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Renal > Conditions > Flashcards

Conditions Flashcards

1
Q 
Torsion of spermatic cord 
age group?
cremasteric reflex absent or present?
Ix?
Rx?
A

puberty
reflex absent
ix = doppler US
rx: prompt exploration to prevent ischaemia. 2-3 point fixation. must fix other side! remove if testis is necrotic

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2
Q

blue dot sign

A

torsion of appendix testis

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3
Q

Rx for appendix testis torsion

A

resolves spontaneously

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4
Q

Signs of and Rx for epididymitis

A

Pyuria
Doppler US shows swollen epidydimis and ^ blood flor
Rx: Ofloxacin

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5
Q

Priapism - prolonged erection > ? hrs
dark blood - low or high flow?
rx for ischamic / non ischaemic?

A

4 hrs
dark blood = low flow/ischaemic
Rx
- ischaemic: aspiration +/- irrigation with saline, inject alpha agonist every 5-10 mins, surgical shunt
- non ischaemic: observe, may resolve itself / selective arterial embolisation

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6
Q

swelling and crepitus of scrotum, marked toxicity out of proportion to clinical findings

A

Fournier’s gangrene

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7
Q

Ix and Rx for fournier’s gangrene

A

Ix: plain xray/US > gas in tissues
Rx: Abx and surgical debridement

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8
Q

Who usually gets emphysematous pyelonephritis

what does it usually require?

A

diabetics

usually requires nephrectomy

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9
Q

imaging for urethral injury

A

retrograde urethrogram

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10
Q

pharmacological therapy for urge incontinence

A

antimuscarinics e.g. oxybutynin

beta - 3 - adrenergic e.g. mirabegron

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11
Q

1st line for treating stress incontinence

A

pelvic floor exercises

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12
Q

foot process fusion

A

minimal change glomerulonephritis

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13
Q

treatment for minimal change glomerulonephritis

responsive?

A

1st line = oral steroids - 94% complete remission

2nd line = cyclophosphamide

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14
Q

what can FSGS be 2y to

A

HIV, heroin use, obesity, reflux nephropathy

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15
Q

what is FSGS assoc with

A

suPAR levels

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16
Q

glomerular crests on biopsy

A

rapidly progressive glomerulonephritis

NB. potential to cause ESRF within DAYS

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17
Q

treatment for RPGN

A

IV methyprednisolone 3 days then oral prednisolone
Cyclophosphamide
may need plasma exchange

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18
Q

what do most cases of IgA nephropathy present with

A

micro or macro proteinuria

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19
Q

what is IgA nephropathy assoc with

A

Henoch-Schonlein purpura

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20
Q

Anti GBM disease - auto antibodies to ??

A

type 4 collagen

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21
Q

2y causes of membranous glomerulonephritis

A 
Hep B 
gold
penicillamine 
SLE 
malignancy
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22
Q

post streptococcal glomerulonephritis
usually present with nephrotic or nephritic syndrome?
rx?

A

nephritic

rx = supportive

23
Q 
nephrotic syndrome
3 features?
damage to what?
proliferative?
normal or abnormal renal function usually?
A

proteinuria >3g per day
hypoalbuminaemia
oedema
(also, assoc with hypercholesterolaemia)

damage to podocytes

non proliferative

usually normal renal function

24
Q

type of oedema in nephrotic syndrome

A

periorbital

25
Q

what is damaged in nephritic syndrome

A

endothelial or mesangial cells

26
Q

what can cause tubular injury

A

gentamicin
rhabdomyolysis
contrast
ischaemia

27
Q

Renal AKI
what might anaemia make you think of?
what might low platelets make you think of?

A

anaemia > CKD? myeloma?

low platelets > HUS?

28
Q

life threatening if K is over ?

A

6.5

29
Q

medical treatment for hyperkalaemia

A

calcium gluconate (10 mls, 10%)
insulin with 50 mms 50% dextrose (actrapid)
salbutamol nebulised - 90 mins
calcium resonium - to prevent absorption from GI tract

30
Q

drug used for bone disease in CKD

what is it?

A

alfacalcidol

hydroxylated form of vitamin D

31
Q

examples of phosphate binders

A

calcium carbonate

calcium acetate

32
Q

why do you get anaemia in CKD?

A

erythropoietin production by the kidneys declines

33
Q

correcting anaemia in CKD

A

IV iron

Epo subcut injections

34
Q

CKD stages

A
  1. > 90 + other evidence of kidney damage
  2. 60-89 + other evidence of kidney damage
  3. a. 45 - 59 ; b. 30 - 44
  4. 15 - 29
    5.
35
Q 
ADPKD 
pkd1 / 2 - chromosomes? (which one results in ESRF earlier)
large or small kidneys?
is there pain?
extra renal features
A 
pkd1 - chromosome 16  - ESRF earlier ):
pdk2 - chromosome 4
large kidneys 
pain
extra renal manifestations:
- hepatic cysts are most common 
- in 1/3: cysts in the liver, pancreas, lung (no functional effect)
- berry aneurysms > subarachnoid haemorrhage 
- cardiac disease - valve prolapse 
- diverticular disease 
- hernias
36
Q

ADPKD
Ix
- are cysts bilateral or unilateral?
Rx

A

Ix:

  • USS > multiple, bilateral cysts
  • CT/MRI if unclear on US
  • genetic linkage/mutation analysis

Rx:

  • rigorous control of hypertension - ACEI
  • hydration
  • proteinuria reduction
  • TOLVAPTAN reduces cyst volume
37
Q 
ARPKD
assoc with ? lesions 
gene on chromosome ? 
renal involvement bilateral or unilateral?
are kidneys usually palpable?
slow or fast decline in GFR?
A 
assoc with hepatic lesions 
gene on chromosome 6 
bilateral 
kidneys always palpable 
slow decline in GFR - less than 1/3 reach dialysis
38
Q

ARPKD
Ix
prognosis

A

US/CT/MRI

infants who survive the neonatal period have a mortality rate of 9-24% in the first year
survival after first year > 80% survival beyond 15 yrs

39
Q

Alports syndrome
mutations in the ? gene (leads to deficient what?)
characteristic feature?
what is seen later and how does this affect prognosis?
extra renal features

typical feature on biopsy
treatment

A

mutations in the COL4A5 gene (leads to deficienct collagen - type 4- matrix)
characteristic feature = haematuria
proteinuria is seen later and confers bad prognosis
extra renal:
- SN deafness
- ocular - anterior lenticonus
- leiomyomatosis of the oesophagus/genitilia - rare

biopsy: thickened GBM + ‘splitting’

Rx = non specific
- standard aggressive tx of BP, proteinuria

40
Q 
Who gets Anderson Fabrys disease?
Inborn error if ? gene leading to deficiency in ???
clinical features 
- renal failure 
- cutaneous?
- cardiac?
- neuro?
A

X linked > males
inborn error of GLA gene leading to deficiency in alpha galactosidase A
- cutaneous: angiokeratomas
- cardiac: cardiomyopathy, valvular disease
- neuro: stroke, acroparaesthesia

41
Q

anderson fabrys
whats seen on biopsy?
treatment?

A

concentric lamellar inclusions with lysosomes

fabryzyme

42
Q 
medullary cystic kidney 
aut dom or rec?
where are the cysts?
Ix?
rx?
A

aut dom
cysts are at corticomedullary junction
Ix: fam hx, CT
rx: renal transplant

43
Q 
medullary sponge kidney
what happens to the collecting ducts?
what do the cysts contain?
increased risk of ?
renal failure?
A

dilation

calculi

UTI

renal failure unusual :)

44
Q

most common cause of renovascular hypertension

A

renal artery stenosis

45
Q

when are ACEI contraindicated

A

bilateral renal artery stenosis

46
Q

Myeloma

  • percentage with renal impairment at presentation?
  • hyper or hypo calcaemia?
  • features
  • renal manifestations
  • renal amyloidosis: +ve ??? stain showing ??? birefringence
A

50%
hypercalcaemia
- bone pain, weight loss, anaemia, amyloidosis, recurrent infections, fatigue
- AKI secondary to hypercalcaemia
- monoclonal immunoglobulin deposition disease
- cast nephropathy
- renal amyloidosis showing +ve congo red stain showing apple green birefringence

47
Q

multiple myeloma is cancer of ? cells

most cases also involve ?

A

cancer of plasma proteins

most cases also involve paraprotein

48
Q

rouleax formation cells

A

myeloma

49
Q

myeloma - lytic or sclerotic lesions?

A

lytic

50
Q

in myeloma, what can be done to remove light chains

A

plasma exchange

51
Q

renal involvement is most common in GPA/MPA/EGPA ??

A

GPA and MPA

52
Q

Lupus nephritis

  • most often proteinuria or haematuria?
  • up to ? % of lupus patients will have renal involvement at presentation
A

proteinuria

up to 50%

53
Q

urgent indications for haemodialysis

A

K > 7 or > 6.5 and unresponsive to medial therapy
urea > 40, pericardial rub/effusion
pH

Renal (9 decks)

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