Clinical questions Flashcards
Ab 8 year old girl present with leg swelling, pre orbital oedema and frothy urine
Minimal change disease
What is the initial treatment for minimal change disease?
Steroids
What is the treatment for minimal change disease which is resistant to steroids?
Cyclophosphamide
A 26 year old male who is on treatment for rheumatoid arthritis shows ++ protein and +blood.
Membranous nephropathy due to penicllamine or gold
What is the treatment for membrabous nephropathy?
Cyclophosphamide
Rituximab
What kidney disease are you most likely to get if you suffer from HIV?
Focal segmental glomerulosclerosis
An obese man present with frothy urine, haemature and hypertension.
Focal segmental glomerulosclerois
How do you treat focal segmantal glomerulosclerosis?
Prednisolone
Ciclosporin
Cyclophosphamide
Aziothioprine
A teenage boy presents with haematuria> he says he notices blood in his urine the last time he had a cold. On dipstick he has +blood and +protein.
IgA nephropathy
Which kidney disease is henoch schonlein purpura associated with?
IgA nephropathy
HHow do you treat IgA nephropathy?
Tight BP control with ACE
ARB
Which renal condition is most associated with red cell casts?
Rapidly progressive glomerulonephritis
What do you see on biopsy with rapidly progressive glomerulonephritis?
Crescents on biopsy
Give three ANCA +ve causes of RPGN?
Wegners granulomatosis
Microscopic polyangiitis
Systemic vasculitis
Give three ANCA -ve causes of PRGN
Goodpastures
Henoch schonlein
SLE
How do you treat goodpastures disease?
Steroids
Cyclophosphamide
Aziothioprine
Plasmapherisis
In what kidney disease do you get deposition of protein fragments and eosonophillic depositis in the mesangium?
Amyloidosis
What is the diagnositic criteria for overt diabetic nephropathy?
Persistent albuminuria (300mg/24h on at least 2 occasions separated by 3 - 6 months.
Describe the pathogenesis of diabetic nephropathy?
- Haemodynamic changes cause an increase in GFR.
- Glomerular basement membrane thickening.
- mesangial expansion
- proteinuria due to break down of podocytes.
- Glomerulosclerosis with nodules
In which renal disease would you expect to see kimmelstiel wilson lesions (glomerulosclerosis with nodules)
Diabetic nephropathy
What is the treatment for diabetic nephropathy?
Glycaemic control
Anti hypertensives (ACE and ARB)
Lipid control
what is the blood pressure target for a patient with diabetes?
Under 130mmHg sysstolic
Small vessel vasculitis
Characterised by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia
Lung most commonly involved (asthma in > 95%)
2/3 have skin involvement (palpable purpura to subcutaneous nodules)
Churg strauss
Nasal crusting, sinusitis, persistent rhinorrhea, otitis media, oral/nasal ulcers, bloody nasal discharge
WG-evidence of bony/cartilage destruction (saddle nose)
Wegners granulomatosis
List the classes of renal disease seen in SLE
Class I: Minimal mesangial
Class II: Mesangial Proliferative
Class III: Focal Proliferative
Class IV: Diffuse Proliferative
Class V: Membranous
Class VI: Advanced sclerosing
How does SLE kidney disease commonyl present?
Proteinura
What do you aim for the blood pressure to be in patients with proliferative SLE?
130/80
What is the treatment for proliferative SLE?
ACEI
ARB
Cyclophasphamide
Prednisolone
When are ACE inhibitors contraindicated?
Bilateral renal artery stenosis
