AkI

Question 1

Location of kidneys

Answer 1

T12 to L3

Lie in retroperitoneum of the abdomen

Question 2

which kidney is lower

Answer 2

R

Question 3

What is the renal corpuscle made of

Answer 3

Glomerulus (ball of capillaries) enclosed by the bowman’s capsule

Question 4

Where does the glomerulus receive blood from and where does it drain

Answer 4

Afferent arteriole and is drained by efferent arteriole

Question 5

What is GFR influenced by

Answer 5

COntractile tone of the arterioles

Question 6

What do the renal tubules consist of

Answer 6

PCT
Loop of Henle
DCT
Collecting duct

Question 7

Role of PCT

Answer 7

Reabsorb Na+

Regulate pH by secreting bicarbonate

Question 8

Which part of LoH is impermeable to ions

Answer 8

descending limb

Question 9

Which part of LOH is v permeable to water

Answer 9

Descending limb

Question 10

What is the ascending limb permeable and impermeable to

Answer 10

Ascending- permeable to ions (Na+/K+ and Cl-)

Impermeable to water

Question 11

How does the ascending limb reabsorb ions

Answer 11

Thin part- passive diffusion

Thick part- active transport

Question 12

Role of Distal convoluted tubule

Answer 12

regulation of K+ sodium Ca+ and pH

Macula densa- involved paracrine function of kidney via RAAS. they do this by detecting NaCl and adjust GFR and renin excretion

Question 13

Role of collection duct

Answer 13

Electrolye and fluid balance

Affected by ADH and Aldosterone

Question 14

Function of kidney

Answer 14

Electrolyte balance
Regulation of BP
Calcium homeostasis
Acid base homeostasis
Nitrogenous waste excretion
Drug excretion 
Red cell production (by secreting EPO)
Fluid balance

Question 15

RAAS system

Answer 15

1) Low bP
2) Renin turns angiotensin into angiotensin 1
3) ACE turns it into angiotensin 2
4) Causes vasoconstriction of arterioles which increases BP
5) OR causes adrenal cortex to release aldosterone which increases Na+ and water reabsorption in kidneys and increases secretion of K+ and H+ into urine. This increases blood volume and BP

Question 16

What is AKI

Answer 16

rapid decline in kidney function. Measured by serum urea and creatinine

Results in failure to maintain fluid, electrolyte and acid-base homeostasis

Question 17

Risk factors for AKI

Answer 17

>65yo 
Hypovolaemia 
Sepsis
Diabetes
Chronic liver disease
cardiac failure
CKD

Question 18

What is a pre-renal cause of AKI

Answer 18

Reduced renal perfusion (blood flow) leads to a reduction in GFR

Question 19

What is intrinsic renal cause of AKI

Answer 19

Injury or damage to renal parenchyma

Question 20

What is post renal cause of AKI

Answer 20

Obstruction of the urinary tract to any point from the calyx to urethra

Question 21

Examples of prerenal causes of AKI

Answer 21

Hypovolaemia (haemorrhage, dehydration, third space losses, increased urinary output, burns, GI losses)

Hypotension (distributive shock)

Fluid overload (cardiac failure, cirrhosis, nephrotic syndrome)

Reduced cardiac output (cariogenic shock, arrhythmias myocardial infarction, congestive HF)

Vascular (renal artery stenosis/occlusion, Drug induced e.g. NSAIDs, ACEI, Renal vein thrombosis, AAA

Question 22

Examples of intrinsic causes of AKI

Answer 22

Glomerular (gmolerulonephritis, thrombosis, haemolytic uraemic syndrome, IgA nephropathy)

acute interstitial nephritis (Drugs e.g. NSAIDs, autoimmune nephritis, lymphoma)

Acute tubular necrosis (prolonged ischaemia, nephrotoxins e.g. ahminoglycosides, light chains in myeloma), rhabdomyolysis, radio contrast agents

Vascular (vasculitis, thrombosis/emboli from angiography)

Question 23

Examples of post renal causes of AKI

Answer 23

Luminal- stones, clots, sloughed papillae

Mural- malignancy, BPH, strictures

Extrinsic compression- pelvic malignancy, retroperitoneal fibrosis

Question 24

Symptoms of AKI

Answer 24

Reduced urinary output
N&V
Dehydration
COnfusion
fatigue

Question 25

How to categorise patients with AKI

Answer 25

Serum creatinine and urine output

Question 26

Diagnosis of AKI

Answer 26

Serum creatinine >26 micromol/L in 48h

50% or more rise in serum creatinine to have occurred within 7 days

fall in urinary output <0.5mL/kg/hour for more than 6 consecutive hours

Question 27

Bedside tests

Answer 27

Urine dip and culture
OBS
ECG

Question 28

Bloods

Answer 28

U&E, FBC, LFT, clotting, CRP

ABG for acid-base imbalance

Immunology if indicated

Creatinine kinase if indicated

Question 29

Imaging

Answer 29

Renal US to rule out obstruction

CXR if pulmonary oedema

CT KUB if obstruction

Question 30

Complications of AKI

Answer 30

Hyperkalaemia 
Volume overload
Uraemia
CkD
Metabolic acidosis 
Electrolyte imbalances (hyperphosphatemia, hyponatraemia, hypermagnesaemia, hypocalcaemia)

Question 31

Causes of flank pain

Answer 31

Renal colic
Pyelonephritis
AAA
perforated peptic ulcer
Biliary pathology
BOwel obstruction
Lower lobe pneumonia
MSK

Question 32

Ureteric obstruction causes

Answer 32

Stones, clots, severe constipation

Enlarged prostate, strictures, malignancy, pregnancy, congenital abnormalities

Question 33

Ureteric obstruction signs and symptoms

Answer 33

Pain, N&V, frank haematuria, difficulty passing urine, recurrent UTIs

Frequency, oliguria, haematuria, hypertension, pyrexia, rigours

Question 34

Risk factors for kidney stones

Answer 34

Males
30-50yo
Anatomical abnormalities
HTN
Gout
Hyperparathyroidism
Immobilisation
Dehydration
Met disorders

Question 35

3 sites of constriction in ureter

Answer 35

Pelviureteric junction (renal pelvis–> ureter)

Pelvic brim (where iliac vessels transverse the ureter at midureter point)

Vesicoureteric junction (ureter–> posterior aspect of bladder)