Diseases of the Renal System 1

Question 1

What are the 4 main functions of the kidney

Answer 1

Eliminate metabolic waste products
Regulate fluid and electrolyte balance
Acid-base balance
Produce some hormones (renin, erythropoietin)

Question 2

What are the 2 main types of mechanisms of glomerular damage?

Answer 2

Immunological

Non-immunological

Question 3

Give 4 conditions whcih cause damage to the glomerulus by immune complexes being deposited in the glomerulus

Answer 3

Lupus
IgA nephropathy
Henoch Schonlein Purpura
Membranous purpura

Question 4

Give 2 examples of conditions that cause damage to the basement membrane through the deposition of antibodies

Answer 4

Anti glomerular basement membrane disease (goodpasture’s syndrome)
Post infective glomerulonephritis

Question 5

5 mechanisms of vascular damage in the kidneys

Answer 5

Thrombotic microangiopathy
Vasculitis
Hypertension
Diabetes
Atheroma e.g. renal artery stenosis

Question 6

Thrombi in capillaries and small arterioles, due to damaged endothelium (bacterial toxins, drugs) or abnormalities in clotting e.g haemolytic uraemic syndrome

Answer 6

Thrombotic microangiopathy

Question 7

Give an example of vasculitis that can affect the kidney

Answer 7

Wegener’s granulomatosis

Question 8

Nephrotic syndrome is due to damage of what part of the renal system?

Answer 8

Glomerulus

Question 9

What are the signs of nephrotic syndrome

Answer 9

Hypoalbuminaemia
Proteinuria
Oedema
\+/-hypertension
\+/-hyperlipidaemia

Question 10

Complciations of nephrotic syndrome

Answer 10

Infections, thrombosis

Question 11

4 causes of nephrotic syndrome

Answer 11

Membranous neuropathy
Focal segmental glomerulosclerosis (FSGS)
Minimal change disease
Diabetes, lupus nephritis, amyloid

Question 12

Most common cause of nephrotic syndrome

Answer 12

Membranous neuropathy

Question 13

Primary glomerular disorder of unknown cause. 30-60yrs, 20-30% progress to end stage renal failure

Answer 13

Membranous neuropathy

Question 14

A pattern of kidney damage affecting the podocytes, with various possible causes (idiopathic, genetic, heroin use, HIV)

Answer 14

Focal segmental glomerulosclerosis

Question 15

Which causes of nephrotic syndrome are more common in males than females?

Answer 15

Membranous neuropathy

Focal segmental glomerulosclerosis

Question 16

In children, what are the most common causes of nephrotic syndrome?

Answer 16

Minimal change disease, or FSGS (less common)

Question 17

What are the 5 signs of acute nephritis

Answer 17

Oedema
Proteinuria
Acute renal failure
Haematuria
Hypertension

Both nephrotic syndrome and nephritis OPAHH

Question 18

4 main causes of acute nephritis

Answer 18

Post infective glomerulonephritis
IgA nephropathy
Vasculitis
Lupus

Question 19

Typically occurs a few weeks after streptococcoal throat infection; common cause of acute nephritis

Answer 19

post infective glomerulonephritis

Question 20

Most common primary glomerular disease- teenagers and young adults iwth haematuria

Answer 20

IgA nephropathy

Question 21

What proportion of people with IgA nephropathy will progress to renal failure over 20 years

Answer 21

20-50%

Question 22

Cause of nephritic syndrome; presents with fever, generally unwell, rash, myalgia, arthralgia

Answer 22

Vasculitis

Question 23

Autoimmune disease commonly affecting women, that can be a cause of acute nephritis

Answer 23

Lupus

Question 24

What are the 3 most common causes of nephritis in children?

Answer 24

Post infective glomerulonephritis
IgA nephropathy
hencoch-schonlein purpura
haemolytic-uraemic syndrome

Question 25

A specific type of IgA nephropathy that is more common in males than females- arthralgia ,abdo pain, rash and haematuria and acute renal failure

Answer 25

Henoch schonlein purpura

Question 26

Typically affects children with E.coli 0157 enteritis

Answer 26

Haemolytic uraemic syndrome

Question 27

What are the 3 signs of haemolytic uraemic syndrome

Answer 27

Acute nephritis, haemolysis and thrombocytopenia

Question 28

What 3 things must be present for a diagnosis of acute renal failure

Answer 28

Anuria/oliguria High plasma creatinine levels High plasma Urea

Question 29

What are the 3 classes of causes for acute renal failure

Answer 29

pre-renal renal post-renal

Question 30

Give 2 examples of pre renal causes of acute kidney failure

Answer 30

Severe dehydration | Hypotension e.g. bleeding, septic shock, LV failure

Question 31

Give 3 examples of post renal causes of acute kidney failure

Answer 31

Tumours bladder stones prostatic enlargement

Question 32

Give 4 examples of renal causes of acute renal failure

Answer 32

Vasculitis | Acute interstitial nephritis

Question 33

Give 3 examples of renal causes of acute renal failure in children

Answer 33

Henoch schonlein purpura Hameolytic uraemic syndrome acute interstitial nephritis

Question 34

5 complications of acute kidney disease

Answer 34

``` Cardiac failure Arrythmias GI bleeding Jaundice Infection ```

Question 35

Which might cardiac failure results from acute kidney failure?

Answer 35

Fluid overload

Question 36

Treatment for acute kidney disease

Answer 36

Short term dialysis | Treat underlying cause

Question 37

Permanently decreased GFR and less nephrons

Answer 37

Chronic renal failure

Question 38

Briefly outline the stages of chronic renal failure

Answer 38

1-2 no treatment 3-moderate reduction in GFR 4- severe reduction in GFR 5-end stage kidney failure

Question 39

3 causes of chronic renal failure

Answer 39

Diabetes Glomerulonephritis Reflux nephropathy

Question 40

Chronic reflux of urine up the ureter leading to repeated infections and scarring

Answer 40

Reflux nephropathy

Question 41

What does a renal biopsy tell you in chronic renal failure?

Answer 41

Scarring, no evidence of initial cause

Question 42

4 effects of chronic renal failure

Answer 42

Decreased excretion of water and electrolytes-oedema and hypertension decreased excretion of toxic metabolites decreased production of erythropoietin- anaemia renal bone disease

Question 43

elderly patient with acute renal failure

Answer 43

acute interstitial nephritis (drug reactions) | myeloma-tumour of the plasma cells, secrete immunoglobulins

Question 44

Young male with haematuria and rash

Answer 44

Henoch Schonlein Purpura

Question 45

Teenager/young adult with haematuria

Answer 45

Post infective glomerulonephritis | IgA nephropathy

Question 46

Adult with acute renal failure, fever and myalgia

Answer 46

Vasculitis

Question 47

Young woman with haematuria and facial butterfly rash

Answer 47

Lupus

Question 48

Adult with nephrotic syndrome

Answer 48

Membranous neuropathy

Question 49

Child with nephrotic syndrome

Answer 49

Minimal change

Question 50

Imaging of the urinary tract

Answer 50

Cytoscopy

Question 51

Causes of isolated haematuria

Answer 51

IgA nephropathy Thin basemement membrane disease Alport type hereidtary nephropathy

Question 52

Inherited abnormalities of collagen type 4 causing abnormal basement membrane in the glomerulus- renal failure +/- deafness +/-occular problems May be autosomal or X linked

Answer 52

Alport type hereditary nephropathy

Question 53

Commonest 3 causes of isolated proteinuria in adults

Answer 53

FSGS Diabetes Lupus

Question 54

Commonest 2 causes of isolated proteinuria in children

Answer 54

Henoch Schonlein purpura | FSGS

Question 55

Causes of acute pyelonephritis

Answer 55

Diabetes | Structural abnormalities of urinary tract

Question 56

Complications of pyelonephritis

Answer 56

Abscess formation

Question 57

What is the cause of chronic pyelonephritis

Answer 57

Associated iwth obstruction of urinary tract and reflux of urine up reter, leading to scarring of the kidney and can lead to renal failure

Question 58

Complications of chronic pyelonephritis

Answer 58

Scarring of kidney | Chronic renal failure

Question 59

What is the result of renal artery stenosis

Answer 59

Ischemia of affected kidney | Activation of renin-angiotensin-aldosterone system leads to hypertension

Question 60

Thrombus blocks the capillary within the glomerulus. Inflammatory cells surround an artery which has fibrin in the wall indicating damage

Answer 60

Vasculitis

Question 61

How does hypertension cause damage to the kidney

Answer 61

Thickening of vessel walls-decrease in size of the lumen-chronic hypoxia-loss of renal tubules-decrease in renal function, decreased blood flow activates RAA system

Question 62

Commonest cause of end stage renal failure?

Answer 62

Diabetes

Question 63

How does diabetes affect the kidney?

Answer 63

hyperglycaemia damages the basement membrane- becomes thicker, glomerulus produces excess extracellular matrix which forms nodules. Also affects small vessels leading to ischaemia and damage to renal tubules

Question 64

What tumour is made of plasma cells which produce excess immunoglobulins-deposit in the tubules- inflammation and fibrosis, decreased kidney function, usually irreversible

Answer 64

Myeloma