Renal & Electrolyte Disorders

Answer: D
Explanation: Nephritic syndrome is characterised by hematuria, hypertension, oliguria, and azotemia. Davidson emphasises that hyperlipidemia is a feature of nephrotic syndrome, not nephritic syndrome. Nephritic syndrome results from glomerular inflammation, leading to red blood cell leakage into the urine. Harrison explains the differences between nephritic and nephrotic syndromes, noting that nephritic syndrome also causes renal insufficiency and fluid retention.

Reference: Davidson 23rd; P-351

Reference: Davidson 23rd; P-758 , fig : 20.22

Explanation: Loss of acidic gastric contents leads to alkalosis and dehydration with low serum chloride and potassium and raised serum bicarbonate and urea concentrations (hypochloraemic metabolic alkalosis).

Reference: Davidson 23rd , Page : 716
Explanation : Too much calcium can lead to constipation , and toxicity has been observed in ‘milk-alkali syndrome’.

Explanation: Acute tubular necrosis (ATN) is most commonly caused by ischemia due to sepsis. Davidson explains that systemic hypotension and renal hypoperfusion in sepsis lead to tubular cell injury and necrosis. Harrison adds that nephrotoxic drugs (e.g., aminoglycosides) and rhabdomyolysis are also significant causes of ATN.

The presence of leucocytes and nitrites in urine is indicative of renal tract infection. Urine pH can provide diagnostic information in the assessment of renal tubular acidosis and urinary tract stones (p. 562).

ABM 475

Dipstick positive
•Hematuria
•Haemoglobinuria
•Myoglobinuria

Reference: Davidson 23rd; P-133

Reference: Davidson 23rd; P-801

Explanation: Chronic kidney disease (CKD) refers to an irreversible deterioration in renal function that usually develops over a period of years Initially, it manifests only as a biochemical abnormality but, eventually, loss of the excretory, metabolic and endocrine functions of the kidney leads to the clinical symptoms and signs of renal failure, collectively referred to as uraemia

According to Davidson, diabetic nephropathy is the most typical cause of nephrotic syndrome in adults. Diabetic nephropathy leads to glomerular damage resulting in proteinuria, hypoalbuminemia, and edoema. Harrison emphasises that strict control of blood sugar and blood pressure can help slow the progression of diabetic nephropathy and reduce the risk of end-stage renal disease.

Reference: Davidson 23rd; P-137

Reference: Davidson 23rd; P-359

Reference: Davidson 23rd; P-801
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-133

Reference: Davidson 23rd; P-361

ECG changes in Hypokalemia 
T wave flattening and  inversion
·Prominent U wave
·Increased amplitude and  width of the P wave
·Prolongation of the PR  interval
·ST depression
·Apparent long QT interval
(= long QU interval)

·Supraventricular  tachyarrhythmias: AF, atrial  flutter, atrial tachycardia
·life-threatening ventricular  arrhythmias, e.g. VT, VF and  Torsades de Pointes

Hypokalemia is the most common electrolyte abnormality associated with prolonged vomiting. Davidson explains that vomiting leads to loss of gastric acid (hydrochloric acid), which triggers renal potassium excretion to maintain acid-base balance. Harrison adds that the body responds to the loss of hydrogen ions by increasing bicarbonate reabsorption, further promoting potassium excretion and hypokalemia.

Reference: Davidson 23rd; P-412

Explanation: Calcium is the most abundant cation in the body and powerful homeostatic mechanisms control circulating ionised calcium levels.

Type II (proximal) RTA is characterized  by
•Hypokalemia
•Hyperphosphaturia
•Aminoaciduria
•Glycosuria
•Rickets and osteomalacia
•Failure to thrive