renal revision quiz
DESCRIPTION
Renal revision quiz. What are the three layers of the glomerular filter?. Endothelium negatively charged endothelial cells Basement membrane type IV collagen, laminin , fibronectin , negatively charged proteoglycans Podocyte /pedicels negatively charged. - PowerPoint PPT PresentationTRANSCRIPT
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RENAL REVISION QUIZ
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What are the three layers of the glomerular filter?
Endothelium negatively charged endothelial cells
Basement membrane type IV collagen, laminin, fibronectin, negatively charged proteoglycans
Podocyte/pedicels negatively charged
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What is the Cockcroft-Gault equation
Estimated GFR (mL/min) =(140-age) * weight (kg)180 * plasma [creatinine]
Multiple this by 0.85 for women
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How does noradrenaline affect GFR?
1. Dilates the afferent arteriole, leading to decreased GFR
2. Constricts the afferent arteriole, leading to increased GFR
3. Constricts the efferent arteriole, leading to increased GFR
4. Constricts the afferent arteriole leading to decreased GFR
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How does angiotensin affect GFR?
1. Dilates the afferent arteriole, leading to decreased GFR
2. Constricts the afferent arteriole, leading to increased GFR
3. Constricts the efferent arteriole, leading to increased GFR
4. Constricts the afferent arteriole leading to decreased GFR
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Let’s draw a nephron and show what gets
secreted/absorbed along its length!!
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What 3 mechanisms does the kidney use to regulate pH?
H+ secretion upregulated by aldosterone; occurs in intercalated cells
HCO3- reabsorption mostly in proximal tubules; also thick ascending LoH and early distal tubules
Buffers phosphate buffer system and ammonia buffer system
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Define acute renal failure >50% decrease in GFR in hours/days Can also have increased BUN Can also have decreased urine output
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Which is NOT a consequence of ARF?
1. Hypokalaemia2. Oedema3. Hypertension4. Anaemia
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Define CKD? GFR < 60mL/min/1.73m2 for > 3 months
with or without evidence of kidney damage
OR Evidence of kidney damage with or
without decreased GFR for > 3 months
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If someone is in stage 3 CKD, what management must you
implement? Cardiovascular risk reduction lifestyle,
BP, lipid-lowering, diabetic control Monitor eGFR every 3 months Avoid nephrotoxic drugs Prescribe ACEI
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Name some complications of diabetes
Retinopathy Nephropathy Neuropathy MI Stroke Gangrene infection
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What three factors contribute to diabetic glomerular sclerosis
Metabolic defect; insulin deficiency hyperglycaemia biochemical alterations in GBM (increased collagen type IV and fibronectin, decreased proteoglycan) and increased ROS ( damage)
Nonenzymatic glycosylation inflammatory cytokines and GF released from macrophages, ROs generation in endothelial cells, increased procoagulant activity in endothelial cells and macrophages, ECM synthesis and SM prolif.
Haemodynamic changes increased GFR, glomerular capillary pressure, glomerular filtration area, and glomerular hypertrophy. Afferent arteriole is damaged bigger afferent than efferent
increased GFR and pressure, causing further damage and increased shearing forces mesangial cell hypertrophy and excretion of ECM products glomerular sclerosis
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Which type of dialysis uses a hydrostatic gradient?
Peritoneal dialysis Hemodialysis
Peritoneal dialysis uses an osmotic gradient
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A patient presents with intermittent haematuria, flank pain and a palpable mass. He
complains of malaise and fever. He is a heavy smoker, obese and
has hypertension. What investigations would you order?
Urinalysis: haematuria Blood: electrolytes, creatinine, BUN Paraneoplastic syndromes: FBC, ESR, LFTs, serum
calcium LDH (prognosis) Renal U/S or abdominal CT cystic Vs solid CXR lung metastases
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What are the conditions of refusing life-sustaining
measures One of
Incurable/irreversible terminal illness, expected to die within a year
Persistent vegetative state Permenantly unconscious No reasonable prospect of recovery without life-
sustaining measures Commencing/continuing artificial
nutrition/hydration is inconsistent with good medical practice
No reasonable prospect of regaining capacity
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Match the clinical manifestation and symptoms/signs
1. Nephritic syndrome
2. Rapidly progressive glomerulonephritis
3. Nephrotic syndrome
4. Chronic renal failure
5. Isolated urinary abnormalities
a) Acute nephritis, proteinuria, ARF
b) Azotaemia progressing over months/years
c) Haematuria, azotemia, proteinuria, oliguria, oedema, hypertension
d) Glomerular haematuria or subnephrotic proteinuria
e) >3.5g/day proteinuria, haematuria, hypoalbuminaemia, hyperlipidaemia, lipiduria
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Match the disease and pathogenesis
1. Postinfectious glomerulonephritis
2. Crescenteric glomerulonephritis type I
3. Crescenteric glomerulonephritis type II
4. Crescenteric glomerulonephritis type III
a) Anti-GBM antibodiesb) Antineutrophil
cytoplasmic antibodies
c) Immune complexes and circulating/planted antigen from bacterial infection
d) Immune complexes as a complication of other nephropathies
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Match the nephrotic syndrome and morphology
1. Membranous nephropathy
2. Minimal-change disease
3. Focal segmental glomerulosclerosis
4. Membranoproliferative glomerulonephritis
a) Effacement of podocyte foot processes
b) Thickened GBM + hypercellularity + leukocyte infilitration
c) Focal and segmental sclerosis and hyalinosos
d) Thickened glomerular capillary wall
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The following renal biopsy specimen is most likely from a patient with which disease?
a) Focal segmental glomerulosclerosisb) Minimal change nephropathyc) Acute post-infectious glomerulonephritisd) Crescenteric glomerulonephritis
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Which is not a treatment you would use for Goodpasture syndrome?
1. Plasmaphoresis2. Corticosteroids3. Cyclophosphamide4. Erythromycin
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How do you differentiate glomerular from non-glomerular
haematuria? Glomerular haematuria: contains
bizarrely-shaped cells (each cell is different)
Non-glomerular haematuria: rbcs are smooth disks (all the same)
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What is the most common cause of acute renal failure?
Acute tubular necrosis
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What are the three phases of ATN?
1. Oliguric phase (tubular obstruction)2. Diuretic phase (tubules not functioning
properly)3. Improving function
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Compare the morphological appearances of ischaemic and toxic ATN
Ischaemic: Focal tubular epithelial necrosis Multiple spots along the nephron
Toxic: Acute necrosis Mostly in the PCT
Both: Occlusion of lumen (eosinophilic hyaline casts) Detachment from BM
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What are some complications of acute pyelonephritis?
Papillary necrosis Pyonephrosis Perinephric abscess
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What are the major risk factors for pyelonephritis?
Being female (more likely to get UTI ) or elderly males (BPH)
Vesicoureteral reflux Intrarenal reflux Catheters Urinary tract obstruction Pregnancy DM Pre-existing renal lesions (scarring, obstruction) Immunosuppression/immunodeficiency
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What are the two forms of chronic pyelonephritis
Reflux nephropathy: Due to superimposition of urinary
infection (childhood) on congenital vesicoureteral reflux and intrarenal reflux
Chronic obstructive pyelonephritis: Recurrent infections superimposed on
diffuse/localised obstructive lesions recurrent renal inflamamtion/scarring chronic pyelonephritis parenchymal atrophy
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Match the congential anomaly and description
1. Agenesis of the kidneys
2. Dual induction3. Hypoplasia4. Horseshoe kidney5. Congenital
hydronephrosis
a) Distension and dilation of pelvis/calyces usually due to outflow obstruction
b) Either two ureteric buds or the division of a single ureteric bud
c) Failure of one/both kidneys to develop
d) Reduced number of nephrons
e) Fusion of kidneys during ascent
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Match the cystic disease and pathological features
1. Adult polycystic kidney disease
2. Childhood polycystic kidney disease
3. Medullary sponge kidney
4. Familial juvenile nephronophthisis
5. Adult-onset medullary cystic disease
6. Simple cysts7. Acquired renal cystic
disease
a) Medullary cysts on excretory radiography
b) Enlarged, cystic kidneys at birth
c) Corticomedullary cysts, shrunken kidneys
d) Large multicystic kidneys, liver cysts, berry aneurysms
e) Cystic degeneration in ESKDf) Single/multiple cysts in
normal-sized kidneysg) Corticomedullary cysts,
shrunken kidneys
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What factors may be involved in the higher prevalence and earlier age-of-onset of kidney disease in
indigenous populations? Dec nephron number at birth (? Low birth
weight) Subsequent insults: nephritis, obesity,
early onset DMII Socioeconomic and environmental
determinants
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What are the WHO criteria for screening tests?
Important health problem for individual/ community
Accepted treatment/intervention Natural history of the disease should be
understood Latent or early symptomatic stage Screening test or examination Facilities for diagnosis and treatment Policy on whom to treat as patients Early tx should be more beneficial than late tx Economically balanced cost Continued case finding