Renal revision quiz

1. Renal revision quiz

2. 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

3. What is the Cockcroft-Gault equation • Estimated GFR (mL/min) = (140-age) * weight (kg) 180 * plasma [creatinine] Multiple this by 0.85 for women

4. How does noradrenaline affect GFR? • Dilates the afferent arteriole, leading to decreased GFR • Constricts the afferent arteriole, leading to increased GFR • Constricts the efferent arteriole, leading to increased GFR • Constricts the afferent arteriole leading to decreased GFR

5. How does angiotensin affect GFR? • Dilates the afferent arteriole, leading to decreased GFR • Constricts the afferent arteriole, leading to increased GFR • Constricts the efferent arteriole, leading to increased GFR • Constricts the afferent arteriole leading to decreased GFR

6. Let’s draw a nephron and show what gets secreted/absorbed along its length!!

7. 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

8. Define acute renal failure • >50% decrease in GFR in hours/days • Can also have increased BUN • Can also have decreased urine output

9. Which is NOT a consequence of ARF? • Hypokalaemia • Oedema • Hypertension • Anaemia

10. 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

11. 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

12. Name some complications of diabetes • Retinopathy • Nephropathy • Neuropathy • MI • Stroke • Gangrene • infection

13. 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) • Nonenzymaticglycosylation 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

14. Which type of dialysis uses a hydrostatic gradient? • Peritoneal dialysis • Hemodialysis Peritoneal dialysis uses an osmotic gradient

15. 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

16. 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

17. Match the clinical manifestation and symptoms/signs • Nephritic syndrome • Rapidly progressive glomerulonephritis • Nephrotic syndrome • Chronic renal failure • Isolated urinary abnormalities • Acute nephritis, proteinuria, ARF • Azotaemia progressing over months/years • Haematuria, azotemia, proteinuria, oliguria, oedema, hypertension • Glomerularhaematuria or subnephroticproteinuria • >3.5g/day proteinuria, haematuria, hypoalbuminaemia, hyperlipidaemia, lipiduria

18. Match the disease and pathogenesis • Postinfectiousglomerulonephritis • Crescentericglomerulonephritis type I • Crescentericglomerulonephritis type II • Crescentericglomerulonephritis type III • Anti-GBM antibodies • Antineutrophilcytoplasmic antibodies • Immune complexes and circulating/planted antigen from bacterial infection • Immune complexes as a complication of other nephropathies

19. Match the nephrotic syndrome and morphology • Membranous nephropathy • Minimal-change disease • Focal segmental glomerulosclerosis • Membranoproliferativeglomerulonephritis • Effacement of podocyte foot processes • Thickened GBM + hypercellularity + leukocyte infilitration • Focal and segmental sclerosis and hyalinosos • Thickened glomerular capillary wall

20. The following renal biopsy specimen is most likely from a patient with which disease? Focal segmental glomerulosclerosis Minimal change nephropathy Acute post-infectious glomerulonephritis Crescentericglomerulonephritis

21. Which is not a treatment you would use for Goodpasture syndrome? • Plasmaphoresis • Corticosteroids • Cyclophosphamide • Erythromycin

22. How do you differentiate glomerular from non-glomerularhaematuria? • Glomerularhaematuria: contains bizarrely-shaped cells (each cell is different) • Non-glomerularhaematuria: rbcs are smooth disks (all the same)

23. What is the most common cause of acute renal failure? • Acute tubular necrosis

24. What are the three phases of ATN? • Oliguric phase (tubular obstruction) • Diuretic phase (tubules not functioning properly) • Improving function

25. 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

26. What are some complications of acute pyelonephritis? • Papillary necrosis • Pyonephrosis • Perinephric abscess

27. 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

28. 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

29. Match the congential anomaly and description • Agenesis of the kidneys • Dual induction • Hypoplasia • Horseshoe kidney • Congenital hydronephrosis • Distension and dilation of pelvis/calyces usually due to outflow obstruction • Either two ureteric buds or the division of a single ureteric bud • Failure of one/both kidneys to develop • Reduced number of nephrons • Fusion of kidneys during ascent

30. Match the cystic disease and pathological features • Adult polycystic kidney disease • Childhood polycystic kidney disease • Medullary sponge kidney • Familial juvenile nephronophthisis • Adult-onset medullary cystic disease • Simple cysts • Acquired renal cystic disease • Medullary cysts on excretory radiography • Enlarged, cystic kidneys at birth • Corticomedullary cysts, shrunken kidneys • Large multicystic kidneys, liver cysts, berry aneurysms • Cystic degeneration in ESKD • Single/multiple cysts in normal-sized kidneys • Corticomedullary cysts, shrunken kidneys

31. 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

32. What are the WHOcriteria 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