Renal

Question 1

How is measurement of proteinuri often done?

Answer 1

Often done by albumin/creatinine ration or protein creatinine ratio

Question 2

A PCR and ACR of what is approximately equal to 1g of protein per 24 hours

Answer 2

o A PRCR of 100 or ACR of 70 is

Question 3

Definitive diagnosis of glomerulonephritis?

Answer 3

Renal biopsy

Question 4

What does ANA look at?

Answer 4

Lupus

Question 5

What does ANCA blood test look at?

Answer 5

Small vessel vasculitis

Question 6

What does the anti GBM antibody look at?

Answer 6

Good pastures syndrome

Question 7

Goodpastures treatment

Answer 7

Plasma exchange- Seperate out all the good plasma proteins and then reduce level of specific antibody
Immunosuppress

Question 8

What is the most common type of glomerulonephritis?

Answer 8

IgA nephropathy

Question 9

What happens in memberanous nephritis

Answer 9

Immune complex deposition in the GBM

Question 10

What antibody is found in 60-80% of cases of membranous nephritis?

Answer 10

Anti-PLA2R

Question 11

Why is an Ace Inhibitor good for perserving kidney function in patients while decreasing BP

Answer 11

Selectively lowers the intraglomerular pressure
So ACEi are renoprotective

Question 12

How do aminoglyclosides cause nephrotoxcity?

Answer 12

Directly nephrotoxic causing acute tubular necrosis

Question 13

How do amphotericin cause nephrotoxcity?

Answer 13

Directly nephrotoxic

Question 14

How does cytotoxic chemotherapy cause nephrotoxcity?

Answer 14

Associated with renal tubilar damage

Question 15

How do diuretics cause nephrotoxcity?

Answer 15

Lead to volume depletion

Question 16

How do immunsuppressants cause nephrotoxcity?

Answer 16

Cause renal vasoconstriction producing ischaemia

Question 17

How do lithium salts cause nephrotoxcity?

Answer 17

Can cause tubulointerstital damage and CKD with long term use. However, it should only be suspended if known lithium overdose or toxic levels due to its importance in the treatment of BPD.

Question 18

How do NSAIDs/Cox2 inhibitors cause nephrotoxcity?

Answer 18

Renal blood flow often relies on prostaglandins. NSAIDs and COX-2 inhibitors reduce prostaglandin synthesis and cause renal hypoperfusion and AKI

Question 19

How does radiocontrast media cause nephrotoxcity?

Answer 19

A high ionic load can produce renal vasoconstriciton leading to ischaemia

Question 20

How does sepsis affect the kidneys?

Answer 20

Endotoxins and inflammatory mediators from infection can dmagae the renal vascular endotherlium resulting in thrombosis

Question 21

How does rhabdomylosysis affect the kindeys?

Answer 21

Myoglobin released from damaged muscles percipitates in renal tubiles and also reduces blood flow in the outer medulla

Question 22

When should you not use the MDRD, CKD-EPI or eGFR to estimate renal function?

Answer 22

Extremes of weight
Childrne
Catabolic states

Question 23

What is CKD classified according to?

Answer 23

the eGFR
Albumin

Question 24

How to stabolise the myocardium in hyperkalaemia?

Answer 24

Calcium gluconate 10%

Question 25

How can you drive potassium into the cell?

Answer 25

Nebulised salbutamol and soluble insulin and glucose

Question 26

What should you look at to diagnose AKI?

Answer 26

Creatinine

Question 27

Risk factors for AKI

Answer 27

Elderly Cardiac failure CKD Diabetes Nephrotoxic medication

Question 28

What fluid to give is someone is hypovalemic?

Answer 28

Hartmann's

Question 29

What is used to stabilise myocardium in hyperkalaemia?

Answer 29

Calcium gluconate or calcium chloride

Question 30

What pushes potassium back into the cells in hyperkalaemia

Answer 30

Insluin and dextrose Salbutamol

Question 31

How is AKI divided?

Answer 31

Pre-renal Renal Post-renal

Question 32

What is pre-renal aki?

Answer 32

Things that occur before kidney. Usually in blood vessels

Question 33

What is renal AKI?

Answer 33

Things in the kidney Most common is acute tubular necrosis

Question 34

The hallmark of intrinsic renal AKI is structural damage. It may be categorised according to the location of the pathology:

Answer 34

Vasculature Glomerular Tubulointerstitial

Question 35

WHat are some extra renal manifestations of autosomal dominant polycystic kidney disease?

Answer 35

Liver cyst Cerebral berry aneurys Cysts

Question 36

What are problems of calcium based phosphate binder?

Answer 36

Hypercalacaemia and vascular calcification

Question 37

What are the four Hs that cause focal segmental glomerulopathy?

Answer 37

Huh?- Idiopathic Hurt kiney- Secondary to other neurpathies HIV Heroin

Question 38

What is Henoch Scholein purpura?

Answer 38

IgA mediated small vessel vasculitis

Question 39

Treatment of henoch scholein purpra

Answer 39

Analgesia for athralgia Treatment of nephropathy is normally supportive

Question 40

Inital managemengt of CKD-mineral bone disease?

Answer 40

Correct hyperphosphataemia first before a phosphate binder

Question 41

Pneumonic for drugs to stop in AKI?

Answer 41

DAMN AKI Diruetics Aminoglyclacides and Ace-I Metformin NSAIDS

Question 42

Features of henoch scholein purpura?

Answer 42

palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs abdominal pain polyarthritis features of IgA nephropathy may occur e.g. haematuria, renal failure

Question 43

Management of minimal change disease?

Answer 43

Oral corticosteroids Cyclophosphamide is next step for steroid resistance cases

Question 44

Membranous glomerulonephritis histology?

Answer 44

basement membrane thickening on light microscopy subepithelial spikes on sliver stain positive immunohistochemistry for PLA2

Question 45

What does the pattern of a rise in creartinine and urea but the rise in urea being much bigger than the rise in creatinine suggest?

Answer 45

Dehydration

Question 46

Causes of a normal anion gap or hyperchloraemic metabolic acidosis

Answer 46

gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula renal tubular acidosis drugs: e.g. acetazolamide ammonium chloride injection Addison's disease

Question 47

Causes of a raised anion gap metabolic acidosis

Answer 47

lactate: shock, hypoxia ketones: diabetic ketoacidosis, alcohol urate: renal failure acid poisoning: salicylates, methanol 5-oxoproline: chronic paracetamol use

Question 48

Management of hyperkalaemia that helps remove potassium from the body?

Answer 48

calcium resonium (orally or enema) enemas are more effective than oral as potassium is secreted by the rectum loop diuretics dialysis haemofiltration/haemodialysis should be considered for patients with AKI with persistent hyperkalaemia

Question 49

What is dialysis disequilibrium syndrome caused by?

Answer 49

Cerebral oedema

Question 50

Gold standard for bladder diagnosis?

Answer 50

Cytososcopy

Question 51

What is amyloidosis?

Answer 51

extracellular deposition of an insoluble fibrillar protein termed amyloid

Question 52

Medication for diabetic nephropathy?

Answer 52

ACE inhibitor or angiotensin-II receptor antagonist