Professional Documents
Culture Documents
A 50% of sodium has been reabsorbed by the start of the distal convoluted tubule (False)
B creatinine is secreted into the proximal tubule (True)
C aldosterone acts predominantly on cells in the collecting duct (False)
D distal tubular lesions lead to amino aciduria (False)
E phosphate resorption is controlled by parathyroid hormone (True)
Comments:
a->50%, b-that's why it isn't a perfect estimate of GFR, c-distal convoluted tubule, d-PTH causes
excretion
A Ciprofloxacin (True)
B Rifabutin (True)
C Erythromycin (True)
D Nitrofurantoin (True)
E Vancomycin (True)
Comments:
The use of drugs in patients with reduced renal function gives rise to problems for several reasons:
Appendix 3 of the British National Formulary has a huge list of such adjustments to dosages, and all the
above drugs are included on it.
Comments:
a - secondary and tertiary hyperparathyroidism b - 25 hydroxylation of Vitamin D is in the liver 1
hydroxylation in the kidney c - ureamia may cause coma, convulsions, flapping tremor, myoclonus,
pericarditis ... d - red cell survival is reduced, red cell production reduced - erythropoietin is produced in
the kidney e - gout is suprisingly rare despite the presence of hyperuricaemia
Comments:
Cysts may occur in the kidney and liver. Absent antenatal urine production results in oligohydramnios
and Potter syndrome. Occasionally they can present with renal failure or nephrogenic DI.
Comments:
b-causes type 1 renal tubular acidosis and can cause a nephrogenic DI, c-diagnostic test, e-usually can
acidify urine (acidosis is from bicarbonate leak?)
Comments:
An acidosis is associated with potassium retention and rise in chloride with maintanence of the anion
gap. Peripheral vasodilatation occurs in an effort to improve oxygenation of metabolising tissue. Alkalosis
is associated with tetany and reduction of ionised calcium concentration. In an effort to correct the
acidosis, respiration increases with consequent reduced pCO2.
In Nephrotic Syndrome:
Comments:
Nephrotic Syndrome is characterised by proteinuria, hypoproteinaemia, oedema, and hyperlipidaemia.
Minimal change disease is found in 85%, mesangial proliferation in 5%, and focal sclerosis in 10%.
Increased glomerular capillary wall permeability results in proteinuria, and this is related to the loss of
negatively charged glycoproteins from within the capillary wall. Loss is predominantly of albumin. The
increased susceptibility to infection may be due to decreased immunoglobulin levels, oedema fluid acting
as a culture medium, protein deficiency, decreased bactericidal activity of leukocytes, steroid therapy,
decreased splenic profusion due to hypovolaemia, urinary loss of properdin factor B (which opsonizes
certain bacteria). Spontaneous peritonitis, septicaemia, pneumonia, cellulitis and urinary tract infections
are seen. Streptococcus pneumoniae and gram negative bacteria are most important. Steroid therapy
may mask fever and physical findings. In minimal change disease, the proteinuria is highly selective, and
95% respond to steroids. Most children with steroid responsive nephrosis (either minimal change or from
other causes) have repeated relapses until the disease resolves itself towards the age of 20 years.
Wilm's Tumour
Comments:
Leukaemias are the commonest cancers in childhood, followed by brain tumours and lymphomas.
Neuroblastoma and Wilm's are equal fourth commonest. Wilm's tumour accounts for most childhood
renal neoplasms, and is associated with congenital anomalies such as genitourinary abnormalities (4%),
hemihypertrophy (3%), and sporadic aniridia (1%). Deletions on chromosome 11 account for 33% of
cases (bilateral cases occur in 10%). There are 3 associated syndromes: · WAGR Syndrome (Wilm's
tumour, aniridia, genitourinary malformations, mental retardation). · Denys-Drash Syndrome (Wilm's
tumour, nephropathy, genital abnormalities). · Beckwith-Weidemann Syndrome. Prognosis is generally
excellent, with stage 1 disease having a 97% survival, stage 2 disease a 92% survival and stage 3
disease an 87% survival. Stage 4 disease has a 73% survival. Copyright © 2002 Dr Colin Melville
Comments:
There is reduced gut absorption of Calcium. A proximal myopathy associated with hypovitaminosis D is
typical and this contributes to hypocalcaemia with hyperphosphataemia. Consequently alkaline
phosphatase is elevated reflecting increased bone demineralisation and secondary hyperPTH ensues.
Comments:
Clinical manifestations of nephrogenic DI include thirst, dehydration and hyperthermia. Patients crave
water and ice cold drinks rather than salt. Inadequate caloric ingestion associated with incessant water
intake can cause growth retardation and repeated bouts of hypernatraemia can cause mental
impairment. Urine osmolarity of less than 200 mOsmols/kg H20, hypernatraemia and urine specific
gravity of 1.005 or less are characteristic. Familial nephrogenic DI is commonly X linked and males
present more often.
Comments:
1. this causes keratomalacia and xerophthalmia
2. Wilm's tumour, haematuria usually a late feature.
3. due to bleeding from the meatal ulcer
5. due to bladder involvement in Schistosoma haematobium infection
A raised serum bicarbonate level is consistent with
A hypokalaemia (True)
B pyloric stenosis (True)
C diabetic ketoacidosis (False)
D chronic lung disease (True)
E chronic renal failure (False)
Comments:
a) Metabolic alkalosis usually accompanies hypokalaemia probably due to a shift of hydrogen ions from
the extracellular to the intracellulr space. b) loss of acid from persistent vomiting c) bicarbonate low d)
respiratory failure with CO2 retention and high bicarbonate e) mild acidosis
A Cholera (False)
B Pyloric stenosis (False)
C Inappropriate ADH secretion (False)
D Diabetes insipidus (True)
E Diabetes mellitus (False)
Comments:
Cholera results in excessive water and sodium losses and hence hyponatraemia. Pyloric stenosis
typically results in hypokalaemic, hypochloraemic, metabolic alkalosis and not cause hypernatraemia.
Inappropriate ADH secretion causes hyponatraemia. In Diabetes insipidus failure to concentrate urine
results in hypernatraemic dehydration with hyperosmolarity. Poorly controlled diabetes results in osmotic
diuresis and renal sodium loss.
Comments:
Hyponatraemia occurs in congenital adrenal hyperplasia due to failure to synthesise cortisol and
mineralocorticoid. Gastroenteritis may cause loss of sodium and water through and hence hyponatraemic
dehydration. Diabetes insipidus causes hypernatraemia. Diabetes mellitus may cause osmotic diuresis
and associated tubular sodium loss. Pneumonia may cause inappropriate ADH secretion and
hyponatraemia results.
Alpha-1 antitrypsin deficiency is associated with:
A panniculitis (True)
B neonatal jaundice (True)
C glomerulonephritis (True)
D bronchiectasis (True)
E cANCA (True)
Comments:
a) Panniculitis is nodular fat necrosis. The nodules vary in size and are tender lasting 1 - 8 weeks. There
may be systemic upset. Other causes of panniculitis with systemic disease include SLE, scleroderma,
lymphoma, histiocytosis and pancreatic disease. b) 80% of PiZZ genotypes show biochemical signs of
hepatocellular damage in the first year of life d) and emphysema of course (Note: Pseudomonus
aeruginosa makes a protease which cleaves alpha-1 antitrypsin thereby producing lung damage). e)
cANCA may be seen in PiMZ and PiZZ genotypes.
In mumps:
Comments:
Paramyxovirus infect the salivary glands, especially the parotids. It is spread by direct contact, saliva,
droplets, and urine. 85% of patients are <5 years to young adults. Fever, myalgia, headache, malaise,
unilateral or bilateral parotid enlargement and pain, rarely a rash (MP).