Test 5 Clinical Applications 2

Question 1

Polycystic kidney disease (PKD):

• Define:
• Cause:

Answer 1

• Define:
  Kidney has hundred of fluid filled cysts which formed throughout nephrons
• Cause:
  Mutation in polycystin-1 or 2 which help the primary cilium detect pressure. They mediate something in second messenger Ca2+ detection

Question 2

Autosomal Dominant Polycystic Kidney Diseases:

- Define:

Answer 2

• Define:

Dominant inherintance, the most common cause for PKD

Question 3

Diabetes insipidus:

• Define:
• Two subtypes:

Answer 3

• Define:
  Large urine volume, thirst, drinking, and osmolality of urine < 300 mOsm
• Two subtypes:
  Central diabetes insipidus (inadequate secretion of ADH)
  Nephrogenic diabetes insipidus (Kidney’s cannot respond to ADH)

Question 4

How can you distinguish between central diabetes insipidus and nephrogenic diabetes insipidus?

Answer 4

Measure plasma levels of arginine vasopressin

Give desmopressin, a synthetics vasopressin, and see if the kidney’s can respond

Question 5

What two possible causes exist for nephrogenic diabetes insipidus?

Answer 5

Response to lithium from treatment of bipolar disorder (predominant cause)
genetic defect in aquaporin
genetic defect in ADH receptor

Question 6

Treatment for central diabetes insipidus?

Treatment for nephronic diabetes insipidus?

Answer 6

Give desmopressin when needed

Drink a lot of water

Question 7

Probenecid:

• Normal use:
• Use during world war two:

Answer 7

• Normal use:
  Treat gout by inhibiting uric acid transporters from reabsorbing uric acid in the proximal tubules.
• Use during world war two:
  Inhibition of organic anion transporters (OATs) to stop renal excretion of penicillin

Question 8

What drug inhibits Organic Anion Transporters (OATs) decreasing renal secretion of penicillin, ampicillin and cephalosporin, increasing effectiveness and reducing nephrotoxicity.

Answer 8

Prebenecid

Question 9

Measurement of what is used to get an estimated glomerular filtration rate (eGFR)?
Why is it just an estimate?

Answer 9

Creatinine (with age, sex and weight)

Creatinine is slightly secreted into tubules, so it doesn’t perfectly represent GFR

Question 10

What does BUN stand for?

What is its significance?

Answer 10

Blood Urea Nitrogen

ratio of BUN to creatinine can give info about kidney health

Question 11

inadequate aldosterone secretion from addison’s disease or other reasons can cause:
- Symptoms:

Answer 11

Hyperkalemia
Hyponatremia
- Symptoms:
nausea, weakness, changes in ECG

Question 12

Hypokalemia:

• symptoms:
• causes:

Answer 12

• symptoms:
  muscle weakness, heart arrhythmias
• causes:
  Diuretics (loop diuretics, thiazide diuretics)
  Vomiting and metabolic alkalosis (vomit removes H+ from body)
  Excessive aldosterone secretion (Hyperaldosteronism or Cushing syndrome)

Question 13

Acute mountain sickness:

- How do the kidneys adapt to help?

Answer 13

• How do the kidneys adapt to help?

increase urination, reducing edema of the brain. Decrease ADH production.

Question 14

What decreases renal absorption of bicarbonates (and thus water) by inhibiting carbonic anhydrase?

Answer 14

Acetazolamide

Question 15

What caused diabetes insipidus in lauren, a patient with bipolar disorder?

Answer 15

She was taking lithium to treat the disorder

Question 16

diuretic which increases K+ secretion, thereby increasing water secretion. Can cause hypokalemia.

Answer 16

Hydrochlorothiazide

Question 17

How can hypokalemia be dealt with in a hypertensive patient?

Answer 17

Prescribe a K sparing diuretic and hydrochlorothiazide

Question 18

Multiple cysts found within the nephrons of the kidney is called:

Answer 18

Polycystic kidney disease