Renal diseases

Question 1

What are the 4 main functions of the kidneys?

Answer 1

• eliminating metabolic waste products
• regulating fluid and electrolyte balance
• influencing acid-base balance
• production of some hormones

Question 2

How would a patient with acute renal failure present?

Answer 2

• rapid rise in creatinine and urea

- generally unwell

Question 3

How would a patient with nephrotic syndrome present?

Answer 3

• oedema + proteinuria + hypoalbuminaemia

- proteinuria >3g per 24 hrs

Question 4

How would a patient with acute nephritis present?

Answer 4

-oedema, proteinuria, haematuria, renal failure

Question 5

How would a patient with chronic renal failure present?

Answer 5

-slowly declining renal function

Question 6

What toxic mechanisms can cause tubular damage to the kidneys?

Answer 6

• direct toxins
• hypersensitivity reactions
• deposition of crystals in tubules
• deposition of abnormal proteins in tubules

Question 7

What is nephrotic syndrome ALWAYS due to?

Answer 7

damage to the glomerulus

Question 8

What complications can you get with nephrotic syndrome?

Answer 8

infection and thrombosis

Question 9

What are the 4 common causes of acute nephritis in adults?

Answer 9

• post-infective glomerulonephritis
• IgA nephropathy
• vasculitis
• lupus

Question 10

What are the 4 common causes of acute nephritis in children?

Answer 10

• post-infective glomerulonephritis
• IgA nephropathy
• Henoch-Schonlein purpura
• haemolytic-uraemic syndrome

Question 11

What are the 3 main groups of causes of acute renal failure?

Answer 11

• pre-renal (reduced blood flow to kidneys)
• renal (damage to kidney)
• post-renal (obstructed urinary tract)

Question 12

What are the major complications of acute renal failure?

Answer 12

• cardiac failure (fluid overload)
• arrhythmias (electrolyte imbalance)
• GI bleeding
• jaundice
• infection

Question 13

How is chronic renal failure characterised?

Answer 13

permanently reduced GFR (reduced number of nephrons)

Question 14

What are the common causes of chronic renal failure in adults?

Answer 14

• diabetes
• glomerunephritis
• reflux nephropathy

Question 15

What are the common causes of chronic renal failure in children?

Answer 15

• developmental abnormalities
• reflux nephropathy
• glomerulonephritis

Question 16

What could cause urinary tract obstruction at the level of the pelvis?

Answer 16

• calculi
• tumours
• ureteropelvic structure

Question 17

What can cause intrinsic uteric obstruction?

Answer 17

• calculi
• tumours
• clots
• sloughed papillae
• inflammation

Question 18

What can cause extrinsic uteric obstruction?

Answer 18

• pregnancy
• tumour
• retroperitoneal fibrosis

Question 19

What would you see in a kidney with hydronephrosis?

Answer 19

• dilated calyces
• dilated pelvis
• cortical atrophy

Question 20

where are renal calculi most commonly formed?

Answer 20

in the kidney (can be anywhere in the urinary tract though)

Question 21

What are the 4 commonest causes of calium stones?

Answer 21

• hypercalcaemia
• excessive absorption of intestinal Ca+
• inability to reabsorb tubular Ca+
• idiopathic

Question 22

How to struvite stones form?

Answer 22

• urea convers urea to ammonia
• causes a rise in urine pH
• precipitation of magnesium ammonium phosphate salts
• larger ‘staghorn’ calculi

Question 23

What is Von Hippel-Lindau Syndrome?

Answer 23

most common of several cancer syndrome in kidneys

-VHL gene required fro breakdown of hypoxia inducible factor-1 oncogene

Question 24

What is the morphology of clear cell RCC?

Answer 24

• well defined yellow tumours
• often haemorrhagic areas
• may extend into perinephric fat or into renal vein

Question 25

What is the morphology of papillary RCC?

Answer 25

more cystic and more likely to have multiple than in clear cell RCC

Question 26

What cell types are present in papillary tumours?

Answer 26

cuboidal, foam cells

Question 27

How does urothelial cell carcinoma present?

Answer 27

• haematuria
• urinary frequency
• pain on urination
• urinary tract obstruction