Renal

Question 1

where does most reabsorption take place in the kidney

Answer 1

PCT

Question 2

where are the glomeruli located

Answer 2

cortex

Question 3

where does fine tuning of Na and K take place

Answer 3

DCT

Question 4

which part is under control of ADH and determines how much H20 reabsorbed

Answer 4

CD

Question 5

Two diseases of the glomerulus

Answer 5

nephrotic syndrome

nephritic syndrome

Question 6

nephrotic syndrome is characterised by

Answer 6

proteinuria >3g/25h
oedema
hyperlipidaemia

Question 7

swelling, frothy urine

Answer 7

nephrotic syndrome

Question 8

most commonly seen in children, loss of podocyte foot processes. thought to be associated with immune process. >90% respond to steroids.

Answer 8

minimal change

Question 9

common in adults
diffuse glomerular BM thickening
IgG and complement along the entire GBM
poor response to steroids
can be associated with SLE, infection, drugs, malignancy
STRONG association with abs to phospholipase A2 receptor on podocytes

Answer 9

membranous

Question 10

common in adults, AC
consolidation and progressive scarring, hyalinosis
Ig and complement in scarred areas
1ry, but can be 2ry to obesity and HIV nephropathy

Answer 10

focal segmental glomerulosclerosis

Question 11

a secondary cause of nephrotic syndrome that shows diffuse BM thickening and Kimmelstiel Wilson nodules

Answer 11

Diabetes

Question 12

secondary cause of nephrotic syndrome. Histology shows apple green birefringence with cong red stain

Answer 12

Amyloidosis

Question 13

chronic inflammation - RA, TB - and apple green birefringence

Answer 13

AA protein deposition amyloidosis

Question 14

Ig light chain deposition i.e in MM, leading to apple green birefringence and nephrotic sydrome

Answer 14

AL amyloid protein deposition

Question 15

macroglossia, heart failure, hepatomegaly

Answer 15

amyloidosis clues

Question 16

coca cola haematuria, dysmorphic RBCs and red cell casts in urine,
+/- oliguria, increased urea and creatitine, HTN and proteinuria (mild)

Answer 16

Nephritic syndrome

Question 17

occurs 1-3 weeks after strep throat infection with GAS. immune compkex deposition leads to red cell casts proteinuria, oedema and HTN.

Answer 17

post strep GN

Question 18

Commonest GN in the world, caused by IgA immune complexes in the glomeruli
presents 1-2 days after a URTI with frank haematuria

Answer 18

IgA nephropathy

Question 19

medical emergency which can rapidly progress to ESRF. characterised by nephritic syndrome with pronounced oliguria and renal failure.
presence of crescents in glomeruli.

Answer 19

Crescenteric GN

Question 20

HLA-DR1 associated syndrome with crescents in glomeruli on light microscopy.
fluorescence microscopy shows LINEAR deposition of IgG in GBM.

Answer 20

Goodpastures - anti-GBM IgG

can also have lung involvement - pulm haemorrhage

Question 21

nephritic syndrome with crescents in glomeruli, fluorescence microscopy shows a granular (lumpy bump) pattern of IgG complex deposition along the GBM and mesangium.
limited additional organ involvement usually.

Answer 21

Immune complex mediated crescenteric GN.

associated with SLE, IgA nephropathy and post-GN strep.

Question 22

crescenteric GN with a lack of/scanty immune complex deposition, may be associated with c-ANCA/p-ANCA, and vasculitits.

Answer 22

pauci-immune crecenteric GN

no immune complex/anti-GBM

Question 23

sensorineural deafness, eye disorders and nephritic syndrome. X linked.

Answer 23

Alports syndrome

mutation on type IV collage alpha 5 chain

Question 24

asymptomatic microscopic haematuria caused by diffuse thinning of the GBM.

Answer 24

Benign familial haematuria

AD inheritance, normal renal function

Question 25

Asymptomatic haematuria ddx

Answer 25

1. Benign familial haematuria 2. IgA nephropathy - more likely to cause frank haematuria, more likely to cause change in renal function, more common in asians 3. Alport syndrome

Question 26

acute damage to the tubular interstitial cells leading to sloughing of the damaged cells, which go on to block tubules. This causes reduced flow --> acute renal failure

Answer 26

Acute Tubular Necrosis

Question 27

Causes of ATN

Answer 27

1. ischaemia - burns, sepsis, severe dehydration | 2. nephrotoxins - drugs (NSAIDS, gent), radioactive contrast, myoglobin, heavy metals, light chains

Question 28

histopathology of ATN

Answer 28

necrosis of the short segments of tubules

Question 29

leukocytic casts in the urine

Answer 29

pyelonephritis

Question 30

hypersensitivity reaction, usually starts days after exposure with fever, skin rash, haematuria, proteinurian and eosinophilia.

Answer 30

acute interstitial nephritis

Question 31

thrombotic microangiopathy with schistocytes, anaemia, often in young children. thrombi confined to the kidneys. usually causes renal failure.

Answer 31

HUS

Question 32

thrombi occuring throughout the ciruclation, MAHA, low plts, neuro sx (headache, altered consciousness, seizures, coma) no renal failure

Answer 32

TTP

Question 33

rapid loss of GFR and tubular function leading to abnomrmal U&E, decreased GFR, increased CR and Urea.

Answer 33

acute renal failure

Question 34

complications of ARF

Answer 34

``` metabolic acidosis hypERkalaemia - reduced Na reaching the DCT - leads to decreased K+ secretion. fluid overload HTN hypocalcaemia uraemia ```

Question 35

pre-renal causes of ARF

Answer 35

failure of perfusion - dehydration, shock, haemorrhage, hypovolaemia, renal artery stenosis

Question 36

renal causes of ARF

Answer 36

failure of kidney intersitium ATN acute GN thrombotic microangiopathy

Question 37

post renal causes of ARF

Answer 37

obstruction | renal stones, tumours, prostatic hypertrophy

Question 38

progressive and irreversible loss of renal function characterised by chronic prolonged symptoms of uraemia - fatigue, itching, anorexi and confusion

Answer 38

Chronic renal failure

Question 39

commonest causes of CRF

Answer 39

diabetes GN HTN and vascular disease

Question 40

autosomal dominant disorder in PKD1 and PKD2 genes leading to large multicystic kidneys with destroyed renal parenchyma.

Answer 40

APCKD

Question 41

extra-renal manifetations of APCKD

Answer 41

``` berry aneurysms liver cysts (PKD1) ```

Question 42

clinical features of APCKD

Answer 42

haematuria, flank pain, UTI. may have complications such as cyst rupture, infection and haemorrhage

Question 43

immune complex depsotiion leading to a number o different patterns of injury dependent on where the deposits are and how many there are. can lead to nephrotic syndrome, ARF, progressive chronic renal failure. ANA+ve,dsDNA+ve

Answer 43

SLE lupus nephritis

Question 44

painless haematuria, can be associ with von hippel lindau syndrome. 2% of all cancers.

Answer 44

renal cell carcinoma

Question 45

what percentage of CKD due to APCKD?

Answer 45

10%

Question 46

form of amyloid deposition in the kidneys in patients with multiple myeloma

Answer 46

AL

Question 47

abs to phospholipase A2 associated with which nephrotic syndrome?

Answer 47

membranous

Question 48

renal ca in pts with dialysis associated cystic disease

Answer 48

papillary ca

Question 49

round blue cells on histology, common cancer in children

Answer 49

wilms

Question 50

effacement of the podocytes is common characteristic of

Answer 50

nephrotic syndrome