Introduction

Question 1

Proximal means close to, proximal tubule is therefore:

Answer 1

It’s the closet to the Bowman’s capsule,

Question 2

Which drug works at the proximal tubule

Answer 2

SGLT-2

Question 3

ADH is also called

Answer 3

VASSOPRESSIN

Question 4

Synthesis of Vitamin D3:
Active vitamin D3 is not found in food or sunlight. Which oragns produce active D3?

Answer 4

Two organs; the kidney and the liver, produce active vitamin D3 (Calcitriol) in the body.

Question 5

Body recieves Vitd3 in what form? From where?

Answer 5

Cholecalciferol

From sun or food

Question 6

What form of VitD3 is produced at the liver ?

Answer 6

25-hydroxycholecalciferol

Question 7

What form is produced at the kidney after hydroxylation at C-25 at the liver?

Answer 7

1,25- dihydrocholecalciferol

Kidney produces :1, a- hydroxycholecalferiol

Question 8

State the types preferred in Liver or kidney impairment.

Answer 8

-Calcitriol (1,25-dihydroxycholecalciferol) ; both

• Alphadol i.e. Alfacalcidol (1α-hydroxycholecalciferol) - Renal impairment

-25-hydroxycholecalciferol (Calcifediol) is used in liver impairment

Question 9

Liver produces how much EPO? KIDNEY?

Answer 9

10% erythropoietin (EPO) is produced by the liver

peritubular cells of the kidney produce the remaining 90%.

Question 10

The type of anemia in kidney disease?

Answer 10

Anemia of chronic disease . Linked to EPO production

Liver does not produced Anemia of chronic dis

Question 11

Anaemia of chronic disease
is described

Answer 11

normocytic normochromic anaemia.

Question 12

Functions of the kidney is divided into
(Remember TEA)

Answer 12

1. Tubular function
2. Endocrine function
3. Autocrine function

Question 13

Tubular function

Answer 13

• Reabsorption of nutrients or electrolytes in the filtrate
  • Excretion of waste
  • Fluid balance or homeostasis
  • pH regulation.

Question 14

Endocrine function

Answer 14

• BP regulation (RAAS activation)
• Vitamin D synthesis.
• Production of erythropoietin

Question 15

Autocrine function

Answer 15

Autocrine function
• Production of renal natriuretic peptide
• Production of prostaglandins
• Production of endothelin

Question 16

How does the kidney produce prostaglandins?

Answer 16

The kidney produces prostaglandins from arachidonic acid by the help of the cyclooxygenase (COX) enzymes. There are two (2) COX isoenzymes; COX-1 and COX-2

Question 17

COX-1 is said to be

Answer 17

COX-1 is said to be constitutive (i.e. it is found always in the system).

Question 18

Which prostaglandin is the first to be produced from the Arachidonic pathway?

Answer 18

Prostaglandin H2 (PGH2)

PGH2 is an unstable prostaglandin that produces other prostaglandins such as

Question 19

Two main lab markers to estimate kidney function are

Answer 19

-BUN

• Creatinine

Question 20

BUN measures

Answer 20

The amount of nitrogen in the blood that comes from UREA, a waste product of protein metabolism.

Question 21

As kidney function declines, BUN

Answer 21

Increases

Question 22

Creatinine is

Answer 22

A waste product of muscle metabolism, mostly filtered by the glomerulus

Question 23

As kidney function declines creatinine

Answer 23

Increases , normal range 0.6- 1.3mg/dl

Question 24

Investigations of kidney problem

Answer 24

Main parameters are
• Urea
• Creatinine
Other parameters include
• Protein in urine
• RBCs in urine

2. Microscopy
3. Imaging

Question 25

Dip stick detects what?

Answer 25

- ketone -NITRITES

Question 26

Nitrites come from? Why is it need?

Answer 26

Nitrates Nitrates we take in food (as preservatives) appear in urine. Certain organisms conver nitrates to nitrites and for that reason,

Question 27

if nitrites are not detected in the urine, it does not

Answer 27

It does not indicate the absence of UTIs since not all organism have the ability to convert nitrates to nitrites.

Question 28

Organisms that covert nitrates to nitrites

Answer 28

• Escherichia coli • Lactobacillus plantarum • Neisseria gonorrhoeae • Rothia mucilaginosa • Veillonella parvula • Actinomyces • Corynebacterium

Question 29

Significance of leukocyte esterase

Answer 29

the absence of leucocyte esterase indicates the absence of UTI. When WBCs fight against microbes, some (WBCs) get destroyed in the process and release the leucocyte esterase enzymes. This explains why they are indicators of UTIs.

Question 30

Clinical presentations of CKD

Answer 30

.Clinical presentations of CKDPeripheral oedema • Anaemia • Osteoporosis • Volume depletion in terms of urine output (Oliguria or anuria) • Metabolic acidosis • Uremic encephalopathy • Uremic gastritis • Hyperphosphatemia

Question 31

Metabolic acidosis & its management

Answer 31

Metabolic acidosis is managed using Sodium bicarbonate (NaHCO3). Sodium bicarbonate comes as a powder or capsule. The capsules come in 500mg while the powder is packaged in 1g quantities to be given T.I.D at the ward.

Question 32

Management of hyperkalemia in CKD how many ways

Answer 32

two (2) ways of managing hyperkalemia; temporary and permanent.

Question 33

three (3) temporary ways of managing hyperkalemia.

Answer 33

1. 5 IU regular insulin in 50mL of 5% dextrose 2. Sodium bicarbonate (NaHCO3) 3. Nebulization using salbutamol push K+ ions back into the cells.

Question 34

Regular insulin is also known as

Answer 34

soluble insulin / short-acting insulin / rapid-acting insulin. Long-acting insulin cannot be used in the management of hyperkalemia.