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WorksheetsBasic Path Quiz 2
Total questions: 100
Worksheet time: 1hrs 3mins
A term used to describe an elevation of blood urea nitrogen (BUN) and creatinine levels and related decreased glomerular filtration rate (GFR) is?
Azotemia
Uremia
Nephronophthisis
Hyalinosis
Prerenal azotemia is a result of?
Hyperperfusion of the kidneys
Hypoperfusion of the kidneys
Urine flow obstructed distal to the kidney
A gut punch
Postrenal azotemia is a result of?
Hyperperfusion of the kidneys
Hypoperfusion of the kidneys
Urine flow obstructed distal to the kidney
A gut punch
Raised levels of urea and other nitrogenous waste compounds in the blood normally eliminated by the kidneys is called?
Azotemia
Uremia
Nephronophthisis
Hyalinosis
Some of the risk factors common to acute and chronic injury are?
Age and race
Metabolic syndromes
Genetic factors
Hypertension
Diabetes Mellitus
Some of the modifiers of acute and chronic kidney disease are?
Severity of the renal injury
Stage of the chronic injury
Number of episodes of injury
Duration of the injury
Presence of protein in the urine
To classify a patient as having chronic renal injury, how long must there be a decrease in GFR?
1 month
2 months
3 months
4 months
In end stage renal failure (ESRF) the GFR is?
less than 5%
less than 10%
less than 15%
less than 20%
Some of the systemic manifestations of chronic kidney disease and uremia are?
Fluid and electrolyte imbalances
Calcium phosphate and bone changes
Hematologic and Skin changes
Cardiopulmonary pathology
GI and neuromuscular effects
What are the three categories of glomerular disease?
Primary glomerulopathies
Systemic diseases with glomerular involvement
Hereditary disorders
Congenital defects
What are the broad pathologic responses of the glomerulus to injury?
Hypercellularity
Basement membrane thickening
Hyalinosis
Sclerosis
Of the broad pathologic responses of the glomerulus to injury, which is the only response that happens in the acute phase?
Hypercellularity
Basement membrane thickening
Hyalinosis
Sclerosis
What are the categories of glomerular syndromes?
Nephritic syndrome
Rapid progressive glomerulonephritis
Nephrotic syndrome
Chronic renal failure
Isolated urine abnormalities
A glomerulonephritis characterized by inflammation and thinning of the glomerular basement membrane and the occurrence of small pores in the podocytes of the glomerulus, which commonly presents with hematuria, hypertension and oliguria is?
Nephritic syndrome
Rapid progressive glomerulonephritis
Nephrotic syndrome
Chronic renal failure
Isolated urine abnormalities
An acute nephritic syndrome characterized by a rapid loss of kidney function, that usually has a 50% decline in the glomerular filtration rate (GFR) within 3 months, crescent formation, and typically no evidence of hypertension?
Nephritic syndrome
Rapid progressive glomerulonephritis (RPGN)
Nephrotic syndrome
Chronic renal failure
Isolated urine abnormalities
_____ or more layers of proliferating cells in Bowman's capsule are a histological marker of severe glomerular injury and a hallmark of inflammatory glomerulonephritis
One
Two
Three
Four
Injury to the glomerulus which results in abnormal filtration leading to extensive proteinuria, edema, and metabolic disturbances with a clinical presentation of hematuria and hypertension is?
Nephritic syndrome
Rapid progressive glomerulonephritis (RPGN)
Nephrotic syndrome
Chronic renal failure
Isolated urine abnormalities
The most common primary cause of nephrotic syndrome in adults is?
Focal segmental glomerulosclerosis (FGGS)
Diabetes
Lupus
NSAIDS or certain antibiotics
Infections
The most common primary cause of nephrotic syndrome in children is?
Minimal change disease/loss of large amounts of protein
Diabetes
Lupus
NSAIDS or certain antibiotics
Infections
The second most common cause of nephrotic syndrome in children and adults is?
Focal segmental glomerulosclerosis (FGGS)
Diabetes
Lupus
NSAIDS or certain antibiotics
Infections
Risk factors for nephrotic syndrome include?
Focal segmental glomerulosclerosis (FGGS)
Diabetes
Lupus
NSAIDS or certain antibiotics
Infections
Risk factors for chronic renal failure include?
Diabetes
Hypertension
Family history of kidney failure
Ethnicity and race
Age
Two thirds of the patients with chronic renal failure have what two common clinical findings?
Hypotension
Hypertension
Diabetes
The two most commonly associated systemic diseases associated with glomerular lesions are?
Hypotension
Hypertension
Diabetes
Lupus
Clinical manifestations of Lupus Nephritis are?
Nephritic syndrome
Rapid progressive glomerulonephritis (RPGN)
Nephrotic syndrome
Recurrent microscopic or gross hematuria
Hypertension and Acute and Chronic renal failure
A childhood syndrome with purpuric skin lesions, abdominal pain and intestinal bleeding, and arthralgias along with renal abnormalities most common in the 3-8 age group is?
H (a) -Schonlein Purpura
A glomerulonephritis that displays fibrillar deposits in the mesangium and glomerular capillary walls that resemble amyloid fibril is?
Henoch-Schonlein Purpura
Diabetic neuropathy
Goodpasture syndrome
Fibrillary glomerulonephritis
What is the mechanism of bacterial endocarditis renal injury?
Bacterial deposition of immune complexes in the glomeruli
Renal infarction from septic emboli
Secondary renal cortical necrosis
Possible drug induced acute interstitial nephritis or acute kidney injury as a result of treating the infection
What is the mechanism of diabetes in renal injury?
High sugar levels in the blood can cause these vessels to become narrow and clogged, damaging the kidney glomerulus, such that albumin passes through and ends up in the urine (proteinuria)
High sugar levels may damage the nerves to the bladder and a person may not recognize their bladder is full, causing pressure that impacts the kidneys
Stagnant urine in the bladder high in glucose is a breeding ground for bacteria
Bacterial deposition of immune complexes in the glomeruli
What is the mechanism of autoimmune diseases and immune complex disorders in renal injury?
The glomerular, tubular and vascular structures are targeted and damaged as a consequence of autoimmune processes
The function of the glomerulus makes non-renal autoantigens a target due to high flow, high-pressure perm-selective filtration
Antibodies or antigen-antibody complexes that reside outside the kidney lodge in the small vessels of the glomeruli
The inflammatory response leads to further damage
The two major pathologic processes of tubular and interstitial diseases of the kidney are?
Dilation of the vascular poles
Ischemic or toxic tubular injury
Inflammatory reactions of the tubules and interstitium
Acute _______ injury causes acute renal failure, specifically ______ damage that often causes necrosis of ______ epithelial cells. (One word)
(a)
Causes of Acute Tubular Injury (ATI) or Acute Tubular Necrosis (ATN) are?
Ischemia, due to decreased or interrupted blood flow
Direct toxic injury to the tubules by endogenous or exogenous agents
Cyanosis, due to decreased or interrupted blood flow
Indirect toxic injury to the tubules by endogenous or exogenous agents
A normal GFR of an adult is?
greater than 40%
greater than 50%
greater than 80%
greater than 90%
What is the percent of high-grade infiltrating Urothelial Carcinomas of the Renal Pelvis that reach five-year survival?
10%
30%
60%
90%
What percentage of primary renal tumors originate from the urothelium of the renal pelvis?
5-10%
10-15%
15-20%
20-25%
Common clinical features of Renal Cell Carcinoma such as costovertebral pain, a palpable mass, and hematuria present how often in these patients?
10%
30%
60%
90%
What benign renal tumor is composed of large eosinophilic cells having small, round nuclei?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
What type of Renal Cell Carcinoma is made up of primarily eosinophilic cells with a perinuclear halo?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
Which type of renal cell carcinoma typically arises from the distal convoluted tubule epithelium?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
Which type of renal cell carcinoma typically arises from the proximal convoluted tubule epithelium?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
What autosomal dominant syndrome (usually occurs in younger individuals) has a higher risk of developing familial cancers such as kidney tumors?
Lynch syndrome
Von Hippel-Lingau (VHL) syndrome
Goodpasture syndrome
Cushing's disease
What percent of patients with Renal Cell Carcinoma have metastasis at the time of diagnosis?
75%
30%
25%
90%
Renal Cell Carcinoma tends to invade what structure?
Renal vein
Renal artery
Ureter
What histologic variant has the worst prognosis?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
What is the most common type of Renal Cell Carcinoma?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
List the major types of Renal Cell Carcinoma
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
The classification of renal cell carcinoma is based on what three criteria?
Histology
Gross appearance
Cytogenetics
Genetics
What is the number one risk factor for Renal Cell Carcinoma?
Alcohol use
Opioid use
Tobacco use
NSAIDs
The most common malignant neoplasm of the kidney found in children is?
W (a) tumor
A mahogany colored benign renal tumor that often has a central scar is?
Oncocytoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
Angiomyolipomas can be clinically important because they can cause?
Spontaneous hemorrhage
Spontaneous scarring
Spontaneous necrosis
Spontaneous clotting
What percentage of patients with tuberous sclerosis have angiomyolipomas?
5-10%
10-15%
25-30%
20-25%
A small (1.5 cm) well circumscribed pale tumor arising from the renal tubular epithelium histologically presenting with tubular or papillary forms often found on autopsy as an incidental finding is?
Renal papillary adenoma
Chromophobe
Papillary carcinoma
Clear cell carcinoma
Sarcomatoid carcinoma
Branched stones that fill all or part of the renal pelvis and branch into several or all of the calyces commonly from struvite or calcium are referred to as?
Fraggle rock
Staghorn calculus
Sticky calculus
Trabeculated calculi
The most common constituent (type) of renal calculi are?
Calcium
Struvite
Uric acid
Cystine
Cholesterol
What are the main types of renal calculi?
Calcium
Struvite
Uric acid
Cystine
Cholesterol
A rapid onset of hydronephrosis that results in oliguria or anuria and post obstructive diuresis is consistent with a complete b (a) obstruction.
What are some of the symptoms of hydronephrosis resulting from bilateral partial obstruction?
Distal tubular acidosis
Renal salt wasting (excrete excessive sodium)
Secondary renal calculi
Chronic tubulointerstitial nephritis with scarring and atrophy of the papilla and medulla
Hypertension
Severe hydronephrosis can lead to what pathologic findings in the kidney?
Thin-walled cystic kidney (15-20 cm diameter)
Striking parenchymal atrophy
Total obliteration of the pyramids
Thinning of the cortex
Common extrinsic lesions causing urinary obstruction are?
Tumor outside the kidney
Botched surgery
Pregnancy
Peritoneal fibrosis
Retroperitoneal fibrosis
Common intrinsic lesions causing urinary obstruction are?
Calculi
Tumor within the kidney
Clots
Sloughed papillae
Inflammation
Common clinical complications of urinary obstructions include?
Increases susceptibility to infection
Stone formation
Hydronephrosis
Obstructive uropathy
Jaundice
A renal cortical cyst that presents radiographically as renal cysts having smooth contours, is avascular and gives fluid signals rather than solid signals on ultrasonography is consistent with?
Simple cortical cyst
Oncocytoma
Multicystic renal dysplasia
Nephronohthisis
Dialysis-Associated Cystic Disease presents what risk for Renal Cell Carcinoma?
40-50 fold risk over time
22-30 fold risk over time
83-92 fold risk over time
12-18 fold risk over time
An enlarged, extremely irregular, and multicystic kidney associated with ureteropelvic obstruction, ureteral agenesis or atresia, and other anomalies of the lower urinary tract is most consistent with?
Simple cortical cyst
Oncocytoma
Multicystic renal dysplasia
Nephronohthisis
Children or adolescents presenting with otherwise unexplained chronic renal failure, a positive family history of renal failure, and chronic tubulointerstitial nephritis on biopsy should be worked up for what disease?
Simple cortical cyst
Oncocytoma
Multicystic renal dysplasia
Nephronohthisis
The most common genetic cause of end-stage renal disease in children and young adults is?
nephronophthisis complex
nephritic complex
nephrotic complex
The most common variant of the nephronophthisis disease complex is?
_____ _______ nephronophthisis
Familial juvenile
Familial advanced
Inherited juvenile
Inherited adult
Nephronophthisis occurs in what age group?
0 to 10
10 to 20
20 to 30
30 to 40
How does medullary sponge kidney affect renal function?
Increases GFR
Decreases GFR
Unaffected
In medullary sponge kidney, small cysts develop where in the kidney?
Glomerulus
Distal convoluted tubule
Proximal convoluted tubule
Collecting duct
The three main types of cystic diseases identified in the renal medulla are?
Medullary sponge kidney
Nephronophthisis
Adult-onset medullary cystic disease
Multicystic Renal Dysplasia
The two most common presentations of Autosomal Recessive (Childhood) Polycystic Kidney Disease have a high probability of developing what condition later in life?
Periportal fibrosis
Portal hypertension
Splenomegaly
Congenital hepatic fibrosis
Pulmonary hypertension
What are some of the extrarenal congenital anomalies associated with APKD?
Polycystic liver disease
Cysts in the spleen, pancreas, and lungs
Berry aneurysms
Mitral valve prolapse
Coarctation of the aorta
What individuals have an increased risk for progression of Polycystic Kidney Disease?
Hypertensive
African Americans
Males
Females
Carriers of sickle cell
Hereditary disorder of adults characterized by multiple expanding cysts of both kidneys that ultimately destroy the renal parenchyma and cause renal failure is consistent with?
Autosomal recessive polycystic kidney disease
Autosomal dominant polycystic kidney disease
Acquired polycystic kidney disease
Congenital polycystic kidney disease
90% of the cases of the fusion of a horseshoe kidney typically is in the upper or lower poles?
Upper
Lower
Ectopic kidneys may have what complications?
Increased risk of viral infections
Increased risk of bacterial infections
Kinking or tortuosity of the ureters
Obstruction to urinary flow
A fetus born without development of the kidney is said to have renal?
Aplasia
Dysplasia
Agenesis
Metaplasia
Defects associated with congenital anomalies are divided into what two groups?
Structural abnormalities in the adrenal glands
Structural abnormalities in kidney or urinary tract
Functional abnormalities in tubular transport
Functional abnormalities in the renal capsule
A congenital anomaly of the kidney that refers to a smaller than normal size kidney is called?
Aplasia
Dysplasia
Hypoplasia
Metaplasia
A congenital anomaly of the kidney that presents as a complete or incomplete malformation of kidney is referred to broadly as?
Aplasia
Renal Dysplasia
Hypoplasia
Metaplasia
Agenesis
Intrarenal reflux is most common where in the kidney, due to the fact that the papillae are flattened or have concave tips rather than the convex pointed type?
Upper and lower (a) of the kidney
Examples of vesicoureteral reflux are?
Congenital absence or shortening of the intravesical portion of the ureter prevents ureter from being compressed during micturition
Congenital lengthening of the intravesical portion of the ureter prevents ureter from being compressed during micturition
Bacteria themselves or the associated inflammation can promote reflux by affecting ureteral contractility
Acquired vesicoureteral reflux can occur from spinal cord injury
Examples of neurogenic bladder dysfunction causing urinary retention are?
Diabetes
Ureteral metaplasia
Spinal cord injury
Fibrotic scarring of the bladder
Examples of urinary bladder obstruction are?
Benign prostatic hypertrophy
Tumors
Waxy casts
Calculi
What are the three mechanisms by which microbes move from the bladder to the kidneys?
Peritoneal abscess
Urinary tract obstruction and stasis of urine
Vesicoureteral reflux
Intrarenal reflux
What are the stages of a UTI?
Colonization of bacteria
Uroepithelium penetration and bacterial replication
The bacteria ascend through the ureters towards the kidney
Infection ensures (pyelonephritis)
Bacteria cascade up the the kidney causing acute kidney injury
What are the two main methods bacteria infect the kidney?
Hematogenous infection
Lymphatic infection
Ascending infection
What type of viral infections are common in the kidney of immunocompromised patients?
Polyomavirus
Cytomegalovirus
Coronavirus
Adenovirus
The most common organisms identified in an upper urinary track infection is?
Candida albicans
S. aureus
S. epidermidis
E. coli
Chronic Tubulointerstitial Nephritis presents with?
Tubular injury
An infiltration of mononuclear leukocytes
Prominent interstitial fibrosis
Widespread tubular atrophy
Interstitial edema
Acute Tubulointerstitial Nephritis presents as rapid onset of what symptoms?
Tubular injury
An infiltration of mononuclear leukocytes
Often accompanied by leukocytic infiltration of the interstitium and tubules
Widespread tubular atrophy
Interstitial edema
What differentiates Tubulointerstitial Nephritis from other kidney diseases?
The absence of nephritic or nephrotic syndrome
The presence of nephritic or nephrotic syndrome
The presence of blood in the urine
The presence of defects in tubular function (polyuria, nocturia, metabolic acidosis as a result of decreased ability to excrete acids)
Tubulointerstitial Nephritis is a group of renal diseases that cause what type of injury to the kidney?
Inflammatory injuries of the tubules and interstitium
Malignancies of the tubules and interstitium
Inflammatory injuries of the renal capsule
Malignancies of the renal capsule
Severe breakdown of muscle is called Rhabdomyolysis and can result in what pathology in the kidney?
Acute renal failure
Chronic renal failure
Waxy casts in the urine are associated with what pathology?
Advanced liver disease
Clear cell carcinoma
Elevated GFR
Advanced kidney disease
Renal tubular epithelial cell casts found in the urine are indicative of?
Damage to the tubule cells
Renal tubular necrosis
Viral disease
Kidney transplant rejection
Toxic injury or ischemia to the tubular cells of the kidney cause the cells to slough and result in what potential event in the tubules?
O (a) of the tubules
