DAY 5

Question 0

What is renal tubular acidosis?

Answer 0

Group of disorders whereby despite preserved GFR, metabolic acidosis due to deficiency in the renal tubules.

Normal anion gap metabolic acidosis.

Question 1

Causes of haemolytic anaemia?

Answer 1

Intrinsic red blood cell defects

• enzyme deficiencies e.g. Hereditary spherocytosis
• haemoglobinopathies E.g. Sickle cell, thalassaemia
• membrane defects G6PD

Intra vascular destruction
- microangiopathic ttp, hus

Question 2

Normal renal role in acid-base balance?

Answer 2

Kidneys reclaim filtered bicarbonate (proximal tubules) and excrete daily acid load (collecting tubules).

Question 3

What are the types of ATA?

Answer 3

Type 1: Distal RTA - defect in hydrogen ion secretion

Type 2: Proximal RTA - defects in bicarbonate reabsorption

Hyperkalemic - hypoaldosteronism

Question 4

What is acute tubular necrosis?

Answer 4

Death of the tubular epithelial cells, that form the renal tubules.

Diagnosed with presence of muddy brown casts from epithelial cells is pathonmeumonic.

Common cause is NEPHROTOXIC drugs and hypotension.

Divided into toxic and ischemic.

Question 5

What is hit?

Answer 5

Heparin induced thrombocytopenia is caused by the formation of abnormal antibodies which stimulate platelets causing coagulation and therefore thrombocytopenia.

Occurs less with LMWH.

4t score test

• thrombocytopenia > 50% drop
• timing of onset of platelet fall 5-10 days
• Thrombosis
• other causes of thrombocytopenia

Ix - monitor platelets daily from day 3 to 14 of starting heparin.

• ELISA immunoassay (SNOUT)
• functional assay (SPIN)

Rx

• stop all heparin
• platelet transfusions are contraindicated
• call haem reg for alternative anticoagulant

Question 6

What is liddles syndrome?

Answer 6

Abnormal kidney function causing with excess reabsorption of Na and loss of K despite low-normal aldosterone.

Also severe HTN, low renin, metabolic alkalosis,