MICRO
KIDNEY.pptx

E amphotericin b d ie aminoglycosides ref harrison

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‘B’ I.E., AMPHOTERICIN B; ‘D’ I.E., AMINOGLYCOSIDES [REF: HARRISON 18VEP. 23001. (279.1), 2298; 17H/EP. 1753] 47
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PRERENAL AND RENAL AZOTEMIA IS DIFFERENTIATED ON THE BASIS OF- (PGI DEC 99) A) CREATININE CLEARANCE B) SERUM CREATININE LEVEL C) SODIUM FRACTION EXCRETION D) URINE BICARBONATE LEVEL 48
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IT IS QUIET CLEAR FROM THE FORMULA THAT FENA WILL BE LESS THAN 1 IF URINARY SODIUM IS LESS THAN PLASMA SODIUM. THIS IS THE CASE IN PRERENAL FAILURE. PRERENAL FAILURE IS CAUSED DUE TO DEPLETION OF BODY FLUID. DECREASE IN BODY FLUID PRODUCES RENAL HYPOPERFUSION. THE KIDNEY RESPONDS TO THIS SITUATION BY INCREASING THE REABSORPTION OF THE SODIUM FROM THE GLOMERULAR FILTRATE. THIS DECREASES THE URINARY SODIUM AND INCREASES SERUM SODIUM. 50
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THUS THE FRACTIONAL EXCRETION OF SODIUM IS < 1 IN PRE-RENAL FAILURE. (FENA IS THE FRACTION OF FILTERED SODIUM LOAD THAT IS REABSORBED BY TUBULES). IN INTRINSIC RENAL FAILURE, THE RENAL PARENCHYMA PARTICULARLY THE TUBULAR EPITHELIUM IS DAMAGED . DAMAGE TO THE TUBULAR CELL LEADS TO DECREASE IN SODIUM REABSORPTION FROM THE GLOMERULAR FILTRATE I.E., URINARY SODIUM INCREASES AND SERUM SODIUM DECREASES. 51
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THUS THE FRACTIONAL EXCRETION OF SODIUM IS MORE THAN ONE IN INTRINSIC RENAL FAILURE. (ACUTE KIDNEY INJURY). PLASMA CREATININE AND URINARY CREATININE ARE ALSO USED IN THE EQUATION, BUT IT DOES NOT ALTER THE EQUATION, BECAUSE CREATININE IS NOT ABSORBED IN BOTH TYPES OF RENAL FAILURE. 52
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PRERENAL AND RENAL AZOTEMIA IS DIFFERENTIATED ON THE BASIS OF- (PGIDEC 99) A) CREATININE CLEARANCE B) SERUM CREATININE LEVEL C) SODIUM FRACTION EXCRETION D) URINE BICARBONATE LEVEL ANS. IS ‘C’ I.E., SODIUM FRACTION EXCRETION . 54
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WHICH OF THE FOLLOWING VALUES ARE SUGGESTIVE OF ACUTE TUBULAR NECROSIS - {AIIMS NOV 2000) A) URINE OSMOLALITY >500 B) URINE SODIUM > 40 C) BLOOD UREA NITROGEN PLASMA CREATININE > 20 D) URINE CREATININE/PLASMA CREATININE > 40 ANS. IS ‘B’ I.E., URINE SODIUM > 40 [REF: HARRISON 18,H/EP. 336, 337, T.(44.2), 2302; 17H/EP. 271, 1758] 55
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PRE-RENAL AZOTEMIA IS ASSOCIATED WITH ONE OF THE FOLLOWING CHARACTERISTIC FEATURE – (AIIMS DEC 98) A) URINARY NA+< 10 MMOL/L B) RENAL FAILURE INDEX > 1 C) OSMOLALITY < 500 D) URINARY CREATININE/P.CREATININE RATIO < 20 ANS. IS ‘A’ I.E., URINARY NA+ < 10 MMOL/LITRE [ REF: HARRISON I8"‘/EP. 330, 3371.(44.2), 2302; 17H/EP. 271, 1758] 56
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WHICH DIFFERENTIATING PRERENAL AZOTEMIA WITH ATN FEATURES FAVORING PRE-RENAL AZOTEMIA - (PGI DEC 02) A) URINE OSMOLALITY > 500 MOSMOL/KG B) SODIUM SPOT EXCRETION < 10 ML/L C) PLASMA TRANSFERRIN/IG RATIO D) FRACTIONAL EXCRETION OF SODIUM > 1 E) PLASMA BUN/CREATININE RATIO < 20 ANS. IS ‘A’ I.E., URINE OSMOLALITY > 500 MOSMOL/KG; ‘B’ I.E., SODIUM SPOT EXCRETION < 10 M MOL/L 58
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OLIGURIC PHASE OF RENAL FAILURE, ALL ARE TRUE, EXCEPT- (AIIMS MAY 93) A) HYPERCALCEMIA B) HYPONATREMIA C) ANAEMIA D) HYPERKALEMIA 59
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THE CLINICAL COURSE OF ACUTE TUBULAR NECROSIS IS DIVIDED INTO :- INITIATION, MAINTENANCE AND RECOVERY PHASES.
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