Passmed renal

Question 1

How does muscle breakdown cause renal failure (eg after long time on floor after fall)

Answer 1

Rhabdomyolysis -Myoglobinuria -> tubular cell necrosis

Question 2

How do drugs cause renal faulure

Answer 2

induce apoptosis

Question 3

Maintenance fluids for adult ?

Maintenance K?

Answer 3

25-30ml/kg/day

1mmol/kg/day

Question 4

Organism for HUS ?

Name 1 non infectivee cause

Answer 4

E coli

tumours
pregnancy
ciclosporin, the Pill
systemic lupus erythematosu

Question 5

HUS triad

Answer 5

acute renal failure

microangiopathic haemolytic anaemia

thrombocytopenia

Question 6

What if

renal failure, sensorineural hearing loss and ocular abnormalities develop in a child

Answer 6

Alport syndrome

Question 7

What will exam q often give if need to calculate anion gap?

how do you do it?

Answer 7

Cl

=(Na + K) - (Cl + HCO3)

Question 8

Acidosis with normal anion gap =? name 2 causes

Answer 8

= hyperchloraemic metabolic acidosis

gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula

renal tubular acidosis

drugs: e.g. acetazolamide
ammonium chloride injection

Addison’s disease

Question 9

young female patients who develop AKI after the initiation of an ACE inhibitor?

Seen on imaging?

Answer 9

fibromuscular dysplasia

string of beads’ appearance.

Question 10

Most common virus in organ transplant

Answer 10

cytomegalovirus

Question 11

3 comps post renal transplant

Answer 11

Ca - due to immune supression Esp Basal / squamous skin Ca

Renal failure - ciclosporin/graft rejection/recurrenc

Cardiovascular disease - due to meds

Question 12

Name 2 differences between IgA nephropathy and post strep glomerulonephritis

Answer 12

IgA - 1-2days after URTI
Can get frank haematuria

Pos t stret - 1-2 weeks
proteinuria

Question 13

Usual screening for PKD

Answer 13

USS

Question 14

name 2 parts of Mx hyper k

Answer 14

Stabilisation of the cardiac membrane
intravenous calcium gluconate

Short-term shift in potassium from extracellular to intracellular fluid compartment
combined insulin/dextrose infusion
nebulised salbutamol

Removal of potassium from the body
calcium resonium (orally or enema)
loop diuretics
dialysis

Question 15

Basics of cranial vs nephrogenic DI

Answer 15

Cranial - dont produce enough vasopressin

neph - kidneys dont respond to vassopressin

Question 16

Mx nephrogenic DI

Answer 16

thiazide like diuretic

Question 17

Mx HUS

Answer 17

Supportive - e.g. Fluids, blood transfusion and dialysis if required

Question 18

DI plasma vs urine osmolality

Answer 18

high plasma osmolality

and a low urine osmolality

Question 19

Dx of DI

Answer 19

water deprivation test

Question 20

Ix for diabetic nephropathy

Answer 20

albumin:creatinine ratio (ACR) in early morning

Question 21

55-year-old man presenting with progressive weakness and dyspnoea, hepatomegaly, proteinuria and worsening renal function.

Answer 21

amyloidosis

Question 22

Stain for amyloid?

Answer 22

congo red staining - apple -green birefringence

Question 23

urea / creatinine in dehydration

Answer 23

urea that is proportionally higher than the rise in creatinine

Question 24

Persistent pyuria and negative urine culture

Answer 24

Renal TB

Question 25

Mx of hyperK

Answer 25

IV calcium gluconate

Question 26

Indication that renal disease is chronic and not acute?

Answer 26

hypocalcaemia [Due to reduced synthesis of vit D -> less Ca reabsorption] Bilat small kidneys on USS

Question 27

Signs of drug induced nephritis

Answer 27

Raised urinary WCC/IgE/Eosiniphils Fever Rash Arthralgia

Question 28

Seen on biopsy of wegners / good pastures / SLE ...[Rapid progressive glomerulonephritis]

Answer 28

Crescentic glomerulonephritis

Question 29

Pre/intra/post renal if dip has protein

Answer 29

only Intra

Question 30

Acute interstitial nephritis vs Acute tubular necrosis on dip

Answer 30

nephritis is inflammatory process -> higher white cell content in the urine

Question 31

A 55-year-old man presents with a one month history of fever, arthralgia and lethargy. He also recently developed haemoptysis and dyspnoea. Investigations show that he has an acute kidney injury. ANCA (anti-neutrophil cytoplasmic antibody) is negative. Que es?

Answer 31

anti gbm

Question 32

tachycardia, fatigue, pallor and an aortic flow murmur in CKD

Answer 32

anaemia

Question 33

Why does nephrotic syndrome predispose to thrombus

Answer 33

Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels

Question 34

How to differentiate kidneys not getting enough blood (pre-renal) and Acute tubular necrosis?

Answer 34

The job of the kidneys is to take blood, remove all the shite from it and make concentrated urine. So if the urine osmolality = plasma osmolality then you know that the kidneys are knackered. But if the urine osmolality > plasma, then you know the kidneys themselves are fine but they're just not getting enough blood.

Question 35

A 4-year-old boy with recurrent urinary tract infections is referred to the paediatric team due to worries over reflux nephropathy. Key Ix?

Answer 35

micturating cystography

Question 36

drug causing rhabdomyolysis?

Answer 36

statin

Question 37

Urinary sodium in pre-renal vs intra renal

Answer 37

pre renal is low Urinary as kidneys try and hold onto sodium to increase blood volume