Mixture

Question 1

What is the role of a nephron?

Answer 1

Filtering unit

Question 2

Which structure is damaged in nephrotic syndrome?

Answer 2

Epithelial foot process

Question 3

In nephrotic syndrome what 3 problems occur?

Answer 3

Proteinuria
Hypoalbuminaemia
Oedema

Question 4

How is blood pressure controlled in kidneys?

Answer 4

Renin secretion:

• Salt/water retention
• converts angiotensinogen to angiotensin I

Question 5

How is urine formed?

Answer 5

Capillary hydrostatic pressure forces water/salts of plasma across to GBM (glomerular basement membrane)

Question 6

Name 3 factors affecting filtration rate across GBM?

Answer 6

1) molecular weight
2) hudrostatic pressure in afferent arteriole
3) surface charge (GBM = -ve)

Question 7

Which 3 things should you not find in urine of healthy person?

Answer 7

1) protein
2) glucose
3) amino acids

Question 8

What is method to adapt urine concentration called?

Where in kidney does this occur?

Answer 8

Counter current mechanism

Medulla

Question 9

What is the function of proximal convoluted tubule?

Answer 9

Recovers 70% glomerular filtrate

Recovers and generates bicarbonate secretion

Question 10

What enzyme does acetazolamide inhibit?

What process is dependent on this enzyme?

Answer 10

Carbonic anhydrase

Reabsorption of bicarbonate

Question 11

What happens at the ascending limb of henle?

Answer 11

Uptake of Na, 2Cl, K, H2O

Question 12

Where is the site of loop diuretics?

What do they do?

Answer 12

Ascending limb of henle

Reduce Na, K, Cl, H2O

Question 13

What happens at distal tubule?

Answer 13

Reabsorption of Na with Cl (co-transport mechanism)

Question 14

Which type of diuretics act in distal tubule?

Answer 14

Thiazide diuretics

Question 15

What gets reabsorbed in cortical collecting duct?

What controls this?

Answer 15

Na (with H2O and Cl) in exchange for K

Aldosterone

Question 16

What is spironalactone?

What is the risk with this drug?

Answer 16

Aldosterone antagonist

Hyperkalaemia

Question 17

Where is the site of urinary concentration?

What hormone acts here to control water reabsorption?

Answer 17

Medullary collecting duct

Anti diuretic hormone (ADH)

Question 18

How does diabetes insipidus affect ADH?

Answer 18

Failure to secrete ADH

Peripheral resistance to ADH

Question 19

What is furosemide?

Answer 19

Loop diuretic

Question 20

What stimulates erythropoietin?

Answer 20

Hypoxia (low O2)

Question 21

What vitamin is activated by kidneys?

What does it increase absorption of?

Answer 21

Vitamin D

Calcium

Question 22

What is a secondary problem of decreased vitamin D levels in kidney?

Answer 22

Renal osteodystrophy:
decreased vit D –> decreased Ca –> stimulation of parathyroid hormone –> secondary hyperparathyroidism –> bone disease (renal osteodystrophy)

Question 23

What is a normal range of kidney function from the following:
50-80mls/min/1.73^2
80-100mls/min/1.73^2
100-120mls/min/1.73^2
120-150mls/min/1.73^2

Answer 23

100-120mls/min/1.73^2

Question 24

Name two ways to measure kidney function exactly?

Answer 24

1) Inject radioactive tracer - Technetium (Tc^99)

2) Creatinine clearance

Question 25

What 4 variables are needed to work out eGFR?

Answer 25

1) Age 2) Sex 3) Ethnicity 4) Serum creatinine

Question 26

What is the difference in time to accquire disease between AKI and CKD? Can they be recovered?

Answer 26

AKI acquired abruptly - potential to recover CKD acquired progressively - irreversible

Question 27

What is normal range of pH of blood?

Answer 27

7.35-7.45

Question 28

What is normal range of PCO2 in arterial blood?

Answer 28

4.5-5.4kPa

Question 29

What is normal range of HCO3- in blood?

Answer 29

24-30mmol/L

Question 30

Name 2 intracellular ions?

Answer 30

Potassium | Phosphate

Question 31

Name 2 extracellular ions?

Answer 31

Sodium | Chloride

Question 32

What is aldosterone responsible for in electrolyte homestasis?

Answer 32

Reabsorbing Na in exchange for K

Question 33

What hormone controls calcium?

Answer 33

Parathyroid hormone

Question 34

What does calcitonin do to calcium?

Answer 34

Enhances renal excretion of Ca so lowers levels

Question 35

Name 2 risks of hypervolaemia?

Answer 35

1) High BP | 2) Oedema

Question 36

Name a risk of hypovolaemia?

Answer 36

Low BP

Question 37

What does atrial natriutertic peptide do to renin? | What is its effect on Na excretion?

Answer 37

Inhibits it | Reduces Na excretion into urine

Question 38

What secretes antiduiretic hormone (ADH)? | Name something that blocks the action of ADH?

Answer 38

Pituitary | Alcohol

Question 39

``` Here are 3 types of hameaturia: Dipstick haematuria Microscopic haematuria Macroscopic haematuria How can they be confirmed? ```

Answer 39

Dipstick haematuria - +ve urinalysis Microscopic haematuria - RBCs on microscopy Macroscopic haematuria - blood visible in urine

Question 40

Which 2 genes are responsible for Autosomal-dominant polycystic kidney disease (ADPKD)?

Answer 40

PKD1 (XX/Y 16) - polycystin 1 | PKD2 (XX/Y 4) - Ca ion channel

Question 41

Advantages of peritoneal dialysis

Answer 41

Increased flexibility Better mobility Less fluid restriction No anti-coagulation

Question 42

Advantages of haemodialysis

Answer 42

Less responsibility Shorter treatment times Small solute clearance is highly efficient

Question 43

Disadvantages of | peritoneal dialysis

Answer 43

``` Large responsibility Storage of equipment Hyperglycaemia Protein losses Complications - hernias, peritonitis ```

Question 44

Disadvantages of haemodialysis

Answer 44

Circulatory stress Scheduled treatment Risk of bleeding Complications - infection, hypotension

Question 45

What do Angiotensin AT1 Receptor Blockers (ARBs) treat? | How?

Answer 45

Hypertension | Prevent angiotensin II working

Question 46

If the site of immunoglobulin deposition is subendothelial what syndrome results?

Answer 46

Nephritic syndrome

Question 47

If the site of immunoglobulin deposition is subepithelial deposition what syndrome results?

Answer 47

Nephrotic syndrome

Question 48

4 symptoms of nephritic syndrome?

Answer 48

1) Haematuria 2) Proteinuria 3) High BP 4) Impaired renal function