renal formatives I + II Flashcards
*Patient on peritoneal dialysis presenting with abdominal pain ?
PD peritonitis
Treatment of PD dialysis
Antibiotics delivered with PF fluid
(This is a medical emergency)
1st line investigating for PD peritonitis
Pd fluid microscopy, culture and sensitivity
What are the indications for dialysis
Pulmonary oedema
Hyperkalaemia
Metabolic acidosis
Uraemic pericarditis
Insulin relationship with potassium and clinical relevance
Causes potassium to shift to the intracellular space thereby reduced the serum concentration
> used to treat hyperkalaemia
Beyond calcium gluconate, insulin what else is needed to treat hyperkalaemia
Dialysis - to remove excess potassium
What must you administer with insulin in treatment of hyperkalaemia
10 units actrapid IV with dextrose
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 ?
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
*which drug is most likely to contribute to hyperkalaemia
ACEi or betablockers (bisoprolol is cardioselective)
*biopsy normal on light microscopy but widespread effacement of foot processes is seen on electron microscopy
Minimal change disease
(Electron is stronger than light microscopy)
How is minimal change nephropathy treated
ACEi and steroids
*malignancy is associated with what nephrotic syndrome
Secondary membranous malignancy
AL amyloidosis vs AA amyloidosis
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
How does myeloma normally present
Anaemia, hypercalcaemia, bone pain and AKI
What is included in the myeloma screen ?
Serum immunoglobulin levels, serum protein electrophoresis is, commonly more the serum free light chain assay now as well, and the unrinary bence jones proteins
What is included in the myeloma screen ?
Serum immunoglobulin levels, serum protein electrophoresis is, commonly more the serum free light chain assay now as well, and the unrinary bence jones proteins
What immunosuppressive is a woman on renal transplant likely to be on ?
Ciclosporin , tacrolimus, azathioprine
What antibiotic should be avoided in treating a patient with a renal transplant ?
Trimethoprim
(Becomes nephrotixic when immunosuppressants in system as well ie ciclosporin)
What order does water travel thorough the nephron
Bowman’s > proximal tubule > descending loop of henle > ascending “ > distal tubule > collecting tubule
Which structure in the kidney has the ability to produce urine of a varying concentration
Loop of henle
Definition of glomerular filtrate
Is a protein-free plasma and is formed as a result of passive forces acting across the glomerular membrane
…an increase in blood colloid osmotic pressure affects the net filtration pressure how ?
Reduces the net filtration pressure
What is the renal threshold
Plasma concentration of a particular substance at which its Tm is reached and the substances first appears in the urine
Action of aldosterone
Stimulates Na+ reabsorption in the distal and collecting tubules and stimulates potassium secretion in the distal tubule
Where does water Reabsorption occurs in the greatest extent ?
Proximal convoluted tubule
Where is water reabsorption under the control of vasopressin
In the distal and collecting tubules
What is plasma clearance
Volume of plasma that is completely cleared of a substance by the kidneys in one minute of time
Action of potassium
-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
What structure establishes the medullary vertical osmotic gradient by means of countercurrent multiplication
Loops of henle of juxtamedullary nephrons
action of vasopressin
Activates the cyclic AMP second messenger system within the tubular cells
What segment of the nephron is impermeable to water even with vasopressin
Ascending limb of loop of henle
