liters

Question 12

Where does all filtration take place in the kidneys?

Collecting duct
Loop of Henle
Proximal convoluted tubule
Glomerulus

Answer 12

Glomerulus

Question 13

Approximately what percent of the total filtered volume is excreted as urine each day?

Less than 1%
10%
30%
100%

Answer 13

Less than 1%

Question 14

Which part of the nephron is responsible for the greatest possible increase in urine concentration?

Collecting duct
Proximal convoluted tubule
Loop of Henle
Bowman’s capsule

Answer 14

Collecting duct

Question 15

Which of the following substances is not normally found in filtrate?

ions, such as sodium and potassium
water and small solutes
nitrogenous waste particles, such as urea
blood cells and large particles

Answer 15

blood cells and large particles

Question 16

What is the primary driving force (pressure) that produces glomerular filtration?

colloid osmotic pressure of blood
gravity
hydrostatic pressure of blood (blood pressure)

Answer 16

hydrostatic pressure of blood (blood pressure)

Question 17

Which substance would be found in higher concentration if the membrane were damaged?

glucose
protein
creatinine
chloride

Answer 17

protein

Question 18

If the osmotic pressure in the glomerular capillaries increased from 28 mm Hg to 35 mm Hg, would net filtration increase or decrease?

net filtration would decrease
net filtration would increase
net filtration would not be altered

Answer 18

net filtration would decrease

Question 19

Calculate the net filtration pressure if capillary hydrostatic pressure is 60 mm Hg, capillary osmotic pressure is 25 mm Hg, and capsular hydrostatic pressure is 10 mm Hg.

35 mm Hg
50 mm Hg
60 mm Hg
25 mm Hg

Answer 19

25 mm Hg

Question 20

Which of the following correctly indicates the direction of the different forces causing filtration in the renal corpuscle (of fluid flow into or out of the Lumen of Bowman’s capsule from the glomerular capillaries)?

     Blood hydrostatic pressure-out; blood colloid osmotic pressure-in; hydrostatic fluid pressure of the Lumen of Bowman's capsule-in        
     Blood hydrostatic pressure-in; blood colloid osmotic pressure-out; hydrostatic fluid pressure of the Lumen of Bowman's capsule-out        
     Blood hydrostatic pressure-out; blood colloid osmotic pressure-out; hydrostatic fluid pressure of the Lumen of Bowman's capsule-in        
     Blood hydrostatic pressure-in; blood colloid osmotic pressure-in; hydrostatic fluid pressure of the Lumen of Bowman's capsule-in

Answer 20

Blood hydrostatic pressure-out; blood colloid osmotic pressure-in; hydrostatic fluid pressure of the Lumen of Bowman’s capsule-in

Question 21

Which combination of changes would increase the glomerular filtration rate (GFR) the most?

Vasodilation of the afferent arteriole and vasoconstriction of the efferent arteriole
Vasoconstriction of both afferent and efferent arterioles
Vasodilation of both the afferent and efferent arterioles
Vasoconstriction of the afferent arteriole and vasodilation of the efferent arteriole

Answer 21

Vasodilation of the afferent arteriole and vasoconstriction of the efferent arteriole

Question 22

The three filtration barriers that substances must pass through when leaving the blood and entering the tubule lumen are the glomerular capillary endothelium, the epithelium of Bowman’s capsule, and which other structure?

Efferent arteriole
Basement membrane
Macula densa
Granular cells

Answer 22

Basement membrane

Question 23

What is the main factor in the net driving force for filtration in the glomerulus?

Capsular hydrostatic pressure
Glomerular filtration rate
Colloid osmotic pressure
Capillary hydrostatic pressure

Answer 23

Capillary hydrostatic pressure

Question 24

Glomerular filtration rate is determined by the net filtration pressure and the filtration coefficient. Which two factors determine the filtration coefficient?

Nephron number and colloid osmotic pressure
Nephron number and the plasma volume
Glomerular surface area and the permeability of the filtration slits
Permeability of filtration slits and fluid pressure in Bowman’s capsule

Answer 24

Glomerular surface area and the permeability of the filtration slits

Question 25

Which of these would cause the greatest increase in glomerular filtration rate? Decreased diameter in the efferent arteriole Decreased diameter in the afferent arteriole Increased resistance in the afferent arteriole Increased diameter in the efferent arteriole

Answer 25

Decreased diameter in the efferent arteriole

Question 26

Which change would cause an increase in afferent arteriolar resistance due to paracrine signaling from the macula densa? Less blood volume in the afferent arteriole Lower filtrate volume in the distal tubule More blood volume in the efferent arteriole Greater sodium concentration in the distal tubule

Answer 26

Greater sodium concentration in the distal tubule

Question 27

Most reabsorption of fluid from the filtrate back into the blood occurs from the __________. proximal tubule descending limb of the loop of Henle ascending limb of the loop of Henle distal tubule

Answer 27

proximal tubule

Question 28

In which process can glucose transport reach saturation? Excretion Filtration Reabsorption Excretion and reabsorption

Answer 28

Reabsorption

Question 29

What is the primary driving force for glucose transport into proximal tubule cells? ATP hydrolysis allows active transport of glucose. Glucose moves down its concentration gradient into tubular cells. Sodium concentration gradient allows secondary active transport of glucose. The apical Na+/K+-ATPase creates a gradient for K+, which can then flow down its concentration gradient to allow co-transport of glucose.

Answer 29

The apical Na+/K+-ATPase creates a gradient for K+, which can then flow down its concentration gradient to allow co-transport of glucose.

Question 30

f all glucose is normally reabsorbed in the proximal tubule of the nephron, why do people with diabetes have glucose in their urine? The plasma concentration is greater than the renal threshold. The excreted glucose is a product of chemical pathways that occur in the urine of diabetic patients. Some glucose is secreted at the distal tubule when serum glucose concentrations are high. The glucose concentration is below its saturation point.

Answer 30

The plasma concentration is greater than the renal threshold.

Question 31

A patient has a genetic defect that decreases the number of GLUT transporters in the nephron tubule. Which would you expect? Decreased transport maximum and decreased glucose in urine Decreased transport maximum and increased glucose in urine Increased transport maximum and increased glucose in urine Increased transport maximum and decreased glucose in urine

Answer 31

Decreased transport maximum and increased glucose in urine

Question 32

Secretion into the nephron is __________ because the direction is __________ the concentration gradient. active; against passive; against active; with passive; with

Answer 32

active; against

Question 33

Which transporter moves molecules with tertiary active transport? Sodium-glucose cotransporters Basolateral GLUT proteins Organic anion transporters Na+/K+-ATPase

Answer 33

Organic anion transporters

Question 34

Secretion is similar to ____. Filtration, because in both, substances cross endothelial cells lining the glomerulus and epithelial cells of Bowman's capsule Reabsorption, because in both, substances cross endothelial cells lining the peritubular capillaries and epithelial cells lining the nephron tubule Reabsoprtion, because in both, substances cross endothelial cells lining the glomerulus and epithelial cells of Bowman's capsule Filtration, because in both, substances cross endothelial cells lining the peritubular capillaries and epithelial cells lining the nephron tubule

Answer 34

Reabsorption, because in both, substances cross endothelial cells lining the peritubular capillaries and epithelial cells lining the nephron tubule

Question 35

What happens if reabsorption of a substance increases (and filtration and secretion stay the same)? Increased excretion of the substance and an increased amount of the substance in blood Decreased excretion of the substance and an increased amount of the substance in blood Increased excretion of the substance and a decreased amount of the substance in blood Decreased excretion of the substance and a decreased amount of the substance in blood

Answer 35

Decreased excretion of the substance and an increased amount of the substance in blood

Question 36

Why is inulin administration an effective way of measuring renal clearance rates? It is not filtered by the glomerulus. Inulin is filtered and completely reabsorbed in the distal tubule. Inulin is neither secreted nor reabsorbed. Inulin is freely filtered and secreted.

Answer 36

Inulin is neither secreted nor reabsorbed.

Question 37

In a diabetic patient with high blood sugar above transport maximum, which would you expect? There will be no reabsorption of glucose because of increased clearance. There will be increased glucose in urine and increased glucose clearance. Glucose clearance is equal to GFR. All of the glucose that filters is reabsorbed, and glucose clearance is zero.

Answer 37

There will be increased glucose in urine and increased glucose clearance.

Question 38

Which of the following would best help a clinician understand how well the kidney was able to remove a substance from the body? the concentration of the substance in the plasma clearance of the substance filtration of the substance secretion of the substance reabsorption of the substance

Answer 38

clearance of the substance

Question 39

Which of the following statements best describes clearance? the rate at which a solute disappears from the plasma by either excretion or metabolism the rate at which plasma is filtered at the glomerulus the amount of urine produced by the body in an hour the rate at which a solute is delivered back into the blood

Answer 39

the rate at which a solute disappears from the plasma by either excretion or metabolism

Question 40

Which of the following variables must be known in order to calculate the clearance of a substance? Select all that apply. the excretion rate of the substance the amount of substance ingested by the body the concentration of solute in the plasma glomerular filtration rate

Answer 40

the concentration of solute in the plasma the excretion rate of the substance

Question 41

Maintaining osmolarity is important to the body because the membranes of most cell types are freely permeable to ____. water cations anions proteins

Answer 41

water

Question 42

Most cell types are permeable to water. An exception is cells of the __________, which can be either impermeable or permeable, depending upon the location of __________. loop of Henle; aquaporins distal nephron; aquaporins loop of Henle; ion channels distal nephron; ion channels

Answer 42

distal nephron; aquaporins

Question 43

The __________ limb of the loop of Henle is permeable only to __________, which are reabsorbed all along the length because the fluid outside is __________ concentrated deeper in the medulla. ascending; water molecules; more descending; water molecules; more ascending; water molecules; less descending; ions; less

Answer 43

descending; water molecules; more

Question 44

Why is a high medullary interstitial osmolarity important to renal function? It allows reabsorption of water. It allows solutes to leave the filtrate. It allows retention of water in the urine. It allows for fine-tuning of hormonal release from granular cells.

Answer 44

It allows reabsorption of water.

Question 45

What is the mechanism of action of vasopressin? Insertion of AQP2 into the apical membrane of collecting duct cells Opening of AQP2 channels in the basolateral surface of proximal tubule cells Closure of V2 receptor channels, preventing sodium movement and osmosis of water from the tubule to the interstitial pace Decreasing the resistance in the afferent arteriole

Answer 45

Insertion of AQP2 into the apical membrane of collecting duct cells

Question 46

At a campus event, you ate a lot of salty treats. Which would you expect? Vasopressin secretion and urination Vasopressin secretion and thirst Aldosterone secretion and thirst Aldosterone secretion and vasopressin secretion

Answer 46

Vasopressin secretion and thirst

Question 47

What is the site and mechanism of the early response phase of aldosterone action? Opening of aquaporins in the cortical collecting duct Increased glucose secretion from the vasa recta Increased number of Na+ and K+ channels in on the basolateral membrane of collecting duct epithelium Increased Na+/K+-ATPase activity in P cells of the distal nephron epithelium

Answer 47

Increased Na+/K+-ATPase activity in P cells of the distal nephron epithelium

Question 48

Aldosterone secretion increases in response to __________ and causes __________. increased angiotensin II; sodium secretion renin; sodium reabsorption increased angiotensin II; sodium reabsorption decreased angiotensin II; sodium secretion

Answer 48

increased angiotensin II; sodium reabsorption

Question 49

At a holiday celebration, you ate foods high in salt. Which would you predict? Decreased urine volume and decreased blood volume Decreased urine volume and increased blood volume Increased urine volume and decreased blood volume Increased urine volume and increased blood volume

Answer 49

Decreased urine volume and increased blood volume

Question 50

Which hormone increases sodium excretion? Renin Aldosterone Atrial natriuretic peptide Angiotensin II

Answer 50

Atrial natriuretic peptide

Question 51

During a workout, a student drinks too much water. Which would you expect to be stimulated? The renin-angiotensin-aldosterone system Salt appetite Oropharynx receptors Angiotensin II

Answer 51

Salt appetite

Question 52

Dehydration leads to __________ blood volume, __________ blood pressure, and __________ osmolarity. decreased; increased; decreased decreased; decreased; increased increased; decreased; increased decreased; increased; increased

Answer 52

decreased; decreased; increased