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Year 3 > Kidney: Passmed > Flashcards

Kidney: Passmed Flashcards

1
Q

What is the cause of Hyperlipidaemia?

A

Mutation in the apo-E gene, which is important of cholesterol and triglycerides, causing a rise in LDL, triglycerides and cholesterol.

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2
Q

What is the cause of idiopathic membranous glomerulonephritis?

A

Anti-phospholipase A2 antibodies directed towards the membrane

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3
Q

What are the features of acute tubular necrosis?

A

Ischaemic damage causes detachment of tubular cells from the basement membrane.

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4
Q

How does GFR increase?

A

Increased hydrostatic pressure within the glomerular capillaries

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5
Q

How is contrast-induced nephropathy managed?

A

Providing fluid with IV 0.9% NaCl before and after infusion.

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6
Q

What is the action of vasopressin?

A

Increased water permeability through insertion of the aquaporin channels in the distal tubular cells of the kidneys .

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7
Q

How do the kidneys respond to cellular hypoxia?

A

Production of EPO.

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8
Q

What is the risk with rapid correction of hyponatremia?

A

Osmotic demyelination syndrome, where there is destruction of the myelin sheath due to rapid movement of water out of the brain cells which causes osmotic stress

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9
Q

How does gynaecomastia occur in testicular cancer?

A

Increased oestrogen to androgen ratio.

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10
Q

What are the features of horseshoe kidneys?

A

Congenital disorder more common in males where Fused kidneys crossed anterior to the aorta, which increases the risk of urinary tract infection and presents with abdominal pain, nausea, vomiting, abdominal discomfort and kidney stones.

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11
Q

What is the site of action of aldosterone antagonists?

A

Cortical collecting duct

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12
Q

What is the site of enlargement in the prostate for BPH?

A

Transitional zone

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13
Q

Which medication should be discontinued with worsened renal function?

A

Furosemide.

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14
Q

What is the aetiology of renal cell carcinoma?

A

Clear cell carcinoma is typically caused by a mutation of chromosome 3p of the Von-Hippel-Lindau (VHL) gene and result in Von-Hippel Landau syndrome. It is associated with smoking, tuberous sclerosis, middle-aged men

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15
Q

What are the features of minimal change disease?

A

Podocyte effacement with electron microscopy

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16
Q

What causes thickened glomerular basement membrane with granular deposits of IgG in ‘spike-and-dome’ pattern?

A

Membranous glomerulonephritis

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17
Q

What causes linear IgG deposits along the glomerular basement membranes

A

Goodpasture syndrome

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18
Q

How do beta blockers work?

A

Metoprolol blocks the B1 receptors in the heart to reduce cardiac output; metoprolol will also block the beta-1 adrenergic receptors in the juxtaglomerular apparatus in the kidneys leading to a decrease in the secretion of the enzyme renin

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19
Q

What is the pathophysiology of Alport syndrome?

A

X-linked dominance caused by a defect in the gene coding for type 4 collagen resulting in a defective glomerular basement membrane. It is a nephritic syndrome which is associated with bilateral sensineural deafness, splitting of the lamina densa with a “basket-and-weave” appearance on biopsy, causing progressive renal failure.

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20
Q

What is the most common type of testicular cancer?

A

Seminomas.

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21
Q

Which kidney pathology occurs after an upper respiratory tract infection?

A

IgA nephropathy, the most common cause of glomerulonephritis which is immune mediated

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22
Q

What is familial hypercholesterolaemia?

A

Autosomal dominant condition which causes a high LDL that has a high risk of myocardial infarction in their 20s

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23
Q

What is hyperacute rejection?

A

Pre-existing antibodies against ABO or HLA antigens which is a feature of Type II hypersensitivity reaction, that leads to widespread thrombosis and necrosis of the graft vessels.

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24
Q

What is acute rejection?

A

Occurs over the course of several months which is caused by mismatched HLA, mediated by cytotoxic T cells that is asymptomatic and picked up by high creatinine, proteinuria and pyuria. It can be managed with steroids and immunosuppressants.

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25
Q

What is chronic rejection?

A

Occurs over more than 6 months caused by antibody and cell-mediated mechanisms which causes fibrosis of the kidney overtime.

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26
Q

What is the cause of pseudohyperkalemia?

A

Rise in serum potassium from cells, which is caused by:
Haemolysis during venupuncture (prolonged tourniquet, excessive vacuum drawing, fine needle gauge)
Myeloproliferative disorders which causes abnormally high platelets, erythrocytes and leukocytes

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27
Q

What is losartan?

A

Angiotensin II receptor blocker which reduces renal perfusion by blocking angiotensin II to allow the vasodilation of the blood vessels and increase the GFR and

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28
Q

What is tolvaptan?

A

Vasopressin V2 receptor antagonist.

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29
Q

Why does gynaecomastia occur in testicular cancer?

A

Increased oestrogen:androgen ratio.

30
Q

Where does furosemide act?

A

THICK ascending loop of Henle.

31
Q

How does diarrhoea affect the anion gap?

A

Metabolic acidosis with No change/ becomes more negative.

32
Q

What does zona glomerulosa release?

A

Aldosterone

33
Q

What does the zona reticulata release?

A

Testosterone and DHEA

34
Q

What does the zona fasiculata release?

A

Cortisol

35
Q

What is the normal passage of blood in the kidneys?

A

Afferent arteriole
Glomerular capillary bed
Efferent arteriole
Peritubular capillaries and medullary vasa recta

36
Q

What is the most common tumour in children?

A

Nephroblastoma, a Wilm’s tumour which often presents with haematuria and often metastasises to the lung. It can cause persistent hypertension in children.

37
Q

What is the best imaging modality to determine the locoregional spread of bladder cancer?

A

Pelvic MRI

38
Q

What carcinogen has the highest risk for bladder cancer?

A

2-naphtyhlamine, found in dyes.

39
Q

Which structure of the kidney is most commonly affected in nephrogenic diabetes insipidus?

A

Vasopressin receptor

40
Q

What are the ECG findings for hyperkalemia ?

A

Wide QRS complexes,
sinusoidal waveform
Small/absent P waves
Tall tented T waves
Asystole

41
Q

Which solution most closely resembles electrolyte composition of human plasma?

A

Hartman’s solution, formed of:
Sodium
Potassium
Calcium
Chloride
Lactate : this is metabolised into bicarbonate which prevents metabolic acidosis

This solution is ideal for surgery.

42
Q

What is the composition of dextrose solution?

A

Sodium, chloride and glucose

43
Q

Which solution is used for volume expansion?

A

Pentastarch, a synthetic colloid solution. However, this has risk of coagukopathy and AKI.

44
Q

Which type of kidney stones are associated with high cell turnover?

A

Uric acid stones, that are not visible on X-ray or act, only visible on ultrasound.

45
Q

Which kidney stones cause staghorn calculi?

A

Struvite stones
Cysteine stones

46
Q

What is normal urine pH?

A

5.5 to 7.5

47
Q

Which kidney stones form in acidic urine?

A

Uric acid stones and cystine stones

48
Q

Which kidney stones form in alkaline urine?

A

Calcium phosphate
Struvite stones

49
Q

What is the effect of NSAIDs on kidneys?

A

Afferent arteriole constriction

50
Q

What is the effect of prostaglandins on kidney?

A

Afferent arteriole vasodilation

51
Q

What are the acute phase reactants?

A

CRP
Platelets due to reactive thrombocytosis
Ferritin, due to sequestering of iron stores in infection away from pathogens
ESR

52
Q

How do fibrates act?

A

They activate PPAR receptors to increase LPL levels and reduce triglyceride levels by increasing uptake.

53
Q

Which kidney cancer is pink and located in renal pelvis?

A

Transitional cell carcinoma, a rare renal cancer but common lower Urinary tract cancer which commonly presents with painless haematuria.

54
Q

Which kidney stone causes diamond/rhomboid crystals?

A

Uric acid

55
Q

Which kidney stone causes envelope shaped crystals?

A

Calcium oxolate stones which is assoicated with dehydration.

56
Q

Which kidney stone causes hexagonal shaped stones?

A

Cystine stones

57
Q

Which kidney stone causes coffin lid stones?

A

Ammonium magnesium phosphate stones and this is associated with UTIs due to urease producing ammonium and under alkaline conditions,

58
Q

What causes wedge shaped crystals?

A

Calcium phosphate stones

59
Q

How does IgA nephropathy appear under light microscope?

A

Proliferation of mesangial cells

60
Q

What changes are seen with dehydration?

A

Rising haematocrit
Metabolic acidosis
Hypernatremia
Increased serum urea and creatinine ratio

61
Q

Which nephropathy causes Congo red stain and apple green birefringence?

A

Amyloidosis

62
Q

What nephropathy causes basket weave appearance?

A

Alport syndrome

63
Q

What nephropathy causes segmental sclerosis and hyalonis siwht effacement of Podocyte?

A

Focal segmental glomerulosclerosis

64
Q

Where do giflozins work?

A

PCT to inhibit glucose rebasorption.

65
Q

Which nephropathy causes decreased peripheral sensation and nephrotic syndrome?

A

Amyloidosis due to Deposition of light chain fragments in the kidneys and peripheral nerves

66
Q

What causes a raised PSA reading?

A

Urinary retention
Benign prostatic hyperplasia
Prostatitis
UTI
Vigorous exercise

67
Q

Where does the blood supply to the kidney is distributed?

A

Majority is distributed to the cortex.

68
Q

Which drug causes hyperkalemia?

A

Heparin

69
Q

Which nephropathy causes wire loop histology?

A

Systemic lupus erythematous

70
Q

What is a substrate of renin?

A

Angiotensinogen

71
Q

How do you calculate the anion gap?

A

(Sodium + potassium) - (bicarbonate -chloride)

Year 3 (38 decks)

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