Renal Quiz 1

Question 1

What are the signs of nephrotic disease?

Answer 1

a. proteinuria > 3.5g/day
b. hypoalbuminemia (< 3 g/dL)
c. edema
d. hyperlipidemia
e. hypercoaguability

Question 2

MCD… Who does it usually affect? What is Dx? What is the treatment?

Answer 2

a. children 2-3 y/o
b. Dx’ed on electron microscope with effacement of foot processes (it “selectively releases albumin)
c. responds well to steroids (90% response in children, 50% response in adults)

Question 3

What nephrotic syndrome is a “more severe form” of MCD?

Answer 3

focal segmental glomerulosclerosis

Question 4

What are some signs of FSGS?

Answer 4

a. HTN+
b. non-selective proteinuria
c. poor response to steroids
d. 33% of adult nephrotic syndrome (50% in blacks)
e. HIV and heroin correlations

Question 5

What are the leading two causes of nephrotic syndrome in the US?

Answer 5

1. Diffuse Membranous Glomerulopathy (30-40%)

2. FSGS (~33%)

Question 6

What are some hallmarks of Diffuse Membranous Glomerulopathy?

Answer 6

a. caucasian adults
b. lupus, HBV, HCV association
c. spike and dome appearance on
d. immune deposits at level of foot processes
e. 40% of patients go into spontaneous remission, and 40% of the remainder go into remission with treatment

Question 7

What two diseases can have both nephritic and nephrotic presentations?

Answer 7

a. MPGN

b. systemic lupus erythematosus

Question 8

What disease has the tram track appearance?

Answer 8

MPGN. More often in Type I

Question 9

MPGN… which is more common, Type I or Type II? Which is more likely to be nephrotic only (as opposed to nephritic)?

Answer 9

More Common: Type I (2/3 of cases)

Nephrotic Only: Type I

Question 10

Where do MPGN Types I and II have immune deposits?

Answer 10

I: subendothelial
II: intramembranous

Question 11

What are the differences in prognosis between MPGN Type I and II?

Answer 11

I: benign course, most have no decline in GFR
II: majority of patients process to ESRD in 5-10 years

Question 12

What are the major signs of nephritic syndrome?

Answer 12

a. hematuria
b. oliguria
c. azotemia
d. HTN

Question 13

Are dysmorphic RBCs from upper or lower tract?

Answer 13

Upper. They get all squished when being filtered in the glomerulus.

Question 14

Acute Proliferative GN often develops after an infection of what?

Answer 14

Certain strains of Group A Beta-Hemolytic Streptococci.

Question 15

Acute Proliferative GN typically affects what demographic?

Answer 15

• 2-6 year olds.

- 10 days after pharyngeal infection or 2-3 weeks after skin infection

Question 16

What are 3 distinct types of Rapidly Progressive GN? Are they ANCA + or -?

Answer 16

a. Good Pastures (ANCA -)
b. Poststrep (ANCA -)
c. Wegener granulomatosis or idiopathic (ANCA +)

Question 17

What is the 60-40-20 rule? How does the ECF get broken down?

Answer 17

Water values:
60% = TBW
40% = ICF
20% = ECF (25% is plasma, 75% is interstitial volume)

Question 18

What is hematocrit?

Answer 18

Proportion of RBCs to all cells in the blood.

Question 19

What is a creatinine test?

Answer 19

Blood draw. Creatinine is removed only by the kidneys. If they are not functioning well, then the level of creatinine in the blood will increase.

Question 20

What is the normal GFR?

Answer 20

120mL/min

Question 21

What is the Filtration Fraction?

Answer 21

GFR/RPF

Glomerular Filtration Rate divided by Renal Plasma Flow

Question 22

What is PAH? What is it used to measure?

Answer 22

Para-Aminohippuric Acid. Used to estimate renal plasma flow because it is filtered and secreted. Kidneys clear out 90% of PAH.

Question 23

In the presence of ADH is urine concentrated or diluted?

Answer 23

Concentrated.

Question 24

Every tubule segment has what on the basolateral side?

Answer 24

Na/K pump that uses ATP

Question 25

What is reabsorbed in the PCT and how?

Answer 25

Glucose, AAs, lactate, and phosphate are all reabsorbed with Na cotransport.

Question 26

What is secreted in the PCT and how?

Answer 26

H+ by Na+ countertransport.

Question 27

Where does Angiotensin II work and what does it do? How about atrial natriuretic factor (ANF)?

Answer 27

AII works on PCT to increase Na+ reabsorption. ANF, released from stretched atria, blocks Na+ reabsorption.

Question 28

What part of the nephron is the "diluting limb" and what transporter does it contain?

Answer 28

The thick ascending limb and is has the K-Na-2Cl transporter.

Question 29

What hormones work on the PCT? Where else do these hormones work?

Answer 29

Angiotensin II and ANF. They also work on the early DCT.

Question 30

What 3 diuretics work where and how?

Answer 30

a. Lasix (forusamide): thick ascending limb, block Cl- transport in the triple transporter. b. Thiazide: distal tubule, blocks Cl- transport c. K-sparing: collecting ducts, blocks Na+ reabsorption

Question 31

What does ADH do and where does it work?

Answer 31

It brings water channels to the late DCT and collecting ducts in order for H2O to be reabsorbed.

Question 32

What conditions are associated with white blood cell casts?

Answer 32

a. pyelonephritis b. interstitial nephritis c. lupus nephritis

Question 33

What condition(s) are associated with RBC casts?

Answer 33

a. glomerulonephritis b. vasculitis c. malignant HTN d. renal ischemia

Question 34

What conditions are associated with granular casts?

Answer 34

chronic renal failure

Question 35

What cell type can be found in acute interstitial nephritis (aka- tubulointerstitial nephritis)?

Answer 35

Eosinophils.

Question 36

What are two causes of acute tubular necrosis?

Answer 36

a. Ischemia: decrease in renal blood flow, PCT and TAL are especially vulnerable. b. Drug-Induced: PCT especially vulnerable, can be caused by radiocontrast, aminoglycosides, lead, crush injury