Lecture 17 - Revision

Question 1

What are some nephrotic syndromes?

Answer 1

Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulosclerosis

Question 2

What are some nephritic syndromes?

Answer 2

IgA Nephropathy
Rapidly progressing Glomerularnephritis
Goodpastures
Post-streptococcal glomerulonephritis

Question 3

Answer question 1 and 2 for Amy’s case study:

Answer 3

1 = nephrotic syndrome

2 = U+Es to show hypoalbuminaemia, urine dip to show proteinuria

Question 4

what investigations can be done to confirm nephrotic syndrome?

Answer 4

Low albumin in blood (hyper hyppoalbuminaemia)

Urine dipstick showing proteinuria

Question 5

What are the 3 changes seen in nephrotic syndrome?

Answer 5

Proteinuria
Low serum albumin
Oedema

Question 6

What is the Triad of Nephritic syndrome?

Answer 6

Haematuria
Reduced GFR
Hypertension

Question 7

What is the main difference in presentation occurs with nephritic or nephrotic syndromes?

Answer 7

Haematuria in nephritic
Oedema in nephrotic

Question 8

Answer question 3 for Amy:

What would you expect GFR, Urea and electrolytes to be like in nephrotic syndrome?

Answer 8

GFR = normal
U + E = normal

Filtration occurs as normal so GFR fine

Nephron can till function so the secretion and reabsorption of urea and electrolytes in affected

Question 9

Whihc part of the glomerulus is affected in Minimial change disease?

Are the changes permanent?

Answer 9

The podocytes specifically the foot processes of the podocytes

No they resolve as the disease goes into remission

Question 10

Why may a child gain weight with minimal change disease?

Answer 10

Podocyte foot processes are damaged, this means albumin is lost in the urine resulting in hypoalbuminaemia

This reduces plasma oncotic pressure
As a result less water is drawn out and filtered into the capillaries
More water remains in interstitium resulting in oedema (water weight)

Question 11

If a patient has gained 4kg in water weight, how much fluid have they retained?

Answer 11

4L

Question 12

What can be measured to stage an AKI?

Answer 12

Serum creatinine
Urine output

Question 13

What is a patients serum creatinine with stage 1,2 and then 3 AKI?

Answer 13

1 = 1.5 - 1.9 x baseline
2 = 2 - 2.9 x baseline
3 = 3 or more x baseline

Question 14

What is the urine output for a stage 1, 2 and 3 AKI?

Answer 14

1 = <0.5 ml/kg/h for 6-12hrs
2 = <0.5ml/kg/h for >12hrs
3 = 0.3ml/kg/h for more than 24hrs or Anuria for >12hrs

Question 15

What value do you use to stage a CKD?

Answer 15

GFR

Question 16

What are the GFR values for G1, G2, G3, G4 and G5 stage CKD?

Answer 16

G1 = >90
G2 = 60 - 89
G3 = 30 - 59
G4 = 15 - 29
G5 = < 15

Question 17

Look at Mr Jenkins case study:
Answer Q1:

Answer 17

Adult polycystic kidney disease

Cysts develop in childhood
They can fill with blood following trauma and result in severe abdominal pain and macroscopic Haematuria
Cysts can become infected

Question 18

What can adult polycystic kidneys cause?
(Q2) Mr Jenkins
What history questions may you want to ask a patient with APKD?

Answer 18

Hypertension and CKD

Headaches, visual problems, breathlessness, itchiness due to hyerpphosphateamia

Symtoms related to cysts in other organs

On FHx of vascular disease

Question 19

Why is it important to take a careful family history with a patient with potential Adult Polycystic Kidney Disease?

Answer 19

Autosomal dominant inherited condition

Question 20

What immediate management methods would you undertake for Mr Jenkins Q4?

Answer 20

Pain control

IV fluids to inc urine output to help wash clot out of kidney

Avoid contact sports

Question 21

What non mediate issues need to be addressed in follow up for Mr Jenkins?
Q5

Answer 21

High BP (possibly give Acei, diuretics, angiotensin receptor blockers)

ECG changes constitute with Left Ventricular Hypertrophy

Question 22

Would you screen a child of a parent who has Polycystic kidney disease?

Answer 22

No just screen on an annual basis for elevated BP
Once in teens do ultrasounds and absence of cysts would rule it out
Repeat in 30s too

Question 23

What type of inheritance is polycystic kidney disease?

Answer 23

Autosomal dominant

Question 24

What is metabolic acidosis?

Answer 24

Too much acid is made in the body
Can happen when the kidneys cant remove enough acid from the body

Question 25

What are the different type of metabolic acidosis?

Answer 25

Diabetic ketoacidosis
Hyperchloremic acidosis
Kidney disease
Lactic acidosis
Poisoning by aspirin, ethylene glycol or methanol
Severe dehydration

Question 26

What is hyperchloremic acidosis?

Answer 26

Loss of too much sodium bicarbonate from the body leads to more chlorine being reabsorbed

Question 27

Answer question on slide 24:

Answer 27

A

Question 28

Why is ammonia an effective urinary buffer?

Answer 28

Wall of renal tubules impermeable to NH4+

Question 29

What will renal correction of acute hyperkalaemia cause?

Answer 29

Acidosis

Question 30

What is the triad of signs for diabetes Mellitus?

Answer 30

Polydipsia
Polyuria
Weight loss

Question 31

What causes Type 1 DM?

Answer 31

Autoimmune B cell destruction leading to absolute insulin deficiency

Question 32

What leads diabetic ketoacidosis with T1DM?

Answer 32

Cells unable to take up glucose so metabolise fatty acids producing ketones