Urinary Flashcards
(44 cards)
how do convoluted tubules regulate body pH
reabsorption of HCO3-
- 90% get reabsorbed in the proximal tubule
what is an early indicator of glomerulosclerosis in a diabetic patient?
microalbuminuria
over the course of 2 days a pt develops oliguria, hypertension fluid retention, uraemia, haematuria and proteinuria. Which of the following is the most likely diagnosis?
nephrotic syndrome
rapidlt progressive glomerulonephritis
acute nephritic syndrome
chronic kidney disease
acute nephritic syndrome
- haematuria
what is the most likely cause of nephrotic syndrome
minimal change disease
a pt present swith severe ankle swelling worsenign over the last week and proteinuria. What is the most likely diagnosis?
nephrotic syndrome
where in the urinary tract are red blood cells most likely to enter the urine
glomerular basement membrane
hypercalcemia question: what are the pts most striking symptoms and lab findings

- bone pain, weakness and constipation
- history of HT and CHD/TIAs
- elevated total serum calcium, PTH and alkaline phosphatase
- low vit D
- despite hypercalcemia, no muscle weakness or altered mental state
differential diagnosis for cause of hypercalcemia

- PT tumour
- Bone destruction
- Increased intestinal absorption- Vit D
- Granulomatous disease
- Drugs e.g. thiazide e.g. lithium
A56yearoldfemalepatientwasrecentlydischargedfromthehospitalforBell’s palsy and was incidentally found to have hypercalcemia. She has been having pain in her legs, constipation and occasional weakness but denies any kidney stones, significant weight loss or abdominal pain. She reports occasional severe headaches.
Shehasahistoryofdiabetesmellitus,hypothyroidism(status:postradioactive iodine ablation for hyperthyroidism), COPD and hypertension. The patient also has a history of IBS. She has had myocardial infarctions and strokes, and in the past month has been hypercalcaemic on 3 consecutive occasions.
Shewentthroughthemenopauseattheageof51.Shesmokes1-2packsof cigarettes daily (since age 14). Patient denies alcohol consumption but has visited clinic with odour of alcohol on breath on occasion. She has a history of substance abuse (3 incidences of narcotic overdose). She has no evidence of altered mental status. She is not known to be taking any calcium or vitamin D supplements.
Bloodpressure143/93mmHg
Heartrate75bmp
Respiratoryrate18rpm

Bonepain,weaknessandconstipation.
HistoryofHTandCHD/TIAs
Elevatedtotalserumcalcium,PTHandalkalinephosphatase.Serum phosphorous is low normal.
LowtotalvitaminD
Despitehypercalcemia,nomuscleweakness,noalteredmentalstatus.
Case study 1: WHAT IS THE DIFFERENTIAL DIAGNOSIS?
- Hyperparathyroidism
- Bone destruction – malignancy or myeloma
• Increased intestinal absorption – vitamin D
- Granulomatous disease
- Drugs – thiazides, lithium
- Hypermagnesemia
Case study 1: A SCAN REVEALED THE PRESENCE OF A PARATHYROID ADENOMA. WHAT IS THE PATIENTS MOST LIKELY DIAGNOSIS?
Most likely diagnosis is primary hyperparathyroidism. Based on the elevated PTH and calcium, the low normal phosphorous and the parathyroid adenoma.
Primary hyperparathyroidism is definitively diagnosed if
hypercalcemia resolves following surgical removal of the adenoma.
EXPLAIN THE MECHANISM BY WITH THE ELEVATED PTH RESULTS IN HYPERCALCAEMIA
released from parathyroid gland
PTH stimulates the bone to:
- increase bone resportion to increase calcium ion release into the blood
PTH release stimulates the kidneys to:
- increase excretion of phosphate, should increase plasma calcium (innervesely proportionate relationship)
- stimulates activation of Vitamin D (1,25-dihydroxycholecalciferol)
- stimulates intestines to absorb more calcium
- increases renal reabsorption of calcium
HOW WOULD SUCH A PATIENT BE MANAGED AND WHY?
parathyroidectomy on cure
case study 1 WHAT DO WE NEED TO CONSIDER IN THE LONG-TERM MANAGEMENT OF THIS PATIENT
- To prevent hypocalcaemia after parathyroidectomy calcium and vitamin D supplements can be prescribed.
- Follow up studies include DEXA bone scan to monitor bone mineral density.
case study 2 JACK WAS DIAGNOSED WITH MINIMAL CHANGE DISEASE. WHAT SIGNS/SYMPTOMS WOULD YOU EXPECT TO SEE IN A CHILD WITH MCD?
- oedema (periorbital swelling, ankle swelling)
- proteinuria
- hypoalbuminaemia
- hyperlipidaemia
case study 2 EXPLAIN THE MECHANISM LEADING TO OEDEMA IN NEPHROTIC SYNDROME
Podocyte damage
Loss of albumin in the urine
Hypoalbuminaemia
Reduced oncotic pressure in capillaries – less water drawn into capillaries from surrounding tissues
case study 2: HOW WOULD THE SIGNS/SYMPTOMS HAVE DIFFERED IF HE HAD NEPHRITIC SYNDROME?
• Oliguria/Anuria
- Hypertension
- Heamaturia
Case study 3 Martin was diagnosed with type 1 diabetes as a teenager. His diabetes was poorly managed for many years. He eventually went on do develop diabetic nephropathy.
EXPLAIN THE MECHANISM OF
HYPERFILTRATION IN DIABETIC NEPHROPATHY
- increased blood glucose, result sin icnreases reabsorption of glucose in PCT
- reabsorption of glucose coupled with sodium absorption
- reduction in delivery of sodium to macula densa cells
- vasoconstriction of effrent arteriole
- increased hydrostratic pressure within glomeurlus and increased GFR
NAME THE FORCES WHICH DETERMINE THE NET FILTRATION PRESSURE IN THE GLOMERULUS?
• Hydrostatic Pressure
- Glomerulus
- Bowmanscapsule
• Oncotic pressure - glomerulus
HE DEVELOPS STAGE 3 CKD. WHAT ARE THE COMPLICATIONS OF CHRONIC KIDNEY DISEASE?
- Anaemia – EPO deficiency
- CKD bone and mineral disorder
- Lack of active vitamin D – reduced calcium absorption
- Hyperphosphatemia – phosphate excretion impaired, PTH released
- Extra skeletal calcification – calcium deposition in soft tissues and arteries
- Hypertension secondary to chronic intravascular volume overload
- Accelerated atherosclerosis/vascular disease
- Metabolic acidosis
