Kidneys

Question 1

What is synthesised in the kidneys?

Answer 1

Vitamin D and EPO

Question 2

What is the usual value for GFR?

Answer 2

125ml/min

Question 3

What is the value for amount of filtrate per day?

Answer 3

180L

Question 4

What 2 layers is the glomerular basement membrane between?

Answer 4

Endothelial cells and podocyte layer (visceral layer)

Question 5

How would you describe the capillary endothelium in the kidney?

Answer 5

Fenestrated

Question 6

What is the macula dense? where found?

Answer 6

wall of the distal tubule, where it touches the glomerulus

Question 7

What is the bowmans space between?

Answer 7

The visceral layer and parietal layer of renal corpuscle

Question 8

Where does the filtrate move to after passing through the fenestrations in the capillary?

Answer 8

Into bowmans space

Question 9

How do you measure renal function?

Answer 9

Measure serum creatinine via blood test

Question 10

What is the definition of GFR?

Answer 10

The sum of filtration rates in all functioning nephrons

Question 11

Which 2 things are sources of creatinine?

Answer 11

Dietary and creatine metabolism in the skeletal muscles.

Question 12

3 methods used to assess GFR?

Answer 12

Creatinine clearance, plasma creatinine concentration and estimation equation (Cockcroft-gault) MDRD

Question 13

What is the equation for creatinine clearance?

Answer 13

urine creatine concxplasma creatinine conc/urine volume

Question 14

Creatinine clearance value - female?

Answer 14

95+-20

Question 15

Creatinine clearance value - male?

Answer 15

120+-25

Question 16

Creatinine clearance value limitations?

Answer 16

Incomplete urine collection and increased creatinine secretion from tubule in renal impairment

Question 17

What does an increase in creatinine mean?

Answer 17

Means dramatic DECREASE in GFR - occurs in CKI

Question 18

MDRD what is it based off?

Answer 18

Race, age, sex, creatinine

Question 19

Biggest cause of chronic renal failure?

Answer 19

Diabetes

Question 20

When should eGFR be measured?

Answer 20

In cases when people at high risk of kidney disease, aka IHD, PVD, pts taking ACEI

Question 21

Who makes more creatine, athlete vs non athlete and why

Answer 21

Athlete - muscly

Question 22

eGFR value for CKD stage 3?

Answer 22

30-59ml/min

Question 23

What are signs of stage 3 CKD?

Answer 23

Anaemic (due to reduced EPO), low vit D so low Ca, hypertension, however, pt is symptomatic

Question 24

stage 4 CKD eGFR value?

Answer 24

15-29ml/min

Question 25

CKD stage 4 creatinine value?

Answer 25

250-600umol/l

Question 26

What drugs are required CKD stage 4?

Answer 26

Diuretics and antihypertensive drugs

Question 27

What is GFR in stage 5 CKD?

Answer 27

below 15mls/min, if below 5 then end stage RF

Question 28

Creatinine level in CKD stage 5?

Answer 28

over 700, if over 900 then end stage renal failure.

Question 29

what is an example of a really excreted drugS?

Answer 29

Opiates

Question 30

In CRF do basic drugs have increased binding or decreased binding?

Answer 30

Increased binding of basic drugs

Question 31

Give 2 examples of nephrotoxic drugs?>

Answer 31

Gentamycin and NSAIDS

Question 32

what is uraemia?

Answer 32

increased urea in kid disease, platelets don't work so increased bruising.

Question 33

how to improve bleeding time in uraemia?

Answer 33

Increased haematocrit (with EPO) or dialysis

Question 34

effects of chronic renal failure?

Answer 34

Metabolic acidosis, hyperkalaemia, hypercalcaemia, peripheral and pul. oedema

Question 35

ESRF dialysis time? and with what drug and at what site

Answer 35

4 hours 3 x per week, heparin tunnelled intrajugular neckline or arm arteriovenous fistula

Question 36

between what artery and vein is the fistula made for the site of dialysis?

Answer 36

radial artery and cephalic vein

Question 37

What is the dialysate made of?

Answer 37

Acid and bicarbonate of correct strength with water

Question 38

What can happen if dialysis is missed?

Answer 38

Fluid overload causing pulmonary oedema

Question 39

What are the signs of acidaemia?

Answer 39

pH below 7.2, HCO3 under 16mmol/l

Question 40

When must be careful when using sodium bicarb to combat acidaemia?

Answer 40

Fluid overload and if the pt is hypocalcaemic already

Question 41

What are three other cases of acidaemia?

Answer 41

lactic acidosis, poisoning, DKA

Question 42

What can pericardial effusion cause?

Answer 42

Cardiac tamponade

Question 43

What are the components of becks triad?

Answer 43

three signs are: low blood pressure (weak pulse or narrow pulse pressure) muffled heart sounds. raised jugular venous pressure.

Question 44

Advantages of CAPD?

Answer 44

no anticoagulation needed, good bio chemistry control can be done at home, holidays

Question 45

Disad of CAPD?

Answer 45

peri mem failure eventually, weight gain and peritonitis

Question 46

in ESRF is prophy needed?

Answer 46

NO

Question 47

what is oral facial digital syndrome

Answer 47

x linked, lethal in males

Question 48

effects of oral facial digital syndrome

Answer 48

bifid tongue, cysts– not distinguishable from ADPKD , liver cysts, facial milia, cleft palate,,

Question 49

sirolimus effect

Answer 49

stomatitis, hyperlipidaemia

Question 50

When is the best time to treat a dialysis patient and why?

Answer 50

Day after dialysis - heparin will have worn off but dialysis will have peaked.

Question 51

What is a quality of heparin?

Answer 51

Has a short half life

Question 52

What is nephrotic syndrome?

Answer 52

Where too much protein is excreted in the urine

Question 53

What is diabetic nephropathy?

Answer 53

Glomeruli are damaged leading to increased protein loss in the urine, due to poor diabetic control.

Question 54

what is renal osteodystrophy?

Answer 54

wasting away of bone due to kidney disease

Question 55

what's indicative of CKI?

Answer 55

GFR low (persisting for over 3 months) .

Question 56

Early CKD symptoms?

Answer 56

nocturia and poor apetite

Question 57

What are the 2 key characteristics of nephrotic syndrome?

Answer 57

Proteinuria with hypoalbuminaemia leading to oedema

Question 58

What meds may nephrotic syndrome patient be taking?

Answer 58

Long term steroids.

Question 59

What is a diagnosing symptom of nephrotic syndrome?

Answer 59

Bilateral periorbital oedema

Question 60

What immunosuppressive drugs are given to renal transplant patient?

Answer 60

Corticosteroid plus steroid sparing drug such as cyclosporin or azathioprine

Question 61

What is the most common cause of ESRF?

Answer 61

Diabetic nephropathy

Question 62

What causes renal osteodystrophy?

Answer 62

Increase in plasma phosphate levels, elevated PTH, suppression of plasma Ca, disruption in bit D metabolism causes calcium metabolism to be further comprimised.

Question 63

What causes anaemia?

Answer 63

Failure of kidney to produce EPO

Question 64

What does marrow fibrosis lead to?

Answer 64

Reduced platelet count and function. Anaemia

Question 65

What are the 2 types of dialysis?

Answer 65

Peritoneal and extra-corporeal

Question 66

The dialysis solution must be ..................... in metabolites across a semi-permeable membrane

Answer 66

hypotonic

Question 67

Where is AV fistula formed?

Answer 67

At ACF or wrist

Question 68

What is thromboxane?

Answer 68

Hormone released from platelets which causes platelet agg. and arterial constriction.

Question 69

what does prostacyclin do?

Answer 69

inhibits platelet activation and vasodilalates

Question 70

vWF function?

Answer 70

Promotes platelet agg and bridging molecule for normal platelet adhesion.

Question 71

what does cyclosporin cause?

Answer 71

Gingival hypoplasia

Question 72

CKD effects on oral ulceration and skin cancers?

Answer 72

Increased as a result of steroids and immunosuppression

Question 73

Sialosis in dialysis its, specifically....

Answer 73

Non neoplastic/infective swelling of major salivary glands especially parotid.

Question 74

CKD effects in kids?

Answer 74

Enamel hypoplasia, delayed tooth eruption, decreased growth

Question 75

What might u see in dialysis pts mouth

Answer 75

Palatal and buccal keratosis

Question 76

Why do you advice CKD patients not to swallow blood post XLA?

Answer 76

Stops renal function as heavy protein load can result in loss of renal reserve.

Question 77

Name a nephrotoxic drug?

Answer 77

Gentamycin (used in prophy)

Question 78

Which drug should be avoid in pts taking cyclosporin

Answer 78

Erythromycin

Question 79

Which tetracycline does NOT need to be avoided in kidney disease?

Answer 79

Doxycycline

Question 80

Which drugs should have a dose reduction?

Answer 80

Aciclovir, amoxicillin, ampicillin, cefalexin, erythromycin

Question 81

If patient has mild kidney impairment which drug can be taken, but not if its any worse...

Answer 81

NSAIDs

Question 82

What urine production volume is produced in hypovolaemia?

Answer 82

30-60ml an hour

Question 83

If potassium levels rise in CKD, what 2 methods can be used to lower it?

Answer 83

Calcium resonium (paste given rectally) or glucose and insulin IV infusions (both take K out of the bloodstream)

Question 84

Ca is taken from bones in which disease?

Answer 84

Renal osteodystrophy

Question 85

25HCC-> 1,25HCC conversion failure leads to...

Answer 85

Secondary parathyroidism

Question 86

What type of anaemia occurs in kidney disease>

Answer 86

normocytic normochromic anaemia

Question 87

If potassium levels rise, what can this cause>

Answer 87

cardiac arrhythmias