Nephrology

Question 1

How is glomerular perfusion maintained when renal blood flow decreases?

Answer 1

Afferent arteriole vasodilates (blood in to glomerulus)
this is disrupted by NSAIDs
Efferent arteriole vasoconstricts (blood out of glomerulus)
this is disrupted by ACEi and ARBs

Question 2

Causes of pre-renal failure?

Answer 2

Hypotension - shock, sepsis, MI etc

Hypovolaemia - haemorrhage, burns, over diuresis etc

Hypoperfusion - AAA, renal artery stenosis, DRUGS

Question 3

Four categories of intrinsic renal failure?

Answer 3

Glomerular
Interstitium
Tubules
Vascular

Question 4

Nephritic vs nephrotic?

Answer 4

Nephritic - haematuria

Nephrotic - proteinuria

Question 5

Most common cause of nephrotic syndrome is children, caucasian adults, and black adults?

Answer 5

Children - minimal change
Caucasian adults - membranous glomerulonephritis
Black adults - Focal segmental glomerular sclerosis

Question 6

Uncommon cause of nephrotic syndrome?

Answer 6

Mesangiocapillary aka membranoproliferative

a) Immunocomplexes - assx with Hep C
b) Alternate complement activation

Question 7

Causes of nephritic syndrome

Answer 7

IgA - commonest
at time of (throat) infection

Post strep GN
2 weeks post infection (group A b-haemolytic strep)

Autoimmune:
Goodpastures, ANCA associated vasculitis

Question 8

Treat pain in renal stones?

Answer 8

For unbearable pain, 75mg IM diclofenac (intragluteal)

For less severe pain 75mg PO or PR diclofenac BD/TDS

Question 9

Anion gap explain?

Answer 9

In metabolic acidosis:
Increased anion gap:
increased production, or decreased excretion of acids eg. lactic acidosis, DKA, drugs, urate

Normal anion gap
Due to loss of bicarbonate of increase in H+ ions eg. RTA, diarrhoea, Addisons, pancreatic fistula