renal formatives I + II

Question 1

*Patient on peritoneal dialysis presenting with abdominal pain ?

Answer 1

PD peritonitis

Question 2

Treatment of PD dialysis

Answer 2

Antibiotics delivered with PF fluid

(This is a medical emergency)

Question 3

1st line investigating for PD peritonitis

Answer 3

Pd fluid microscopy, culture and sensitivity

Question 4

What are the indications for dialysis

Answer 4

Pulmonary oedema
Hyperkalaemia
Metabolic acidosis
Uraemic pericarditis

Question 5

Insulin relationship with potassium and clinical relevance

Answer 5

Causes potassium to shift to the intracellular space thereby reduced the serum concentration

> used to treat hyperkalaemia

Question 6

Beyond calcium gluconate, insulin what else is needed to treat hyperkalaemia

Answer 6

Dialysis - to remove excess potassium

Question 7

What must you administer with insulin in treatment of hyperkalaemia

Answer 7

10 units actrapid IV with dextrose

Question 8

A 25- year-old man with crescentic IgA presents to the low clearance renal clinic. His latest eGFR is 20mls/min. He asks which renal replacement therapy offers him the best outcomes in terms of mortality.

What is best for this patient ?

Answer 8

Live donor renal transplant

-for a young patient with no contraindications PD and HD are the very last choices - always try a live donor transplant

Question 9

*which drug is most likely to contribute to hyperkalaemia

Answer 9

ACEi or betablockers (bisoprolol is cardioselective)

Question 10

*biopsy normal on light microscopy but widespread effacement of foot processes is seen on electron microscopy

Answer 10

Minimal change disease

(Electron is stronger than light microscopy)

Question 11

How is minimal change nephropathy treated

Answer 11

ACEi and steroids

Question 12

*malignancy is associated with what nephrotic syndrome

Answer 12

Secondary membranous malignancy

Question 13

AL amyloidosis vs AA amyloidosis

Answer 13

AL = depositions of protein derived from immunoglobulin , a complication of plasma cell dyscrasia which means monoclonal protein is detectable in urine and or serum

So use free light chain assay to investigate

AA = complication of chronic diseases of ongoing or recurrent inflammation

Question 14

How does myeloma normally present

Answer 14

Anaemia, hypercalcaemia, bone pain and AKI

Question 15

What is included in the myeloma screen ?

Answer 15

Serum immunoglobulin levels, serum protein electrophoresis is, commonly more the serum free light chain assay now as well, and the unrinary bence jones proteins

Question 15

What is included in the myeloma screen ?

Answer 15

Serum immunoglobulin levels, serum protein electrophoresis is, commonly more the serum free light chain assay now as well, and the unrinary bence jones proteins

Question 16

What immunosuppressive is a woman on renal transplant likely to be on ?

Answer 16

Ciclosporin , tacrolimus, azathioprine

Question 17

What antibiotic should be avoided in treating a patient with a renal transplant ?

Answer 17

Trimethoprim

(Becomes nephrotixic when immunosuppressants in system as well ie ciclosporin)

Question 18

What order does water travel thorough the nephron

Answer 18

Bowman’s > proximal tubule > descending loop of henle > ascending “ > distal tubule > collecting tubule

Question 19

Which structure in the kidney has the ability to produce urine of a varying concentration

Answer 19

Loop of henle

Question 20

Definition of glomerular filtrate

Answer 20

Is a protein-free plasma and is formed as a result of passive forces acting across the glomerular membrane

Question 21

…an increase in blood colloid osmotic pressure affects the net filtration pressure how ?

Answer 21

Reduces the net filtration pressure

Question 22

What is the renal threshold

Answer 22

Plasma concentration of a particular substance at which its Tm is reached and the substances first appears in the urine

Question 23

Action of aldosterone

Answer 23

Stimulates Na+ reabsorption in the distal and collecting tubules and stimulates potassium secretion in the distal tubule

Question 24

Where does water Reabsorption occurs in the greatest extent ?

Answer 24

Proximal convoluted tubule

Question 25

Where is water reabsorption under the control of vasopressin

Answer 25

In the distal and collecting tubules

Question 26

What is plasma clearance

Answer 26

Volume of plasma that is completely cleared of a substance by the kidneys in one minute of time

Question 27

Action of potassium

Answer 27

-is filtered, reabsorbed and secreted in the kidney -is actively reabsorbed in the proximal tubule -controlled by aldosterone -actively secreted in the distal and collecting tubules

Question 28

What structure establishes the medullary vertical osmotic gradient by means of countercurrent multiplication

Answer 28

Loops of henle of juxtamedullary nephrons

Question 29

action of vasopressin

Answer 29

Activates the cyclic AMP second messenger system within the tubular cells

Question 30

What segment of the nephron is impermeable to water even with vasopressin

Answer 30

Ascending limb of loop of henle