Renal Review - Lessons

Question 1

What is an important causative antibody target in Goodpasture syndrome?

Answer 1

Type IV collagen, α3 subchain

Question 2

What is an important causative antibody target in membranous nephropathy?

Answer 2

Phospholipase A2 receptor

Question 3

What is an important causative antibody target in Wegener polyangiitis?

Answer 3

Proteinase 3

Question 4

(T/F) Deposits can be identified in cases of Goodpasture’s syndrome by both immunofluorescence and electron microscopy.

Answer 4

False. Only IF.

Question 5

Which nephrotic syndrome causing disesae can also cause hematuria?

Answer 5

MPGN

Question 6

What are the clinical features of amyloidosis? Which syndrome does it cause?

Answer 6

Macroglossia, heart failure, 10 nm glomerular fibrils on EM; Nephrotic

Question 7

What is another common name for the Shiga-like toxin that can cause classical hemolytic-uremic syndrome?

Answer 7

Verocytotoxin

Question 8

What is the main mechanism of Ca reabsorption in the nephron and how can it be pharmacologically inhibited?

Answer 8

Ca follows Na reabsorption especially in the PCT and the thick ascending limb. Loop diuretics can inhibit this, and can thus result in hypercalciuria.

Question 9

What is the approach in a 5 yo child with foamy urine and facial edema?

Answer 9

The child almost certainly has MCD, so immediate steroid therapy is indicated.

Question 10

What is the clinical presentation of tumor lysis syndrome (describe BP and potassium, phosphate, nitrogen, and creatinine levels)?

Answer 10

Hyperkalemia, hyperphosphatemia, acidosis, azotemia, hypertension, and high serum creatinine

Question 11

How does 1/2 NS distribute upon IV administration?

Answer 11

Half goes to the ECF (3/4 IS and 1/4 plasma) and the other half distributes as free water (2/3 ICF and 1/3 ECF)

Question 12

Are recurrence rates in low grade urinary papillary carcinomas high or low?

Answer 12

High

Question 13

What is the blood supply to the medullary pyramid of the kidney lobe?

Answer 13

Vasa recta

Question 14

Where are the arcuate vessels located?

Answer 14

Between the cortex and medulla

Question 15

Where does vasa recta empty into?

Answer 15

Arcuate veins

Question 16

What electrolyte abnormality can be caused by clay ingestion or amphotericin B toxicity?

Answer 16

Hypokalemia

Question 17

What is a crucial histological finding in lupus nephritis?

Answer 17

Wire loop capillaries

Question 18

What is “thyroidization” of the kidney?

Answer 18

Tubules are often dilated and filled with eosinophilic casts. Seen in chronic pyelonephritis.

Question 19

What are some clinical features of nephrosclerosis?

Answer 19

Reduced size/mass (esp. cortex) and have increased peripelvic fat; very vulnerable to nephrotoxic drugs; usually don’t cause renal insufficiency but have low functional reserve so can fail in case of shock/trauma/etc.

Question 20

What does the urine look like in a patient with prerenal azotemia?

Answer 20

Low urine Na concentration but high osmolarity because of ADH response from the low GFR

Question 21

List 5 main treatments of hyperkalemia

Answer 21

Insulin and glucose (facilitates uptake), IV bicarb (alkalizes causes uptake), IV calcium chloride (prevents VT), beta-2 agonists (facilitates uptake), loop/thiazide diuretics (increases K excretion)

Question 22

What cell/virus combo causes post-transplant lymphoproliferative disorder?

Answer 22

EBV-induced B cell proliferation

Question 23

What are the most common causative organisms of acute pyelonephritis?

Answer 23

E. coli (70-80%) and Enterococcus (10%)

Question 24

What is most likely to cause edema in a patient with CHF?

Answer 24

High venous pressure

Question 25

What is the most common complication of CKD?

Answer 25

Cardiovascular disease (also causes hypocalcemia and hyperphosphatemia)

Question 26

What is the main purpose of the medullary osmotic gradient?

Answer 26

To excrete hypertonic urine

Question 27

What is the clinical picture of prerenal vs. intrarenal azotemia?

Answer 27

Prerenal has low urine Na (high ATII and aldosterone), low FENa, and negative urine cytology; intrarenal has high urine Na and high FENa (ATN)

Question 28

What are the four main compartments of the kidney?

Answer 28

(1) glomerular, (2) vascular, (3) tubular, and (4) interstitial

Question 29

Name three mechanisms that link hypokalemia and metabolic alkalosis.

Answer 29

(1) K+ extravasation during hypokalemia results in absorption of extracellular H+, (2) aldosterone causes both K+ and H+ excretion in the distal tubule and collecting duct, and during hypokalemia, H+ secretion in the DCT/CCD increases, (3) most common causes of metabolic alkaloses (vomiting, diarrhea) cause the loss of both H+ and K+

Question 30

Which diuretics cause acidemia?

Answer 30

Carbonic anhydrase inhibitors and K+ sparing diuretics

Question 31

Which diuretics cause alkalemia?

Answer 31

Loop and thiazide diuretics

Question 32

What is the effect of loop and thiazide diuretics on serum Ca?

Answer 32

Loop diuretics can cause hypocalcemia and thiazide diuretics can cause hypercalcemia

Question 33

What is the homeostatic response to increased serum osmolality with an unchanged effective arterial blood volume?

Answer 33

Increased ADH and thirst stimulus from the hypothalamus

Question 34

In the empty bladder, the fully differentiated cells at the top of the urothelium are _____

Answer 34

Dome-shaped (umbrella cells)

Question 35

On H&E, does the PCT or the DCT appear thicker?

Answer 35

PCT

Question 36

How is K reabsorbed in the PCT?

Answer 36

Passive transport

Question 37

Which disease causes full-house IF staining?

Answer 37

DPGN

Question 38

Which disease is associated with IgA nephropathy?

Answer 38

Celiac disease

Question 39

Is ATN reversible?

Answer 39

Yes

Question 40

Where in the prostate does carcinoma generally develop?

Answer 40

Peripheral zone

Question 41

White blood cell casts are most likely to be seen in which renal disease?

Answer 41

Acute pyelonephritis

Question 42

Presbynephrosis has which main characteristic?

Answer 42

Shrunken kidneys with peripelvic fat

Question 43

Ca and Mg are mostly absorbed along which nephron segment?

Answer 43

Thick ascending loop of Henle

Question 44

What is the daily GFR in a normal 70 kg person?

Answer 44

150 L per day

Question 45

In patients who already have renal insufficiency, what are the most serious side effects of ACE-inhibitors or angiotensin-receptor blockers?

Answer 45

Lower GFR, hyperkalemia (can also cause metabolic acidosis)

Question 46

What are some causes of high anion gap metabolic acidosis?

Answer 46

Glycols (ethylene or propylene glycol), Oxyproline (derivative of acetaminophen), uremia, L-lactate, D-lactate, methanol, aspirin, renal failure, ketoacidosis

Question 47

What group is affected by rhabdoid tumors and what is the prognosis?

Answer 47

Infants, and they are highly aggressive despite treatment

Question 48

Which kidney cells produce EPO?

Answer 48

Peritubular interstitial cells

Question 49

Describe the serum potassium and pH in a patient with significant hyperaldosteronism

Answer 49

Hypokalemia and high bicarb

Question 50

Which type of kidney stone is radiolucuent?

Answer 50

Uric acid stones

Question 51

What are the three main types of channels in the PCT?

Answer 51

Na+/H+ antiporter, simple Na+ channels, and Na+/organic solute cotransporters

Question 52

What is the the most rapidly effective IV treatment for EKG changes caused by hyperkalemia?

Answer 52

IV calcium

Question 53

Why does the plasma K+ concentration contributes to the resting membrane potential of cells?

Answer 53

The permeability across the membrane is higher for K+ than it is for Na+

Question 54

What sort of depositions do we see in Henoch-Sch_nlein purpura?

Answer 54

IgA subendothelial deposits

Question 55

What are some histological findings of acute tubular necrosis?

Answer 55

Swollen tubular epithelium, interstitial edema, dilated convoluted tubules

Question 56

How is pH calculated from serum bicarb and PCO2?

Answer 56

pH = 6.1 + log [HCO3-] / 0.03 PCO2

Question 57

How much K is in a standard 70 kg person?

Answer 57

4000 mEq

Question 58

What is the best treatment for severe diarrhea hypotension in areas where there is no access to intravenous fluids?

Answer 58

Oral rehydration therapy of water with glucose, NaCl, bicarb, and KCl

Question 59

How does clay ingestion cause hypokalemia?

Answer 59

It sticks to the gut wall and traps K+, preventing the ingestion of potassium.

Question 60

Which three classes of drugs can really mess with glomerular filtration regulation?

Answer 60

NSAIDs, ACEIs, and ARBs

Question 61

What are the three main causes of isotonic volume depletion?

Answer 61

Hemorrhage, sepsis, and CHF

Question 62

What sort of urological cancer does schistomiasis predispose patients to?

Answer 62

Squamous cell carcinoma of the bladder

Question 63

Is mesoblastic nephroma malignant or benign?

Answer 63

Benign

Question 64

55-year-old man with blood in his urine. The light microscopy shows a total of 12 glomeruli of which four show global sclerosis and two contain cellular crescents. The remaining glomeruli appear normal. There is no staining by immunofluorescence. What is the best diagnosis?

Answer 64

Pauci-immune glomerulonephritis

Question 65

What has been shown in clinical trials to reduce the progression of chronic renal failure?

Answer 65

ACE inhibitors to reduce proteinuria

Question 66

What are some examples of factors leading to a complicated UTI?

Answer 66

Pregnancy, male sex, diabetes, urinary tract instrumentation, anatomic abnormalities, immunosuppression

Question 67

What types of glomerulonephritidies present with low serum C3?

Answer 67

MN, PSGN, DPGN, cryoglobulinemia

Question 68

With a substance that is freely filtered/secreted maximally, what will happen to its clearance as you raise the plasma concentration?

Answer 68

It will decrease and approach the clearance of inulin

Question 69

Reasons for diuretic refractoriness

Answer 69

Low oncotic pressure, too much dietary salt, impaired kidney function, pre-renal azotemia

Question 70

Adenocarcinoma of the bladder is associated with what?

Answer 70

Persistent urachus and exstrophy

Question 71

What is the big pathogenic finding of diabetic nephropathy?

Answer 71

BM thickening and mesangial proliferation

Question 72

Which nephropathy gives subepithelial "spike-and-dome" or "diffuse deposits"?

Answer 72

Membranous nephropathy

Question 73

What causes intracapillary lipids with non-specific trapping of plasma proteins?

Answer 73

FSGS

Question 74

What causes intramembranous deposition of C3?

Answer 74

Type II MPGN

Question 75

What is suggested by the finding of hemosiderin laden macrophages?

Answer 75

Hemolysis

Question 76

Carcinoma in situ of the bladder has which characteristics (cellular and nuclear morphology)?

Answer 76

Flat, non-invasive; high-grade nuclear atypia

Question 77

What is the embryonal origin of podocytes?

Answer 77

Primitive renal tubule epithelium

Question 78

What is a renal corpuscle?

Answer 78

The initial blood-filtering component of a nephron

Question 79

Crescent formation is most typically associated with which finding?

Answer 79

RBC casts

Question 80

What is the prognosis for patients with thin basement membrane disease?

Answer 80

Benign; they will likely maintain kidney function for their whole lives

Question 81

What kidney issue can multiple myeloma cause?

Answer 81

Renal failure caused by tubulointerstitial nephritis

Question 82

Which cancer can you treat with BCG?

Answer 82

Bladder carcinoma

Question 83

What toxins can cause ATN?

Answer 83

Aminoglycosides, cisplatin, Hg, Pb, other heavy metals

Question 84

What cells are in muddy brown casts?

Answer 84

Epithelial cells

Question 85

Which kinds of bacteria almost never cause UTIs?

Answer 85

Staph

Question 86

Which foods have the saltiest content?

Answer 86

Canned foods

Question 87

Low magnesium causes what electrolyte abnormality?

Answer 87

Hypokalemia

Question 88

What disease causes mesangial and endocapillary proliferation with lobular accentuation and double contoured capillary walls?

Answer 88

MPGN Type I

Question 89

Name four causes of renal papillary necrosis

Answer 89

Sickle cell disease or trait, analgesic use, diabetes mellitus, and severe pyelonephritis

Question 90

What finding is associated with thrombotic micropathy?

Answer 90

Thrombocytopenia

Question 91

"Free access to water" means what about someone's electrolyte levels?

Answer 91

They'll normalize

Question 92

What are the four signs of CKD?

Answer 92

Hematuria, proteinuria, low GFR, hypertension