Pathology 1

Question 1

Is glomerulonepritis or pyelonephritis infective?

Answer 1

Pyelonephritis - bacterial infection

Question 2

What is glomerulonephritis?

Answer 2

Group of renal conditions that are usually characterised by inflammation either of the glomeruli or small blood vessels in the kidneys

Question 3

What is pyelonephritis?

Answer 3

Bacterial infection of the renal eliv, calyces. tubules and interstitium
Acute or chronic (more common)

Question 4

What is the most common infecting organism of pyelonephritis?

Answer 4

E. coli

Question 5

What other organisms can cause pyelonephritis?

Answer 5

Pseudomonas

Strep. Faecalis

Question 6

Give the risk factors for pyelonephritis?

Answer 6

Female 
Pregancy - ureteric dilation 
Imstrumentation or surgery 
urinary tract obstruction 
Vesico-ureteric reflux (VUR) 
Diabetes

Question 7

What can cause urinary tract obstruction?

Answer 7

Calculus 
Stricture 
Neoplasm 
Congenital anomaly - duplex systems, posterior urethral valves 
Prostatic disease (BPH)
Uretheral pathology

Question 8

What is Vesico-ureteric reflux (VUR)?

Answer 8

Incompetence of uretero-vsical valves - ureter enters bladder more perpendicularly
congenital or acquired

Question 9

What can conribute to chronic pyelonephritis?

Answer 9

Hypertensio

Uraemia

Question 10

Do patients with chronic pyelonephritis produce large volumes of urine?

Answer 10

Yes - can’t concentrate urine as nephrons don’t work

Question 11

What is the spread of TB to cause tuberculus pyelonephritis?

Answer 11

Haematogenous spread usually from the lung

Question 12

What oraganisms can cause cystitis?

Answer 12

E. coli
Klebseilla
Proteus
Pseudomonas

Question 13

What is cystitis?

Answer 13

Lower urinary tract infection

acute inflammation but can become necrotizing if associated with outlet obtruction (prostatic disease in males)

Question 14

What organism causes Schistosomiasis?

Answer 14

S. Haematobium

Question 15

What does chronic Schistosomiasis predispose a pateint to?

Answer 15

Urothelial maligancy - esp. squamous carcinoma

Question 16

What is hydronephrosis?

Answer 16

Water inside the kidney

urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure

Question 17

What are the main causes of hydronephrosis?

Answer 17

Urinary tract obstruction and reflux

Question 18

Which muscle is associated with bladder hypertrophy?

Answer 18

detrusor muscle

Question 19

What is the Nephrotic syndrome?

Answer 19

Proteinuria >3g per day
Hypoalbuminaemia
Oedema

Question 20

What is the Nephritic sydrome?

Answer 20

Acute Kidney injury 
Oliguria 
Oedema/ fluid retention 
Hypertension 
Active urinary sediment

Question 21

What is Stage 1 CKD?

Answer 21

GFR >90ml/min with evidence of kidney damage

Question 22

What is Stage 2 CKD?

Answer 22

GFR > 60-90ml/min with evidence of kidney damage

Question 23

Stage 3 CKD.

Answer 23

GFR 30-60ml/min

Question 24

How is stage 3 CKD broken down?

Answer 24

3A - 45-60ml/min

3B - 30-44ml/min

Question 25

Stage 4 CKD

Answer 25

GFR 15-30ml/min

Question 26

Stage 5 CKD

Answer 26

GFR <15ml/min

Question 27

What can cause CKD?

Answer 27

``` DM Vascular disease HTN Rflux nephropathy Chronic GN PKD Unknown cause ```

Question 28

Paients with CKD often present late. What symptoms do they tend to present with?

Answer 28

``` Tiredness Poor appetite Itch Sleep disturbance If nocturia pt may resent earlier ```

Question 29

What 2 drug classes are used to control BP and proteinuria in CKD?

Answer 29

ACEinhibitor | ARB

Question 30

If using ACEi for CKD what should be noted and what should be monitored?

Answer 30

Initial fall in GFR | Hyperkalaemia - monitor

Question 31

Apart from managing BP and proteinuria, what other management options are available for CKD?

Answer 31

Good glycaemic control Stop smoking reduce CV risk Identify and treat complications of CKD

Question 32

What are the complications of CKD?

Answer 32

Anaemia Renal bone disease Hyperparathyroidism

Question 33

What else could be anaemia in CKD apart from reduced EPO production?

Answer 33

Iron deficiency

Question 34

What other deficiences should be checked for in a CKD patient with the complication of anaemia?

Answer 34

Vit B12 | Folate

Question 35

Waht is the target haemoglobin for a patient with CKD and anaemia?

Answer 35

10.5-12.5g/dl

Question 36

What mechanism leads to rena bone disease in CKD?

Answer 36

Reduced Vit D hydroxylation in the kidney whihc leads ot reduced calcium absorption which causes secondary hyperparathyroidism

Question 37

In advanced CKD, what other mechanism leads to secondary hyperparathyroidism?

Answer 37

Serum phosphate rises which increases PTH secretion (2y hyperparathyroidism)

Question 38

What are the treatment options for renal bone disease?

Answer 38

Alfaccalcidol - hydroxylated Vit D Phosphate intake - dietary advice Phosphate binders - taken with meals to decrease gut absorption

Question 39

At what stage is dialysis considered in CKD?

Answer 39

GFR ~20ml/min (deffos when <15ml/min) | Earlier if disease is progressing fast

Question 40

What are the indications for dialysis?

Answer 40

A - Acidosis - acute setting E - Electrolyte abnormalities (hyperkalaemia, hyponatraemia, hyperalcaemia) I - Intoxicants (methanol, lithium, salicism) O - Overload U - Uraemia