1. An infant is born still-borned and presents with low set ears, flat face and hypoplastic lungs. What is the most likely etiology?
    B/L agenesis -> oligohydramnios (Potter sequence)
  2. What are the characterisitcs of ADPKD?
    • Usually bilateral
    • HTN and hematuria
    • berry aneurysm
    • hepatic cysts
    • Mitral valve prolapse     
  3. What is the disease that leads to
    -  B/L small corticomedullary cysts
    -  tubulointerstitial sclerosis of collecting duct
    - shrunken kidneys 
    - Progresses to end stage renal disease  
    -similar to Nephronophthisis (but occurs in older population)
    Medullary cystic kidney disease
  4. Patient presents with oliguria w/ brown granular casts
    - increased BUN and creatinine
    - hyperkalemia w/ metabolic acidosis

    What is the
    - diagnosis
    - two possible causes
    This is acute tubular necrosis

    • Ischemia - affects all tubules
    • Nephrotoxic- affects the proximal convoluted tubule only
    •    (aminoglycosides, cisplatin, ethylene glycol)
  5. What is usually casued by Hypersensitivty to Methicillin?
    Acute intersitital nephritis -> eosinophilia
  6. What is a main cause of diffuse cortical necrosis?
    Sepsis -> disseminated intravascular coagulation
  7. Where is the most common site for a subarachnoid hemorrhage in a patient with adult polycystic kidney disease?
    Circle of Willis
  8. What is the equation for clearance?
    Image Upload 1

    Urinary excretion = filtered and excreted
  9. Free water clearance equation
    Urine flow rate - (urine flow * urine osmolarity)/plasma omolality.
  10. What causes acidosis, hyperchloremic, normal anion gap?
    • This is due to loss of bicarbonate.
    • Diarrhea is a common cause for this.
  11. How does the body deal with an increase in sodium intake?
    By increasing ADH secretion which will increase the permeability of the late distal tubule and collecting duct to water leaving a concentrated urine.
  12. Inulin is a good indicator for what?
    What would yuo use it for?
    • Extracellular fluid volume.
    • To estimate interstitial fluid volume:
    • Plasma volume - inulin space = interstitial fluid volume
  13. What is a dangerous complication of aortic dissection?
    Bilateral renal infarction -> flank pain and hematuria
  14. Describe Goodpasture syndrome
    Hematuria, hemoptysis, proteinuria, red cell casts.

    Linear deposits of IgG against the basement membrane.
  15. What is the rate of excretion of creatinine?
    • GFR x [plasma creatinine]
    • When GFR decreases, the plasma creatinine concentration continues to increase unitl the rate of creatinine excretion becomes = to the rate of production.
  16. What is elevated in nephrotic syndrome?
    Hyperlipidemia = - increased cholesterol, triglycerides, and LDL proteins
  17. What is a cuase of uteropelvic junction obstruction?
    • Compression by aberrant renal vessels
    • disorganized smooth muscle
    • intramuscular collagen deposition

    causes hydronephrosis with pelvis dilated but ureter normal size.
  18. synthesis of hormones in the medulla of the kidney?
    Image Upload 2
  19. What part of the kidney is the tubular osmolarity the lowest even in the presence of high ADH?
    The early distal convoluted tubule.
  20. Where does parathyroid hormone work in relation to the kidney?
    At the distal tubule to increase calcium reabsorption.
  21. What causes low blood pressure, cardiac enlargement, perihilar infiltrates on chest x-ray, and BUN only to rise?
    This is pre-renal failure as a result of congestive heart failure -> decreased renal perfusion.
  22. Why is prostatic hyperplasia the most common cause of compensatory hypertrophy of the smooth muscle in the urinary bladder wall?
    There is narrowing of the proximal urethra causing a chronic impediment to the outflow of urine which leads to the smooth muscle hypertrophy and trabeculation.
  23. What are the 3 types of congenital adrenal hyperplasia and how do they differ?
    • 17-alpha-hydroxylase deficiency:
    • - High ACTH, deoxycortisone and corticosterone (salt retention)
    • - no sex steroids -> female is the default pathway

    • 21-beta-hydroxylase deficiency:
    • - High ACTH, adrenal androgens -> virilization
    • - salt wasting & hyperkalemia

    • 11-beta-hydroxylase deficiency:
    • - High ACTH, deoxycorticosterone (salt retention)
    • - High androgens -> virilization
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