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MBBS CPRS > CPRS 86 87: Diseases of Kidney I&II > Flashcards

CPRS 86 87: Diseases of Kidney I&II Flashcards

1
Q

Location of Kidney

A

T12-L3

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2
Q

Can glomerulus regenerate

A

no

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3
Q

3 ways to investigate a renal biopsy sample?

A

Light Microscopy
Direct Immunofluorescence Study
Electron Microscopy

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4
Q

Consider Nephrotic Syndrome

Name 1 MAJOR Presentation and 3 Associated derived presentation

A
  • Proteinuria (>3.5 gm per day)
  • Hypoalbuminemia
  • Oedema
  • Hyperlipidaemia
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5
Q 
Consider Nephrotic Syndrome
Name 4 Associated Glomerular Disease with it
- M N
- MPGN
- M C D 
- FSGS
A
  • Membranous nephropathy
  • Membranoproliferative Glomerulosclerosis
  • Minimal Change Disease
  • Focal Segmental Glomerulosclerosis
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6
Q

Consider Nephrotic Syndrome

Name 2-3 Associated Complications with it

A

Hypercoagulability
Hyperlipidaemia
Decrease serum binding protein

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7
Q

Consider Nephritic Syndrome

Name 1 MAJOR Presentation and 3 Associated derived presentation

A
  • Haematuria
  • Mild to moderate proteinuria
    (Diminished GFR)
    (Hypertension)
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8
Q 
Consider Nephritic Syndrome
Name 3 Associated Glomerular Disease with it
- A P G
- IgA..
- SLE
A
  • Acute Postinfectious Glomerulonephritis
  • IgA Nephropathy
  • Systemic Lupus Erythematous
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9
Q

Consider Nephritic Syndrome

Name 2 Associated Complications with it

A

Hypercoagulability
Hyperlipidaemia
Decrease serum binding protein

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10
Q

Acute Kidney Injury

Name 2 Presentations of this disease

A

Rapidly decline in GFR in hours to days

Oliguria or Anuria (reduced or no urine output)

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11
Q

Chronic Kidney Disease

Presentation: Persistent decline in GFR (less than ______ml per minute/ 1.73m^2) for at least ____ months

A

Chronic Kidney Disease
Presentation: Persistent decline in GFR (less than 60ml per minute/ 1.73m^2) for at least 3 months

Stage 3 or worse; 3 months

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12
Q

End stage renal disease is irreversible.
It has GFR less than ___ % of normal
Requires ______________ therapy

A

less than 5%

Requires renal replacement therapy

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13
Q

What is it called when there is elevation of blood urea and creatinine levels due to decrease in GFR

A

Azotemia

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14
Q

What is it called when there is toxic condition where waste products normally excreted are retained in blood

A

Uraemia

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15
Q

Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes
Metabolic Alterations of GBM- _____________
Genetic Defects of GBM- ________________

A

Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes
Metabolic Alterations of GBM- Diabetes
Genetic Defects of GBM- Alport Syndrome

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16
Q

Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes:
- Antibodies bind to intrinsic glomerular antigen against _________ receptors on ________ (In-situ): __________
- Antibody binds to normal components of ______ (In-situ): _____________
- Deposition of circulating antigen-antibody complexes in glomerulus (Circulating): __________ and ______________

A

Consider Glomerulonephritis: 3 major causes
Immune Mechanism Causes:

  • Antibodies bind to intrinsic glomerular antigen against PLA2R receptors on podocytes (In-situ):
    Membranous Nephropathy
  • Antibody binds to normal components of GBM (In-situ):
    Goodpasture Syndrome
  • Deposition of circulating antigen-antibody complexes in glomerulus (Circulating):
    IgA Nephropathy and Systemic Lupus Erythematous
17
Q

Consider Glomerulonephritis
What are the results?

  • Podocyte injury: Do they have good capacity in replication and repair?
  • Glomerular Injury: What is compensatory hypertrophy? How would it lead to glomerulosclerosis
A

Consider Glomerulonephritis
What are the results

  • Podocyte injury: Podocytes have very limited capacity in replication and repair
  • Glomerular Injury: Compensatory hypertrophy by remaining glomeruli => Progressive fibrosis and further decrease in number of functional glomeruli => Glomerulosclerosis
18
Q 
Nephrotic Syndromes
Associated Glomerular Disease: Membranous Nephropathy
- Nature?
- Major Prevalence
- Primary cause
- Secondary cause
- Light Microscopy
- IgG Immunofluorescence
- Electron Microscopy
- Treatment Primary
- Treatment Secondary
A

Nephrotic Syndromes
Membranous Nephropathy
- Nature: Immune Complex Glomerulonephritis
- Major Prevalence: 30-50 years old adults
- Primary cause: PLA2R expressed on podocytes
- Secondary cause: Hepatitis B and C, Drugs like NSAIDs
- Light Microscopy: Spikes under Silver Stain
- IgG Immunofluorescence: Spotty and Green
- Electron Microscopy: Subepithelial Electron Dense Deposits
- Treatment Primary: Steroids
- Treatment Secondary: Treat the underlying causes

19
Q 
Nephrotic Syndromes
Associated Glomerular Disease: Membranoproliferative Glomerulonephritis
- Nature
- Features (2)
- Light Microscopy
- IgG Immunofluorescence
- Electron Microscopy
- Treatment (2)
- What are not useful/ should be avoided
A

Nephrotic Syndromes
Associated Glomerular Disease: Membranoproliferative Glomerulonephritis
- Nature: Immune Complex Glomerulonephritis
- Features (2): Capillary wall thickened + Cells markedly increased
- Light Microscopy: Basement Membrane Splitting under Silver Stain
- IgG Immunofluorescence: Spotty and Green
- Electron Microscopy: Basement Membrane Splitting
- Treatment: Treat underlying Causes + Drugs targetting C3 complement pathway for glomerulonephritis
- What are not useful/ should be avoided: Steroids

20
Q 
Nephrotic Syndromes
Associated Glomerular Disease: Minimal Change Disease
- Nature
- Major Prevalence
- Which type of the cell are problematic? and why?
- IgG Immunofluorescence
- Electron Microscopy
- Treatment
A

Nephrotic Syndromes
Associated Glomerular Disease: Minimal Change Disease
- Nature: NOT immune complex
- Major Prevalence: Children
- Which type of the cell are problematic? and why?: Podocytes, loss of protein filter function for GBM
- IgG Immunofluorescence: No staining (Not immune complex)
- Electron Microscopy: Diffuse effacement of foot processes of podocytes
- Treatment: Steroids

21
Q 
Nephrotic Syndromes
Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS)
- Nature
- Major Prevalence
- Which type of the cell are problematic? and why?
- Primary Cause: 
- Secondary Cause: 
- IgG Immunofluorescence
- Electron Microscopy
- What should NOT be used in treatment?
A

Nephrotic Syndromes
Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS)
- Nature: NOT immune complex
- Major Prevalence: Children
- Which type of the cell are problematic? and why?:
Podocytes, loss of protein filter function for GBM
- Primary cause: Idiopathic
- Secondary cause: HIV, Obesity, Hypertension
- IgG Immunofluorescence: No staining (Not immune complex)
- Electron Microscopy: Diffuse effacement of foot processes of podocytes
- What should NOT be used in treatment: Steroids

22
Q 
Nephrotic Syndromes
Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS)
What does the following mean?
- Focal
- Segmental
- Glomerulosclerosis
- What disease is it very similar to?
A

Nephrotic Syndromes
Associated Glomerular Disease: Focal Segmental Glomerulosclerosis (FSGS)
What does the following mean?
- Focal: Less than 50% of the glomerulus
- Segmental: A certain section of 1 glomerulus
- Glomerulosclerosis: Replacement of capillary loops of glomerulus by acellular materials
- What disease is it very similar to? Minimal Change Disease

23
Q 
Nephritic Syndromes
Associated Glomerular Disease: Acute Post-infectious Glomerulonephritis
- Nature
- Major Prevalence
- Pathologic Agent
- Preceding infection
- Light microscopy
- IgG Immunofluorescence
- Electron Microscopy
- Treatment therapy
A

Nephritic Syndromes
Associated Glomerular Disease: Acute Post-infectious Glomerulonephritis
- Nature: Immune Complex Glomerulonephritis
- Major Prevalence: Children
- Pathologic Agent: Streptococcal infection (Group A)
- Preceding infection: Pharynx or skin
- Light microscopy: Hypercellular glomeruli with neutrophils
- IgG Immunofluorescence: Spotty and green
- Electron Microscopy: Subepithelial humps
- Treatment therapy: Conservative therapy

24
Q

Consider Acute Renal Failure
Type I: Anti-GBM Antibody- ___________
Type II: Immune Complex- ____________
Type III: Pauci-immune- ______________

A

Consider Acute Renal Failure
Type I: Anti-GBM Antibody- Goodpasture Syndrome
Type II: Immune Complex- IgA Nephropathy
Type III: Pauci-immune- ANCA-associated

25
Q

Consider Acute Renal Failure
Type I: _______________- Goodpasture Syndrome
Type II: _______________- IgA Nephropathy
Type III: _______________- ANCA-associated

A

Consider Acute Renal Failure
Type I: Anti-GBM Antibody- Goodpasture Syndrome
Type II: Immune Complex- IgA Nephropathy
Type III: Pauci-immune- ANCA-associated

26
Q

Consider Acute Renal Failure
Type I: Goodpasture Syndrome- Anti-GBM Antibody Mediated
- Nature
- Light Microscopy
- IgG Immunofluorescence
- Electron Microscopy, and why?
- Treatment: High dose _____ with _______

A

Consider Acute Renal Failure
Type I: Goodpasture Syndrome- Anti-GBM Antibody Mediated
- Nature: Autoantibody against NC1 of collagen type 4 that cross react with pulmonary alveolar basement membrane
- Light Microscopy: Cellular Crescent under Silver Stain
- IgG Immunofluorescence: Linear staining pattern
- Electron Microscopy: No deposits, antibodies are too small to be detected
- Treatment: High dose steroid and Cyclophosphamide

27
Q 
Consider Acute Renal Failure
Type II: IgA Nephropathy- Immune Complex Mediated
- Nature
- Prevalence
- Presentation (Consider Haematuria and Proteinuria and the degree)
- Light Microscopy
- Direct Immunofluorescence
- Electron Microscopy
- Treatment:
A

Consider Acute Renal Failure
Type II: IgA Nephropathy- Immune Complex Mediated
- Nature: Immune Complex Glomerulonephritis
- Prevalence: Wide Range of Age Presentation
- Presentation: Haematuria (Suggests nephritic) and Proteinuria (little)
- Light Microscopy: Mesangial proliferation
- Direct Immunofluorescence: IgA deposits
- Electron Microscopy: Mesangial electron dense deposits
- Treatment: Corticosteroid

28
Q 
Consider Acute Renal Failure
Type III: ANCA-associated- Pauci Immune
- Nature
- IgG Immunofluorescence
- Electron Microscopy
A 
Consider Acute Renal Failure
Type III: ANCA-associated- Pauci Immune
- Nature: No antibodies and no immune complexes
- IgG Immunofluorescence: No deposits
- Electron Microscopy: No deposits
29
Q

Consider Acute Tubular Injury

  • Causes (1 Major 1 Minor)
  • 3 stages
A

Consider Acute Tubular Injury
- Causes (1 Major 1 Minor):
Major: Ischaemia; Minor: Direct Toxic Injury
- 3 stages: Initiation, Maintenance, Recovery

30
Q

Consider Tubulointerstitial Nephritis

  • It has raised _______ and _______ level
  • Histological Feature: It has lots of which type of WBCs?
  • Causes: Which type of drugs?
  • Causes: Which type of infection?
A

Consider Tubulointerstitial Nephritis

  • It has raised blood creatinine and Blood urea level
  • Histological feature: Lots of eosinophils
  • Causes: Which type of drugs? - NSAIDs
  • Causes: Which type of infection? - Acute and Chronic pyelonephritis
31
Q

Consider Acute Pyelonephritis
Note: Acute Pyelonephritis is caused by UTI
- Causes x4 (Consider UTI)
- Features: During autopsy, what colour of pus?
- Features: Large amount of which type of WBCs?
- Symptoms: Name 2-3
- Common pathogens: Name 2-3
- Treatment: _______ therapy

A

Consider Acute Pyelonephritis
Note: Acute Pyelonephritis is caused by UTI
- Causes x4: Pregnancy, Vesico-ureteric reflux, Catheterization, Obstruction by stones
- Features: During autopsy, yellow colour pus
- Features: Large amount of neutrophils
- Symptoms: Fever, shaking chills, loin pain
- Common pathogens: Escherichia coli, Proteus mirabilis, Mycobacterium tuberculosis
- Treatment: Antibiotic therapy

32
Q

Consider Chronic Pyelonephritis

  • Causes x2
  • Symptoms: Name 2-3 (Consider acute C. P.)
  • Other features: Cause Compensatory _________ of remaining glomeruli
  • Treatment: ________ therapy
A

Consider Chronic Pyelonephritis

  • Causes: Vesico-ureteric reflux, Obstruction by stones
  • Symptoms: Recurrent high fever, recurrent shaking chills, recurrent loin pain
  • Other features: Cause Compensatory hypertrophy of remaining glomeruli
  • Treatment: Antibiotic therapy
33
Q

Consider Light Chain Cast Nephropathy

  • Prevalence:
  • Presentations (name 2)
  • Treatment: Stem cell…
A

Consider Light Chain Cast Nephropathy

  • Prevalence: 90% of cases are greater than 50 years old
  • Presentations (name 2): Acute Renal Failure, Proteinuria
  • Treatment: Hematopoietic Stem Cell Transplantation
34
Q

Consider Vascular Disease- Blood Vessel damages
Hypertensive Nephrosclerosis
- Disease associated:
- Features (name 2)

A

Consider Vascular Disease- Blood Vessel damages
Hypertensive Nephrosclerosis
- Disease associated: Hypertension
- Features:
Hyalinization of Arteriolar Wall,
Intimal fibrosis and medical thickening of interlobar and arcuate arteries

35
Q

Consider Vascular Disease- Blood Vessel damages
Malignant Nephrosclerosis
- Disease associated:
- Definition with relation to the blood pressure:
- Histology:
- Treatment:

A

Consider Vascular Disease- Blood Vessel damages
Malignant Nephrosclerosis
- Disease associated: Malignant hypertension
- Definition with relation to the blood pressure: Systolic pressure greater than 200 mmHg, Diastolic pressure greater than 120 mmHg
- Histology: Fibrinoid Necrosis of arterioles
- Treatment: Antihypertensive medication

36
Q

Consider Vascular Disease- Blood Vessel damages
Diabetic Nephropathy
- Disease associated
- Features: Name 2-4

A

Consider Vascular Disease- Blood Vessel damages
Diabetic Nephropathy
- Disease associated: Type I and II Diabetes
- Features: Thickened GBM, Diffuse increase in mesangial matrix, Kimmelstiel-Wilson nodules, Hyalinosis of both afferent and efferent arterioles

MBBS CPRS (44 decks)

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