renal key notes

Question 1

16 y/o low grade fever started a week ago, feeling fatigued, indicates pain in joints. visiting toilet more.

Urine dipstick shows trace proteins. Blood test shows raised eosinophils.

Likely diagnosis is:

Answer 1

Acute tubulointerstitial nephritis.

• –> fever
• –> skin rashes
• –> raised eospinophils

Question 2

Dysuria
Elevated white cell count
Raised leukocutes
Raised nitrites in urine

charactersitic of:

Answer 2

UTI

Question 3

33 y/o female, A&E severe RHS flank pain/ pain started 3hrs ago, not constant. moving towards right iliac fossa. nauseas and has low grade fever.

most likley has?

Answer 3

Suspected renal stone.

Thus appropriate action would be abdominal USS.

Question 4

Diabetic nephropathy always presents with:

Answer 4

increased proteinuria.

Question 5

21 y/o female complains of urinary frequency, nocturia, constipation and polydipsia. symptoms started 2 weeks ago.

genreal malaise, some pain in her left flank.

most appropriate investigation is:

Answer 5

Patient has symptoms of hypercalcaemia.

measure calcium/

Question 6

renal carcinoma characterised by what triad

Answer 6

1. haematuria
2. flank pain
3. abdominal or flank mass

alongside malignancy symptoms

• weight loss
• malaise

Question 7

67 y/o diabetic female, collapsed while going to toilet. did not lose consciousness, appears well.

Urine dipstick positive for glucose nitrates, leukocytes and haematuria

Answer 7

UTI

Question 8

66 y/o poorly controlled T2DM, 2 day history of severe pain in RHS flank, nausea and fevers that come and go/

on examination patient appears unwell, sweaty and has visible rigors with temp of 38 degrees.

Urine dipstick positive for protein, blood, leukocytes and nitrates/

CT of abdomen reveals gas in renal parenchyma

likely diagnosis?

Answer 8

Pyelonephritis.

- GRAM NEGATIVE

Question 9

describe the action of NSAIDs on glomerular filtration pressure?

Answer 9

vasoconstriction of afferent arteriole.

Question 10

bladder’s lymphatic drainage is predominantly by:

Answer 10

• external and internal iliac nodes

Question 11

para-aoritc lymph nodes predominantly drain:

Answer 11

• the ovaries and testes

Question 12

ADH key facts

Answer 12

• released from posterior pituitary
• acts on aquaporin 2 channels in apical membranes
• of DCT and collecting ducts

Question 13

left testicular vein drains into…

Answer 13

left renal vein

Question 14

in patients complaining of abdominal discomfort and nausea, with frequent epsiodes of kidney stones and UTIs. what anatomical abnormality may be found on imaging?

Answer 14

• horse shoe kidney

- fused kidneys crossing anterior to aorta

Question 15

18 month baby boy with recurrent urinary tract infections.

he is noted to have abnormal renal function.

USS performed showing bilateral hydronephrosis.

most likely underlying diagnosis

Answer 15

patient may have posterior urethral valves

Question 16

46 yo female, acute intermittent sharp pain in RHS flank, haematuria, slight nausea, history of hyperparathyroidism. BMI of 28. restless and right flank tenderness.

What substance is most likely causing the pain in this patient?

Answer 16

• renal colic caused by renal stones

- most renal stones are made up of calcium oxalate

Question 17

Rampiril

Answer 17

ACE inhibitor

Question 18

chancre

Answer 18

painless genital ulcer.

most commonly formed during primary stage of syphillis.

Question 19

majority of renal phosphate reabsorption occurs in the ….

Answer 19

PROXIMAL CONVOLUTED TUBULE

Question 20

which cells detect changes in salt concentrations and adapts the glomerular filtration rate accordingly?

Answer 20

• macula densa

Question 21

Describe where principal cells are located and their role?

Answer 21

• located in DCT

- have ADH and aldosterone receptors

Question 22

which cells are located in DCT and have aldosterone and ADH receptors?

Answer 22

• principal cells

Question 23

Role of juxtaglomerular cells?

Answer 23

• smooth muscle cells
• mainly lcoated in afferent arteriole walls
• baroreceptors
• detect BP changes
• secrete RENIN

Question 24

mechanisms a patient in hypovolemic shock may use to maintain BP

Answer 24

• increase heart rate
• peripheral vasoconstriction
• arterioles are sites of highest resistance in CV system

Question 25

29 y/o male, polyuria, polydipsia, in hospital previously for a head injury. water deprivation test was done. pituitary MRI showed thickened pituitary stalk. patient most likely has?

Answer 25

- diabetes insipidus

Question 26

y wave on JVP

Answer 26

ventricular filling emptying of right atrium

Question 27

arterial baroreceptors located

Answer 27

carotid sinus and aortic arch

Question 28

bladder recieves parasympathetic innervation from

Answer 28

- pelvic splanchnic nerves

Question 29

what recieves venous drainage from the bladder and prostate?

Answer 29

- vesicoprostatic venous plexus

Question 30

A 25-year-old man is injured in a road traffic accident. His right tibia is fractured and is managed by fasciotomies and application of an external fixator. Over the next 48 hours his serum creatinine rises and urine is sent for microscopy, muddy brown casts are identified. What is the most likely underlying diagnosis?

Answer 30

acute tubular necrosis.

Question 31

acute interstitial nephritis

Answer 31

- usually occurs aar of drug toxicity | - no muddy brown casts

Question 32

A 63-year-old male presents with several episodes of haematuria. He suffers from COPD secondary to long term smoking. What is the most likely underlying cause?

Answer 32

transitional cell carcinoma of bladder strongly linked to smoking/

Question 33

Alport syndrome

Answer 33

- X linked dominant - defect in type 4 collagen gene - abnormal glomerular basement membrane

Question 34

42 y/o female with diabetes. has been started on metformin. worried about how diabetes will affect kidneys longterm. by which mechanism does the most damage to kidneys occur?

Answer 34

1. non-enzymatic glycosylation of vascular membrane 2. in large and medium vessels leads to atherosclerosis 3. NEG in small vessels ----> hyaline arteriosclerosis 4. sclerosis of renal efferent arteriole of glomerulus 5. leads to nephropathy

Question 35

bladder receives sympathetic innervation from the?

Answer 35

superior and inferior hypogastric plexuses

Question 36

horseshoe kidneys become trapped under what which prevents their anterior ascent

Answer 36

inferior mesenteric artery

Question 37

in females the bladder is drained by

Answer 37

- vesicouterine venous plexus

Question 38

40 y/p RUQ pain, radiates to RHS shoulder, nausea and vomiting. palpable abdominal mass, Murphy's sign positive.

Answer 38

- cholecystitis | - leads to post hepatic jaundice aar of biliary obstruction

Question 39

A 56-year-old male presents to rheumatology clinic with ongoing pain from his rheumatoid arthritis, he is initiated on a NSAID for pain control, what affect does this have on the kidneys?

Answer 39

- afferent arteriole constriction