renal formatives I + II Flashcards

1
Q

*Patient on peritoneal dialysis presenting with abdominal pain ?

A

PD peritonitis

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2
Q

Treatment of PD dialysis

A

Antibiotics delivered with PF fluid

(This is a medical emergency)

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3
Q

1st line investigating for PD peritonitis

A

Pd fluid microscopy, culture and sensitivity

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4
Q

What are the indications for dialysis

A

Pulmonary oedema
Hyperkalaemia
Metabolic acidosis
Uraemic pericarditis

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5
Q

Insulin relationship with potassium and clinical relevance

A

Causes potassium to shift to the intracellular space thereby reduced the serum concentration

> used to treat hyperkalaemia

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6
Q

Beyond calcium gluconate, insulin what else is needed to treat hyperkalaemia

A

Dialysis - to remove excess potassium

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7
Q

What must you administer with insulin in treatment of hyperkalaemia

A

10 units actrapid IV with dextrose

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8
Q

A 25- year-old man with crescentic IgA presents to the low clearance renal clinic. His latest eGFR is 20mls/min. He asks which renal replacement therapy offers him the best outcomes in terms of mortality.

What is best for this patient ?

A

Live donor renal transplant

-for a young patient with no contraindications PD and HD are the very last choices - always try a live donor transplant

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9
Q

*which drug is most likely to contribute to hyperkalaemia

A

ACEi or betablockers (bisoprolol is cardioselective)

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10
Q

*biopsy normal on light microscopy but widespread effacement of foot processes is seen on electron microscopy

A

Minimal change disease

(Electron is stronger than light microscopy)

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11
Q

How is minimal change nephropathy treated

A

ACEi and steroids

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12
Q

*malignancy is associated with what nephrotic syndrome

A

Secondary membranous malignancy

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13
Q

AL amyloidosis vs AA amyloidosis

A

AL = depositions of protein derived from immunoglobulin , a complication of plasma cell dyscrasia which means monoclonal protein is detectable in urine and or serum

So use free light chain assay to investigate

AA = complication of chronic diseases of ongoing or recurrent inflammation

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14
Q

How does myeloma normally present

A

Anaemia, hypercalcaemia, bone pain and AKI

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15
Q

What is included in the myeloma screen ?

A

Serum immunoglobulin levels, serum protein electrophoresis is, commonly more the serum free light chain assay now as well, and the unrinary bence jones proteins

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15
Q

What is included in the myeloma screen ?

A

Serum immunoglobulin levels, serum protein electrophoresis is, commonly more the serum free light chain assay now as well, and the unrinary bence jones proteins

16
Q

What immunosuppressive is a woman on renal transplant likely to be on ?

A

Ciclosporin , tacrolimus, azathioprine

17
Q

What antibiotic should be avoided in treating a patient with a renal transplant ?

A

Trimethoprim

(Becomes nephrotixic when immunosuppressants in system as well ie ciclosporin)

18
Q

What order does water travel thorough the nephron

A

Bowman’s > proximal tubule > descending loop of henle > ascending “ > distal tubule > collecting tubule

19
Q

Which structure in the kidney has the ability to produce urine of a varying concentration

A

Loop of henle

20
Q

Definition of glomerular filtrate

A

Is a protein-free plasma and is formed as a result of passive forces acting across the glomerular membrane

21
Q

…an increase in blood colloid osmotic pressure affects the net filtration pressure how ?

A

Reduces the net filtration pressure

22
Q

What is the renal threshold

A

Plasma concentration of a particular substance at which its Tm is reached and the substances first appears in the urine

23
Q

Action of aldosterone

A

Stimulates Na+ reabsorption in the distal and collecting tubules and stimulates potassium secretion in the distal tubule

24
Q

Where does water Reabsorption occurs in the greatest extent ?

A

Proximal convoluted tubule

25
Q

Where is water reabsorption under the control of vasopressin

A

In the distal and collecting tubules

26
Q

What is plasma clearance

A

Volume of plasma that is completely cleared of a substance by the kidneys in one minute of time

27
Q

Action of potassium

A

-is filtered, reabsorbed and secreted in the kidney
-is actively reabsorbed in the proximal tubule
-controlled by aldosterone
-actively secreted in the distal and collecting tubules

28
Q

What structure establishes the medullary vertical osmotic gradient by means of countercurrent multiplication

A

Loops of henle of juxtamedullary nephrons

29
Q

action of vasopressin

A

Activates the cyclic AMP second messenger system within the tubular cells

30
Q

What segment of the nephron is impermeable to water even with vasopressin

A

Ascending limb of loop of henle