Diseases of the kidney

Question 1

what are the functions of the kidney

Answer 1

regulates BP
filter toxins 
electrolyte balance 
production of renin and EPO 
acid base balance 
activates vit D

Question 2

what are the classical presentations of renal diseases: 
AKI 
nephrotic syndorme
CKD
nephritic syndrome
glomerulonephritis 
haematuria/proteinuria

Answer 2

unwell - rapid rise in creatinine and urea

proteinurea, hypoalbuminemia, odeama

slow decline in renal function

oedema, proteinuria, haemturia, renal failure

nephritic syndrome with rapid decreases in GFR

blood or protein

Question 3

describe the mricocirculation of the nephron

Answer 3

two capillary beds
frist glomerulus then leave via efferent arteriole and enters secondary network - peritubular network where fluid and solutes are reabsorbed by the tubules and returned to circulation

Question 4

what are 4 causes of immunological glomerular injury

Answer 4

complement activation
neutrophil activation
ROS
clotting factors

Question 5

what are the two types of tubular injury

Answer 5

ischameic - redcued perfusion from shock/hypotension, blood vessel damage, glomerular damage

toxic - direct toxins (drugs, printer ink, heavy metals)
hypersensitivity, Crystals (calcium oxalate ro urates)

Question 6

what are the symptoms, complications and pathogenesis of nephrotic syndrome

Answer 6

proteinuria greater than 3.5g/24 hours
symps- hypoalbuminaemia, odema, hyperlipidaemia, lipidura
increased glomerular permeability to albumin and other plasma proteins

associated with infection, thromboembolism, aki, anaemia

Question 7

what is a method of checking for nephrotic syndrome

Answer 7

jones methenamine silver - hard on end pattern of sub epithelial spikes of GBM

Question 8

what is the most common cause of nephrotic syndrome in adults

Answer 8

membranous nephrophathy via autoantibodies

Question 9

what is FSGS in renal pathophysiology

Answer 9

focal segmental glomerulosclerosis - common cause of nephrotic syndrome (idiopathic)

Question 10

what is the most common cause of nephrotic syndrome in children

Answer 10

minimal change disease

Question 11

what is nephritic syndrome - what are the symptoms

Answer 11

haematuria, proteinuria, elevated creatinine, hypertension, odeama

loss of function due to decreased glomerular blood low and salt retention

Question 12

what are 4 common aetiologies of nephritic syndrome

Answer 12

PIGN - post-infectious glomerulonephritis (neutrophils damage to GBM from infection)

IgA nephropathy - most common cause of glomerulonephritis and in young adults

vasciculitis - ANCA-associated glomerulonephritis - present with neutrophils and fibrin

SLE - lupus nephritis - autoimmune

Question 13

what are two causes of nephritic syndrome in children

Answer 13

henoch-schonlein Purpura - IgA

haemolytic uraemic syndrome - E coli enteritis

Question 14

what is the presentation of acute renal failure and complications

Answer 14

anuria with raised creatinine and urea, fatigue, nausea, vomiting, electrolyte imbalance

associated with GI bleeding, jaundice, cardiac failure and arrhythmias

Question 15

what causes renal artery stenosis and what can it lead to

Answer 15

atherosclerosis

ischamiea of the kidney and atrophy which leads to activation of RAAS and hypertension

Question 16

what is chronic renal failure and the stages

Answer 16

permanently reduced GFR - reduced number of functional nephrons 
1 = normal more than 90 ml/min/1.73
2 = 60-80
3 = 30-59 
4 = 15-29 
5 = less than 15 - requires dialysis

Question 17

what are the effects of chronic renal failure

Answer 17

reduced: 
excretion of water and electrolytes = hypertension and oedema 
excretion of toxins - poisoning 
production of EPO = anaemia 
renal bone disease

Question 18

what is the most common consequence of chronic renal failure

Answer 18

diabetes

Question 19

what is the normal nephrotic protein range

Answer 19

3-3.5g/24 hours

Question 20

what is isolated proteinuria and what is it caused by

Answer 20

less than nephrotic range
pyrexia and exercise
may indicate SLE or diabetes

Question 21

what is isolated haematuria and what is it associated with

Answer 21

normal renal function
inherited thin basement membrane
alport’s disease - inherited type 4 collagen weak

Question 22

what are the risk factors of acute vs chronic pyelonephritis

Answer 22

inflammation of kidney due to bacterial infection - fever and flank tenderness

acute - female, diabetes, UTI
chronic - UT obstruction

Question 23

what are the complication of acute and chronic pyelonephritis

Answer 23

acute - abscess formation

chronic - scarring, chronic renal failure

Question 24

which kidney disease displays flea bitten surface (petechial ahemorrahegs)

Answer 24

hypertensive nephropathy

Question 25

what is the most common cause of end stage renal disease in developing world

Answer 25

diabetic nephropathy - due to hyperglycaemia

Question 26

what is light chain case nephropathy (myeloma kindey)

Answer 26

cytotoxic and obstructive accumulation of monoclonal light chain casts in distal nephron segments

Question 27

what is the most common protein excreted

Answer 27

uromodulin

tamm-horsfall protein