Kidney disease

Question 1

Give examples of inherited renal diseases

Answer 1

1. Autosomal dominent polycystic Kidney disease (ADPKD)
2. Reflux nephropahty
3. renal stone disease
4. Hypertensive nephrosclerosis and atheromatous reno vascular disease
5. Renal osteodystrophy

Question 2

Name the most common inherited renal disease

Answer 2

Autosomal dominant polycystic kidney disease (ADPKD)

Question 3

What is the prevalence of autosomal dominant polycystic kidney disease

Answer 3

Between 1 in 400 and 1 in 1000

Question 4

What is autosomal dominant polycystic kidney disease characterised by

Answer 4

The development and enlargement of renal cysts typically progression to end stage renal failure

Question 5

What is reflex nephropahty also known as

Answer 5

Chronic pyelonephritis or Vesicoureteric reflux

Question 6

When does Vesicoureteric reflux occur

Answer 6

When there is a congenital abnormality of the junction between the ureter and bladder such that urine can flow from the bladder back up the ureter to the kidney

Question 7

What is Vesicoureteric reflux associated with

Answer 7

An increased risk of urinary tract infections and renal scarring which can lead to hypotension and progressive renal failure

Question 8

How common is renal stone disease

Answer 8

Up to 10% of adults int eh western world will suffer from renal stones at one point

Question 9

What are renal stones made up of

Answer 9

Most are made up of calcium oxalate
(rarely made up of uric acid or cystine)

Question 10

What can renal stones cause

Answer 10

1. Renal colic
2. Haematuria
3. Urinary tract infection
4. Obstruction

Question 11

What is a common cause of renal dysfunction in teh elderly

Answer 11

Renal vascular disease in those patients with arterial disease

Question 12

Which minerals does the kidney control level of

Answer 12

Calcium and phosphate

Question 13

When does phosphate retention occur

Answer 13

In chronic kidney disease

Question 14

When does Hyperphosphataemia occur

Answer 14

usually once GFR is below 25–30 ml/min.

Question 15

what is a consequence of hypocalcaemia

Answer 15

Parathyroid hormone is released from the parathyroid glands

Question 16

What is the significance of the parathyroid hormone

Answer 16

It maintain calcium homeostasis by increasing bone remodelling to release calcium and phosphate thus increases renal reabsorption of calcium and excretion of phosphate

Question 17

What can continued parathyroid stimulus be due to

Answer 17

hyperphosphataemia and hypocalcaemia in Chronic liver disease

Question 17

What can continued parathyroid stimulus cause

Answer 17

Hypertrophy of the parathyroid gland and hyperparathyroidism

Question 18

What renal osteodystrophy may patients with chronic kidney disease suffer from

Answer 18

1. Osteomalacia
2. Osteitis fibrosa cystica
   3, Uraemia osteodystrophy
3. Adynamic bone disease

Question 19

How can raised parathyroid hormone be treated

Answer 19

With vitamin D supplements

Question 20

What can severe arterial calcium deposition result in

Answer 20

tissue ischaemia with skin necrosis, called calciphylaxis

Question 21

How can end stage renal failure be treated

Answer 21

1. Haemodialysis
2. Peritoneal dialysis
3. Renal transplantation

Question 22

What does Haemodialysis require and what does it do

Answer 22

It required access to the circulation to allow pumping of blood through a dialysis machine
The dialysis machine essentially works as an artificial kidney

Question 23

What does a Haemodialysis machine aim to do

Answer 23

Remove waster products such as urea and creatine from the blood
Absorbs bicarbonate into the blood

Question 24

How many sessions of Haemodialysis do patients with end stage renal failure usually need

Answer 24

3 Haemodialysis sessions a week each last about 4 hours

Question 25

What is the difference between Haemodialysis and peritoneal dialysis

Answer 25

Haemodialysis is usually done through a fistula in the arm to access the arteries and veins
peritoneal dialysis utilises the peritoneal membrane lining the peritoneal cavity

Question 26

When is peritoneal dialysis not possible

Answer 26

In patients with previous abdominal surgery leading to adhesions and scarring as an intact unscarred peritoneal membrane is needed

Question 27

What does end stage renal failure increase risk of

Answer 27

Cardiovascular disease

Question 28

What must renal transplant receipts be taking

Answer 28

Immunosuppressive drugs to prevent rejection of transplanted kidney

Question 29

Name the immunosuppressants renal transplant recipients are on

Answer 29

azathiopine,
ciclosporin or tacrolimus
prednisolone