Renal

Question 1

Pre-renal BUN:Cr

Answer 1

Increased ratio: low RBF activates RAAS, increased BUN absorption

Question 2

Post-renal BUN:Cr

Answer 2

Early: high ratio, increased pressure “forces” BUN out
Late: low ratio, tubular damage–less absorption

Question 3

Fanconi syndrome

Answer 3

PCT dysfunction

Question 4

Bartter’s syndrome

Answer 4

TAL dysfunction

Question 5

Gitelman’s syndrome

Answer 5

DCT dysfunction

Question 6

Pre-renal FENa

Answer 6

Low FENa (RAAS activation)

Question 7

Acute Tubular Necrosis FENa

Answer 7

High FENa: Na not reabsorbed due to tubular damage

Question 8

Pyuria + WBC casts

Answer 8

Interstitial nephritis

Question 9

“Muddy brown” granular casts, isosthenuria

Answer 9

Acute tubular necrosis (ATN)

Question 10

Hematuria, RBC casts

Answer 10

Acute glomerulonephritis

Question 11

Subepithelial “hump”

Answer 11

Post-infectious glomerulonephritis (immune complex deposition)

Question 12

IF: granular mesangium

Answer 12

IgA nephropathy

Question 13

What complement pathway is used in IgA nephropathy?

Answer 13

Alternative

Question 14

What is Henoch-Schönlein Purpura (HSP)?

Answer 14

IgA nephropathy + extra-renal symptoms

Question 15

Cause of Hereditary Nephritis?

Answer 15

Mutation in collagen type IV (Alport syndrome)

Question 16

Hereditary nephritis triad

Answer 16

Isolated hematuria, hearing, and ocular abnormalities

Question 17

RPGN Type I

Answer 17

Anti-basement membrane antibodies

Question 18

RPGN Type II

Answer 18

Immune complex depositions

Question 19

RPGN Type III

Answer 19

ANCAs cause activation of neutrophils and release of lytic enzymes

Question 20

IF: linear

Answer 20

RPGN Type I, Goodpasture syndrome

Question 21

Hematuria + Hemoptysis

Answer 21

RPGN Type I: antibodies against basement membrane in kidneys and lungs (Goodpasture syndrome)

Question 22

“Spike and dome” on silver stain

Answer 22

Membranous nephropathy

Question 23

What is membranous nephropathy?

Answer 23

Autoimmune response against renal antigen (PLA2R)

Question 24

Effacement of podocytes

Answer 24

Minimal change disease or FSGS

Question 25

APOL1

Answer 25

Risk allele for FSGS, Africans at higher risk (confers resistance to trypanosomes)

Question 26

"Tram track" or "double contour"

Answer 26

Membranoproliferative glomerulonephritis (MPGN): immune complex formation with classical pathway of complement

Question 27

Dense deposits in lamina densa

Answer 27

Dense deposit disease (DDD)

Question 28

"Basket weave" lamina densa splitting

Answer 28

Hereditary nephritis

Question 29

Libman-Sacks Endocarditis

Answer 29

SLE

Question 30

Oxalate crystals in urine

Answer 30

Ethylene glycol (antifreeze) poisoning (nephrotoxic ATN)

Question 31

What can be found in urine in acute interstitial nephritis?

Answer 31

Eosinophils

Question 32

Dense deposit disease

Answer 32

C3 nephritic factor: autoantibody stabilizes C3 convertase, leads to over activation of complement, inflammation, and low levels of C3

Question 33

What causes Kimmelstiel-Wilson (KW) nodules?

Answer 33

Diabetes mellitus (sclerosis of the mesangium)

Question 34

"Apple-green birefringence" after congo red staining

Answer 34

Systemic amyloidosis

Question 35

What are "crescents"?

Answer 35

Fibrin and macrophages in Bowman's space seen in Rapidly Progressive Glomerulonephritis (RPGN)

Question 36

Berger disease

Answer 36

IgA nephropathy

Question 37

Alport syndrome

Answer 37

Inherited defect in Type IV collagen

Question 38

"Thyroidization" of the kidney

Answer 38

Chronic pyelonephritis (atrophic tubules containing eosinophilic proteinaceous material)

Question 39

What causes hypocalcemia in chronic renal failure?

Answer 39

Decreased conversion of vitamin D into (1,25)-OH-Vitamin D (happens in kidney) -- will also cause hyperphosphatemia which exacerbates the hypocalcemia by binding serum Ca

Question 40

What causes stag horn calculi in adults? In children?

Answer 40

Adults: ammonium magnesium phosphate (AMP) (A=A) Children: cystine (C=C)

Question 41

What is a major risk of dialysis?

Answer 41

Renal cell carcinoma: cysts often develop within shrunken end-stage kidneys

Question 42

Describe pathogenesis of renal cell carcinoma.

Answer 42

Loss of VHL tumor suppressor gene leads to increased IGF-1 (growth) and HIF transcription factor

Question 43

What is the most common malignant renal tumor in children?

Answer 43

Wilms tumor

Question 44

What locus is implicated in many autoimmune diseases?

Answer 44

HLA locus

Question 45

What causes Libman-Sacks Endocarditis?

Answer 45

SLE

Question 46

What's the major cause of mortality in SLE?

Answer 46

Cardiovascular disease

Question 47

Sjogren's syndrome

Answer 47

Lymphocytic infiltration of exocrine glands (risk of lymphoma)

Question 48

What's the major cause of mortality in systemic sclerosis?

Answer 48

Pulmonary complications

Question 49

Cause of DIFFUSE scleroderma

Answer 49

Anti-topoisomerase I antibody

Question 50

Cause of LIMITED scleroderma

Answer 50

Anti-centromere antibody

Question 51

Cause of scleroderma renal crisis

Answer 51

Anti-RNA polymerase III antibody

Question 52

What is limited scleroderma?

Answer 52

CREST syndrome

Question 53

What is CREST syndrome?

Answer 53

Limited scleroderma: calcinosis, Raynaud, esophageal dysmotility, sclerodactyly, telangiectasia

Question 54

What is the most common and most severe stage of lupus nephritis?

Answer 54

Stage IV (diffuse proliferative nephritis)

Question 55

What autoantibody is found in membranous nephropathy?

Answer 55

Anti-PLA2R

Question 56

What gene is mutated in adult polycystic kidney disease?

Answer 56

PKD1 or PKD2