Renal

Question 1

What monitors BP in the kidney? and what are the specialist cells in it?
What happens if a low BP is detected? and how does it help this?

Answer 1

Juxtaglomerular apparatus
Macula densa
Releases Renin which starts the RAAS system to increase BP through the increase of cardiac output and blood volume.

Question 2

What is Acute kidney injury determined by?

Answer 2

Decreased eGFR, increased creatinine and urea

Question 3

What 3 conditions are associated with intrinsic kidney damage?

Answer 3

Hypertension
Diabetes mellitus
Glomerular disease

Question 4

What 9 drugs are nephrotoxic?

Answer 4

ACEI 
ARB
NSAIDs 
bisphosphonates 
calcineurin inhibitors (ciclosporin) 
diuretics 
lithium 
mesalazine

Question 5

What 4 conditions are associated with obstructie uropathy?

Answer 5

Structural renal tract disease
bladder voiding problems - neurogenic bladder or BPH
Urinary division surgery, recurrent urinary tract calculi

Question 6

What is the pathophysiology behind renal bone disease and what is it a complication of?

Answer 6

Less phosphate is being removed renally so its concentration increases whilst calcium decreases triggering PTH release so calcium is removed from the bones meaning the bones are left weak.
Complication of CKD

Question 7

What is the treatment of renal bone disease?

Answer 7

Vitamin D or calcium supplementation
Phosphate binders and dietary restrictions
PTH reducing drugs - cinacalcet
Parathyroidectomy

Question 8

What can increased urea be a sign of?

Answer 8

Reduced eGFR - CKD

Question 9

What are the possible complications of CKD

Answer 9

Anaemia - B12, folate, iron and erythropoietin deficiency
Renal acidosis - can lead to bone resorption (hyperkalaemia)
AKI
CV disease - strokes
Peripheral neuropathy
End stage renal disease

Question 10

What findings would warrant a investigation for CKD?

Answer 10

eGFR <60mL/min/1.73
Persistent haematuria (UTI ruled out)
proteinuria (ACR>3)
Urine sediment abnormalities (RBC, WCC)

Question 11

What symptoms and signs should make you suspect a AKI?

Answer 11

Vomiting/Nausea or diarrhoea with evidence of dehydration
Reduced urine output or change in colour
confusion, fatigue, drowsiness

Question 12

What are examples of pre-disposing AKI risk factors?

Answer 12

Low eGFR 
g5+ 
Vascular, cardiac or liver disease 
diabetes
polypharmacy 
previous AKI

Question 13

What are the examples of precipitation AKI risk factors?

Answer 13

Hypovolaemia - low BP
Sepsis
Nephrotoxins - diuretic, ACEI/ARB, NSAIDs, contrast
Recent surgery

Question 14

What are the 3 main causes for pre-renal AKI?

Answer 14

Hypovolemia - blood loss or blood is in body just wrong place
Reduced cardiac output
haemodynamic disturbances

Question 15

Why do NSAIDs increase risk of AKI?

Answer 15

Block dilation of afferent arteriole

Question 16

Why do ACEI/ARBs increase risk of AKI?

Answer 16

Block constriction of efferent arteriole

Question 17

What are the 4 causes of post renal AKI?

Answer 17

Malignancy
BPH
Stones/strictures
Neuropathic bladder

Question 18

What is haemolytic uraemic syndrome

Answer 18

Acute onset of microangiopathic haemolytic anaemia, thrombocytopenia and AKI

Question 19

What is the most common cause of haemolytic uraemic syndrome?

Answer 19

Shiga toxin infection - e.coli, shigella or citrobacter

Question 20

What is SLEs effect on the kidney?

Answer 20

small vessel vasculitis

Question 21

What is the difference between nephritis and nephrotic syndrome?

Answer 21

Nephrotic:
- high proteinuria, oedema, hypoalbuminemia, hyperlipidaemia, damage to GBM/podocytes
Nephritic:
- haematuria, proteinuria, hypertension, reduced renal function
- Due to inflammation

Question 22

What are the 5 types of nephrotic syndrome and who are they most common in?

Answer 22

Minimal change - children
Membranous nephropathy - adults
focal segmental glomerulosclerosis - african adults
Diabetic glomerulopathy
Renal amyloidosis - infection AA or myeloma AL

Question 23

What are the 3 types of nephritic syndrome and who are they most common in?

Answer 23

IgA nephropathy and IgA vasculitis - children (most common form of glomerular nephropathy)
Anti-GBM disease - old children and older adults

Question 24

If unsure how to treat a glomeurular disease what should you guess?

Answer 24

IMMUNOSUPPRESANTS

Question 25

What is type 1 renal Tubular Acidosis?
What does it cause and what are complications of it?
What are the causes?

Answer 25

Inability to secrete H+ into the distal tubule
Causes hypokalaemia
Complications = Nephrocalcinosis and renal stones
Causes = RA, SLE, Sjorjen’s, Idiopathic, analgesia

Question 26

What is type 2 renal tubular acidosis?
what does it cause?
What is a complication?
What can cause it?

Answer 26

Decreased HCO3- due to reabsorption in the proximal tubule
Causes hypokalaemia
Complications = osteomalacia
Causes = Fanconi syndrome, Wilsons disease, carbonic anhydrase inhibitors, idiopathic