Extras Flashcards
Aldosterone acts WHERE
cortical collecting duct
principal cell
most sodium resorbed where
65% PCT
25% LOH
10% DCT and CD
PLA2 actually expressed where
podocytes
reduced podocyte levels in diabetes correlates with
risk prog diabetic nephropathy
Klotho expression in CKD
reduced- less responsive to FGF23
factors in membranous nephropathy that predict progression CKD
renal function off at baseline male over age 50 increase degree and duration proteinuria hypertension biopsy showing tubuloint fibrosis, stage 3 or 4, non asian
podocyte foot effacement seen in
minimal change
ANP acts on which bit of nephron
medullary collecting duct to inhibit sodium reabsorption
BK nephropathy RF
female donor
use ATG
older recipient
DR mismatch
treatment BK nephropathy
(urine and blood PCR positive, biopsy show tubulitis, interstitial infiltrate lymphocytes, intranuclear inclusion bodies)
reduce overall immunosupression
leflunomide (antiviral as well as pyrimidine synth inhibitor)
IV cedofovir maybe
when would you consider bicarb for contrast induced neph prevention
when urgent CT and do not have the 12 hours pre-scan, bicarb is probably non inferior
heart failure AND proteinuria, think
AL amyloidosis
Most common presentation of dialysis related amylodiosis
carpal tunnel
shoulder pain
Thy cystic lesions at the end of long bones contain amyloid
Why do you hold metformin before and after contrast?
If there is deterioration in renal function, then will be at higher risk of lactic acidosis, NOT because there is increased risk lactic acidosis
on the other hand,
ACEi and ARB, diuretics, NSAIDS DO increase risk
what type of transplant is most likely to give you PTLD?
bowel
heart lung
10-20% each
liver next
then lung
kidney only 1%
PTLD treatment
reduce immunosupresssion
next line ritux
no antivirals work
Uveitis and interstitial nephritis, think
acute tubuloint nephritis with uveitis syndrome
HLADQA1 DQB1 and DRB1
FSGS after renal transplant- what does it look like?
hours to days- massive proteinuria
or
late- insidiously years to months
give high dose ARB, ACE, statins
immunosupression increase
most commonly try plasmapheresis or immunoadsorption with protein A
can try ritux if no response to plasmapheresis
COX2 inhib use assoc with which GN
minimal change
MPGN on
- light
- immuno
- EM
Light: diffuse thickening capillary walls, mesangial hypercellularity
IF: coarse granular pattern along capillaries
EM: large discreet electron dense supendothelial deposits
For every 100 patients given tac instead of CycA…
2 fewer graft loss
12fewer rejectons
5 extra cases DM
Benefits of mTOR over CNI
not nephrotoxic alone malignancy- def reduced skin cancers reduced CMV - definite early on there is more rejection- only swap after a few months increased graft survival better renal function but MORE proteinuria
When conversion from a CNI to an mTOR inhibitor is performed late, the patient has GFR
When picking a kidney, is matching or Ab level most important?
levels ab
Tac does what to your hair
alopecia
What cells in urine suggest BK nephropathy?
Decoy cells
also look for EM- bug
and IHC- SV70 antigen
Which GN cause does not really reccur
post strep GN
which is highest risk of recurrence
which is highest risk failure
GN
recurrence MPGN
failure IgA
Which transplant med does NOT increase risk DM
MMF
