BLOCK 10

Question 1

what are the 4 stages of an AKI?

Answer 1

intiiation
anuria
polyuria
restitution

Question 2

why does AKI cause metabolic acidosis?

Answer 2

kidneys cant remove enough H+

Question 3

why does AKI cause hyperkalaemia?

Answer 3

when the individual is oliguric, potassium isn’t effectively removed from the blood.

Question 4

why can an AKI cause hypocalcaemia?

Answer 4

because the impaired kidney no longer produces calcitriol (reducing calcium absorption from the gastrointestinal tract) and because hyperphosphatemia causes calcium phosphate precipitation in the tissues.

Question 5

what is microalbunaemia an early feature of?

Answer 5

diabetic nephropathy

Question 6

what are the symptoms and signs of nephrotic syndrome?

Answer 6

oedema of the ankles and face, protein in the urine

Question 7

whats the epithelium of ureters?

Answer 7

stratified transitional epithelium

Question 8

whats the blood supply to the ureters?

Answer 8

The upper ureter closest to the kidneys receives blood directly from the renal arteries. The middle part is supplied by the common iliac arteries, branches from the abdominal aorta, and the gonadal arteries. The most distal part of the ureter receives blood from branches of the internal iliac artery

Question 9

is the ureter covered in peritoneum?

Answer 9

only the anterior surface

Question 10

who might you find hyaline casts in urine?

Answer 10

dehydrated or those who do vigorous exercise

Question 11

what causes hyaline casts?

Answer 11

excess tamm-horsfall proteins in urine

Question 12

whats the first line antibiotic for a UTI/

Answer 12

trimethoprim (nitrofurantoin too but this is not active against proteus spp.)

Question 13

whats a huge cause of proteus miribalis UTIs?

Answer 13

catheters

Question 14

why may nitrites in the urine be a sign of bacterial infection in urine?

Answer 14

as bacteria have nitrate reductase

Question 15

what can cause false negative nitrites in urine?

Answer 15

infections cause by non-nitrate reducing bacteria
low numbers of bacteria
patients taking vitamin c

Question 16

what are some blood parameters that would be elevated in CKD?

Answer 16

creatinine
K+
urea
blood urea nitrogen

Question 17

what is hydronephrosis?

Answer 17

kidneys become stretched and swollen as the result of a build-up of urine inside them.

Question 18

what are angiotensin 2 effects?

Answer 18

•vasoconstriction of vascular smooth muscles = increased bp.
vasocostriction of efffernt arteriole of glonerulus = preserves GFR
stimulates first
stimulates aldosterone and ADH release - aldosterone causes retention of Na+ in exchange for K+/H+ in the distal tubule
increases proximal tubule Na+/H+ activity

Question 19

what are some examples of drugs that should be stopped in AKI as may worsen renal function?

Answer 19

NSAIDs
aminoglycosides
ACEi
angiotensin 2 receptor blockers
diuretics

Question 20

what are some drugs that may have to be stopped in AKI due to increased risk of toxicity?
(but doesnt worsen AKI itself)

Answer 20

metformin
lithium
digoxin

Question 21

how does angiotensin 2 act on the kidney?

Answer 21

it constricts both afferent and efferent arterioles but has a greater increase on resistance of efferent due to 2 reasons…
efferent has a smaller diameter in the basal state
it causes NO release from afferent which is a vasodilator

Question 22

what stimulates renin release?

Answer 22

decreased renal perfusion

hyponatremia

Question 23

whats the most common cause of AKI seen in clinical practice?

Answer 23

acute tubular necrosis

Question 24

what are the 2 main causes of acute tubular necrosis?

Answer 24

ischaemia and nephrotoxic drugs

Question 25

what causes red blood cell casts in urine?

Answer 25

glomerulonephritis

renal ischaemia and infarction

Question 26

what causes white blood cell casts in urine?

Answer 26

acute pyelonephritis and interstitial nephritis

Question 27

what causes granular casts?

Answer 27

these are muddy brown

acute tubular necrosis

Question 28

what causes hyaline casts?

Answer 28

common and non specific but may be seen following exercise or dehydration

Question 29

what causes epithelial casts in urine?

Answer 29

acute tubular necrosis

Question 30

what causes waxy casts in the urine?

Answer 30

advanced chronic kidney disease

Question 31

what causes fatty casts in the urine?

Answer 31

nephrotic syndrome

Question 32

what is chronic pyleonephritis causes by?

Answer 32

recurrent infections causing scarring of the renal parenchyma and impaired function
e.. vesicouretal reflux or recurrent renal stones

Question 33

what does it mean if a drug has a large therapeutic index?

Answer 33

It is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes toxicity - a measure of relative safety

Question 34

what is probenecid used for?

Answer 34

its use adjunct to penicillin therapy to increase the plasma drug levels

Question 35

what is stress incontinence?

Answer 35

weakness of bladder sphincter muscles or the pelvic floor

Question 36

what is mixed incontinence?

Answer 36

stress and urge incontinence

Question 37

whats the most common cause of bladder outflow obstruction in older men? and in young boys?

Answer 37

BPH

posterior urethral valves

Question 38

where does bladder cancer typically cause an obtrsuction?

Answer 38

at the vesicle ureteric junction

Question 39

what imaging modality do we typically use to look at the kidneys?

Answer 39

ultrasound

Question 40

which nervous system stimulates juxtaglomerular cells to secrete renin?

Answer 40

sympathetic NS

Question 41

what is derived from the intermediate mesoderm?

Answer 41

kidneys, gonades, respective ductal systems, adrenal cortex