1. Renal Medicine

Question 1

Where does filtration occur

Answer 1

Glomerus

Question 2

What is filtration dependent upon

Answer 2

Glomerular pressure

Question 3

What does the juxta-glomerular apparatus contain

Answer 3

RAAS

Question 4

Function of prostaglandins

Answer 4

Control glomerular functions

Question 5

Definition of polyuria

Answer 5

Excess urine

Question 6

Definition of dysuria

Answer 6

Pain when passing urine

Question 7

Definition of haematuria

Answer 7

Blood in urine

Question 8

Definition of proteinuria

Answer 8

Protein in urine

Question 9

Definition of uraemia

Answer 9

Excess urea in blood

Question 10

Renal function is measured by (3)

Answer 10

Serum urea
Serum creatinine
24hr urine collection (creatinine clearance)

Question 11

Renal failure involves (4)

Answer 11

Loss of renal excretory function
Loss of water and electrolyte balance
Loss of acid base balance
Loss of renal endocrine function (EPO, calcium metabolism, renin secretion)

Question 12

Renal failure can be (2)

Answer 12

Acute (usually reversible)

Chronic

Question 13

Features of acute renal failure

Answer 13

Rapid loss of renal function, usually over hours/days

Question 14

Features of chronic renal failure

Answer 14

Gradual loss of renal function, usually over many years

Question 15

Causes of renal failure (3)

Answer 15

Pre-renal
Renal
Post-renal

Question 16

Definition of pre-renal failure and examples (3)

Answer 16

Hypo-perfusion of kidney
Shock
Renal artery disease
Aorta disease

Question 17

Examples of renal failure (4)

Answer 17

Chronic disease
Drug damage
Trauma
Rhabdolysis

Question 18

Definition of rhabdolysis

Answer 18

Breakdown of skeletal muscle

Question 19

Examples of post-renal failure

Answer 19

Renal outflow obstruction

Question 20

Acute renal failure involves (5)

Answer 20

Rapid loss of renal function
Anuric initially with volume overload
Gradual progression to polyuria
Development of hyperkalaemia
Development of uraemia and acidosis

Question 21

Creatinine level in acute renal failure

Answer 21

> 200umol/l

Question 22

Symptoms of acute renal failure (5)

Answer 22

Ankle oedema (ambulatory) or sacral oedema (sedentary)
Pulmonary oedema
Breathlessness
Raised JVP
Weight gain

Question 23

Effects of acidosis (3)

Answer 23

Low bicarbonate
Increased respiratory excretion of CO2
Raised respiratory rate

Question 24

Main cause of acute renal failure

Answer 24

Pre-renal cause

Question 25

Specific cause and example of acute renal failure (2)

Answer 25

Trauma/drug-induced | Crush injury --> muscle breakdown --> uraemia --> kidneys blocked --> acute failure

Question 26

Types of chronic renal failure (2)

Answer 26

Primary | Secondary

Question 27

Causes of primary renal failure (2)

Answer 27

Glomerulonephritis | Polycystic kidney disease

Question 28

Causes of secondary renal failure (6)

Answer 28

``` Diabetes (30%) HTN (20%) Drug therapy Vasculitis Renal artery disease Aorta disease ```

Question 29

Presentation of glomerulonephritis (4)

Answer 29

Haematuria Proteinuria In an otherwise healthy individual Gradual progression to HTN and chronic renal failure

Question 30

Complications of glomerulonephritis

Answer 30

Nephrotic syndrome

Question 31

Nephrotic syndrome involves (4)

Answer 31

Excessive loss of protein in urine (leads to hypoalbuminaemia) Loss of plasma oncotic pressure Tissue swelling (oedema) Hypercoagulable state (loss of clotting factors)

Question 32

Why should NSAIDs be avoided in renal failure (2)

Answer 32

Inhibit glomerular blood flow | Causes interstitial nephritis

Question 33

Nephrotoxic drugs include

Answer 33

Cyclosporin

Question 34

Renal vascular disease involves (2)

Answer 34

Reduced blood flow to kidney (atheroma, HTN) | Microangiopathy

Question 35

Immune-mediated renal damage can be (3)

Answer 35

Multiple myeloma (plasma cell tumour/tubular nephritis) Goodpasture's syndrome Vasculitis (lupus)

Question 36

Polycystic kidney disease causes (2)

Answer 36

``` Gene mutation (PKD 1, 2, 3) Multiple cysts in renal parenchyma (enlarged kidney, progressive destruction, gradual renal failure) ```

Question 37

When does end stage renal disease (ESRD) occur (2)

Answer 37

When eGFR <15ml/min | Creatinine is 800-1000umol/l

Question 38

Chronic renal failure management involves (5)

Answer 38

``` Reduce rate of decline (control underlying cause) Correct fluid balance Correct deficiencies Remove outflow obstruction Treat infection ```

Question 39

Signs of chronic renal failure (3)

Answer 39

Anaemia HTN Renal bone disease (low Ca, high PO4, hyperparathyroidism, osteomalacia)

Question 40

Symptoms of chronic renal failure (6)

Answer 40

``` Insidious (may be few) Polyuria Nocturia Tired Weak Nausea ```

Question 41

Renal malignancies include (2)

Answer 41

Renal cell carcinoma (HTN, polycythaemia) | Transitional cell carcinoma (haematuria, asymptomatic)

Question 42

Secondary oral effects of anaemia include (2)

Answer 42

Oral ulceration | Dysaesthesia