Metabolic Flashcards
1
Q
Gold standard imaging for renal cell carcinoma (RCC)
A
= CT imaging of abdominal-pelvis pre- and post- IV contrast
2
Q
Most common type of adult renal tumour?
A
= renal cell carcinoma (RCC)
3
Q
The following microscopic findings in a renal biopsy indicates what?
- polyhedral clear cells
- dark staining nuclei
cytoplasm rich with lipid + glycogen granules
A
= renal cell carcinoma (RCC)
4
Q
Classic triad of RCC
A
- haematuria
- mass
- flank pain
5
Q
Treatment for RCC
A
- surgical removal (nephrectomy) combined,
- immunotherapy (INF-a, or IL-2 agents)
6
Q
Biological agents which may be used in treatment of RCC?
A
= tyrosine kinase inhibitors
(e.g., Sunitinub, Pazopanib)
7
Q
Majority of prostate cancers arise from which zone:
- transitional zone
- central zone
- peripheral zone
A
- peripheral zone
8
Q
2 types of prostate adenocarcinomas
A
- acinar adenocarcinoma
- ductal adenocarcinoma
9
Q
Most common type of prostate adenocarcinoma?
- acinar adenocarcinoma
- ductal adenocarcinoma
A
- acinar adenocarcinoma
10
Q
Which of the following prostate adenocarcinoma grows + metastasises faster?
- acinar adenocarcinoma
- ductal adenocarcinoma
A
- ductal adenocarcinoma
11
Q
Investigations for prostate cancer (3)
A
- PSA levels
- DRE
- multi-parametric MRI scan
12
Q
Scan used to diagnose prostate cancer
A
= multi-parametric MRI scan (mp-MRI)
13
Q
2 types of biopsy techniques for diagnosing prostate cancer
A
- transperineal biopsy
- transrectal ultrasound guided (TRUS) biopsy
14
Q
Which of the following types of biopsy is most commonly used in diagnosing prostate cancer?
- transperineal biopsy
- transrectal ultrasound-guided (TRUS) biopsy
A
- transperineal biopsy
(reduced risk of infection)
15
Q
Which scoring system is used to grade prostatic cancers based on their histological appearance?
A
= Gleason Grading System
16
Q
How is the Gleason Grading Score calculated?
A
= calculated as sum of most common growth pattern + second most common growth pattern seen
(higher the score, worse the prognosis)
17
Q
Management of prostate cancer is related to risk stratification. What is used to calculate this? (3)
A
- PSA levels
- Gleason score
- T staging (TNM)
18
Q
What is brachytherapy?
(in relation to prostate cancer)
A
= internal radiaiton, transperineal implantation of radioactive seeds into prostate gland
19
Q
Mainstay treatment options from localised or locally advanced prostate cancer? (2)
A
- surgical management (radical prostatectomy)
- radiotherapy (external-beam or brachytherapy)
20
Q
Treatment effectively used in metastatic prostate cancer?
A
= anti-androgen therapy
21
Q
Orchidectomy
A
= surgical removal of one or both testicles
22
Q
Which of the following types of primary testicular tumours are more common:
- germ cell tumour (GCT)
- non-germ cell tumour (NGCTs)
A
- germ cell tumour (GCT)
23
Q
Seminomas + non-seminomatous tumours are subtypes of which of the following primary testicular tumours?
- germ cell tumour (GCT)
- non-germ cell tumour (NGCTs)
A
- germ cell tumour (GCT)
24
Q
Which of the following type of primary testicular tumours tend to be benign?
- germ cell tumour (GCT)
- non-germ cell tumour (NGCTs)
A
- non-germ cell tumour (NGCTs)
25
Which of the following sub-types of GCT testicular tumours have a better prognosis?
- seminomas
- non-seminomatous GCTs
- seminomas
26
Which type of imaging is used for initial assessment of scrotal lumps?
= scrotal USS
27
What is used to diagnose testicular cancer? (2)
- imaging (USS)
- tumour markers
28
Most common type of renal stone?
= calcium oxalate
29
Which of the following are often larger, softer renal stones, most common cause of "staghorn calculi"?
- struvite stones
- urate stones
- cystine stones
- struvite stones
30
Which of the following type of renal stone forms in alkaline urine?
- struvite stones
- magnesium ammonium phosphate stones
- urate stones
- cystine stones
- struvite stones
31
Which of the following type of renal stone forms in people with high purine diets?
- struvite stones
- magnesium ammonium phosphate stones
- urate stones
- cystine stones
- urate stones
32
Gold standard imaging for renal stones?
= non-contrast CT scan of renal tract (KUB)
33
Treatment of renal calculi
Most stones will pass spontaneously with:
- fluid resuscitation
- analgesia
Other management options:
- extracorporeal shock wave lithotripsy (ESWL)
- percutaneous nephrolithotomy (PCNL)
- flexible uretero-renoscopy (URS)
If signs of infection or AKI, urgent decompression required by:
- stent insertion, or
- nephrostomy
34
Which of the following type of renal stone is associated with a familial disorder (genetic testing advised)
- struvite stones
- magnesium ammonium phosphate stones
- urate stones
- cystine stones
- cystine stones
35
Stage 1 AKI is classified as
Creatinine, 1.5-1.9x the baseline
36
Stage 2 AKI is classified as
Creatinine, 2-2.9x the baseline
37
Stage 3 AKI is classified as
Creatinine, >3x the baseline
38
Pre-renal causes of AKI
(hypovolaemia or reduced amount of blood)
- sepsis
- dehydration
- haemorrhage
- cardiac failure
- liver failure
- renal artery stenosis
39
Intra-renal causes of AKI
- nephrotoxins/ drugs: NSAIDs, ACEi or ARBs, antibiotics (aminoglycosides), chemotherapy (cisplatin)
- parenchymal disease: glomerulonephritis, acute tubulointerstitial nephritis, rhabdomyolysis, haemolytic uraemia syndrome (HUS), multiple myeloma
40
Post-renal causes of AKI
(obstruction)
Ureteric - retroperitoneal fibrosis, bilateral renal stones, tumours (mural or extra-mural)
Bladder - acute urinary retention, blocked catheter
Urethral - prostatic enlargement (BPH or malignancy), renal stones
41
High urine specific gravity + osmolarity, as well as low Na excretion is indicative of which type of cause of an AKI?
- pre-renal
- intra-renal
-post-renal
- pre-renal
42
Drugs which should be potentially stopped in AKI? (4)
- ACEi or ARBs
- NSAIDs
- Aminoglycoside antibiotics
- Potassium-sparing diuretics (risk of hyperkalaemia)
43
eGFR range in G1 CKD
>90 mL/min/1.73m^2
44
eGFR range in G2 CKD
60-89 mL/min/1.73m^2
45
eGFR range in G3a CKA
45-59 mL/min/1.73m^2
46
eGFR range in G3b CKD
30-44 mL/min/1.73m^2
47
eGFR range in G4 CKD
15-29 mL/min/1.73m^2
48
eGFR range in G5 CKD
<15 mL/min/1.73m^2
49
2 most common causes of CKD
- diabetes
- vascular disease
50
In CKD, what happens to:
- serum creatinine
- eGFR
- albumin:creatinine ratio
- serum creatinine - high
- eGFR - reduces
- albumin:creatinine ratio increases
51
How do you diagnose CKD?
(1-2, 3-5)
CKD stages 1-2: requires additional evidence of renal disease (other then eGFR), such as:
- proteinuria
- urine sediment abnormalities
- electrolyte abnormalities
- structural abnormalities
- histological abnormalities
- history of kidney transplantation
CKD stages 3-5: can be diagnosed based on eGFR alone
52
How often are CKD patients monitored if they are considered low-moderate risk?
= annually
53
How often are CKD patients monitored if they are considered high risk?
= every 6 months
54
How often are CKD patients monitored if they are considered very high risk?
= every 3-4 months
55
What value of eGFR indicates dialysis?
= 5-10 ml/min/1.73m^2
56
2 types of dialysis
- haemodialysis
- peritoneal dialysis
57
Complications of CKD
Mnemonic 'A WET BED'
Acid-base balance – metabolic acidosis
Water removal – pulmonary oedema
Erythropoiesis – anaemic of chronic kidney disease
Toxin removal – uraemic encephalopathy
BP control – CVD
Electrolyte balance – hyperkalaemia
vitamin D activation – bone-mineral disorder of chronic kidney disease (CKD-BMD), previously referred to as renal osteodystrophy
58
Which of the following is preferred when gaining access for dialysis? why?
- arterio-venous fistula
- tunnelled central venous catheter
- arterio-venous fistula
(less complications e.g., infection)
59
What is pyelonephritis?
= inflammation of kidney parenchyma + renal pelvis due to bacterial infection
60
What is the most common causative organism in pyelonephritis?
= E. coli
61
Classic triad of pyelonephritis presentation
- fever
- unilateral loin pain (rarely bilateral)
- nausea + vomiting
62
What is important to rule out in a patient presenting with loin pain in suspected pyelonephritis?
= AAA rupture
63
Investigations for pyelonephritis
Urinalysis - assess for nitrates + leucocytes
Urine culture
Routine bloods
Renal USS scan - to check for any evidence of an obstruction
64
Which scan is used to check for obstruction in a patient with suspected pyelonephritis?
And if evidence of an obstruction is found, what scan should be performed after?
= renal USS
= non-contrast CT (CT KUB)
65
Treatment for pyelonephritis
- appropriate resuscitation if needed
- start empirical antibiotics (against anticipated causative organism(
- IV fluids if appropriate, suitable analgesia, + anti-emetics
- tailor antibiotic therapy once sensitivities are available
(consider admission in those cases where pt is clinically unstable, significantly dehydrates, or with co-morbidities)
66
Which of the following is the insulin regimen of choice for patients with T1DM:
- basal-bolus regime
- 1,2,3 injections per day
- continuous insulin infusion via pump
- basal-bolus regime
67
Which of the following of the following basal-bolus regimes are first-line?
- twice‑daily insulin detemir
- once-daily insulin glargine
- twice‑daily insulin detemir
68
What is serum C-peptide a measure of?
= insulin production
69
Is serum C-peptide usually high or low in T1DM?
= low
70
What autoantibodies are associated with T1DM? (3)
- anti-islet cell antibodies
- anti GAD antibodies
- anti-insulin antibodies
71
Diagnostic criteria for T1DM
If symptomatic:
- fasting glucose >/= 7.0 mmol/L
- random glucose >/= 11.1 mmol/L
If asymptomatic above needs to be demonstrated twice
72
BMI > 25 is classed as?
= overweight or obese
73
What conditions make up metabolic syndrome? (4)
- hypertension
- hyperglycaemia
- excess fat around waist
- hypercholesterolaemia
74
Obesity Class I BMI range
30-34.9 kg/m2
75
Obesity Class II BMI range
35-39.9 kg/m2
76
Obesity Class III BMI range
>/= 40 kg/m2
77
How does Orlistat work?
= prevents absorption of dietary fat
78
How does Liraglutide work in weight loss?
= delaying gastric emptying + inducing early satiety (satisfaction) resulting in overall reducing in calorie intake + weight loss
79
What is dumping syndrome?
= group of symptoms caused by food rapidly emptying or being ‘dumped’ from the stomach into the small intestine. This results in undigested food in the small intestine that the body finds hard to absorb
Symptoms: sweating, bloating, abdominal cramps/ pain, diarrhoea + nausea
80
What can be used to treat hyperthyroidism SYMPTOMS?
= beta-blocker (Propanolol)
81
First-line definitive treatment in Graves' disease?
= radioactive iodine
82
What is first-line definitive treatment in Graves' disease if radioactive iodine + surgery are unsuitable?
= anti-thyroid drugs (e.g., Carbimazole)
83
In relation to using anti-thyroid drugs in hyperthyroidism, what is a 'block + replace regimen', compared to a 'titration regimen'?
Block + replace - involves using a higher dose of Carbimazole which blocks all production, and then using Levothyroxine to replace
Titration regime - Carbimazole titrated to maintain normal levels
84
Most common cause of hyperthyroidism in developed countries?
= Graves' disease
85
What is Graves' disease?
= autoimmune condition resulting in overproduction of thyroid hormones, due to formation of antibodies to thyroid-stimulating hormone (TSH) receptors
86
What exceptions are there to using radioactive iodine first-line in treating Graves' disease? (4)
- pregnancy
- attempts to conceive within next 4-6 months
- presence of active eye disease
- concerns about compression or malignancy
87
What would you expect TSH, fT3 + fT4 values to be in a patient with Graves' disease?
TSH - low
fT3 - high
fT4 - high
88
Which antibodies are present in Graves' disease?
= TSH-receptor antibodies
89
What is Plummer's disease AKA?
= toxic multi nodular goitre
90
What type of scan is used to help diagnose a toxic multi nodular goitre?
= radioisotope scan (I-123 - preferred isotope)
91
What are the 2 management options for treating multi nodular goitre? (and which is first-line)?
- surgery (thyroidectomy)
- radioactive iodine < first-line
92
Most common cause of hypothyroidism in the developed world?
= Hashimoto's thyroiditis (AKA autoimmune thyroiditis)
93
Management in hypothyroidism?
= Levothyroxine
94
In pregnancy would should be done to Levothyroxine dose?
= increased, due to increased demands during pregnancy
95
DKA is characterised by what 3 things?
- hyperglycaemia
- ketosis
- metabolic acidosis
96
What pH indicates DKA?
= < 7.3
97
Is DKA more common complication in type 1 or type 2 diabetes?
= type 1
98
Drug: -flozin'
= SLGLT-2 inhibitor
99
What is the first-line drug choice in T2DM treatment?
= Metformin
100
Which type of diabetes has a stronger genetic predisposition?
= type 2 DM
101
What HbA1c value is diagnostic of diabetes?
>/= 48 mmol/mol
102
On treatment, what is the HbA1c threshold which indicates diabetes is not well controlled?
> 58 mmol/mol
103
What drug is added to T2DM treatment if patient is at risk of developing CVD, or has CVD or chronic HF?
= SLGT-2 inhibitor
104
T2DM: If triple therapy is not effective what kind of rug can be added and swapped for another patient is currently on?
= GLP-1 mimetic
105
What is Addison's disease?
= also known as primary adrenal insufficiency, refers specifically to when the adrenal glands have been damaged, resulting in reduced cortisol + aldosterone
106
Most common cause of adrenal insufficiency?
= autoimmune
107
What is secondary adrenal insufficiency?
= results from inadequate adrenocorticotropic hormone (ACTH), this is a result of loss or damage to the pituitary gland
108
What is tertiary adrenal insufficiency?
= results from inadequate corticotropin-releasing hormone (CRH) release by the hypothalamus
109
What is tertiary adrenal insufficiency usually caused by?
= patients taking long-term oral steroids > leads to suppression of the hypothalamus
110
Electrolyte imbalances associated with Addison's disease (sodium, potassium, glucose + calcium)
- hyponatraemia
- hyperkalaemia
- hypoglycaemia
- hypercalcaemia
111
Test of choice for diagnosing adrenal insufficiency
= short Synacthen test
112
How does the short Synacthen test work?
Involves giving a dose of Synacthen (synthetic ACTH). Blood cortisol checked before, 30, and 60 minutes after dose
Failure of cortisol to increase indicates either:
- primary adrenal insufficiency
- very significant adrenal atrophy, after prolonged absence of ACTH in secondary adrenal insufficiency
113
When differentiating between primary adrenal insufficiency + adrenal atrophy due to secondary adrenal insufficiency, how will ACTH levels differ?
Primary - ACTH high
Secondary - ACTH low
114
Treatment in adrenal insufficiency, including what is used to replace cortisol + aldosterone
= replacement steroids
Hydrocortisone - used to replace cortisol
Fludrocortisone - used to replace aldosterone
115
Adrenal insufficiency: What should be done to steroid dose in acute illness?
= double it
116
What is given to patient with adrenal crisis?
IM or IV hydrocortisone
IV fluids
IV dextrose (correct hypoglycaemia)
117
What is Cushing's disease?
= refers to pituitary adenoma secreting excessive adrenocorticotropic hormone (ACTH), stimulating excessive cortisol release from the adrenal glands
118
What is paraneoplastic Cushing's syndrome?
= occurs when ATCH is released from a tumour somewhere other than the pituitary gland (ectopic ACTH)
119
Most common cause of paraneoplastic Cushing's syndrome?
= small cell carcinoma
120
What does skin pigmentation tell you about the cause of Cushing's syndrome?
If present - indicates high ACTH > so either caused by Cushing's disease or ectopic ACTH
(can exclude adrenal adenoma or exogenous steroids)
121
1st-line test for Cushing's syndrome?
= overnight dexamethasone suppression test
122
Which test can be used to identify determine the cause of Cushing's syndrome?
= High-dose 48 hour dexamethasone suppression test
123
In a low-dose dexamethasone suppression test, what would the following different causes of Cushing's syndrome cortisol result be?
- normal
- adrenal adenoma
- pituitary adenoma
- ectopic ACTH
Normal - low
Adrenal adenoma - not suppressed
Pituitary adenoma - not suppressed
Ectopic ACTH - not suppressed
124
In a high-dose dexamethasone suppression test, what would the following different causes of Cushing's syndrome cortisol result be?
- normal
- adrenal adenoma
- pituitary adenoma
- ectopic ACTH
- normal - low
- adrenal adenoma - not suppressed
- pituitary adenoma - low
- ectopic ACTH - not suppressed
125
Primary treatment option for Cushing's disease?
= trans-sphenoidal removal or pituitary adenoma
126
What is Conn's syndrome?
= refers to an adrenal adenoma producing too much aldosterone (type of primary hyperaldosteronism)
127
In primary hyperaldosteronism, would you expect renin levels to be high or low?
= low
128
In secondary hyperaldosteronism, would you expect renin levels to be high or low?
high
129
What is secondary hyperaldosteronism caused by?
= caused by excessive renin stimulating release of excessive aldosterone
130
Why might excess renin be released in secondary hyperaldosteronism? (3)
- Renal artery stenosis
- HF
- Liver cirrhosis + ascites
131
First investigation in suspected hyperaldosteronism?
= aldosteron-to-renin ratio (ARR)
132
A high-aldosterone to low renin ratio is seen in which of the following:
- primary hyperaldosteronism
- secondary hyperaldosteronism
- primary hyperaldosteronism
133
A high-aldosterone to high renin ratio is seen in which of the following:
- primary hyperaldosteronism
- secondary hyperaldosteronism
- secondary hyperaldosteronism
134
Is hyperaldosteronism patients can present with which of the following:
- metabolic acidosis
- metabolic alkalosis
- metabolic alkalosis
(loss of hydrogen ions in the urine occurs when excess aldosterone (Conn's syndrome) increases the activity of a sodium-hydrogen exchange protein in the kidney. This increases the retention of sodium ions whilst pumping hydrogen ions into the renal tubule)
135
Medical treatment for hyperaldosteronism?
= aldosterone antagonists (e.g., Eplerenone or Spironolactone)
136
What is a phaeochromocytoma?
= = tumour of the adrenal glands that secretes unregulated + excessive amounts of catecholamines (adrenaline)
137
What cells produce adrenaline?
= chromaffin cells
138
First-line investigation for suspected phaeochromocytoma?
= 24 hr urine metanephrines
(metanephrine - breakdown product of adrenaline)
139
Management of phaeochromocytoma (3)
- alpha-blockers
- beta-blocker
- surgical removal of tumour
140
What is acromegaly?
= disorder that occurs when your body makes too much growth hormone (GH)
141
What is acromegaly most commonly caused by?
= pituitary adenoma
142
What visual defect is seen in patients with acromegaly?
= intemporal hemianopia
143
First-line test for acromegaly?
= serum IFG-1 levels
144
First-line treatment in acromegaly?
= trans-sphenoidal surgery, to remove pituitary tumour
145
Drugs which block the release of growth hormone (2)
- somatostatin analogues
- dopamine agonists
146
What causes primary hyperparathyroidism?
= tumour of the parathyroid
147
What causes secondary hyperparathyroidism?
= low vitamin D or CKD
148
What causes tertiary hyperparathyroidism?
= hyperplasia of parathyroid gland
(happens when secondary hyperparathyroidism continues for extended periods of time, after being treated
Hyperplasia of parathyroid glands > produce more parathyroid > when secondary cause treated, baseline parathyroid hormone remains high > hypercalcaemia)
149
What 3 ways does parathyroid hormone act to raise blood calcium?
- increasing osteoclast activity in bone
- increasing calcium reabsorption in kidneys
- increased vitamin D activity – resulting in increased calcium absorption in intestines
150
Symptoms of hypercalcaemia?
'Stones, bones, groans and psychiatric groans'
- kidney stones
- painful bones
- abdominal groans (constipation, nausea + vomiting)
- psychiatric moans (fatigue, depression + psychosis)
151
What is SIADH?
= refers to the increased release of ADH from the posterior pituitary. This increases water reabsorption from urine, diluting blood > leads to hyponatraemia
152
In SIADH, what do you expect urine osmolality + urinary sodium to be?
Urinary osmolarity: high
Urinary sodium: high
153
3 important causes of SIADH to remember (there are many)
- small cell lung cancer
- post-operative
- SSRIs
154
Investigations for SIADH
- Urine osmolarity
- Urine sodium concentration
155
What is the effect of Demeclocycline, in the treatment of ADH?
= reduces responsiveness of collecting tubule cells to ADH
156
Where does osmotic demyelination syndrome, AKA central pontine myelinosis (CPM) arise from?
= is a complication of long-term severe hyponatraemia being treated too quickly
157
First-line treatment for steroid-induced diabetes?
= Sulfonylureas
158
Which of the following works most immediate to lower blood sugar?
- DDP-4 inhibitor
- Pioglitazone
- Sulfonylurea
- SGLT-2 inhibitor
- Sulfonylurea
158
Which of the following works to lower blood sugar by causing the kidneys to remove sugar from the body through the urine?
- DDP-4 inhibitor
- Pioglitazone
- Sulfonylurea
- SGLT-2 inhibitor
- SGLT-2 inhibitor
159
Which DDP-4 inhibitor can be used to lower blood sugar in patient with kidney disease?
= linagliptin
160
Which metabolic imbalance is seen in Cushing's disease?
- hypokalaemic metabolic alkalosis
- hyperkalaemic metabolic acidosis
- hyperkalaemic metabolic alkalosis
- hypokalaemic metabolic acidosis
- hypokalaemic metabolic alkalosis
161
Most common type of glomerulonephritis?
= IgA Nephropathy (Berger's disease)
162
Symptoms associated with nephritic syndrome (4)
- haematuria
- oliguria
- proteinuria
- fluid retention
163
Nephrotic syndrome criteria (4)
- peripheral oedema
- proteinuria > 3g/ 24 hours
- serum albumin < 25g/L
- hypercholesterolaemia
164
Most types of glomerulonephritis are treated with what 2 things?
Steroids - immunosuppression
ACE-i or ARBs - BP control, by blocking renin-angiotensin system
165
What is the most common cause of nephrotic syndrome in children?
= minimal change disease
166
Most common cause of nephrotic syndrome in adults?
= focal segmental glomerulosclerosis
167
Histology: IgG + complement deposits on basement membrane. Is suggestive of which type of glomerulonephritis?
= membranous glomerulonephritis
168
What is Goodpasture's syndrome?
= rare condition where body produced anti-GBM (glomerular basement membrane) antibodies. Which attack the kidneys + lungs
169
What antibody is present in Goodpasture's syndrome?
= anti-GBM (glomerular basement membrane) antibodies
170
Patient with acute interstitial nephritis presents with which 2 features?
= AKI + hypertension
171
'Muddy brown casts' on urinalysis are suggestive of what condition?
= acute tubular necrosis
172
Is acute tubular necrosis reversible?
= yes
173
What is type 1 renal tubular acidosis?
(pathology is where, and what is unable to occur)
= pathology in distal tubule, unable to excrete hydrogen ions
174
What is type 2 renal tubular acidosis?
(pathology is where, and what is unable to occur)
Pathology in proximal tubule, unable to reabsorb bicarbonate
175
Type 4 renal tubular acidosis is caused?
= reduced aldosterone, can be caused by adrenal insufficiency, ACE-i, Spironolactone, SLE, diabetes, or HIV
176
What is Fludrocortisone?
= mineralocorticoid, given in Addison's and type 4 renal tubular acidosis to replace aldosterone is insufficient
177
What is haemolytic uraemia syndrome (HUS)?
= occurs when there is thrombosis in small vessels throughout the body (formation of blood clots)
178
Which bacteria toxin usually triggers haemolytic uraemia syndrome?
= shiga toxin
179
Classic triad of patient presenting with haemolytic uraemia syndrome (HUS)
- haemolytic anaemia
- AKI
- thrombocytopenia
180
What is rhabdomyolysis?
= where skeletal muscle tissue breaks down and releases breakdown products into the blood
181
What is diabetes insipidus due to?
Lack of anti-diuretic hormone (ADH) production, or lack of response to ADH
182
What is vasopressin also known as?
= anti-diuretic hormone, ADH
183
What are the 2 types of diabetes insipidus?
- nephrogenic DI
- cranial DI
184
What is nephrogenic diabetes insipidus?
= when the collecting ducts of the kidney don't respond to ADH
185
What is cranial diabetes insipidus?
= when the hypothalamus doesn't produce ADH for the pituitary gland to secrete
186
How is diabetic insipidus diagnosed?
= water-deprivation test
187
What is primary polydipsia?
= person drinks excessive amount of water, and therefore produces a lot of urine (ADH system is fully functioning)
188
In cranial diabetes insidious, what would you expect the urine osmolarity to be: after water deprivation, and after desmopressin?
After water deprivation: low
After desmopressin: high
189
In primary polydipsia, what would you expect the urine osmolarity to be: after water deprivation?
After water deprivation: high
190
In nephrogenic diabetes insidious, what would you expect the urine osmolarity to be: after water deprivation, and after desmopressin?
After water deprivation: low
After desmopressin: low
191
Management of cranial diabetes insipidus?
Demopressin (synthetic ADH) can be used to replace absent ADH
192
Management of nephrogenic diabetes insipidus
Thiazide diuretics (to decrease urine volume)
Ensure plenty of water
