12. extra

Question 1

calcium, PTH, and phosphate levels in primary and secondary hyperparathyroidism

Answer 1

primary
-high
-high
-low

secondary
-low (not absorbed so only getting it from bones)
-high
-high

Question 2

tertiary hyperparathyroidism

Answer 2

presents like primary, if secondary is left untreated
parathyroid grand enlarges

Question 3

in nephrotic syndrome, what would GFR, urea and electrolytes be like? why?

Answer 3

normal as filtration, secretion and reabsorption OK in glomerulus and nephron

Question 4

what part of glomerulus is affected in nephrotic syndrome?

Answer 4

podocytes- foot process effacement so don’t repel negatively charged albumin

Question 5

is minimal change disease permanent in children?

Answer 5

no foot processes can reappear as disease goes into remission

Question 6

explain the mechanism of hyper filtration in diabetic nephropathy

Answer 6

-increased blood glucose so more reabsorption in PCT
-coupled to sodium so more sodium reabsorbed
-less sodium to macula densa
-activates RAAS so vasconstricts EA
-increases GFR due to increased hydrostatic pressure in glomerulus

Question 7

complications of stage 4 CKD, and how to treat each

Answer 7

anaemia: IV iron and recombinant EPO

bone mineral disorder: vit D, diet reduce phosphate

HTN: ACEi/ARB

atherosclerosis: lifestyle advice, statins

Question 8

signs/symptoms of uraemia

Answer 8

skin colour change
fatigue
nausea and vomiting
pruritis
confusion
cramps

Question 9

explain how loop diuretics work

Answer 9

block NKCC2 in LoH thin asc limb, less sodium reabsorbed so less corticopapillary gradient so less water reabsorbed from CD

more water lost in urine so oedema decreases