A.

inulin is a good GFR marker because it is freely

RENAL PHYSIOLOGY MCQ filtered in the glomeruli and it is not reabsorbed, or
You have 33 questions in this exam. secreted, by the renal tubules
B. inulin concentration in the proximal tubule's lumen
increases progressively as water is reabsorbed in the
1. Concerning renal ontogeny: segment of the nephron
A. the pronephros is a transitory kidney present during C. PAH (para-amino-hippuric acid)is a good marker of
the embryonic life of all vertebrates renal plasma flow because it is freely filtered and is
B. the mesonephros is a functional yet transitory kidney rapidly secreted by the proximal tubule; as a result
during intrauterine life of mammals very little PAH reaches the renal vein
C. a main morphological difference between the D. A and C are correct
metanephros (permanent kidney) and the E. all are correct
mesonephros, is the development of the loop of Henle
D. A and C are correct
E. all are correct
Show answer

Correct Answer: E
Show answer

Correct Answer: E

4. Concerning the functional histology of the kidney:

A. the superficial nephrons have short loops of Henle;
thus, they have a low capacity to reabsorb salt (salt
2. The main barrier precluding the free passage of losing nephrons)
albumin across the glomerular capillary walls is formed B. the deep nephrons have long loops of Henle; thus
by: they have a high capacity to reabsorb salt and water
A. the fenestrated glomerular endothelium C. in dehydration, the blood flow to deep nephrons
B. anionic proteoglycan clusters within the glomerular tends to increase
basement membrane D. A and C are correct
C. the filtration slits in between visceral epithelial cells E. all are correct
(podocytes)
D. none are correct
E. all are correct
Show answer

Correct Answer: E
Show answer

Correct Answer: B

5. The following factor(s) tend(s) to INCREASE the rate

of glomerular filtration (GFR):
A. decreased albumin concentration in plasma
3. Concerning the measurement of renal plasma flow B. vasodilation of the afferent (pre-glomerular)
(RPF) and glomerular filtration rate(GFR): arteriole
C. vasoconstriction of the efferent (post-glomerular)
arteriole Correct Answer: D
D. A and C are correct
E. all are correct

Show answer
8. Concerning the function of the proximal tubule:
Correct Answer: E A. most of the glomerular ultrafiltrate is reabsorbed in
the proximal tubule in an iso-osmotic fashion.
B. the concentration of PAH doesn't change much along
the length of the proximal tubule
C. under normal conditions, most of the filtered
glucose and bicarbonate are reabsorbed in the proximal
tubule
6. The following factor(s) tend(s) to INCREASE the rate D. A and C are correct
of glomerular filtration (GFR): E. all are correct
A. sympathetic stimulation (norepinephrine) of the
afferent arteriole
B. obstruction of the renal tubules, ureter or urethra
C. vasodilation of the efferent arteriole Show answer
D. none are correct
E. all are correct Correct Answer: D

Show answer

Correct Answer: D
9. Concerning metabolic energy (at production) for
renal transport:
A. the main substrate for proximal tubule is glucose
B. the cortical PO2 is about 10 mmHg
C. the papillary tissues normally generate ATP via
oxidative metabolism
7. Concerning the function of the glomerular mesangial D. A and C are correct
cells: E. all are correct
A. mesangial cells can contract and cause some
decrease in total glomerular filtration area
B. mesangial cells play a major role in systemic
angiotensin II production Show answer
C. mesangial cells are phagocytic and play a role in the
clearing of proteins and immune-deposits entrapped in Correct Answer: B
the mesangium
D. A and C are correct
E. all are correct

Show answer 10. Concerning water reabsorption by the proximal

tubule: generally hypotonic with respect to plasma
A. main driving forces for water reabsorption in the C. in the absence of ADH, urine is not concentrated
proximal tubule are solute uptake and oncotic pressure along the length of the collecting duct
in peritubular capillaries D. A and C are correct
B. a significant amount of water uptake in the proximal E. all are correct
tubule is dependent on sodium uptake by the Na/H
antiports present in their luminal membrane
C. aquaporine-I (water channels) are abundantly
present in the cellular membranes of proximal tubule Show answer
cells
D. A and C are correct Correct Answer: E
E. all are correct

Show answer

Correct Answer: E 13. Concerning the transport of urea in the different

segments of the nephron:
A. main tubular urea sound is the plasma via the
glomerular ultrafiltrate
B. the urea concentration in the lumen of the cortical
collecting ducts increases as water is reabsorbed
C. the thin loop of Henle and the medullary collecting
11. Concerning the THICK loop of Henle: duct are permeable to urea
A. the thick segment of the loop has a very powerful D. A and C are correct
Na/K/2Cl pump that moves salt from the tubular E. all are correct
lumen into the peritubular space
B. water and urea move freely across the epithelium of
the thick ascending segment of the loop
C. following the administration of furosemide (lasix) Show answer
large volumes of diluted urine are produced
D. A and C are correct Correct Answer: E
E. all are correct

Show answer

Correct Answer: D 14. Concerning the macula densa:

A. the macula densa senses the total amount of sodium
chloride (sodium chloride concentration times volume)
of tubular urine being delivered by the loop of Henle
into the distal convoluted tubule
B. if the delivery of sodium chloride is lower than
normal the macula densa signals the afferent arteriole
12. Concerning urinary concentration: (pre-glomerular) to release renin
A. the thick loop of Henle generates most of the C. renin release causes intravascular angiotensin
osmotic gradient needed for reabsorption of water in formation and indirectly aldosterone release
the collecting duct D. A and C are correct
B. the tubular urine that reaches the collecting duct is E. all are correct
Show answer

Correct Answer: E
17. Within eight hours following large intravenous
aldosterone infusion the following is(are)clinically
evident:
A. unchanged sodium reabsorption by the collecting
duct
B. decreased potassium and hydrogen excretion in
15. Concerning angiotensin II: urine
A. the exocrine renin-angiotensin-aldosterone system C. hypernatremia (high sodium in plasma),
includes angiotensinogen production by the liver, renin hypokalemia (low potassium in plasma) and alkalosis
secretion by the juxtaglomerular apparatus and (low hydrogen ion activity in plasma)
angiotensin-converting enzyme present at the luminal D. A and C are correct
surface of endothelial cells E. all are correct
B. aldosterone, but not AII, stimulate thirst and salt
appetite
C. angiotensin II induces marked increases in sodium
reabsorption by the loop of Henle and the collecting Show answer
duct
D. A and C are correct Correct Answer: C
E. all are correct

Show answer

Correct Answer: A 18. Concerning arterial blood pressure regulation:

A. prostaglandins and dopamine and bradykinin are
vasodilators
B. ADH, angiotensin II and epinephrine are
vasoconstrictors
C. the vasodilator/vasoconstrictor ratio that regulates
total peripheral resistance plus cardiac stroke volume
16. Within an hour following intravenous angiotensin II and heart rate are determinants of blood pressure
infusion, the following is(are) clinically evident: D. all are correct
A. increased sodium uptake in the proximal tubular E. none are correct
epithelium
B. systemic vasoconstriction
C. increased plasma aldosterone
D. A and C are correct Show answer
E. all are correct
Correct Answer: E

Show answer

Correct Answer: E
 Show answer
19. Concerning cell volume regulation:
A. the Na/H and Cl/HCO3 antiports are involved in Correct Answer: C
hypertonic cell volume regulation
B. rapid efflux of cytoplasmic water is followed by
volume regulatory KCL efflux
C. KCL efflux is involved in hypotonic cell volume
regulation
D. A and C are correct
E. all are correct 22. Atrial natriuretic peptide
A. Increased H2O reabsorption
B. Decreased sodium reabsorption
C. AII formation
Show answer D. Increased sodium reabsorption
E. Decreased phosphate reabsorption
Correct Answer: D

Show answer

Correct Answer: B

20. Intravenous administration of 1.5 liters of isotonic

Ringer's solution to a healthy adult could cause:
A. increased cardiac output and renal blood flow
B. increased GFR
C. increased atrial natriuretic peptide and decreased
renin in plasma 23. ADH
D. A and C are correct A. Increased H2O reabsorption
E. all are correct B. Decreased sodium reabsorption
C. AII formation
D. Increased sodium reabsorption
E. Decreased phosphate reabsorption
Show answer

Correct Answer: E
Show answer

Correct Answer: A

21. Renin
A. Increased H2O reabsorption
B. Decreased sodium reabsorption
C. AII formation 24. AII
D. Increased sodium reabsorption A. Increased H2O reabsorption
E. Decreased phosphate reabsorption B. Decreased sodium reabsorption
C. AII formation
D. Increased sodium reabsorption
E. Decreased phosphate reabsorption
 27. All of the following occur within one hour of eating
a large acid load EXCEPT:
A. the acid load is immediately buffered by
Show answer intracellular proteins and phosphates as well as
extracellular bicarbonate
Correct Answer: D B. the lungs will begin eliminating CO2 generated as a
result of the acid load
C. the kidney will eliminate all the nonvolatile acids
and regenerate bicarbonate to replace all the
bicarbonate used in buffering
D. hemoglobin will buffer some of the protons

25. PTH
A. Increased H2O reabsorption
B. Decreased sodium reabsorption Show answer
C. AII formation
D. Increased sodium reabsorption Correct Answer: C
E. Decreased phosphate reabsorption

Show answer

Correct Answer: E 28. If the pH is 7.60 (H+ concentration = 25 nEq/L) and

the pCO2 is 40 mmHg, what is the HCO3-
concentration (in mEq/liter).
A. 10
B. 20
C. 30
D. 40
26. Which one of the following is correct about
nonvolatile acids.
A. they are not essential to eliminate from the body
B. we generate much greater amounts of nonvolatile Show answer
than volatile acids
C. they are fully buffered by bone Correct Answer: D
D. they are products of intermediary metabolism and
protein degradation
E. they are eliminated by the lungs

Show answer 29. A patient takes a drug overdose and becomes

comatose. His blood pCO2 was 40 mmHg ten minutes
Correct Answer: D ago, but you discover it is now 80 mmHg. Which one of
the following statements about this patient is correct.
A. the pH of his CSF is likely to fall more slowly than
the pH of his blood
B. the pH of his blood is likely to fall more slowly than
the pH of his CSF
C. the pH of the blood and CSF will not change because
he will rapidly eliminate bicarbonate in the urine in
response to the rise in pCO2 Correct Answer: A
D. the pH of the blood and CSF will change to a similar
degree in this time period

Show answer
32. Renal ammonium ion excretion is increased by
Correct Answer: B aldosterone, elevated blood pCO2 and acidemia
A. true
B. false

Show answer
30. Which one of the following statements is true about
the proximal tubule. Correct Answer: A
A. the Na+/K+ ATPase drives sodium into the cell from
the urine side of the tubule
B. Na+/H+ exchange is largely the mechanism by which
hydrogen ion secretion occurs
C. bicarbonate reabsorption is independent of carbonic
anhydrase activity
D. the pH in the lumen of the proximal tubule can 33. Which one of the following statements is correct
reach as low as about 5.0 with regard to net collecting duct hydrogen ion
secretion.
A. it is decreased by increased renal production of
ammonia
Show answer B. it is increased by increased reabsorption of sodium
through the apical sodium channel
Correct Answer: B C. it is not affected by the presence or absence of
titratable acids
D. aldosterone does not modify collecting duct
hydrogen ion secretion

31. A patient ingests antifreeze and needs to eliminate Show answer

the ingested acid. Renal elimination of the protons in
this excess acid is primarily accomplished by which of Correct Answer: B
the following mechanisms.
A. increased urinary ammonium excretion Questions
B. increased urinary excretion of phosphates Major Exam #5 -- Renal Physiology
C. hyperventilation (24 Questions)
D. increased urinary free hydrogen ion concentration
1. For those substances that are actively
E. increased urinary sulfate excretion
reabsorbed, the maximal amount that can be
transported per unit time by the kidney tubules:
A. depends on the maximum rate at which the
Show answer transport mechanism itself operates
B. is directly related to the plasma concentration 7. About 4 to 6 days after you place a normal
of the substance person on a low-sodium diet, which of the
C. is termed the tubular transport maximum following will be observed?
D. is dependent upon tubular load A. plasma renin and aldosterone are below
E. A and C are correct. normal
2. If the clearance of Substance X is greater than B. plasma renin and aldosterone are above normal
the clearance of inulin, it is most likely that C. plasma sodium concentration is below normal
Substance X is: D. plasma sodium concentration is normal
A. bound to tubular proteins E. B and D are correct.
B. bound to plasma proteins 8. A 100 kg man has a plasma osmolarity of 300
C. secreted mOsM (milliosmolar). After he drinks 2 liters of
D. reabsorbed water (and before any fluid losses) his steady-state
E. neither secreted nor reabsorbed plasma osmolarity would be approximately:
3. Co-transport of glucose: A. 270 mOsM
A. is equivalent to a uniport for glucose B. 280 mOsM
B. will not be affected if the Na+/K+ pump is C. 290 mOsM
blocked D. 300 mOsM
C. cannot move glucose against its concentration E. 321 mOsM
gradient 9. The normal human glomerular filtration rate
D. is equivalent to an antiproton (GFR) is approximately (in mL/min):
E. depends on the interaction of Na+ with the A. 25
glucose carrier B. 50
4. The plasma concentration at which a particular C. 125
substance begins to appear in the urine is the: D. 300
A. transport maximum (Tm) E. 500
B. fractional excretion 10. Which of the following statements is/are
C. filtered load correct?
D. renal threshold A. Filtration fraction equals glomerular filtration
E. titration point rate divided by renal plasma flow.
5. The volume of plasma needed each minute to B. Tubular maximum secretion has a finite upper
supply a substance at the rate at which it is limit, though it exhibits a phenomenon analogous
excreted in the urine is known as the: to the threshold phenomenon for reabsorption.
A. diffusion constant of the substance C. Clearance ratio equals renal clearance of one
B. clearance of the substance substance divided by the clearance of another
C. extraction ratio of the substance substance.
D. tubular mass of the substance D. Effective renal plasma flow is the volume of
E. filtration rate of the substance plasma flow supplied to juxtamedullary
6. Renin is produced and secreted from granules nephrons.
located in the: E. A, B, and C are correct.
A. macula densa 11. The renal "countercurrent" mechanism is
B. mesangial cells dependent upon the anatomic relationship
C. intercalated cells between:
D. afferent arteriole A. the distal tubule and the macula denza
E. interstitial cells B. the loop of Henle and the macula denza
C. the loop of Henle and the vasa recta
 D. the glomerulus and the afferent and efferent A. isotonic
arterioles B. hypotonic or isotonic, but never hypertonic
E. the glomerulus and the proximal tubule C. hypotonic
12. If renal perfusion pressure does not change, D. hypertonic
which of the following changes in afferent and E. hypertonic or isotonic, but never hypotonic
efferent arteriolar resistance would result in an 16. Which of the following might you expect to
increase in renal blood flow but no change in find associated with chronic renal failure?
filtration fraction? A. elevated packed cell volume (hematocrit)
B. abnormally low plasma creatinine
Afferent arteriolar concentration
Efferent arteriolar resistance
C. decreased bone density
resistance
D. lower than normal PTH (parathyroid hormone)
A unchanged decreased
concentration
B decreased unchanged E. None of the above is correct.
C increased unchanged 17. The vasa recta:
A. are the straight portions of the proximal
D decreased decreased
tubules, found just proximal to the loops of Henle
E increased increased B. extend from the efferent arterioles of the
13. An increase in the osmolality of the superficial cortical nephrons
extracellular fluid will: C. are the microvilli found on the cells of the
A. stimulate the volume and osmoreceptors, and macula densa
stimulate ADH secretion D. comprise the capillary network found in the
B. stimulate the volume and osmoreceptors, and medulla of the kidney
inhibit ADH secretion E. are the small straight segments of afferent
C. inhibit the volume and osmoreceptors, and arterioles found directly next to the macula densa
stimulate ADH secretion 18. The loops of Henle of the outer cortical
D. inhibit the volume and osmoreceptors, and nephrons:
inhibit ADH secretion A. are functionally unimportant in the renal
E. cause no change in ADH secretion conservation of sodium and water
14. Polyuria (diuresis) occurs in a diabetic patient B. do not contribute to the medullary osmotic
who has a GFR = 120 mL/min and a blood sugar = gradient
350 mg/dL. This is indicative of: C. do not participate in the urinary diluting
A. losses of water and sodium which could be mechanism
prevented by administration of antidiuretic D. do not play any important role in overall renal
hormone (ADH) and an aldosterone-like function and are simply unimportant vestiges of
mineralocorticoid evolutionary development
B. diuresis due to reduced active transport of E. A and C are correct.
sodium out of the tubule because of diminished 19. Ammonia produced by the kidneys comes
+ +
activity of the Na /K ATPase mainly from:
C. a cellular and extracellular over-hydration due A. glutamine
to water retention, caused by the glucose B. glycine
D. an osmotic diuresis due to glucosuria, in which C. leucine
water loss will exceed "salt" loss D. alanine
E. B and D are correct. E. B and D are correct.
15. The tonicity of the urine as it enters the renal 20. Glomerular filtration produces an ultrafiltrate
collecting duct is: of plasma:
A. in which the concentration of electrolytes is 1-E
equal to plasma 2-C
B. in which the concentration of protein is equal to 3-E
plasma 4-D
C. containing only those substances which must 5-B
be eliminated in the urine
D. A and B are correct. 6-D
E. B and C are correct. 7-E
21. Which of the following is NOT a function of 8-C
the kidneys? 9-C
A. regulation of extracellular volume 10 - E
B. regulation of plasma glucose concentration
C. regulation of arterial blood pressure 11 - C
D. excretion of the end products of protein 12 - B
metabolism 13 - A
E. excretion of foreign chemicals (e.g. 14 - D
pharmaceuticals, food additives, etc.) 15 - B
22. Which of the following does NOT contribute to
titratable acid when found in the urine? 16 - C
A. H2PO4- 17 - D
B. lactic acid 18 - B
C. beta-hydroxybutyric acid 19 - A
D. acetoacetic acid 20 - A
E. NH4+
23. Which of the following is NOT a function of 21 - B
the kidneys? 22 - E
A. regulation of extracellular osmolality 23 - D
B. regulation of acid-base balance 24 - A
C. excretion of end-products of muscle
metabolism 1. The term "renal autoregulation" refers in part to
D. activation of antidiuretic hormone the fact that
E. activation of vitamin D A. the kidney does not require blood flow to
24. Which of the following does NOT contribute to sustain its active transport
the formation of maximally concentrated urine? B. the kidney contains baroreceptors (pressure
A. active NaCl transport in the proximal receptors) that contribute to the regulation of
convoluted tubule cardiac output
B. active NaCl transport in the thick ascending C. renal blood flow is relatively constant over a
limb of the loop of Henle wide range of systemic arterial pressures
C. impermeability of the thick ascending limb of D. renal blood flow is not affected by activation of
the loop of Henle to water the sympathetic nerves that innervate the kidney
D. high water permeability of the collecting duct E. a combination of both C and D above
due to presence of ADH 2. The nerves that innervate the kidney are
E. presence of urea in the inner medullary essential for regulating which of the following?
interstitium A. Na-K-ATPase active transport pump rate
B. renal autoregulation of blood flow
Answer Key C. urine volume and tonicity (osmolality)
D. all of the above B. concentration of ADH (antidiuretic hormone) in
E. none of the above the blood
3. Which of the following would be expected to C. osmotic pressure developed by plasma proteins
cause renal inulin (or creatinine) clearance to in the proximal tubule
increase? D. active transport of water molecules by the
A. dilation of the afferent arteriole proximal tubule cells
B. dilation of the efferent arteriole E. passive filtration due to the high hydrostatic
C. constriction of the afferent arteriole pressure in the proximal tubule
D. constriction of the efferent arteriole 8. Urea has a higher concentration in the fluid that
E. both A and D above leaves the proximal tubule (and enters the loop of
4. Kidney inflammation may result in the Henle) than in blood plasma because
appearance of albumin (a plasma protein) in the A. urea is synthesized by proximal tubule cells
urine because B. urea is secreted into the proximal tubule
A. more albumin enters the proximal tubule in the C. urea is reabsorbed from the proximal tubule
glomerular filtrate but at a lesser rate that water is reabsorbed
B. reabsorption of albumin from the proximal D. urea diffuses back into the proximal tubule
tubule is inhibited because of the high urea concentration in the renal
C. secretion of albumin into the distal tubule and medulla
collecting ducts is increased E. urea is actively transported into Bowman's
D. increased peritubular blood flow makes more capsule from the glomerular capillaries
albumin available for diffusion into the tubule 9. In the proximal tubule, penicillin is
E. reduced active transport of sodium ion reduces A. actively secreted into the tubule
cotransport of other substances, including B. actively reabsorbed from the tubule
albumin C. passively reabsorbed from the tubule
5. As blood passes along the glomerular capillaries D. metabolized by the tubule cells
from the afferent to efferent arteriole, the net E. neither secreted nor reabsorbed nor
filtration pressure (DP - Dp) metabolized
A. increases 10. At which sites would the concentration of
B. decreases creatinine be expected to be highest? (Note:
C. first decreases, reaches a minimum about half assume the person is normally hydrated.)
way along the capillary, then increases A. glomerular filtrate
D. first increases, reaches a maximum about half B. end of the proximal tubule
way along the capillary, then decreases C. end of the loop of Henle
E. remains constant D. urine
6. Sodium is actively reabsorbed from the renal E. the concentration would be the same in all of
tubule in which of the following nephron the above, since creatinine is neither secreted or
segments? reabsorbed
A. proximal tubule 11. Suppose a person loses the function of half his
B. distal tubule nephrons because of renal degenerative disease.
C. thick ascending limb of the loop of Henle Assuming the person survives and reaches a new
D. all of the above steady state and that body urea production
E. none of the above remains normal, which of the following would be
7. The rate of water reabsorption from the expected to decrease below normal?
proximal tubule is determined primarily by the A. plasma urea concentration
A. rate of dissolved particle (solute) reabsorption B. renal urea excretion
from the proximal tubule C. renal urea clearance
D. urine urea concentration
E. all of the above
12. The following values are measured for
potassium ion in a human subject.
Plasma K+ 5 meq/liter
Urine K+ 50 meq/liter
Renal creatinine clearance 80 ml/min
Urine formation rate 1.5 ml/minute
This patient's potassium clearance is closest to
which of the following?
A. 5 ml/minute
B. 7.5 ml/minute
C. 15 ml/minute
D. 50 ml/minute
E. 75 ml/minute
13. Assuming the subject in the preceding
question is a normal adult, we can conclude that
most likely potassium is
A. filtered but not secreted or reabsorbed
B. secreted but not filtered or reabsorbed
C. reabsorbed but not secreted or filtered
D. filtered and secreted
E. filtered and reabsorbed