Nephrology Quiz: Glomerular Diseases
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Questions and Answers

What is the primary characteristic of nephritic syndrome?

  • Presence of very heavy proteinuria
  • Sodium retention without any impact on blood volume
  • Asymptomatic until late stages
  • Presence of haematuria and hypertension (correct)
  • In nephrotic syndrome, which of the following is NOT typically observed?

  • Hypoalbuminaemia
  • Fluid retention
  • Presence of haematuria (correct)
  • Heavy proteinuria greater than 3.5 g/24 hrs
  • Which of the following conditions is a common cause of glomerular damage?

  • Hypertension
  • Chronic kidney disease
  • Acute interstitial nephritis
  • Alport’s syndrome (correct)
  • What is a hallmark feature of glomerular disease that can be found even in mild cases?

    <p>Renal sodium retention</p> Signup and view all the answers

    What key factor might indicate a need for immunosuppressive therapy in glomerulonephritis?

    <p>Prognostic indicators common to various causes</p> Signup and view all the answers

    Which statement about acute kidney injury (AKI) is correct?

    <p>AKI can be reversible in many cases.</p> Signup and view all the answers

    What is the major risk factor associated with poor outcomes in patients with glomerular disease?

    <p>Hypertension</p> Signup and view all the answers

    Which condition is most commonly associated with nephrotic syndrome?

    <p>Minimal change disease</p> Signup and view all the answers

    In chronic interstitial nephritis, which of the following is a common finding on renal biopsy?

    <p>Tubulo-interstitial fibrosis</p> Signup and view all the answers

    What characterizes the hematuria associated with nephritic syndrome?

    <p>It typically presents with red blood cell casts.</p> Signup and view all the answers

    Which lab finding is most likely indicative of the severity of nephrotic syndrome?

    <p>Severe and persistent proteinuria</p> Signup and view all the answers

    Acute interstitial nephritis often results from which type of immune response?

    <p>Allergic reaction to medications or infections</p> Signup and view all the answers

    Which factor increases the likelihood of developing acute kidney injury in older adults?

    <p>Multiple underlying health conditions</p> Signup and view all the answers

    What is the primary characteristic of chronic interstitial nephritis (CIN)?

    <p>Renal dysfunction with fibrosis and lymphocyte infiltration</p> Signup and view all the answers

    Which of the following is NOT a typical presentation of patients with chronic interstitial nephritis?

    <p>Significant proteinuria</p> Signup and view all the answers

    In acute interstitial nephritis, what type of casts may form within affected tubules?

    <p>Granulocyte casts</p> Signup and view all the answers

    Which of the following interventions is crucial when managing acute kidney injury (AKI) related to dehydration?

    <p>Fluid challenge to optimize systemic hemodynamic status</p> Signup and view all the answers

    What is a common underlying factor contributing to acute interstitial nephritis?

    <p>Autoimmune reactions leading to tubule destruction</p> Signup and view all the answers

    What distinguishes acute kidney injury from chronic kidney disease?

    <p>AKI is reversible, while CKD is typically irreversible</p> Signup and view all the answers

    Which of the following is a crucial step when a patient with AKI presents with hyperkalemia?

    <p>Administer calcium and insulin to stabilize myocardium</p> Signup and view all the answers

    Which process leads to the creation of casts in acute kidney injury?

    <p>Destruction of the tubule wall and inflammation</p> Signup and view all the answers

    What is a common characteristic feature found in chronic interstitial nephritis?

    <p>Interstitium infiltration with mononuclear cells</p> Signup and view all the answers

    Which of the following is typically NOT associated with acute interstitial nephritis?

    <p>Chronic renal failure leading to proteinuria</p> Signup and view all the answers

    In the context of chronic kidney disease, which of the following statements best describes the relationship between kidney function and proteinuria?

    <p>Higher levels of proteinuria are typically seen as kidney function declines.</p> Signup and view all the answers

    Which of the following best distinguishes acute interstitial nephritis from chronic interstitial nephritis?

    <p>Duration of symptoms and progression</p> Signup and view all the answers

    Which feature would least likely be found during the assessment of a patient with chronic interstitial nephritis?

    <p>Presence of significant hematuria</p> Signup and view all the answers

    Which factor is NOT associated with an increased risk of developing acute kidney injury (AKI)?

    <p>Extreme physical fitness</p> Signup and view all the answers

    In the context of chronic interstitial nephritis, which finding is least likely to be observed on renal biopsy?

    <p>Red cell casts</p> Signup and view all the answers

    Which statement about chronic kidney disease (CKD) is false?

    <p>It typically presents with acute and sudden changes in function.</p> Signup and view all the answers

    Which type of casts would be most indicative of acute interstitial nephritis?

    <p>White blood cell casts</p> Signup and view all the answers

    What is NOT a prognostic indicator for poor outcomes in glomerular disease?

    <p>Female sex</p> Signup and view all the answers

    Which of the following correctly identifies a mechanism leading to the injury of the glomerulus?

    <p>Subepithelial immune complex deposition</p> Signup and view all the answers

    Which condition is most closely linked to the development of tubulo-interstitial fibrosis?

    <p>Chronic kidney disease</p> Signup and view all the answers

    Which characteristic is observed in the acute phase of interstitial nephritis?

    <p>Sudden onset of renal failure</p> Signup and view all the answers

    What is a common histological finding in acute interstitial nephritis?

    <p>Granulocyte casts within dilated tubules</p> Signup and view all the answers

    Which of the following clinical features is most associated with chronic interstitial nephritis (CIN)?

    <p>Fibrosis and infiltration of renal parenchyma</p> Signup and view all the answers

    In the management of acute kidney injury due to fluid overload, what should be prescribed if loop diuretics are ineffective?

    <p>Hemodialysis</p> Signup and view all the answers

    Which of the following is a risk factor associated with the development of chronic kidney disease (CKD) in patients with chronic interstitial nephritis?

    <p>Hypertension</p> Signup and view all the answers

    What key feature distinguishes chronic interstitial nephritis from acute interstitial nephritis?

    <p>Renal fibrosis and lymphocytic infiltration</p> Signup and view all the answers

    Which complication can arise from untreated acute interstitial nephritis?

    <p>Acute renal failure</p> Signup and view all the answers

    Which electrolyte disturbance is commonly managed in patients with acute kidney injury who present with hyperkalemia?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the primary pathophysiological change observed in chronic interstitial nephritis?

    <p>Fibrosis of renal parenchyma</p> Signup and view all the answers

    Study Notes

    Approach to the Patient with Kidney Disease

    • Examination techniques for renal abnormalities:
      • Blood pressure measurements
      • Blood tests for creatinine and electrolytes
      • Urinalysis for protein, blood, nitrites and leucocytes
      • Abdominal examination for palpable kidneys
      • Percussing for tenderness in renal angle
      • Digital rectal examination for prostate enlargement
      • Checking sacrum and ankles for pitting oedema

    The Kidneys

    • Central role in excreting metabolic breakdown products (ammonia, urea, creatinine, uric acid, drugs, toxins).
    • Produce large volumes of ultrafiltrate (120 mL/min, 170L/24h) at the glomerulus.
    • Selectively reabsorb components of the ultrafiltrate along the nephron.
    • Filtration and reabsorption rates are controlled by hormonal and haemodynamic signals to regulate fluid and electrolyte balance, BP, and calcium and phosphorus homeostasis.
    • Activate Vitamin D and control red blood cell synthesis by producing EPO.

    Functional Anatomy of the Kidney

    • Composed of cortex and medulla.
    • Contains nephrons:
      • Afferent arteriole
      • Efferent arteriole
      • Glomerulus
      • Bowman's capsule
      • Proximal convoluted tubule
      • Loop of Henle
      • Distal convoluted tubule
      • Collecting duct

    Glomerular Architecture

    • Filtration barrier:
      • Fenestration endothelium
      • Glomerular basement membrane
      • Podocytes (epithelial visceral cells)
      • Mesangial cells
    • Blood vessels:
      • Afferent and efferent arterioles
    • Bowman's space

    Glomerular Diseases

    • Most patients present asymptomatically until abnormalities are detected on routine screening.
    • Various causes of injury:
      • Immunological
      • Inherited (eg, Alport's syndrome)
      • Metabolic (eg, diabetes)
      • Deposition of abnormal proteins (eg, amyloid)
    • Glomerular cells are the target.
    • Clinical features vary according to the insult type.

    Nephritic and Nephrotic Syndromes

    • Nephritic syndrome:
      • Haematuria
      • Hypertension
      • Oliguria
      • Fluid retention
    • Nephrotic syndrome:
      • Heavy proteinuria (>3.5 g/24 hrs)
      • Hypoalbuminaemia
      • Oedema
    • Many patients may not exhibit all features but some are typical of rapidly progressive glomerulonephritis.

    Glomerular Diseases Mechanisms and Pathology

    • Various mechanisms lead to glomerular injury.
    • Mechanisms involve:
      • Deposition of immune complexes
      • Inflammation
      • Cell injury (e.g., podocyte injury)
    • Different staining will reveal different characteristics of the diseases.

    Renal Ultrasound

    • Used to image the kidneys.
    • Shows different components:
      • Normal kidney
      • Simple renal cyst
      • Hydronephrosis
      • Renal stone
      • Renal tumour

    Imaging Techniques

    • Various imaging techniques are available for kidney diagnosis. Including simple X-rays, ultrasound, CT scan (angio), MRI and myocardial perfusion.

    Acute Kidney Injury (AKI)

    • Sudden and often reversible loss of renal function (days or weeks).
    • Associated with reduced urine volume.
    • Significant complications, poor outcome (mortality = 50-70% in sepsis/multi-organ failure).
    • Elderly patients at higher risk than non-elderly patients.
    • Pre-renal, renal, and post-renal sub-types
    • AKI can be classified using RIFLE criteria and AKIN criteria

    Pathophysiology of AKI

    • Pre-renal: decreased perfusion to kidney.
    • Renal: damage to the kidney itself.
    • Post-renal: obstruction to urine flow.
    • Stages of damage include: initiation, extension, maintenance, and recovery.

    Phases of AKI

    • Initiation: ischemia, cell injury.
    • Extension: microvascular injury, inflammation.
    • Maintenance: dedifferentiation, proliferation.
    • Recovery: redifferentiation/repolarization.

    Renal Haemodynamics

    • Afferent arteriole: prostaglandins cause vasodilation.
    • Efferent arteriole: angiotensin II vasoconstricts.
    • NSAIDs inhibit prostaglandins.
    • ACE inhibitors / ARBs inhibit angiotensin II.

    Acute Kidney Failure

    • Tubule destruction, inflammation.
    • Loss of function (decreased renal function).

    Classification of AKI

    • RIFLE (Risk, Injury, Failure, Loss, ESRD) and AKIN systems used to classify AKI based on
      • Creatinine levels
      • Urine output criteria

    Management of AKI

    • Assess fluid status (hypovolemia, fluid overload)
    • Administer calcium and glucose/insulin to correct hyperkalemia
    • Sodium bicarbonate to correct acidosis.
    • Discontinue/reduce nephrotoxic drugs
    • Ensure adequate nutritional support
    • Screen for intercurrent infections
    • Treat any urinary tract obstructions.

    Acute Interstitial Nephritis

    • Immune-mediated disorder.
    • Primarily drug-induced (e.g., antibiotics, NSAIDs, diuretics)
    • Can also be caused by infections (bacterial or viral), or toxins (e.g., heavy metals, certain fungi).
    • Renal biopsy (Bx) usually required for diagnosis.
    • Biopsy will show intense inflammation in the tubules and interstitium, with PMN and lymphocyte infiltrates.

    Chronic Interstitial Nephritis

    • Renal dysfunction with fibrosis and infiltration of the renal parenchyma by lymphocytes and plasma cells.
    • Damage to tubules.
    • Can lead to chronic kidney disease (CKD).

    Chronic Kidney Disease (CKD)

    • Irreversible deterioration in renal function over years
    • Initially, only a biochemical abnormality.
    • Eventually, loss of excretory, metabolic, and endocrine functions leads to clinical symptoms.
    • CKD grade 5 = end-stage renal disease (ESRD).

    Investigations of CKD

    • Kidney function tests (GFR or Cr)
    • Urine analysis (albumin/creatinine ratio)
    • Other tests (electrolytes, blood counts, etc)
    • Imaging studies

    Management of CKD

    • Monitor renal function
    • Prevent or slow further renal damage
    • Limit complications of renal failure
    • Treat risk factors for cardiovascular disease
    • Prepare for renal replacement therapy (RRT) if appropriate

    End-Stage Renal Disease (ESRD)

    • Complication of CKD
    • Conservative management or dialysis/transplantation

    Indications for Dialysis

    • Fluid overload
    • Hyperkalemia
    • Metabolic acidosis
    • Other relative indications (e.g., severe hypertension, intractable oedema)

    Options for Renal Replacement Therapy

    • Haemodialysis
    • Haemofiltration
    • Peritoneal dialysis
    • Transplants

    Haemodialysis Access

    • Catheter
    • Arteriovenous fistula
    • Arteriovenous graft

    Diagnostic Methods

    • Non-invasive
      • X-ray
      • Ultrasound
      • CT scan
      • AngioCT
      • Myocardial perfusion
      • MRI
    • Invasive
      • Angiography
      • IVUS
      • Angioscopy
    • Functional
      • Tonometry
    • Physical Exam

    Physical Signs in Advanced CKD

    • Possible physical findings include yellow complexion, pallor, raised jugular venous pressure, pulsations, pericardial friction rubs, etc.

    The Progress of CKD

    • Progression can be accelerated by various factors (disease, treatments).

    Prevention of Early and Late CKD

    • Early intervention and control of risk factors can slow the progression of CKD and reduce the risk of complications.

    Cardiovascular and Renal Events Associated With Albuminuria

    • Increased risk for cardiovascular and renal events with higher levels of albuminuria.

    Biomarkers

    • Early markers for progressive kidney disease include FGF-23, 1,25-dihydroxyvitamin D, parathyroid hormone, phosphorous.

    Vascular Calcification in CKD

    • Both intimal and medial calcification are noted.
    • Specific factors, like Klotho and FGF-23, are involved.

    Coronary Artery Calcification in CKD

    • Atherosclerosis and Uremic arteriopathy frequently occur together.
    • Uremic arteriopathy is associated with inflammation and oxidative stress

    Calcifilaxis

    • Skin condition, usually associated with chronic kidney disease.

    Diagnostic Methods for CKD

    • Non-invasive: simple X-rays, ultrasound, CT angio, myocardial perfusion, MRI
    • Invasive: angiography, IVUS, angioscopy
    • Functional tests: tonometry

    Physical Signs in Advanced CKD

    • Possible physical findings include yellow complexion, pallor, raised jugular venous pressure, pulsations, pericardial friction rubs, etc.

    End-Stage Renal Disease (ESRD) Pathway

    • Conservative or dialysis/transplantation are management options.

    Indications for Dialysis

    • Fluid overload, hyperkalemia, metabolic acidosis, and related clinical features can dictate the need for dialysis.

    Options for Renal Replacement Therapy

    • Haemodialysis involves filtering blood through a machine. Haemofiltration filters blood via a different process. Peritoneal dialysis involves using the peritoneum to filter waste. Renal transplant involves replacing the patient's diseased kidney with a healthy donor kidney.

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    Description

    Test your knowledge on nephrology and glomerular diseases with this quiz. Explore characteristics of nephritic syndrome, nephrotic syndrome, and common causes of glomerular damage. Challenge yourself with critical questions related to acute kidney injury and interstitial nephritis.

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