Renal Past Year Questions

1. [PROBLEM CASE] Post Streptococcal Glomerulonephritis

a. Blood Supply of Kidneys – renal artery, segmental, etc, etc.
b. Juxtaglomerular apparatus – mesengial, lacis and macula densa cells at
afferent arteriole
c. Structural arrangement at the hilum – anterior to posterior – vein, artery,
ureter
d. mechanism of micturation – conscious inhibition is removed, relaxation
of pelvis floor muscles, pulls detrusor to initiate contraction. Intra-
abdominal pressure is increased by straining. External urethral sphincter
relaxed. In women emptying of urethra is by gravity, in men it’s by
contraction of bulbocavernosus.
e. urine specific gravity – 1.002 to 1.025
2. [PROBLEM CASE]
a. 3 gram negative organisms causing UTI – e.coli, proteus, klebsiella
pneumoniae
b. Defence mechanisms of UT – flushing by urine, non-pathogenic flora,
shedding of epithelial cells, urinary pH
c. Cause of a bulge in abdomen – the 6 Fs, fetus, flatulence, fat, fatal
growth, feces, etc.
d. Actions of Probenezide & thiazide –
probenezide, uricosuric drug, primarily used in treating gout or
hyperuricemia, that increases uric acid removal in the urine. Thiazide,
decreases active reabsorption of Na and Cl by binding to the Cl side of
the Na/Cl co-transport system and inhibiting its action
e. Causes and prevention of renal stones – causes, dehydration, infection
which causes stasis, hyperparathyroidism, low citrate. Prevention, drink
more water, diet less in meat, fish and eggs prevent accumulation of
uric acid
f. Blood investigation for renal stones – test for PTH, citrate, uric acid,
calcium level
g. 2 sites normally impacted by stones – renal pelvis, calyces, pelvic brim,
the ureter pelvic junction
3. [PROBLEM CASE] minimal change glomerulonephritis lost of foot process and
selective protein urea, haematuria, small kids
4. [PROBLEM CASE] list 3 types of NSAIDs, 4 main effects of NSAIDs, 2 side effects –
aspirin, ibuprofen, ketoprofen.
Anti-inflammation, anti-pyretic, analgesic, reduces platelet aggregation.
GI symptoms, renal ischemia, hypertension due to renal ischemia
5. [PROBLEM CASE]
a. How renal ischemia cause hypertension – ischemia, low capillary
pressure in arterioles of JGA, secretion of renin, hypertension
b. What causes uremia – chronic renal failure, high protein diet, etc
 c. Cells of JGA – lacis, mesengial and macula densa
d. Why chronic renal failure causes metabolic acidosis – impairment of
kidney’s ability to secrete H ions and reabsorb HCO3 ions
6. [PROBLEM CASE] Pre renal causes of renal failure – cardiogenic/hypovolumic
shock, renal artery stenosis, renal vein thrombosis, inappropriate renal
vasoconstriction [due to NSAIDs], artheriosclerosis
7. [PROBLEM CASE] Microscopic anatomy of kidneys
PCT: cuboidal,pink cytoplasm, microvilli, mitochondria
LOH: squamus
DCT: cuboidal and less mitochondria
CD: cuboidal, pale cytoplasm, less organelles
8. [PROBLEM CASE] Patient presents with burning pain during micturition. His urine
is fishy smelling, dark coloured and theres pain in the lumbar region.
Probable diagnosis: urethritis, cystitis?
Name 4 lab examinations: urine culture, urine smear, urinalysis, microscopic
examination
Muscle that control voluntary micturition: compressor urethrae
Spinal segments that control micturition: S2,3,4
Mechanism of prevention of vesicourethral reflux: oblique entry of ureter into
bladder, ureters travel a few cm below the bladder mucosa before entering the
bladder muscle.
Define renal plasma clearance: volume of plasma cleared of a substance by the
kidneys in unit time
Substances used to determine GFR & RBF: Creatinine, inulin, RBF: use PAH
Numerical value of renal threshold of glucose: 180 mg/dl
3 factors affecting GFR: renal blood flow, hydrostatic pressure, oncotic pressure,
sympathetic activity
3 renal causes of hypertension: renal stenosis, diabetic neuropathy, PKD,
glomerulonephritis (post-strep, membranous)
MCQ: RCC can extend into renal vein into IVC - TRUE
Nephroblastoma is common in adults – FALSE, in kids instead
Schistosomiasis is a risk factor for RCC – FALSE, it’s urothelial cancer
Transitional cell carcinoma is common
9. [OSPE] renal neoplasms - teratoma
a. hydronephrosis – describe, 2 causes, 4 signs and symptoms: dilatation of
renal calyces and pelvis due to outflow obstruction. Due to congenital
[atresia, renal ptosis] or tumors. Oliguria, anuria, polyuria, nocturia
depending on where it’s blocked.
b. RCC – describe, 3 causes, 3 clinical features, predisposing age group:
adenocarcinoma arising from tubular cells. Costovertebral pain,
palpable mass, hematuria. 60-70 years old, M:F 2-3.1:1
c. Wilm’s tumor – describe histology, list 2 clinical features, differential
diagnosis: lobulated tumor mass, encapsulated, mixture of immature
 cells, metanephric, stromal, tubular cells. Abdominal mass, low grade
fever, hematuria rare. DDx: neuroblastoma arising from adrenals.
d. renal anatomy
e. male and female pelvis cross section
10. [VIVA] how to measure GFR, what is clearance, what’s the formula
With inulin, plasma cleared of a substance in unit time, C = (UV)/P
in urinary bladder cancer – TRUE
11. [OSPE]
a. Label the kidney
b. Layers of ureter – from inside to outside: mucosa [transitional
epithelium, lamina propria], muscularis [longitudinal, circular, external
longitudinal layer appears in the lower 1/3 of ureters], adventitia
c. Given a diagram of LOH, DT. Hormones that act on distal tubule and their
effect on electrolyte balance – ADH and aldosterone on CD and DCT.
ANP, ANG II and PTH on PCT.
d. Describe renal cell carcinoma – adenocarcinoma arising from tubular
cells. Large spherical masses, yellow-gray-white with focal hemorrhage,
partially encapsulated.
e. Prostate lesion, name 2 investigations for prostate lesions – Prostate
Specific Antigen, biopsy, transrectal sonography
12. [OSPE] History of fever, increase urinary frequency, dysuria. Given result of
urinalysis. Comment on result and give diagnosis. Cystitis.

13. [OSPE] Polycystic Kidney Disease – describe and diagnose. List 2 investigations. –
xray, CT scan, MRI,renal function test
14. [OSPE] Renal threshold substances – glucose
15. [OSCE] Kidney balloting
16. [OSCE]
a. Self standing: kidney IVP
b. Hx: left loin pain
c. Patient complain of dysuria. Examine the abdomen.