Renal Week 3 Saq Questions Study Guide.Pdf

RENAL WEEK 3 SAQ QUESTIONS STUDY GUIDE 1. What is the difference between azotaemia and uraemia (1 mark) Answer: • • Azotaemia: increase serum nitrogen in the blood. Uraemia: increased serum urea in the blood. 2. Answer the following questions about potassium sparing diuretics. a. Explain the mechanism by which potassium sparing diuretics causes metabolic acidosis. (2 marks) b. What type of potassium sparing should not be used in patients with metabolic acidosis? (0.5 marks) c. Outline the mechanism in which potassium sparing be used to treated hypokalaemia? (2 marks) Answer: a. It crosses the cell membrane and bins to the intracellular receptor of aldosterone. This is known as a non-competitive inhibition which, as it prevents aldosterone from binding to its’ binding sites. This prevents the formation of the aldosterone receptor complex and thus it will not translocate to the nucleus. This will reduce transcription of proton pumps which excrete H+ out of the tubule into the lumen of the nephron. This causes an increased build up of H+ into the tubule and the blood and thus causes metabolic acidosis. b. Triamterene and amiloride c. When a potassium sparing binds competitively inhibits the intercellular aldosterone receptor, it prevents the formation of the aldosterone-receptor complex and thus it will not translocate to the nucleus. This is preventing the induction of transcription factors for apical K+ channels. This will cause prevent K+ existing from the blood and tubules into the lumen of the nephron for excretion. This will greatly reduce the excretion of potassium and increase the reserve of potassium and thus help treat hypokalaemia. a 3. 4. a. b. c. Describe the mechanism of urea recycling (3 marks) Describe the following mechanisms of renal regulation. Myogenic Tubuloglomerular Sympathetic 5. For each of the following categories of AKI describe on mechanism by which AKI can occur: a. Normal blood volume, but decreased volume of blood in vessels. b. Overall reduction in blood volume c. Large vessel obstruction d. Affected small vessels. 6. List five features that affect the degree of glomerular filtration of an individual solute. (2.5 marks) Answer: • • • • • Size of a molecule Charge of a molecular Degree of damage to the anatomical filtration barrier Pressure of filtration (starling forces) Surface area for filtration. 7. Mira is a 36-year-old female who presents with dysuria, pain and increased urination. Upon taking history from her you find out that she is sexually active, despite going to the bathroom more often there is no increase in the overall volume of urine. She tells you that she has no fever, not nauseous or had vomited. (4 marks) a. Explain why Mira is more at risk of UTI than her male counterpart? (1 mark) b. Based on the given history, does Mira have an upper or lower UTI? (0.5 mark) c. Name a diagnostic tool that you would use and name two things that you would expect to see. (1.5 marks) d. Name ONE pathogen that causes upper UIT and ONE that causes lower UIT. (1 mark) 8. Answer the following questions about polycystic kidney disease. a. Explain the difference between the one hit vs the two-hit hypothesis. (1 mark) b. Explain how mutations in PDK-1 and PDK-2 causes cysts. (3 marks) Answer: a. • The one hit hypothesis means that the patient is born with a mutation in all their kidney cells in one copy of either PDK1 or PDK2. • In the two-hit hypothesis, a mutation develops in the second copy of PDK1 or PDK2. b. • PDK 1 will make less PC 1 and PDK 2 make less PC2 of which both are inserted into the apical surface of the kidney cells. When the urine infiltrate rushes in, due to the mutation there will be decreases bending. This will allow decreases Ca2+ influx if any. This will dysregulate proliferation and cell cycle, and thus causes the formation of cysts. As a result, through Cl- channels and aquaporins fluid will enter and thus form fluid sac cysts. 9. Adam is a 40-year-old male who presents to the emergency department feeling confused and his skin seems less elastic. He tells you he came because today morning he did fainted. Upon taking his medical history he tells you he has hepatic failure, and he is currently taking aspirin has tooth ache. (9.5 marks) a. Based on Adam’s history, what type of AKI is he at most risk of? (0.5 marks) b. What two features of history has made you choose your answer for part a? Explain. (4 marks) c. Explain THREE complications of the AKI. (3 marks) d. How would you treat Adam? (2 marks) Answers: a. Pre-renal AKI b. The hepatic failure: because this would mean that there is deceased albumin synthesis, this will cause less albumin within blood vessels, causing a decrease in oncotic pressure, where the hydrostatic pressure will exceed it, so blood from the blood vessel, will leave out into the interstium, causing deceased blood within blood vessels and thus decrease blood flow to the kidney. Another clue to pre-renal Aki is the fainting, because this indicates that the decreased volume of blood in vessels, means that there is less blood going to the heart and thus less blood being pumped to the brain, thus causing fainting. c.