L7: Kidney disease and renal failure

Question 1

3 categorises of kidney disease

Answer 1

pre-renal
intrinsic
post-renal

Question 2

what does post-renal lead to in the kidney

Answer 2

hydronephrosis

Question 3

can nephrons regenerate

Answer 3

NO

Question 4

urinary excretion rate=

Answer 4

filtration rate - reabsorption rate + secretion rate

Question 5

3 layers of glomerular capillaries

Answer 5

endothelium
basement membrane
podocytes

Question 6

how does glomerular filtrate move through the podocytes

Answer 6

through slit pores between them

Question 7

apart from the basement membrane what can also stop protein passage

Answer 7

the podocytes also have a negative charge

Question 8

main consequence of nephrotic syndrome

Answer 8

protein loss

Question 9

4 features of nephrotic syndrome

Answer 9

peripheral oedema
proteinuria
hypoalbuminaemia
hypercholesterolaemia

Question 10

what biochemical markers are needed for a nephrotic syndrome diagnosis

Answer 10

proteinuria

hypoalbuminaemia

Question 11

what is nephrotic range proteinuria almost always due to

Answer 11

glomerular disease

Question 12

what are most nephrotic diseases associated with

Answer 12

podocyte injury and loss of anionic charge in the capillary wall

Question 13

what 2 things does proteinuria result from

Answer 13

loss of charge and size selectivity

Question 14

2 mechanisms for oedema in nephrotic syndrome

Answer 14

overfill and underfill mechanism

Question 15

underfill mechanism=

Answer 15

• reduced oncotic pressure means fluid moves into ECF

- reduced plasma volume activates sodium and water reabsorption

Question 16

what is the overfill mechanism

Answer 16

a defect in sodium excretion increases blood volume increasing hydrostatic pressure moving fluid into ECF

Question 17

3 primary causes of nephrotic disease

Answer 17

minimal change disease
focal segmental glomerulosclerosis
membranous GN

Question 18

what is minimal change disease

Answer 18

• effacement of pedicles causing protein leakage

- little chronic damage

Question 19

treatment of minimal change disease

Answer 19

steroids

Question 20

what is segmental glomerulosclerosis

Answer 20

• segmental scarring lesions within glomerular tuft

- bad prognosis (hard to treat)

Question 21

membranous nephropathy

Answer 21

electron dense immune deposits on basement membrane creating holes

Question 22

in whom are secondary causes of nephrotic disease more common

Answer 22

adults

Question 23

in whom are primary causes of nephrotic disease more common

Answer 23

children

Question 24

name 4 secondary causes of nephrotic disease

Answer 24

diabetic nephropathy
amyloidosis
chronic viral infection
cancer

Question 25

main feature of nephritic syndrome

Answer 25

haematuria

Question 26

5 features of nephritic syndrome

Answer 26

``` haematuria small amount of proteinuria mild hyertension oliguria possible oedema ```

Question 27

in nephritic syndrome what is the oedema secondary to

Answer 27

oliguria

Question 28

3 causes of nephritic syndrome in children

Answer 28

haemolytic uraemic syndrome Henoch-schonlein purpura post-streptococcal GN

Question 29

3 causes of nephritic syndrome in adults

Answer 29

goodpasture's ANCA- associated vasculitis primary or secondary mesangiocapillary GN

Question 30

2 pathways of membrane attack

Answer 30

classic | alternative

Question 31

what is the classic pathway characterised by

Answer 31

antigen-antibody complex

Question 32

what activates the classic pathway

Answer 32

Fc portion on the antigen-antibody complex

Question 33

what does the antigen-antibody complex trigger to cause membrane attack

Answer 33

complement

Question 34

what does the alternative pathway not depend on

Answer 34

antibody-antigen complexes

Question 35

what can activate the classic pathway (4)

Answer 35

enzymes endotoxins cell membrane viruses

Question 36

what can activate the alternative pathway (4)

Answer 36

venom aggregated Ig yeast cell wall bacterial endotoxins

Question 37

what is MAC

Answer 37

membrane attack complex

Question 38

what happens to MAC

Answer 38

its inserted into the lipid bilayer leading to movement of ions and water across the membrane leading to cell lysis

Question 39

in what disease can immune complex trapping happen

Answer 39

lupus

Question 40

what happens in immune complex trapping

Answer 40

immune complexes present in blood get stuck on basement membrane activating complement

Question 41

in what disease is the antigen already present in the basement membrane

Answer 41

goodpastures disease

Question 42

what damage occurs in the basement membrane in goodpastures disease

Answer 42

alpha 3 chain collagen is damaged

Question 43

in what disease can the antigen be implanted

Answer 43

post infectious GN

Question 44

what happens in post infectious GN

Answer 44

bacterial antigen implanted in basement membrane causing circulating antibody to bind

Question 45

what happens in diarrhoea + HUS ( haemolytic uraemic syndrome)

Answer 45

certain endotoxins activate complement (can be through classical or alternative pathway)

Question 46

who is vasculitis seen in and when

Answer 46

adults in winter season

Question 47

what causes damage to the kidney in vasculitis

Answer 47

anti-neutrophil cytoplasmic antibodies

Question 48

what is acute kidney failure

Answer 48

sudden decline in renal function over hrs or days

Question 49

to cause acute renal failure what does the insult need to be

Answer 49

bilateral

Question 50

what is acute on chronic renal failure

Answer 50

sudden decline in renal function with CKD background

Question 51

presentation of acute renal injury

Answer 51

oliguria/ anuria | azotaemia

Question 52

azotaemia=

Answer 52

high levels of nitrogen containing compounds

Question 53

3 causes of acute renal injury

Answer 53

glomerular injury interstitial injury acute tubular necrosis

Question 54

what part of the kidney does diabetes type 1 damage

Answer 54

glomerular injury

Question 55

3 pre-renal causes of kidney damage

Answer 55

sepsis heart failure dehydration

Question 56

2 post renal causes of kidney damage

Answer 56

tumour | stones

Question 57

3 intrarenal causes of kidney damage

Answer 57

glomerular injury tubulo-interstitial injury vascular injury

Question 58

in CKD what stage do symptoms develop

Answer 58

after stage 4 (GFR <15-29ml/min)

Question 59

normal kidney function (A wet bed)

Answer 59

-acid base balance -water balance -electrolyte balance -toxin removal -Blood pressure -EPO vit D

Question 60

3 symptoms of Na/sodium retention

Answer 60

hypertension oedema raised JVP

Question 61

why are patients with CKD prone to gout

Answer 61

high uric acid