227: Acute Renal Failure

Question 1

Thiazides (e.g. chlorothiazide, indapamide) can cause…

Answer 1

hypokalemia. (inhibit Na-K-Cl transporter in distal convoluted tubule, if sodium isnt being retained potassium isnt entering blood stream) )

Question 2

Loop Diuretics (e.g. bumetanide, furosemide) can cause…

Answer 2

hypokalemia ( inhibits Na-K-Cl cotransporter in the ascending limb)

Question 3

ACE inhibitors (e.g. ramipril) cause…

Answer 3

hyperkalemia ( no ang 2 = no aldosterone from adrenals)

Question 4

Ang receptor blockers (candersartan, losartan) can cause…

Answer 4

hyperkalemia (no aldosterone production)

Question 5

Spirolactone is …

Answer 5

a potassium sparing diuretic therefore can contribute to hyperkalemia.

Question 6

long term use causes renal damage…

Answer 6

aminoglycoside - gentamicin, NSAIDS (reduced prostaglanins from the distal tubule… so reduced perfusion and reduced renin from afferent arterioles…reduced aldosterone.

Question 7

drug causing falsely elevated creatinine

Answer 7

Trimethoprim (antibiotic for urinary tract infection)

Question 8

Drug that causes hypercalcaemia

Answer 8

Vit D and calcium

Question 9

Drug causing high uric acid ( or urate stones)

Answer 9

chemotherapy drugs (cell break down - so lots of nucleic acid converted to uric acid for excretion)

Question 10

drugs causing rhabdomyolysis

Answer 10

statins, calcineuin inhibitors ( cyclosporin/ tacrolimus)

Question 11

how do statins cause rhabdomyolysis?

Answer 11

they cause muscle breakdown

Question 12

how do calcineuin inhibitors cause rhabdomyolysis?

Answer 12

its a drug reaction…however they also cause vasoconstriction of the afferent arteriole.

Question 13

What is rhabdomyolysis?

Answer 13

muscle breakdown releasing myoglobin - toxic to kidney.

Question 14

when would you biopsy the kidney?

Answer 14

to look at the glomerulus and tubules. nephrotic syndrome, AKI, urinary abnormalitis and post transplant.

Question 15

electrolyte imbalance associated with: MDMA

Answer 15

hyponatraemia

Question 16

electrolyte imbalance associated with: ARF after strenuous exercise

Answer 16

hypocalcaemia (calcium deposits in the damaged muscles)

Question 17

electrolyte imbalance associated with: recovery phase of ARF due to rhabdomyolysis

Answer 17

hypercalcaemia (deposited calcium from injured muscle is released)

Question 18

electrolyte imbalance associated with: ARF after introduction of an ACEI in a patient with chronic heart failure

Answer 18

hyperkalaemia

Question 19

electrolyte imbalance associated with: chronic laxative abuse

Answer 19

hypokalaemia

Question 20

condition associated with RBC casts

Answer 20

poststreptococcal glomerulonephritis

Question 21

condition associated with WBC casts

Answer 21

acute pyelonephritis

Question 22

condition associated with fatty casts

Answer 22

nephrotic syndrome

Question 23

condition associated with pigmented casts

Answer 23

rhabdomyolysis

Question 24

calcium oxalate urine sediments

Answer 24

envelope

Question 25

urine sediments: cystine

Answer 25

hexagon

Question 26

urine sediments: uric acid

Answer 26

diamond

Question 27

urine sediments: triple phosphate

Answer 27

coffin

Question 28

histopathological finding: crescentric change in the bowmans space

Answer 28

rapidly progressive glomerular nephritis

Question 29

histopathological finding: eosinophils in the interstitium

Answer 29

acute interstitial nephritis

Question 30

histopathological finding:mitotic figures in the tubular epithelial nuclei

Answer 30

acute tubular necrosis

Question 31

histopathological finding: tubular dilation

Answer 31

obstructive dilatation