RENAL SYSTEM

?Which of the following is true about renal blood flow .1

a) The kidneys receive 12-15% of cardiac output
b) Is kept constant within a small range by
sympathetic
vasomotor tone
c) Measured by renal clearance of inulin
d) The dilution method is used for its measurement
e) Goes mainly to the renal cortex

:The characteristics of the Loop of Henle include .2

a) Descending limb is not permeable to water
b) Urine becomes more dilute as it reaches the tip of
the loop
c) Ascending limb is permeable to water
d) In thin ascending limb urea is actively transported
to interstitial fluid
e) Na is reabsorbed by Na-K ATPase in ascending
limb

:The following is true about the Vasta Recta .3

a) Descending vasta recta reabsorbs water from
the interstitial fluid
b) The descending capillaries loose Na and Urea
c) Plasma becomes hyperosmotic as it descends in
vasta recta
d) Ascending capillaries loose water to interstitial
fluid
e) They are responsible for the countercurrent
multiplier mechanism

:About Bicarbonate Reabsorption .4

a) Represents a high capacity low gradient system
b) Filtered bicarbonate/ day= 400 – 500 mmol/day
c) More HCO3 is absorbed in distal than proximal
tubules
-
d) PCT apical membrane is permeable to HCO3
e) H2CO3 is PCT lumen is catalyzed at brush border
by carbonic anhydrase to
-
give CO2 and HCO3
All of the following are true of ammonium production .5
:except
a) It is mainly a function of PCT
b) The source is mainly glutamine
c) It represents the main mechanism in renal
+
excretion of H
d) It is a low capacity high gradient system
e) It is increased when the urine pH is low

The functions of the renal proximal convoluted tubes .6

:include
a) Reabsorption of all bicarbonate filtered at the
glomerulus
b) Production of renin
c) Reaborption of 80% of filtered bicarbonate
d) Reabsorption of bicarbonate resulting in fixed acid
secretion
e) Hydrogen ion secretion by facilitated diffusion

:Titrable Acidity (TA) .7

a) Can be measured by titration against sodium
hydroxide to pH 7.4
b) Is a measure of H+ mainly buffered by ammonium
ions in the distal tubules
c) Is the same as the/ amion gap
d) Creatinine contributes to significant amounts to
TA
e) Ketoacids in diabetic acidosis do not increase TA

For those substances that are actively reabsorbed or .8

secreted, the highest limit of the amount that can be
:transported per unit time by the kidney tubules
a) Depends on the rate at which the transport
mechanism operates
b) Is directly related to the plasma concentration of
the substance
c) Depends on the tubular transport maximum
d) Is dependent upon tubular load
e) Depends on the GFR
If the clearance of Substance X is greater than the .9
:clearance on inulin, it is most likely that substance X is
a) Bound to tubular proteins
b) Bound to plasma proteins
c) Secreted
d) Reabsorbed
e) Neither secreted nor reabsorbed

Renin is produced and secreted from granules located in .10

:the
a) Macula densa
b) Mesangial cells
c) Intercalated cells
d) Afferent arteriole
e) Interstitial cells

The tonicity of urine as it enters the renal collecting duct .11

:is
a) Isotonic
b) Hypotonic or isotonic, but never hypertonic
c) Hypotonic
d) Hypertonic
e) Hypertonic or isotonic, but never hypotonic

:On assuming the upright posture, one would expect .12

a) Stimulation of the baroreceptore reflex
b) Increased pulmonary artery pressure
c) A decrease in pulse rate
d) Venodilation
e) An increase in renal blood flow

In a healthy adult man the glomerular filteration rate is .13

:expected to be
a) 225 ml/min
b) 325 ml/min
c) 125 ml/min
d) 25 ml/min
e) 180 ml/min

The following factors when increased, they will increase .14

:the glomerular filteration rate except
a) Renal blood flow
b) Afferent arteriolar diameter
c) Efferent arteriolar diameter
d) Permeability of glomerular membrane
e) Capillary surface area

A substance that is used to measure renal plasma flow .15

:should be
a) Bound to plasma proteins
b) Easily reabsorbed
c) Highly secreted
d) Metabolized by the body
e) Stored only in the kidney

:Renal blood flow is .16

a) Increased when renal sympathetic nerves are
stimulated
b) Autoregulated when mean arterial blood pressure
is between 60-180 mmHg
c) Measured by urea clearance
d) About 2 liters in a normal man
e) Decreased when the fluid flow at the site of the
macula densa is decreased

The following hormones can be formed by the kidney .17

:except
a) Erythropoietin
b) Angiotensin II
c) Prostaglandins
d) ADH
e) Calcitrol

Sodium reabsorption in the proximal tubules from the .18

:luminal surface is marked by all of the following except
a) Sodium glucose co-transporters
b) Sodium-hydrogen exchanger
c) Na-K pump
d) Solvent drag
e) Sodium amino acid transporters

:Glomerular filtration rate would be increased by .19

a) A decrease in afferent arteriolar pressure
b) A decrease in renal blood flow
c) A decrease in efferent arteriolar resistance
d) Decrease in the concentration of plasma proteins
e) Obstruction of ureters

Potassium secretion in the distal tubule will be increased .20

:if there is an increase in
a) Plasma (H+)
b) Plasma volume
c) Plasma sodium concentration
d) Plasma potassium concentration
e) Plasma calcium concentration

The following is true about glucose reabsorption in the .21

:renal tubules
a) Transport maximum is 80 mg/min
b) The transport maximum is dependent
on the amount of
glucose filtered
+
c) It is mainly a symport with K
d) It is reduced with metabolic inhibitors that reduce
the activity Na/K ATPase
e) About 50% of filtered glucose is reabsorbed

:Water reabsorption in the collecting duct .22

a) Is dependent on aldosterone
b) Is increased by ADH
c) Has the largest percentage of total water
reabsorbed
d) Is facilitated by sodium reabsorption
e) Independent of osmotic difference across the
tubules
The Glomerular Filteration Rate (GFR) can be .23
:calculated by all of the following except
a) PAH clearance
b) Creatinine clearance
c) Urea clearance
d) Inulin clearance
e) Formula using plasma creatinine concentration

:Ammonia produced by the kidneys comes mainly from .24

a) Glutamine
b) Glycine
c) Leucine
d) Alanine
e) B and D are correct

?Which of the following is NOT a function of the kidneys .25

a) Regulation of extracellular volume
b) Regulation of plasma glucose concentration
c) Regulation of arterial blood pressure
d) Excretion of end products of protein metabolism
e) Excretion of foreign chemicals (eg.
Pharamaceuticals, food additives, etc)

The transport of glucose across the luminal membrane in .26

:the proximal part of the renal tubule is
a) Through insulin dependent glucose transporters
b) Cannot take place against the concentration
gradient
c) Is not affected by Na+/K+ pump inhibitors
d) Is a co-transport with sodium
e) Is decreased in diabetes mellitus

:In a 70kg normal male, the GFR is .27

a) 25 ml/minute
b) 50 ml/minute
c) 125 ml/minute
d) 225 ml/minute
e) 250 ml/minute

The following contributes to the high osmolarity of the .28

:renal medulla
a) Low blood flow in the medulla
b) The very low rate of tubular flow in the medulla
c) The increase in the permeability of the collecting
ducts caused by ADH
d) Aldosterone
e) The sodium dependent organic substance
transporter

The restriction of protein to pass through the filtration .29

:membrane is due to
a) The size of the pores in the capillary wall
b) The size of the spaces between the cells of the
epithelial layer
c) The basement membrane
d) The positive charge on the membrane
e) The presence of the phagocytic mesangial cells

The following hormones act on the proximal tubules of .30

:the kidney
a) ADH
b) Aldosterone
c) 25 hydroxy cholecalciferol
d) Angiotensin II
e) Dihydrotestosterone

:The following decreases the GFR .31

a) Increased constriction of the afferent arteriole
b) Decrease in the pressure of the afferent arteriole
c) Decrease in concentration of plasma protein
d) Decreased hydrostatic pressure in Bowman's
capsule
e) Decrease in the radius of efferent arterioles

:The tubular fluid as it leaves the proximal tubules is .32

a) Hypotonic
b) Hypertonic
c) Has the same sodium concentration as the filtrate
 d) Has a volume that is 20% of the filtrate
e) Has very low inulin concentration following inulin
administration

The clearance of a substance was found to be less than .33

:that of inulin. This substance is
a) Not bound to plasma proteins
b) Actively reabsorbed
c) Secreted
d) Neither reabsorbed nor secreted
e) Secreted at a rate greater than reabsorbed

:High osmalarity of the extracellular fluid results in .34

a) Decreased thirst stimulation
b) Increased rennin secretion
c) Increased ADH secretion
d) Increased urine formation
e) Increased stimulation of macula densa cells

:The micturition reflex .35

a) Is integrated in the medulla
b) Efferent limb is parasympathetic
c) Can take place if the sacral spinal segments were
damaged
d) Is absent in children
e) Threshold is higher in males than females

:In the proximal tubules .36

a) 20% of filtered amino acid is reabsorbed
b) Sodium reabsorption is aldosterone dependent
c) Equal percentage of sodium and water is
reabsorbed
d) Potassium is mainly secreted
e) Calcium cannot be reabsorbed

:Renin secretion by the kidney is increased by increasing .37

a) Tubular fluid flow rate
b) Mean systemic blood pressure
c) Atrial natriuretic peptide
d) Renal sympathetic nerve activity
e) Discharge from baroreceptors

The segment of the nephron that contributes most to .38

:potassium excretion when dietary potassium is altered is
a) Proximal convulated tube
b) Descending limb of Henle's loop
c) Proximal straight tubule
d) Distal tubule
e) Thick ascending limb of Henle's loop

The ability of the kidney to excrete a concentrated urine .39

:will increase if
a) The permeability of the proximal tubules decreases
b) The rate of blood flow through the medulla
decreases
c) The rate of flow through the loop of Henle
increases
d) The activity of the Na-K pump in the loop of Henle
decreases
e) The permeability of the collecting duct to water
decreases

:Potassium excretion is enhanced by .40

a) An osmotic diuresis
b) Acute metabolic acidosis
c) A low aldosterone level
d) Decreased tubular flow rate
e) Ingestion of a low-potassium diet

Which of the following decreases the glomerular .41

:filteration rate
a) An increase in Bowman's capsule pressure
b) A decrease in glomerular capillary hydrostatic
pressure
c) An increase in tubular fluid hydrostatic pressure
d) A decrease in efferent arteriolar resistance
e) A decrease in plasma colloid pressure
:In renal hemodynamics .42
a) Renal plasma flow is measured by clearance of
creatinine
b) Urea clearance provides a close estimation of GFR
c) If the renal clearance of a substance exceeds that of
inulin it must be
secreted into the tubules
d) A substance that has a clearance less than that of
inulin must be reabsorbed
by the tubules
e) Inulin clearance rises with an increase in inulin
plasma level

Which of the following substances is more concentrated .43

:at the end of the proximal tubule than at the beginning
a) Glucose
b) Potassium
c) Bicarbonate
d) Creatinine
e) Sodium

The bicarbonate: carbonic acid ration of the plasma that .44

:corresponds to pH 7.4 equals
a) 1:1
b) 5:1
c) 10:1
d) 15:1
e) 20:1

The macula densa in the juxtaglomerular apparatus .45

:regulate
a) Plasma pH
b) Glomerular fileration rate
c) Reabsorption of potassium by the proximal tubules
d) Red blood cell production
e) Phosphate excretion