3. Physiology continued

Question 1

What is important to know when looking at those with an acidic pH?

Answer 1

They are disposed to hyperkalaemia as hydrogen ions are buffered intracellularly in exchange for K ions

This creates a danger of Vf.

Question 2

How you correct a hyperkalaemia?

Answer 2

Calcium gluconate,
calcium and
salbutamol
Insulin

Question 3

What is used to measure eGFR?

Answer 3

Its a formula that uses creatinine to ESTIMATE glomerular filtration rate.

Question 4

Why is eGFR sometimes not the most accurate measure of kidney function.

Answer 4

This can change in conditions such as myositis, malnutrition, vegetarians which will produce more creatinine

This is why inulin clearance is used in high class studies

Question 5

What is the best way of detecting protein in the urine?

What are the thresholds to detect disease?

Answer 5

P:CR (>15mg/mmol)
A:CR(2.5 males, 3.5, females)

Question 6

What are you differentials for polyuria?

Answer 6

Diabetes meelitus
Diabetes insipidus
Hypercalcaemia- disturbers the water gradient (aquaporins?)
Renal medullary disorders

Question 7

What is diabetes insipidus?

Answer 7

Condition where you drink lots and pee lots due to an imbalance of atrial naturetic peptide and vasopressin

Question 8

What are the differentials for loin pain?

Answer 8

Ureteric colic- renal Stone, sloughed papilla (can obstruct the ureter)

Localised loin pain- pyelonephritis, renal cyst pathology, renal infarctions

Question 9

What are the differentials for visible heamaturia?

Answer 9

Renal tract malignancy
Polycystic kidney disease
Glomerular Disease
Alport syndrome- x linked degenerative kidney disease

Question 10

If an individual has proven nephrotic syndrome, hypoalbuminea and peripheral oedema what is the next step

Answer 10

Renal biopsy

Note hypoalbuminea is a consequence of abnormally high protein

Question 11

Give some examples of auto-immune diseases that affect the kidneys (6)

Answer 11

ANCA associated vasculitis
SLE
HSP
systemic sclerosis
Sarcoid
Sjögren’s syndrome

Question 12

What causes proteinuria?

Answer 12

Glomerulonephritis,
dm,
amyloidosis
Myeloma

Question 13

The first three components of a urine dip are

Glucose
Bilirubin
Ketones

Please explain why these are tested for.

Answer 13

Glucose- DM, DM medications, tubular disease causes raised glucose

Bilirubin- bilirubin in urine suggests conjugated bilirubin suggests obstruction

Ketones- starvation/DKA

Question 14

The next three components of a urine dip are

Specific gravity
pH
Blood

Please explain why these are tested for.

Answer 14

Specific gravity- low= dilute urine(DI, acute tub necrosis), high= thick urine (proteinuria,

pH- low- DKA, UTI High- alkalosis, medications

Blood-UTI, renal stones, rhabdomyolosis, cancer

Question 15

The final 4 components are

Protein
Nitrites
Urobillirubin
Leukocytes

Explain why these are tested

Explain why these are tested for?

Answer 15

Protein- nephrotic syndrome, CKD

Nitrites- gram negative organisms (e.g. e.coli)

Urobillirubin- high- heamolysis, low- obstruction

Leukocytes-UTI/ heamaturia