Phys 32 Flashcards

Which general mechanism best describes diuretics?

A) Increase tubular sodium reabsorption

B) Decrease tubular sodium reabsorption

C) Block water secretion directly

D) Increase glomerular protein filtration

Why does water excretion increase after most diuretics inhibit tubular sodium reabsorption?

A) Sodium draws water into cells

B) Water secretion is directly stimulated

C) Sodium in tubules reduces water reabsorption

D) Plasma proteins enter the tubule

A diuretic increases urinary sodium delivery and secondarily raises urinary K+, Cl−, Mg2+, and Ca2+. What explains this broader solute loss?

A) Na reabsorption affects other solutes

B) Calcium blocks sodium secretion

C) Proteins bind all tubular ions

D) Water reabsorption occurs first

After chronic diuretic therapy, urine output eventually matches intake again. What must occur before this new steady state is reached?

A) Increased plasma proteins and GFR

B) Increased aldosterone and hypertension

C) Reduced arterial pressure and ECF volume

D) Increased renal sodium reabsorption

A diabetic patient’s plasma glucose exceeds the tubular transport maximum, leaving excess glucose in the tubule and causing rapid fluid loss. Which process is occurring?

A) Pressure natriuresis

B) Osmotic diuresis

C) Carbonic anhydrase inhibition

D) Aldosterone antagonism

Furosemide, ethacrynic acid, and bumetanide produce powerful diuresis by acting mainly on which nephron segment

A) Proximal tubule

B) Collecting tubule

C) Early distal tubule

D) Thick ascending limb

Loop diuretics block which luminal transporter in the thick ascending limb?

A) Na+-Cl− cotransporter

B) H+-ATPase pump

C) Na+-K+-2Cl− cotransporter

D) Epithelial sodium channel

Why do loop diuretics markedly reduce water reabsorption in distal nephron segments?

A) They increase aldosterone secretion

B) They block glucose filtration

C) They increase distal solute delivery

D) They increase plasma oncotic pressure

Loop diuretics impair the countercurrent multiplier mainly by decreasing ion absorption into which region?

A) Cortical collecting duct

B) Medullary interstitium

C) Bowman capsule

D) Renal pelvis

A patient on furosemide has reduced medullary interstitial osmolarity. Which renal ability is most directly impaired?

A) Urine concentration

B) Glomerular filtration

C) Albumin restriction

D) Potassium filtration

Loop diuretics inhibit NaCl reabsorption in the loop of Henle and increase water excretion. Which urinary process is impaired?

A) Tubular protein filtration

B) Urinary dilution

C) Bicarbonate secretion

D) Glucose reabsorption

Acetazolamide reduces proximal tubular bicarbonate reabsorption by inhibiting which enzyme?

A) Lipoprotein lipase

B) HMG-CoA reductase

C) Carbonic anhydrase

D) Angiotensin-converting enzyme

Which pairing correctly matches osmotic diuretics such as mannitol with their main tubular action?

A) Collecting duct; aldosterone blockade

B) Thick ascending limb; NKCC inhibition

C) Early distal tubule; NCC inhibition

D) Proximal tubule; increased tubular osmolarity

Which diuretic class inhibits Na+-Cl− cotransport in the luminal membrane of the early distal tubule?

A) Loop diuretics

B) Thiazide diuretics

C) Osmotic diuretics

D) Aldosterone antagonists

Which pairing correctly matches carbonic anhydrase inhibitors with their tubular site and effect?

A) Proximal tubule; reduced HCO3− reabsorption

B) Collecting duct; reduced aldosterone action

C) Thick ascending limb; NKCC blockade

D) Early distal tubule; NCC blockade

Spironolactone and eplerenone decrease Na+ reabsorption and K+ secretion by blocking aldosterone action primarily where?

A) Proximal tubules

B) Thick ascending limbs

C) Collecting tubules

D) Early distal tubules

A patient with hypertension is given amiloride. Which mechanism and site best match this potassium-sparing diuretic?

A) Blocks ENaC; collecting tubule

B) Blocks NKCC; thick ascending limb

C) Blocks NCC; distal tubule

D) Blocks CA; proximal tubule

A patient takes acetazolamide and develops increased urinary bicarbonate and sodium loss. Why does reduced bicarbonate reabsorption also reduce sodium reabsorption?

A) Sodium binds bicarbonate in plasma

B) Sodium transport requires aldosterone only

C) HCO3− reabsorption couples to Na-H exchange

D) Bicarbonate blocks ENaC channels

Which diuretic class is correctly described as potassium-sparing because it blocks mineralocorticoid receptor signaling?

A) Loop diuretics

B) Aldosterone antagonists

C) Carbonic anhydrase inhibitors

D) Osmotic diuretics

A patient has severe renal disease classified by rapid onset versus long-term progression. Which two broad categories are used?

A) Prerenal and postrenal only

B) Glomerular and tubular only

C) Diuretic and natriuretic disease

D) AKI and CKD

A patient develops acute kidney injury after hemorrhagic shock reduces renal perfusion. Which AKI category best fits

A) Prerenal AKI

B) Intrarenal AKI

C) Postrenal AKI

D) Chronic kidney disease

A patient develops AKI from direct injury to renal blood vessels, glomeruli, and tubules. Which category best fits?

A) Prerenal AKI

B) Intrarenal AKI

C) Postrenal AKI

D) Functional oliguria

A patient develops AKI from obstruction between the renal calyces and bladder outlet. Which category and common cause best match?

A) Prerenal; hemorrhage

B) Intrarenal; glomerulonephritis

C) Postrenal; kidney stone

D) Chronic; nephron aging

A patient has an acute fall in renal blood flow. Which paired renal changes are most expected?

A) Increased GFR; increased urine output

B) Decreased GFR; decreased urine output

C) Increased GFR; decreased solute output

D) Decreased GFR; increased water output

A patient with oliguria from acutely reduced kidney blood flow begins retaining water and solutes. Which mechanism best explains the accumulation?

A) Output falls below intake

B) Intake falls below output

C) GFR rises above normal

D) Solute filtration increases

A patient with severe renal ischemia has complete cessation of urine output. Which term best describes this finding?

A) Oliguria

B) Anuria

C) Polyuria

D) Dysuria

A patient’s renal blood flow falls below 20–25% of normal for a prolonged time. Which renal cells are especially vulnerable to hypoxic injury?

A) Collecting duct principal cells

B) Glomerular podocytes only

C) Renal capsular fibroblasts

D) Tubular epithelial cells

Which set correctly lists the major intrarenal AKI injury compartments?

A) Glomerular vessels, tubules, interstitium

B) Ureter, bladder, prostate

C) Renal artery, aorta, vena cava

D) Cortex, pelvis, urethra

A patient develops intrarenal AKI from an abnormal immune reaction that damages glomeruli. Which diagnosis best fits?

A) Acute tubular necrosis

B) Acute glomerulonephritis

C) Postrenal obstruction

D) Prerenal azotemia

After group A streptococcal infection, antibodies and antigens form insoluble immune complexes. Where do these complexes become trapped to cause acute glomerulonephritis?

A) Tubular lumen only

B) Renal pelvis

C) Glomerular basement membrane

D) Collecting duct papilla

In acute glomerulonephritis, immune complex deposition causes proliferation of which cells?

A) Mesangial cells and leukocytes

B) Principal cells and podocytes

C) Juxtaglomerular cells and fibroblasts

D) Macula densa and erythrocytes

A patient develops intrarenal acute kidney injury from destruction of renal tubular epithelial cells. Which diagnosis best matches this mechanism?

A) Tubular necrosis

B) Postrenal obstruction

C) Prerenal azotemia

D) Chronic pyelonephritis

A patient in circulatory shock develops acute tubular necrosis with epithelial cells sloughing into nephron lumens. What is the immediate consequence of this sloughing?

A) Increased bicarbonate secretion

B) Plugged nephrons with no urine output

C) Increased glomerular capillary filtration

D) Ureteral dilation from stones

Which cause is most commonly associated with ischemic acute tubular necrosis?

A) Renal artery stenosis only

B) Bladder neck obstruction

C) Circulatory shock

D) Chronic obesity

A patient develops acute tubular necrosis after exposure to carbon tetrachloride, ethylene glycol, and cisplatin. Which mechanism best explains the AKI?

A) Immune complexes in glomeruli

B) Bilateral ureteral obstruction

C) Loss of renal sympathetic tone

D) Toxic epithelial sloughing and plugging

Which set contains toxins or medications that can cause acute tubular necrosis?

A) Heavy metals, tetracycline, cisplatin

B) Albumin, glucose, bicarbonate

C) ACE inhibitors, insulin, heparin

D) Aldosterone, renin, angiotensin II

Which obstruction pattern best matches postrenal acute kidney injury?

A) Glomerular immune complex trapping

B) Bilateral ureters, bladder, or urethra

C) Renal tubular epithelial poisoning

D) Reduced blood supply before kidneys

A patient with acute kidney injury retains water, metabolic wastes, and electrolytes. Which complication pair can result from water and salt overload?

A) Gangrene and claudication

B) Cyanosis and clubbing

C) Edema and hypertension

D) Leukopenia and jaundice

A patient with AKI develops metabolic acidosis. Which renal failure mechanism most directly explains this acid-base disorder?

A) Excess bicarbonate filtration

B) Excess aldosterone secretion

C) Increased potassium excretion

D) Impaired hydrogen ion excretion

A patient has kidney damage and reduced kidney function persisting for 4 months. Which classification best fits?

A) Chronic kidney disease

B) Acute tubular necrosis

C) Prerenal AKI

D) Postrenal AKI

Chronic kidney disease is most accurately associated with which nephron-level process?

A) Rapid complete regeneration

B) Progressive irreversible nephron loss

C) Temporary ureteral obstruction

D) Isolated bladder outlet spasm

Why may serious CKD symptoms be absent until late disease

A) Tubules stop filtering early

B) Kidneys regenerate most nephrons

C) Remaining nephrons maintain balance

D) Ureters compensate for filtration

A patient with advanced CKD can no longer survive without dialysis or kidney transplantation. Which stage has been reached?

A) End-stage renal disease

B) Acute glomerulonephritis

C) Mild prerenal azotemia

D) Reversible tubular injury

After surgical removal of large kidney portions, surviving nephrons initially undergo which adaptive change?

A) Decreased GFR and urine output

B) Increased blood flow, GFR, and urine output

C) Complete cessation of filtration

D) Reduced nephron size and perfusion

Which changes help explain increased function in surviving nephrons after partial kidney removal?

A) Ureteral obstruction and edema

B) Immune complexes and leukocytes

C) Hypertrophy and lower vascular resistance

D) Tubular plugging and ischemia

Which strategy most effectively slows progressive kidney function loss toward ESRD?

A) Raise glomerular hydrostatic pressure

B) Increase renal arterial pressure

C) Increase surviving nephron flow

D) Lower arterial and glomerular pressure

Which drug classes help slow ESRD progression by lowering glomerular hydrostatic pressure?

A) ACE inhibitors and ARBs

B) Loop and osmotic diuretics

C) Statins and fibrates

D) Beta agonists and nitrates

Primary kidney disease can create a vicious cycle after nephron loss. Which sequence best describes this progression?

A) Lower flow; regeneration; recovery

B) Higher surviving-glomerulus pressure; sclerosis

C) Less filtration; ureteral obstruction

D) Tubular dilation; nephron multiplication

What happens to surviving glomerular capillaries after initial nephron loss in progressive kidney disease?

A) Pressure and flow decrease immediately

B) They become immune-complex free

C) Increased pressure eventually injures them

D) They regenerate lost nephrons

Which risk factor is most important for the two major causes of ESRD, diabetes and hypertension?

A) Low dietary protein

B) Chronic low body weight

C) High water intake

D) Excessive weight gain

A patient with CKD has renal ischemia and tissue death from large-artery sclerosis, fibromuscular hyperplasia, and small-vessel sclerosis. Which set best matches common vascular lesions causing ischemic CKD?

A) Vasculitis, cystitis, pyelonephritis

B) Atherosclerosis, fibromuscular hyperplasia, nephrosclerosis

C) Glomerulonephritis, reflux, cystitis

D) Tubular necrosis, stones, hydronephrosis

A patient with the most common form of kidney disease has vascular lesions in small renal vessels. Which vessels are most involved in benign nephrosclerosis?

A) Renal veins and calyces

B) Ureters and renal pelvis

C) Interlobular arteries and afferent arterioles

D) Large renal arteries only

Benign nephrosclerosis begins when plasma leaks through which vascular layer of small renal vessels?

A) Adventitial membrane

B) Intimal membrane

C) Glomerular basement membrane

D) Bowman capsule

In benign nephrosclerosis, plasma leakage produces fibrinoid deposits in the medial layer, causing progressive wall thickening. What is the final vascular consequence?

A) Vessel dilation and hyperfiltration

B) Vessel constriction or occlusion

C) Ureteral dilation and reflux

D) Medullary infection and hyperfiltration

Why can occlusion of small renal arteries in benign nephrosclerosis destroy nephrons?

A) Small renal arteries lack collaterals

B) Glomeruli regenerate poorly after birth

C) Ureters obstruct during micturition

D) Plasma cannot enter renal veins

Aging-related nephrosclerosis and glomerulosclerosis reduce functioning nephrons. Which renal hemodynamic changes are expected?

A) Increased RBF and GFR

B) Decreased RBF and GFR

C) Increased GFR only

D) Decreased RBF, increased GFR

A patient with severe hypertension develops malignant nephrosclerosis. Which histologic pattern is most characteristic?

A) Fibrous glomerular replacement and cystitis

B) Tubular pus and medullary abscesses

C) Fibrinoid deposits and vessel thickening

D) Ureteral reflux and cystitis

Malignant nephrosclerosis causes severe ischemia primarily because which structures are progressively thickened and narrowed?

A) Renal pelvises

B) Bladder walls

C) Ureters

D) Arterioles

Chronic glomerulonephritis may follow acute glomerulonephritis or occur secondary to which systemic disease?

A) Systemic lupus erythematosus

B) Primary biliary cirrhosis

C) Diabetes insipidus

D) Rheumatic fever

Compared with acute glomerulonephritis, what role do streptococcal infections play in chronic glomerulonephritis?

A) Cause nearly all cases

B) Account for small percentage

C) Are required for diagnosis

D) Prevent chronic progression

In end-stage chronic glomerulonephritis, many glomeruli are replaced by fibrous tissue. What functional consequence follows?

A) Excess urine concentration

B) Inability to filter fluid

C) Increased renal blood flow

D) Increased nephron regeneration

Primary damage to the renal interstitium by poisons, drugs, or bacterial infections is best termed what?

A) Interstitial nephritis

B) Benign nephrosclerosis

C) Acute cystitis

D) Fibromuscular hyperplasia

Renal interstitial injury caused by bacterial infection is called what?

A) Cystitis

B) Pyelonephritis

C) Nephrosclerosis

D) Glomerulosclerosis

Which organism most commonly causes pyelonephritis from fecal contamination of the urinary tract?

A) Staphylococcus aureus

B) Group A streptococcus

C) Escherichia coli

D) Pseudomonas aeruginosa

Bacteria causing pyelonephritis may reach the kidney by blood, but more commonly they ascend from the lower urinary tract through which structures?

A) Ureters

B) Renal veins

C) Collecting ducts

D) Glomeruli

A patient cannot flush bacteria effectively from the bladder, allowing bacterial multiplication and bladder inflammation. Which condition develops?

A) Cystitis

B) Pyelonephritis

C) Nephrosclerosis

D) Hydronephrosis

Vesicoureteral reflux predisposes to pyelonephritis by allowing urine and bacteria to move in which direction?

A) Bladder into ureters

B) Kidney into renal veins

C) Cortex into glomeruli

D) Medulla into lymphatics

Pyelonephritis begins in which renal region?

A) Renal cortex

B) Renal capsule

C) Renal medulla

D) Renal hilum

Because pyelonephritis begins in the medulla, which renal function is especially impaired early?

A) Urine concentration

B) Protein filtration

C) Renin storage

D) Erythrocyte filtration

Patients with pyelonephritis often cannot concentrate urine well because the medulla normally provides which mechanism?

A) Juxtaglomerular renin release

B) Countercurrent concentrating mechanism

C) Glomerular filtration barrier

D) Vesicoureteral valve closure

Which general disease mechanism can cause nephrotic syndrome across many different kidney disorders?

A) Increased glomerular permeability

B) Decreased renal pelvic pressure

C) Decreased plasma creatinine

D) Increased tubular sodium reabsorption

A patient with chronic glomerulonephritis develops nephrotic-range proteinuria. Which mechanism best links this disease to nephrotic syndrome?

A) Ureteral obstruction raises pressure

B) Medullary infection blocks concentration

C) Glomerular disease increases permeability

D) Tubular necrosis blocks urine flow

A patient with amyloidosis develops nephrotic syndrome. Which pathologic change best explains the proteinuria?

A) Renal artery fibromuscular hyperplasia

B) Abnormal proteinoid deposition damages GBM

C) Bladder reflux infects medulla

D) Proximal tubules stop filtering proteins

A 4-year-old develops severe edema and selective albuminuria with minimal histologic change. Which mechanism best explains the protein loss?

A) Loss of GBM negative charge

B) Increased Bowman capsule pressure

C) Increased tubular creatinine reabsorption

D) Decreased renal venous pressure

Why does loss of negative charge in minimal change nephrotic syndrome promote albuminuria?

A) Albumin becomes positively charged

B) Normal electrostatic repulsion is lost

C) Creatinine becomes protein-bound

D) Tubular flow becomes slower

A patient with progressive CKD has rising urea and creatinine. Their accumulation is most proportional to which variable?

A) Number of destroyed nephrons

B) Bladder urine volume

C) Plasma sodium concentration

D) Ureteral diameter

Why do urea and creatinine accumulate as nephron number falls?

A) They depend largely on GFR

B) They are mainly excreted by lungs

C) They are actively stored in tubules

D) They require aldosterone for filtration

A nephrology student calculates the filtered load of creatinine. Which relationship is correct?

A) GFR divided plasma creatinine

B) GFR times plasma creatinine

C) Plasma creatinine minus GFR

D) Creatinine excretion divided sodium

If creatinine is filtered and not reabsorbed, which value can approximate creatinine filtration rate?

A) Sodium reabsorption rate

B) Creatinine excretion rate

C) Plasma urea production

D) Tubular bicarbonate secretion

A patient has an acute decrease in GFR. What happens first to creatinine excretion and plasma creatinine?

A) Excretion rises; plasma falls

B) Excretion falls; plasma rises

C) Both fall permanently

D) Both remain unchanged

In severe CKD, plasma sodium and chloride can remain nearly constant despite low GFR. Which adaptation best explains this

A) Greatly decreased tubular reabsorption

B) Complete cessation of filtration

C) Increased protein-bound sodium

D) Increased glomerular permeability

A patient with advanced kidney disease loses the ability to concentrate or dilute urine. Which term describes this abnormality?

A) Isosthenuria

B) Proteinuria

C) Pyelonephritis

D) Hydronephrosis

Remaining nephrons in diseased kidneys carry high tubular flow. What is the major functional consequence?

A) Better urine concentration

B) Complete sodium retention

C) Impaired concentration and dilution

D) Increased protein repulsion

Why does rapid tubular flow impair urine concentration in diseased kidneys?

A) It prevents adequate water reabsorption

B) It increases GBM negative charge

C) It lowers plasma creatinine production

D) It blocks all sodium filtration

Rapid flow through the loop of Henle and collecting ducts impairs the countercurrent mechanism. What medullary effect follows?

A) Better solute trapping

B) Poor medullary solute concentration

C) Increased urine protein filtration

D) Complete cortical ischemia

A patient with renal failure develops generalized edema, metabolic acidosis, elevated urea/creatinine/uric acid, hyperkalemia, and retained sulfates/phosphates. Which syndrome best describes these body-fluid effects?

A) Nephrotic syndrome

B) Uremia

C) Renal glycosuria

D) Essential cystinuria

Why is the syndrome of renal failure body-fluid toxicity called uremia?

A) High urea in body fluids

B) Low sodium in plasma

C) High glucose in urine

D) Low proteins in urine

A patient with renal failure develops generalized edema. Which retained substances most directly explain the fluid accumulation?

A) Glucose and amino acids

B) Cystine and oxalate

C) Water and salt

D) Phenols and sulfates

A patient with renal failure develops metabolic acidosis. Which mechanism best explains this finding?

A) Failure to excrete acids

B) Excess bicarbonate reabsorption

C) Increased pulmonary ventilation

D) Increased aldosterone secretion

A patient with advanced CKD has elevated urea, creatinine, and uric acid. These are examples of which retained solute group?

A) Protein-bound fatty acids

B) Nonprotein nitrogens

C) Filtered plasma proteins

D) Bile acid resins

Which retained substances in renal failure belong to the “other kidney-excreted substances” group rather than the nonprotein nitrogen group?

A) Urea, creatinine, uric acid

B) Albumin, globulin, fibrinogen

C) Phenols, sulfates, phosphates

D) Glucose, amino acids, cystine

A patient with CKD-related hypertension improves after strict dietary salt restriction and removal of extracellular fluid during dialysis. Which mechanism best explains the BP improvement

A) Reduced salt-fluid overload

B) Increased renin secretion

C) Increased aldosterone action

D) Reduced glucose excretion

Why does decreased erythropoietin in CKD cause anemia?

A) Bone marrow RBC production falls

B) Intestinal iron absorption stops completely

C) Plasma volume becomes zero

D) Red cells enter the urine

A patient with prolonged CKD develops osteomalacia from impaired calcium absorption. Which renal metabolic defect best explains this?

A) Impaired vitamin D activation

B) Excess erythropoietin release

C) Increased cystine reabsorption

D) Increased glucose excretion

A CKD patient develops skeletal demineralization due to high serum phosphate and secondary hyperparathyroidism. What causes the elevated phosphate?

A) Decreased GFR

B) Excess aldosterone

C) Increased EPO

D) Renal glycosuria

In CKD, elevated serum phosphate promotes secondary hyperparathyroidism. What does this parathyroid response do to bone?

A) Increases calcium release

B) Prevents osteomalacia

C) Blocks phosphate retention

D) Stops demineralization

Which renal lesion pattern generally promotes hypertension by reducing sodium and water excretion?

A) Increased GFR only

B) Decreased GFR or increased reabsorption

C) Decreased tubular reabsorption only

D) Increased glucose excretion

A patient develops hypertension from renal artery stenosis. Which hemodynamic change best explains reduced sodium-water excretion?

A) Increased renal vascular resistance

B) Decreased tubular reabsorption

C) Increased filtration coefficient

D) Decreased aldosterone secretion

Chronic glomerulonephritis causes hypertension by decreasing the glomerular capillary filtration coefficient. Which renal variable directly falls?

A) Renal venous pressure

B) GFR

C) Plasma oncotic pressure

D) Tubular glucose transport

A patient with excessive aldosterone secretion develops hypertension from sodium retention. Where does aldosterone mainly increase sodium reabsorption?

A) Proximal tubule

B) Thick ascending limb

C) Cortical collecting tubules

D) Bowman capsule

Patchy ischemic renal damage causes hypertension by increasing secretion of which hormone from ischemic nephrons?

A) Renin

B) Erythropoietin

C) Calcitriol

D) Insulin

In patchy renal damage, ischemic nephrons secrete renin and excrete less salt and water. How does angiotensin II worsen hypertension in surrounding normal nephrons?

A) Impairs sodium-water excretion

B) Increases glucose filtration

C) Blocks aldosterone secretion

D) Decreases tubular reabsorption

A patient excretes large amounts of glucose in urine despite normal blood glucose. Which tubular disorder is most likely?

A) Aminoaciduria

B) Renal glycosuria

C) Nephrotic syndrome

D) Uremia

Renal glycosuria occurs despite normal plasma glucose because which process is limited or absent?

A) Tubular glucose reabsorption

B) Glomerular protein filtration

C) Distal potassium secretion

D) Collecting duct water secretion

A patient has failure of renal tubular reabsorption of amino acids. Which disorder is being described?

A) Renal glycosuria

B) Aminoaciduria

C) Uremia

D) Nephrosclerosis

A patient has essential cystinuria with recurrent kidney stones. Which reabsorption defect directly causes stone formation?

A) Failed cystine reabsorption

B) Failed glucose filtration

C) Excess phosphate reabsorption

D) Excess urea secretion

In essential cystinuria, renal stones form because unreabsorbed cystine does what in urine?

A) Crystallizes

B) Binds albumin

C) Converts to glucose

D) Blocks aldosterone

A child has chronic failure of renal phosphate reabsorption, leading to low phosphate and impaired bone calcification. Which disorder and complication best match?

A) Fanconi syndrome; osteomalacia

B) Renal hypophosphatemia; rickets

C) Gitelman syndrome; tetany

D) Bartter syndrome; fractures

A patient has impaired tubular H+ secretion, continuous urinary sodium bicarbonate loss, and metabolic acidosis. Which disorder best fits?

A) Nephrogenic diabetes insipidus

B) Bartter syndrome

C) Renal tubular acidosis

D) Liddle syndrome

A patient makes large volumes of dilute urine because the kidneys do not respond to ADH. Which diagnosis is most likely?

A) Nephrogenic diabetes insipidus

B) Central diabetes insipidus

C) Fanconi syndrome

D) Renal glycosuria

A patient has a generalized renal tubular reabsorptive defect affecting transport of multiple substances. Which diagnosis best matches?

A) Bartter syndrome

B) Fanconi syndrome

C) Liddle syndrome

D) Gitelman syndrome

A patient has increased urinary loss of amino acids, glucose, and phosphate due to a broad tubular reabsorption defect. Which syndrome is most likely?

A) Gitelman syndrome

B) Bartter syndrome

C) Fanconi syndrome

D) Liddle syndrome

Fanconi syndrome from tubular injury especially affects proximal tubular cells. Why are these cells vulnerable?

A) They store renin granules

B) They filter plasma proteins

C) They form medullary gradients

D) They handle toxins and drugs

A patient has impaired Na+, Cl−, and K+ reabsorption in the loop of Henle. Which inherited tubular disorder best matches

A) Bartter syndrome

B) Liddle syndrome

C) Fanconi syndrome

D) Renal tubular acidosis

A patient has an autosomal-recessive defect in the thiazide-sensitive Na+-Cl− cotransporter of the distal tubule. Which diagnosis is most likely?

A) Liddle syndrome

B) Gitelman syndrome

C) Bartter syndrome

D) Fanconi syndrome

A patient has hypertension and metabolic alkalosis from an autosomal-dominant ENaC mutation causing increased sodium reabsorption in distal and collecting tubules. Which syndrome is most likely?

A) Bartter syndrome

B) Gitelman syndrome

C) Liddle syndrome

D) Fanconi syndrome

A patient with Liddle syndrome has expanded extracellular volume from excess sodium reabsorption. Which hormone pattern is expected?

A) High renin, high aldosterone

B) High renin, low aldosterone

C) Low renin, high aldosterone

D) Low renin, low aldosterone

Which diuretic treats Liddle syndrome by blocking excessive epithelial sodium channel activity?

A) Amiloride

B) Furosemide

C) Hydrochlorothiazide

D) Acetazolamide

A patient receives a kidney transplant. Which long-term therapy is required in almost all patients to prevent acute rejection and graft loss?

A) Chronic bicarbonate therapy

B) Immunosuppressive therapy

C) High-dose phosphate therapy

D) Lifelong heparin infusion

During dialysis, the concentration of urea is higher in the patient's blood plasma than in the dialyzing fluid. In which direction will the urea net diffuse?

A) From the dialyzing fluid into the plasma

B) From the plasma into the red blood cells

C) From the plasma into the dialyzing fluid

D) From the kidney tubules into the dialyzing fluid

At the start of dialysis, solute transfer is fastest and then slows over time. What explains this pattern?

A) Gradient greatest initially

B) Heparin blocks diffusion

C) EPO secretion increases

D) Hydrostatic pressure disappears

Blood entering an artificial kidney receives a small amount of medication to prevent clotting. Which medication is used?

A) Warfarin

B) Aspirin

C) Alteplase

D) Heparin

A dialyzer uses hydrostatic pressure to force water and solutes across its membrane. Which process is being described?

A) Diffusion or hemofiltration

B) Bulk flow or hemofiltration

C) Active tubular secretion

D) Osmotic countercurrent multiplication

A patient on dialysis develops anemia because the artificial kidney cannot replace one endocrine function of normal kidneys. Which substance is missing?

A) Erythropoietin

B) Angiotensin II

C) Aldosterone

D) Calcitonin