Kidney

Acid base balance ●

Water and electrolyte balance ●

Function of renal tubules ●

GFR and plasma clearance ●

Renal failure ●

Renal blood flow regulation ●

Functional anatomy of the kidney, juxtaglomarular apparatus and ●

mechanism of urine formation

Physiology of ureter and urinary bladder ●

Acid-base balance:
Renal acid secretion is independent of:
K )a
Intracellular CO2 ) b
Carbonic anhydrase level )c
Aldosterone ) d
ADH )e

The most important buffer in intracellular fluid is:

Bicarbonate )a
Ammonia ) b
Phosphate )c
Albumin ) d
Myoglobin )e
 The secretion of H+ in the proximal tubule is associated with :
secretion of potassium. )a
secretion of sodium. ) b
reabsorption of calcium. )c
reabsorption of bicarbonate. ) d
reabsorption of phosphate. )e

The principle mechanism of acid secretion by intercalated cell is :

Na-H exchanger. )a
H ATPase. ) b
Na - K - 2 CL transporter. )c
H- Ca exchanger. ) d
Na - K ATPase. )e

Metabolic acidosis is caused by:

Hypoaldosteronism. )a
Hyperventilation. ) b
Hypokalemia. )c
Hypovolemia. ) d
Hypercalcemia. )e

Which of the following best describes the changes in uncompensated respiratory alkalosis ?
Low pH, HCO3 and PaCO2 )a
High pH, low HCO3 and PaCO2 ) b
Low pH and HCO3 and normal PaCO2 )c
High pH, low HCO3 and normal PaCO2 ) d
Low pH, high HCO3 and normal PaCO2 )e

A patient with these laboratory values pH 7.32, pCO2 31, HCO3 20mmol/L represent is
likely to have
Primary metabolic acidosis. ) a
Primary respiratory alkalosis. ) b
Primary respiratory acidosis. ) c
Mixed respiratory acidosis & metabolic acidosis ) d
Partially compensated metabolic acidosis )e

Water and electrolyte balance.

Which of the following is most permeable to water:

Thin ascending limb of the loop of Henle )a
 Distal convoluted tubule ) b
Thin descending limb of the loop of Henle )c
Cortical portion of the collecting tubule ) d
Thick ascending loop of Henle )e
The diluting segment of the nephron is:
Descending loop of Henle. )a
Proximal convoluted tubule. ) b
The initial part of distal convoluted tubule. )c
Collecting duct. ) d
Thick ascending loop of Henle. )e

Most of the filtered water is reabsorbed in:

Proximal convoluted tubule ) a
Descending loop of Henle ) b
Ascending loop of Henle ) c
Distal convoluted tubule ) d
Collecting duct )e

Regarding water handling by the nephron:

At least 90% is reabsorbed. )a
50% of the filtered water is reabsorbed by the end of the PCT ) b
the first part of the DCT is impermeable to water. ) c
water tends to recirculate in the medullary pyramids ) d
decreasing the tonicity in the medulla has no effect on water excretion )e

Which of the following tend to decrease potassium secretion by the cortical collecting
tubule?
Increased plasma potassium concentration )a
A diuretic that decreases proximal tubule sodium reabsorption ) b
A diuretic that inhibits the action of aldosterone (e.g., spironolactone) )c
Acute alkalosis ) d
High sodium intake )e

Which of the following leads to hyponatremia?

Liver cirrhosis )a
Renal failure )b
Conn’s disease )c
Cushing syndrome )d
Excessive vomiting )e

Function of renal tubules.

 Substance completely reabsorbed by PCT are:
Amino acid. )a
Sodium. ) b
Water. )c
Urea. ) d
Potassium. )e

Glucose reabsorption in the kidney is:

A passive process )a
Closely regulated with K ) b
By secondary active transport with sodium at the luminal border. )c
Occurs predominantly in the distal tubule ) d
Is the same in all nephrons )e

Regarding tubuloglomerular feedback, which is true?

tends to maintain renal blood flow. )a
the sensor is JG cell. ) b
operates via contraction of the mesangial cells. )c
acts to reduce GFR if the flow rate in the ascending loop of Henle falls, ) d
decrease GFR is modulated by contraction of efferent & dilation of the afferent )e
arteriole

With regard to the effects of hormones on the renal tubules, which is correct
Aldosterone increases K reabsorption from the distal tubule. )a
Angiotensin II decreases H secretion from the proximal tubule ) b
ADH increases water reabsorption in the PCT )c
ANP decreases Na reabsorption from the PCT ) d
PTH increases PO4 reabsorption in the PCT )e

In the loop of Henle:

Descending limb is impermeable to water )a
Thin ascending limb is permeable to water ) b
Thick ascending limb is permeable to water )c
Fluid in the descending limb becomes hypotonic ) d
Fluid at the upper end of the ascending limb is hypotonic. )e

The amount of potassium excreted by the kidney decreases if:

plasma level of potassium increase. )a
circulating aldosterone level increase. ) b
dietary intake of potassium increase. )c
+
Na reabsorption by the distal nephron decreases. ) d
hydrogen ion excretion is decreased. )e
 In the distal tubules, sodium reabsorption is increased directly by increased :
parasympathetic nerve stimulation of the kidney. )a
atrial natriuretic peptide hormone secretion. ) b
antidiuretic hormone secretion. )c
aldosterone hormone secretion. ) d
parathyroid hormone secretion. )e

The filtrate will be isotonic to plasma in the :

descending limb of the loop of Henle. )a
ascending limb of the loop of Henle. ) b
proximal convoluted tubule. )c
medullary collecting tubule. ) d
renal pelvis. )e

Regarding the regulation of K+ excretion, which of the following is true:

K+ is reabsorbed and Na+ secreted in DCT. )a
K+ secretion is increased in conditions of alkalosis. ) b
Hypoaldosteronism produces increase K+ secretion. )c
K excretion is decreased when H+ secretion is decreased. ) d
+

Increased Na+ delivery to the collecting ducts leads to increased K+ reabsorption. )e

In the kidney, potassium secretion occurs in:

Proximal convoluted tubule )a
Loop of Henle ) b
Distal convoluted tubule )c
Collecting ducts ) d
Potassium is not secreted into renal tubules )e

GFR and plasma clearance.

Which of the following is most likely to cause an increase in the glomerular filtration rate?
Contraction of mesangial cells. )a
Blockage of the ureter. ) b
Decrease renal blood flow. )c
V.D of afferent arterioles ) d
V.D of efferent arterioles. )e

What is the GFR (ml/min) if the urinary concentration of inulin is 40mg/mL, the urinary flow
rate is 60mL/h and the plasma concentration is 0.4m g/ml
0.6 )a
2.6 ) b
100 )c
 160 ) d
1000 )e

What is the clearance of a substance when its concentration in plasma is 1mg/mL , its
concentration in urine is 10mg/mL and urine flow is 2mL/min
2mL/min )a
10mL/min ) b
20mL/min )c
200mL/min ) d
clearance cannot be determined from the information given )e

Which of the following substances has the lowest plasma clearance:

Urea. )a
Glucose. ) b
Para amino hippuric acid. )c
Inulin. ) d
Creatinin. )e

Glomerular filtration rate would be increased by :

constriction of the afferent arteriole. )a
dilatation of the efferent arteriole. ) b
compression of the renal capsule. )c
a decrease in the concentration of plasma protein. ) d
a decrease in renal blood flow )e

Renal failure.
Which one of the following will be observed in a patient with chronic renal failure ?
An increase in excretion of sodium. )a
An increase in the free water excretion. ) b
An increase in the anion gap )c
A decrease in the excretion of creatinine ) d
An increase in the net acid excretion. )e

Which one of the following signs of renal failure is caused by the loss of a hormone
produced by the kidney?
Edema )a
Hypertension ) b
Anemia)c
Uremia ) d
Acidosis )e

Which of the following changes would you expect to find in a patient who developed acute
renal failure?
 Increased plasma bicarbonate concentration )a
Metabolic acidosis ) b
Decreased plasma potassium concentration ) c
Decreased blood urea nitrogen concentration ) d
Decreased hydrostatic pressure in Bowman’s capsule )e

Prerenal acute renal failure is caused by

Anaphylactic shock. )a
Acute glomerulonephritis. ) b
Acute tubular necrosis. ) c
Acute pyelonephritis. ) d
Acute allergic interstitial nephritis. )e

In chronic renal failure

Glomerular filtration rate increased. )a
Water excretion is increased. ) b
Blood PCO2 tends to be high. ) c
Ionized calcium levels in the blood tend to be high. ) d
Anemia is common. )e

Renal blood flow regulation

Normal effective renal plasma flow is approximately:
300 ml/min )a
600 ml/min ) b
900 ml/min )c
1200 ml/min ) d
1500 ml/min )e

Regarding renal blood flow:

Glomerular capillaries drain into peritubular veins )a

Renal autoregulation is prevented by denervation )b
Is slower in cortex than medulla. )c
Kidney’s receive approximately 15% CO )d
Angiotensin II causes greater constriction of the efferent than the afferent arteriole )e

Which of the following effects on the renal blood flow is true?

Increased by noradrenalin ) a
Increased by high protein diet ) b
Increased by angiotensin II ) c
Decreased by Acetylcholine ) d
Decreased by atrial natriuretic peptide. )e
 Regarding renal blood flow:
Glomerular capillaries drain into peritubular veins. )a
Renal autoregulation is prevented by denervation. ) b
Oxygen extraction is higher in the cortex than the medulla. )c
Kidney’s receive approximately 15% of COP. ) d
Angiotensin II causes greater constriction of the efferent than the afferent arteriole )e

Which of the following increases renal blood flow?

High protein diet )a
Sympathetic stimulation ) b
Angiotensin II ) c
Noradrenaline ) d
Exercise )e
Functional anatomy of the kidney, juxtaglomarular
apparatus and mechanism of urine formation:

Concerning the functional anatomy of the kidney, which of the following is correct: ) 1
The cortical nephrons constitute about 15% of total number of nephrons )a
The glomerulus of the juxtamedullary nephrons are present in the outer cortex ) b
The cortical nephrons have long loop of Henle that reach renal papilla )c
The vasa recta supply loops of Henle of cortical nephrons ) d
The macula densa forms a part of the juxtaglomerular apparatus )e

Regarding the juxtaglomerular apparatus, which of the following is true? ) 2

It contains macula densa cells in the wall of afferent and efferent arterioles. )a
It contains juxtaglomerular cells which detect change in NaCl load. ) b
It acts as a sphincter for the distal convoluted tubule. )c
It responds to the decrease in NaCl load by vasodilatation of afferent arteriole. ) d
It regulates the glomerular filtration rate via contraction of the mesangial cells. )e

Regarding the function of the juxtaglomerular apparatus, which of the following is ) 3

correct:
It filters fluids from glomerular capillaries )a
It reabsorbs vital solutes from glomerulus ) b
It actively secretes solutes into glomerulus )c
It acts as a sphincter for distal convoluted tubule ) d
It has an important role in autoregulation of GFR )e

Regarding the juxtamedullary nephrons, which of the following is true? ) 4

It constitutes 30% of nephrons in the human kidney. )a
Their glomeruli lie in the outer cortex. ) b
 Have vasa recta that act as counter-current multiplier system. )c
Are responsible for creating the hyperosmolarity of the medullary interstitium. ) d
Have proximal convoluted tubules, which extend into the renal medulla )e

Stimulation of sympathetic supply to the kidney causes: ) 5

Increase in GFR. )a
Vasodilatation of afferent arteriole. ) b
Vasodilatation of efferent arteriole. )c
Stimulation of renin secretion. ) d
Vasodilatation of afferent arteriole )e

Regarding the renal autoregulation, which of the following is correct: ) 6

The macula densa cells sense change in afferent arteriolar pressure )a
Decrease in GFR results in efferent arteriolar V.D ) b
Decrease in GFR results in an increase in renin secretion from the juxtaglomerular )c
cells
Decreased NaCl to macula densa results in dilation of the efferent arteriole ) d
Decreased GFR decreases tubular reabsorption. )e

The thin ascending limb of loop of Henle is: ) 7

Relatively impermeable to water. ) a
Secretes Na+ to luminal fluid actively ) b
Relatively impermeable to Na+. ) c
Reabsorbs Na+ from luminal fluid actively ) d
Relatively impermeable to both Na+ and water. )e

About the loop of Henle of the juxtamedullary nephrons, which of the following ) 8
statements is FALSE?
Thick ascending limb has Na/K/2Cl active transport. )a
Descending limb is highly permeable to water. ) b
Osmolarity is greatest at the tip. )c
The fluid leaving ascending limb is hypertonic. ) d
The ascending limb is impermeable to water. )e
A decrease in the concentration of NaCl in the intraluminal fluid causes the ) 9
juxtaglomerular apparatus to release:
ADH )a
Aldosterone ) b
Adenosine )c
Renin ) d
Angiotensinogen )e

The effect of antidiuretic hormone (ADH) on the kidney is to increase: )10

 the permeability of the distal nephron to water. )a
the excretion of Na+ )b
the excretion of water )c
medullary hyperosmolarity. )d
the diameter of the renal artery. )e

ADH will be released from the posterior pituitary when there is a decrease in: )11
Plasma Na+ concentration )a
Plasma volume ) b
+
Plasma K concentration )c
Plasma pH ) d
2+
Plasma Ca concentration )e

Physiology of ureter and urinary bladder:

Regarding micturition in normal person, which of the following is correct: ) 1
It is initiated by the pelvic nerves )a
Its center is located in the lumbar portion of the spinal cord ) b
It is initiated at a volume of 600mL )c
It is significantly affected by sympathetic nerves ) d
It is not facilitated at the level of the brain stem )e

Concerning micturition in the normal bladder, which of the following is correct: ) 2

It becomes obligatory when intra-vesical volume exceeds 400 ml. )a
Its center is in the lumbar segments of the spinal cord ) b
Sense of blabber fullness starts when the intra-vesical volume is 600 ml. )c
Micturition reflex is a spinal reflex. ) d
It is pure reflex without voluntary control in adults )e

Regarding evacuation of the bladder, which of the following is correct: ) 3

Contraction of the trigone is mainly responsible for emptying of the bladder )a
It depends on the integrity of a sacral spinal reflex arc. ) b
It occurs due to activation of the sympathetic nerves to the bladder. )c
It is due to activation of somatic innervation to the detrusor muscle. ) d
The relationship between bladder volume and intravesical pressure has a linear )e
relationship.

The micturition becomes obligatory (can’t be suppressed) when the urine volume is: ) 4
150 – 300 ml. )a
300 – 400 ml ) b
 More than 700 ml. )c
600 – 700 ml. ) d
400 – 600 ml )e

Which of the following conditions leads to automatic micturition: ) 5

Destruction of afferent nerve from the bladder. )a
Stage of recovery in complete transection of spinal cord above the sacral region ) b
Destruction of efferent nerves to the bladder )c
Stage of failure in complete transection of spinal cord above the sacral region ) d
Destruction of bladder innervation, both afferent and efferent nerves )e