Renal pathology

Question 1

Why are the kidneys so sensitive to drug toxicity?

Answer 1

receive a large amount of blood

Concentration at the hair pin loops means the medulla can get very concentrated with the drug

The concentration can greatly build up in the tubules and be reabsorbed.

Question 2

What is Autonomic dysreflexia?

Answer 2

A massive sympathetic reaction in spinal injured patient in response to distented bladder and full rectum.

High BP
Low heart rate

Question 3

Define the Bulbocavernosa reflex

Answer 3

pulling the catheter or pinching glan of penis/ clitoris which triggers constriction of the anus

Question 4

what can Neuropathic Detrusor hyperreflexia lead to? and what is its main treatment?

Answer 4

Hydronephrosis

M3 Antagonists

Question 5

What is the process called where damage occurs to the arterioles within the glomerulus due to excessive glucose (diabetes)?

Answer 5

hyaline arteriole sclerosis

Question 6

Definition of CKD?

Answer 6

Renal impairment for >3 months

Question 7

Define hydronephrosis .

Answer 7

The build up of fluid in the pelvis of the kidney leading to dilation of the pelvis and calcyes - eventually leading to atrophy of the kidney.

Question 8

What can low Mg+ cause?

Answer 8

Low K+

Low Ca2+

Question 9

What is the diagnostic criteria for oliguria?

Answer 9

<0.5ml/kg of body weight per hour

Question 10

What are the most common Kidney stones?

Answer 10

Calcium Phosphate
Calcium Oxalate
Stuviate - Mg, Ammonia, PO4

Question 11

What are the treatments for kidney stones?

Answer 11

<0.5mm will pass itself

> 0.6mm - tamsulosin

<2cm - Extracorapeal shockwave lithotripsy therapy

> 2cm - Percutaneous shockwave lithotripsy therapy

Question 12

What is the syndrome which affects the NCC transporters in the early DCT?

Answer 12

Gitelman syndrome

Question 13

What genetic disorder causes defects in the NK2C transporters in the thick ascending loop?

Answer 13

Barter Syndrome

Question 14

What is the defect that renders the PCT functionally useless?
and what drug can cause it?

Answer 14

Fanconi Syndrome

Tetracycline

Question 15

What syndrome causes defects in the ENac cells?

Answer 15

Liddle Syndrome

Question 16

When would you see a euvolaemic and what is it?

Answer 16

Normal Na2+ due to increased water retention. Seen in SIADH

Question 17

if a person has a eGFR of 60-89 what is there stage of kidney disease?

Answer 17

2: decrease in GFR without notable changes to kidney symptoms

Question 18

If a person’s eGFR is 15-29, what stage are they?

Answer 18

Stage 4. with or without other symptoms

Question 19

What is end stage kidney failure eGFR?

Answer 19

<15

Question 20

What is the definition of renal injury/ disease?

Answer 20

Defined by reduced eGFR and detection of blood/ protein in urine.

Question 21

Acute tubular necrosis causes? and what are they more vulnerable to and what is a pre-sign?

Answer 21

Reduced GFR - resulting hypoxia occuring to renal tubules.
More vulnerable to drugs and toxins.

Oligourea is a sign of this

Question 22

Outline treatments used for renal disease

Answer 22

Reduce renal damage.

Reduce blood pressure which may occur due to fluid overload.

Reduce anaemia - EPO

Bisphosphonates - as hyperparathyroidism can come about

Question 23

Why might a person develop hypocalcaemia from reduced GFR?

Answer 23

Reduction in 1 alpha hydroxylase enzyme activity

Reduction in phosphate excretion - Ca2+ and phosphate have to be kept in narrow parameters, so a rise in PO4- leads to a reduction in Ca2+

Reduced Reabsorption of Ca2+

Question 24

What is oestodystrophy?

Answer 24

Secondary bone disease due to kidney disease:

• reduced vit D
• increased PTH

Question 25

What is normal anion gap?

Answer 25

<18mmol

Question 26

Define the Basal metabolic rate:

Answer 26

The calculated oxygen use and heat production in a fasting individual at rest

Question 27

Why does the thyroid gland move up and down during swallowing?

Answer 27

It is tethered to the larynx - when you swallow this moves up and pulls the thyroid with it.

Question 28

What nerves must be avoided when carrying out thyroidectomy and what is the consequence of them being damaged?

Answer 28

Recurrent laryngeal nerve. associated with inferior thyroid artery.
Damage causes hoarseness of voice

External superior laryngeal branch. Associated with superior thyroid artery.
Damage causes paralysis of the cricothyroid muscle causing phonation and pitch problems.