Renal

Question 1

Renal bicarbonate resorption

Answer 1

mediated by contraction of extracellular fluid, hypokalaemia, hypochloraemia, MCC activity

Question 2

polyuria

Answer 2

> 3L/day
DI normal to high Na
use water deprivation test
then ADH if does not concentrate to differentiate nephrogenic and cranial DI
psychogenic polydipsia normal to low Na

Question 3

RTA

Answer 3

1 distal, stones, pH > 5.5, scleroderma
2 proximal
4 aldosterone resistant

Question 4

diuretic use

Answer 4

high HCO3, low Cl-, low Na+, low K+

met alkalosis

Question 5

cushings, conns, addisons

Answer 5

cushings, conns - too much - met alkalosis
high Na, high K, low K
addisons - too little - non gap met acidosis
low Na, low H, high K

Question 6

henoch schoenlein

Answer 6

IgA, normal complement

Question 7

malabsorption renal stone

Answer 7

calcium oxalate
calcium usually binds to oxalate and oxalate is not absorbed
in malabsorption calcium binds to free fatty acids and oxalate is absorbed –> oxaliurea

Question 8

Bartters

Answer 8

not hypertensive

NKCC2 mutation / ROMK gene mutation

Question 9

Gitelmans

Answer 9

NaCl cotransporter inactivating mutation

Question 10

FeNa

Answer 10

< 1% in pre renal AKI

> 1% in renal AKI

Question 11

urinary casts in interstitial nephritis

Answer 11

white cell casts, non pigmented granular casts, eosinophils

Question 12

haemostasis in ESRF

Answer 12

decreased activity platelet factor 3

renal loss of anticoagulant factors

Question 13

GN immunofluorescence - linear IgG

Answer 13

post strep GN
lupus (subendothelial)
GPA (wegeners)
membranous (C3)
Goodpastures

Question 14

subacute bacterial endocarditis

Answer 14

biopsy: necrosis with IgG, IgM, C3 deposits

low complement, high Rh factor, cryo

Question 15

Alports

Answer 15

congenitally abnormal GBM due to mutation in alpha collagen

a/w sensorineural deafness

Question 16

GN immunofluorescence membranoproliferative

Answer 16

membranoproliferative type 1
subendothelial Ig deposits with low C3
type 2 C3; no Ig
low C1, C2, C4 (classical complement components)

Question 17

GN immunofluoresnce membranous

Answer 17

subepithelial immune complexes

Question 18

Barters

Answer 18

thick ascending limb loop of Henle
high urinary PGE2, calcium
normotensive
met alkalosis
hypokalaemia, hypomagnesaemia
autosomal recessive

Question 19

Gitelman’s

Answer 19

distal tubule
normal urinary PGE2, low calcium
normotensive
met alklalosis
hypokalaemia, hypomagnesaemie
autosomal recessive

Question 20

urine chloride

Answer 20

< 25 if low volume - past diuretic, vomiting

> 25 otherwise - current diuretic use

Question 21

aldosterone

Answer 21

increases production of sodium channels in collecting tubules
SAME - increased aldosterone
Liddles - cannot break down sodium channels

Question 22

cyclosporin dosing

Answer 22

interacts with MMF - reduces MMF by 30%

level 2/24 post dose

Question 23

drugs that can be cleared by dialysis

Answer 23

BLAST
barbiturates
lithium
alcohol
salicylates
theophylline