Passmed Renal Flashcards
What is a test for renal function?
Inulin which is wholly filtered in the glomerulus and not secreted or excreted.
How can systemic lupus affect the kidneys?
Autoimmune complex deposition affects the glomerulus and causes diffuse proliferative glomerulonephritis, with wire-loop glomerular lesion with proteinuria on histopathological testing. It is managed by treating the underlying hypertension and steroid therapy to reduce immune response.
How can systemic lupus be detected on examination?
Autoimmune complex deposition affecting the glomerulus and causes proliferative wire-loop glomerular lesion with proteinuria on histopathological testing. It is managed by treating the underlying hypertension, steroid therapy to reduce immune response and
How does diabetes affect the kidneys?
Non-enzymatic glycation results in nodular glomerulosclerosis and hyaline arteriosclerosis.
What is the most common cause of acute kidney injury?
Acute tubular necrosis, which is typical following dehydration and loss of perfusion to the kidneys. Dysfunction of the renal cells results in dark concentrated urine. A hallmark of acute tubular necrosis is muddy brown granular casts because of the loss of the cells. Treatment is typically addressing Hypovolemia and correcting electrolyte imbalances.
What are the causes of acute tubular necrosis?
-> Shock due to ischaemia or sepsis
-> Use of Nephrotoxins like aminoglycosides, myoglobin, radio-contrast agents or lead.
In acute tubular necrosis, there is an oliguria phase, polyuria phase and recovery phase.
What is the risk with correction of low sodium?
“Low to high, the brains will die”
Osmotic demyelination syndrome, where fluid shifts from the cells to extracellular space causes damage to myelin of neural cells, causing dysphagia, seizure, dysarthria and motor abnromalities.
What is the risk with correction of hypernatremia?
“High to low the brain will blow”
Rapid drops in serum osmolality will cause fluid to deposit in the extracellular space.
What is Goodpasture’s syndrome?
Type 2 hypersensitivity where antibodies attack the glomerular basement membrane and lung membranes, causing haemoptysis and haematuria.
Which glomerulopathies are mediated by immune complexes?
Systemic lupus erythematous
Post-streptococcal glomerulonephritis
Which glomerulopathies are mediated by immune complexes?
Systemic lupus erythematous
Post-streptococcal glomerulonephritis
What occurs after parathyroidectomy?
Removal of the parathyroid glands results in severe hypocalcaemia known as hungry bone syndrome due to a shift from osteoclasts activity to osteoblast activity
What are the features of post-streptococcal glomerulonephritis?
Immune complex deposition of IgG, IgM and C3 in the glomeruli with endothelial profileration by neutrophils, granular appearance on immunofluoresence and a subepithelial hump which results in nephritic syndrome with haematuria and proteinuria, which occurs 7-14 days following an infection with a group B streptococcus pathogen and commonly affects young children.
Which medications should be stopped during an acute kidney injury?
ACE inhibitors
NSAIDs
Diuretics
What is the implication with the use of lithium?
Diabetes insipidus which targets the collecting duct by desensitising the body’s response to ADH.
What is the most common cause of nephrotic syndrome in children?
Minimal change disease, where there is T cella and cytokine mediated damage to the basement membrane, resulting in an increased glomerular permeability to albumin. It is typically managed with corticosteroids and
How does raised pH affect levels of potassium?
Alkalosis indicates that there is a higher concentration of H+ ions in the cell which causes the loss of potassium levels intracellularly.
What are the causes of hyperkalemia?
Metabolic acidosis
Rhabdomyolysis
AKI
Addison’s disease
Large blood transfusion: donated blood may be high in K+ that induces loss of in vivo K+ via the urine
Why does Addison’s disease result in hyperkalemia?
Destruction of the adrenal glands results in undersecretion of aldosterone, which prevents the excretion of K+ into the urine and promotes the loss of Na+ and H20.
What is the specific gravity of urine?
Concentration of solutes in the urine.
Which factors affect the clearance of a drug?
Diffusivity across the membrane and tubular reabsorption/secretion.
Which cells make up the juxtaglomerular apparatus?
Juxtaglomerular cells
Extraglomerular mesangial cells
Macula dense cells