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J Renal > Kidney conditions > Flashcards

Kidney conditions Flashcards

1
Q

drug history questions for kidneys (6)

A 
gentamicin 
vancomycin 
beta blockers
ACE inhibitors/ARBs
diuretics 
NSAIDs
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2
Q

arrhythmia associated wit hyperkalaemia (significant in renal disease)

A

peaked T waves

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3
Q

classic presentation of nephritic syndrome (4)

A

hypertension
oliguria
oedema (not periorbital)
haematuria

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4
Q

classic presentation of nephrotic syndrome (4)

A

Oedema (periOrbital) = nephrOtic
prOteinuria
hypoalbuminaemia
hypercholesterolaemia

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5
Q

aetiology of most nephrotic syndrome

A

glomerulonephritis (glomerular damage)

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6
Q

what investigation would you do for someone presenting with nephrotic syndrome

(think about likely cause)

A

renal biopsy

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7
Q

most common cause of chronic kidney disease (CKD)

A

diabetic nephropathy

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8
Q

aetiology of chronic kidney disease (CKD)

A

basically anything that affects the kidneys for a long time

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9
Q

definition of chronic kidney disease (CKD)

A

reduced kidney function and/or evidence of kidney damage >3months

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10
Q

what colour of skin may someone have with chronic kidney disease (CKD)

why

A

lemon yellow

from urea

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11
Q

common presentation of chronic kidney disease (CKD) (3)

A

fatigue
weight loss
nocturia
loads of things

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12
Q

G1 stage CKD criteria

A

GFR >90 but evidence of kidney damage

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13
Q

G2 stage CKD criteria

A

GFR 60-89

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14
Q

G3a stage CKD criteria

A

GFR 45-59

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15
Q

G3b stage CKD criteria

A

GFR 30-44

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16
Q

G4 stage CKD criteria

A

GFR 15-29

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17
Q

G5 stage CKD criteria

A

GFR <15 established renal failure

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18
Q

how many measurements how far apart of GFR do you need for chronic kidney disease (CKD)

A

2 measurements 90 days apart

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19
Q

what 3 things on urinalysis would you do/look for for someone with CKD

why

A

proteinuria
haematuria
albumin creatinine ratio (ACR)

find out cause of CKD

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20
Q

investigations for CKD (3)

A

creatinine/GFR
urinalysis
imaging (US if renal, MR angiogram if prerenal, CT if post renal)

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21
Q

at what stage should you refer CKD to renal specialist (probs for dialysis)

A

G3 - if progression (25% drop in GFR) or young
G4
G5

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22
Q

definitive treatment for CKD G5

A

renal replacement therapy (haemodialysis, peritoneal dialysis, transplant)

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23
Q

contraindication of ACE inhibitors in renal disease

A

bilateral renal artery stenosis

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24
Q

conservative treatment of CKD if G1-G4 (4)

A

ACE inhibitors/ARBs to reduce BP
statins for CVD
fluid restriction/diuretics
lifestyle modification - reduce K, PO4, salt

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25
Q

BP target in CKD

A

<130/80mmHg

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26
Q

what happens to vitamin D in CKD (chronic kidney disease)

what does this cause

A

vit D is not hydroxylated = so is inactive

CKD mineral bone disease

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27
Q

if vit D is not hydroxylated in CKD, what happens to Ca

what does this result in (hormones)

A

reduced Ca absorption in bones
high serum Ca binds with high serum phosphate
= calcium phosphate = serum Ca decreases

secondary (also tertiary from high PO4 bc bone doesnt excrete it as normal) HYPERparathyroidism

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28
Q

presentation of mineral bone disease in CKD (4)

A

fractures
bone pain
osteomalacia
vascular/soft tissue/bone calcification

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29
Q

treatment of mineral bone disease in CKD (3)

think about the 2 problems

A

decrease PO4 in diet (chocolate)
alfacalcidol (already hydroxylated vit D)
phosphate binders eg calcium carbonate

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30
Q

why may someone with CKD present with anaemia

A

kidneys produce EPO (erythropoietin) so in CKD = decreased EPO = decreased RBC = anaemia

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31
Q

definition of acute kidney injury (AKI) (4)

include creatinine and urine (and 2 other)

A

abrupt (<48 hours) reduction in kidney function
increase in creatinine >50%
reduction in urine <0.5ml/kg/hour
no response to fluid resus

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32
Q

is acute kidney injury (AKI) common

A

very

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33
Q

what are the 3 categories of causes of acute kidney injury

A

prerenal
renal
postrenal

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34
Q

description of prerenal AKI

aetiologies (4)

A

hypoperfusion to kidneys

drugs - ACE inhibitor, NSAIDs
sepsis
renal artery stenosis
diarrhoea/vomiting/haemorrhage

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35
Q

treatment of someone with prerenal AKI

think about it

A

bloods
fluids

the problem is hypoperfusion!

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36
Q

complication of untreated prerenal AKI

A

acute tubular necrosis

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37
Q

what is acute tubular necrosis

what is it caused by

A

death of tubular epithelial cells = renal cause of AKI

bc of hypoperfusion (untreated prerenal AKI)

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38
Q

‘muddy brown casts of epithelial cells’

A

acute tubular necrosis

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39
Q

treatment of acute tubular necrosis

think about the aetiology

A

fluids

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40
Q

drugs that can cause renal damage = AKI

A

gentamicin

PPI eg omeprazole

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41
Q

in old people/alcoholics what is a likely cause of AKI

A

rhabdomyolysis from collapse

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42
Q

apart from drugs and rhabdomyolysis, what is another major cause of renal AKI

A

glomerulonephritis

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43
Q

description of post renal AKI

examples (3)

A

obstruction of urine outflow = back pressure of urine into kidneys = AKI

prostate enlargement
kidney stones
tumours

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44
Q

treatment of post renal AKI (3)

A

catheter
stent
nephrostomy (surgery)

to relieve obstruction

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45
Q

general presentation of AKI (non specific to aetiology)

A

oliguria (decreased urine output) <0.5ml/kg/hour

rest of symptoms depends on cause

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46
Q

what is the creatinine and oliguria like in the 3 different stages of AKI

A

stage 1 - x1-1.9 of normal, oliguria <0.5ml/kg/hour for 6 hours
stage 2 - x2-2.9 of normal, oliguria <0.5ml/kg/hour for 12 hours
stage 3 - x3 of normal, oliguria <0.3ml/kg/hour for 24 hours

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47
Q

in an old lady who fell 2 nights ago and lay on the floor until being found and has been producing low conc brown urine (‘coca cola urine’), what investigation would you do (specific to this case)

what are you trying to confirm

A

CK

rhabdomyolysis causing renal AKI

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48
Q

if you suspect glomerulonephritis causing renal AKI, what blood tests do you want to do (specific to glomerulonephritis)

A

ANCA for vasculitis
anti-dsDNA for lupus
anti-GBM for goodpastures

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49
Q

when might you do a biopsy in AKI

think about it

A

if ?renal cause, eg glomerulonephritis

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50
Q

is AKI an emergency or routine situation

A

emergency!

high mortality rates

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51
Q

if someone has stage 3 AKI and uraemia, what else will you do apart from fix the cause

A

dialysis to clear toxins

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52
Q

life threatening complication of AKI

A

hyperkalaemia!

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53
Q

what ion do you need to monitor in AKI to prevent complications

significant findings of this

A

K+ (otherwise hyperkalaemia)

K >5.5 (K >6.5 is life threatening)

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54
Q

what may hyperkalaemia present with

test for this

findings of test

A

arrhythmias

ECG - tall/prominent T waves

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55
Q

hypontraemia and hyperkalaemia

A

addisonian crisis

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56
Q

treatment of hyperkalaemia (4)

A

calcium gluconate
insulin dextrose
salbutamol nebulised
dialysis if K>7

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57
Q

what does calcium gluconate do when you give it for hyperkalaemia

A

protects your myocardium from high K

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58
Q

what does insulin dextrose do when you give it for hyperkalaemia

A

lowers K

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59
Q

is glomerulonephritis usually chronic or acute

A

chronic

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60
Q

which type of glomerulonephritis is acute

A

acute rapidly progressive glomerulonephritis

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61
Q

3 categories of aetiology of glomerulonephritis

A

idiopathic
drugs
immune

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62
Q

drugs that cause glomerulonephritis (4)

A

gold
penicillin
heroin
NSAIDs

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63
Q

immune causes of glomerulonephritis(5)

A 
lupus 
ANCA vasculitis (GPA, MPA) 
goodpastures
diabetes 
hepB/C
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64
Q

is glomerulonephritis an infection

A

no

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65
Q

if there is endothelium damage in glomerulonephritis (eg vasculitis) how does this present

A

haematuria

podocytes can still catch the proteins

66
Q

if there is mesangial damage in glomerulonephritis how does this present

A

haematuria

mesangial damage causes inflammation in capillary = endothelium damage

67
Q

if there is podocyte damage in glomerulonephritis how does this present

A

proteinuria (bc podocytes filter out proteins normally in the glomerulus)

68
Q

apart from haematuria and proteinuria, how else does glomerulonephritis typically present

A

hypertension

69
Q

investigations for glomerulonephritis (4)

A

autoantibodies - cANCA for GPA, pANCA for MPA, anti-GBM for goodpastures, anti-dsDNA for lupus
renal biopsy
urinalysis - for proteinuria and haematuria
urine microscopy

70
Q

which group of people get minimal change nephropathy

71
Q

do you biopsy kids with ?glomerulonephritis

A

no bc they probs have ‘minimal change nephropathy’ so wont see anything anyway

72
Q

treatment of glomerulonephritis (2)

A

ACEi/ARB to decrease bp

steroids (prednisolone PO 40-60mg OD)

73
Q

most common nephrotic syndrome in the UK

A

focal segmental glomerulonephritis

74
Q

glomerulonephritis type with small Ig/complement deposition, podocyte damage, mesangial collapse, <50% of glomeruli are affected, only part of the glomerulus is affected (not the whole thing), small areas of sclerosis

A

focal segmental glomerulonephritis

<50% affected = focal only part of glomerulus affects = segmental

75
Q

glomerulonephritis type with immune complex deposition in the basement membrane = thick basement membrane

A

membranous glomerulonephritis

76
Q

glomerulonephritis type with immune complex deposition in the basement membrane = thickened membrane and extra cells there

A

membranoproliferative

77
Q 
glomerulonephritis type 
recent URTI/gastroenteritis
haematuria (mesangial damage) 
most common world wide 
HSP purpuric skin rash on extensor surfaces

treatment

A

IgA nephropathy

ACEi/ARB asap (no steroids)

78
Q

biopsy finding in acute progressive glomerulonephritis

A

glomerular crescents (bowmans space)

79
Q

when do people present with acute rapidly progressive glomerulonephritis

how do they present

(classic presentation)

A

hameturia/rusty coloured urine/proteinuria 1-3 weeks after infection eg tonsillitis

80
Q

if you dont biopsy a kid with ?glomerulonephritis bc you probs wont find anything on biopsy, what do you do instead

A

give steroids (prednisolone) and wait and see if they respond

81
Q

which aetiology of glomerulonephritis present with pulmonary emboli too

A

goodpastures

82
Q

what is dilation of the pelvicalyceal system bc of presence of water called

A

hydronephrosis

83
Q

where is the obstruction in bilateral hydronephrosis (2)

A

urethra

both ureters

84
Q

where is the obstruction in unilateral hydronephrosis (2)

A

ureter

kidney

85
Q

what is LARGE pelvicalyceal system dilatation indicated of

A

chronic problem (only a partial obstruction = patient hasn’t present earlier)

86
Q

most common cause of hydronephrosis

A

kidney stones

87
Q

treatment of hydronephrosis (2)

A 
remove obstruction (nephrostomy if kidney stones) 
drain accumulated fluid (eg catheter)
88
Q

kimmelsteil Wilson lesions

A

diabetic nephropathy

89
Q

which type of vasculitis may present in the kidneys

A

small vessel/ANCA positive (bc the arteries inside the kidney (afferent arterioles etc) are small!)

90
Q

which drug is contraindicated in bilateral renal artery stenosis

A

ACE inhibitors

91
Q

flash pulmonary oedema

accelerated malignant hypertension - severe headache, blurred vision

A

renovascular disease (eg renal artery stenosis)

92
Q

investigations for renovascular disease (3)

A

US
angiogram
renal artery duplex

93
Q

treatment of renovascular disease if not too bad

A

stent = make it reversible

94
Q

treatment of renovascular disease if bad (majority of people) (3)

A

ACE inhibitor
antiplatelet
statin

95
Q

what is fibromuscular dysplasia

A

abnormal growth within artery = artery stenosis = beading of renal artery

96
Q

beading of renal artery

A

fibromuscular dysplasia

97
Q

what is deposited in the kidneys in multiple myeloma that causes renal failure

98
Q

bone destruction and renal failure

A

multiple myeloma

99
Q

apple green birefringence on congo red stain

A

multiple myeloma with kidney involvement

100
Q

most common inherited kidney disease

A

polycystic kidney disease (PCK)

101
Q

is polycystic kidney disease that presents in adults autosomal dominant or autosomal recessive

A

autosomal dominant

102
Q

which chromosome has the mutation in autosomal dominant polycystic kidney disease

A

PKD1 on chromosome 16

or PKD2 on chromosome 4 though more rare

103
Q

if polycystic kidneys metastasise what type of tumour do they typically turn into

A

benign adenoma

104
Q

which age group present with autosomal dominant polycystic kidneys

A

middle age adults

105
Q

chronic flank pain
hypertension!!
renal failure
palpable kidneys (abdo mass)

A

polycystic kidney disease

106
Q

diagnostic investigation for polycystic kidney disease (autosomal dominant (adults) and autosomal recessive (kids))

A

US

CT/MRI if unclear

107
Q

what is the chance of someone with autosomal dominant polycystic disease passing it onto their kids

why is this important

A

50% (bc its autosomal dominant)

need genetic counselling

108
Q

treatment of polycystic kidney disease with no renal failure (2)

(think about what they present with)

A

ACE inhibitor/ARB

tolvaptan (carbonic anhydrase inhibitor - causes diuresis = cyst doesnt get any larger)

109
Q

treatment of polycystic kidney disease with renal failure

A

renal replacement therapy

110
Q

if you have polycystic kidneys, where else may you end up with cysts (3)

A

liver (hepatic cysts) - common!
pancreas
lung

111
Q

complication of polycystic kidney disease in the brain

A

intra cranial aneurysm (berry aneurysm)

112
Q

who present with autosomal recessive polycystic kidney disease

A

young children

113
Q

what do kids with autosomal recessive polycystic kidney disease also present with

A

hepatic lesions/fibrosis

114
Q

is autosomal recessive polycystic kidney disease common or rare

115
Q

how does autosomal recessive polycystic kidney disease present

A

hypertension
abdo mass (palpable kidneys)
renal failure

(same as autosomal dominant)

116
Q

whats the prognosis of autosomal recessive polycystic kidney disease (presents in kids)

mortality in first year

A

bad - 25% mortality in first year

117
Q

which chromosome has the mutation in autosomal recessive polycystic kidney disease

A

PKDH1 mutation on chromosome 6

118
Q

which inherited kidney condition is associated with goodpastures

119
Q

sensorineural hearing loss
haematuria
bulging of lens in eye

A

alports syndrome

120
Q

aetiology of alports syndrome

who is it more common in (males or females)

A

genetic - x linked

males bc its x linked

121
Q

what type of collagen disorder is present in alports that causes a thickened glomerular basement membrane

A

type IV collagen

122
Q

what does alports syndrome look like on renal biopsy

A

thickened glomerular basement membrane

123
Q

treatment for alports syndrome (2)

A

ACE inhibitor/ARB

dialysis/transplant

124
Q

inherited kidney disease
lysosomal storage disease = increase in glycosphinogolipids in lots of places (skin, kidneys, blood cells, brain lung, liver, eyes)

renal failure + lots of unspecific symptoms

A

Anderson fabrys disease

125
Q

cutaneous manifestation of Anderson fabrys disease

A

angiokeratomas (deposition of lysosomes in the skin = blue dots in the umbilical area)

126
Q

which cell is strongly associated with andersons fabrys disease

A

LYSOSOMES!

127
Q

treatment of andersons fabrys disease

A

fabryzyme enzyme replacement

for the disease with lysosomal involvement!

128
Q

congenital disorder causing shrunken kidneys

A

medullary cystic kidney

129
Q

what does medullary cystic kidney (genetic condition with cysts in the medulla) cause the kidney to do

how does this present

A

shrunken kidney

reduced renal function - polyuria, polydipsia, enuresis (cant concentrate urine)

130
Q

investigation for medullary cystic kidney disease (inherited condition)

A

CT (probs wont see on ultrasound bc too small)

131
Q

treatment of medullary cystic kidney disease (inherited condition)

A

transplant (bc young) bc their kidneys will never regain function

132
Q

which age do medullary cystic kidney disease (inherited condition) present in

133
Q

pathophysiology of medullary sponge kidney (inherited condition)

A

dilation of collecting ducts = urinary stasis = medulla looks like a sponge

134
Q

where is an ectopic kidney located

A

pelvis (think of embryology)

135
Q

what is the name of a kidney that is made of the left and right kidneys joined together

A

horseshoe kidney

136
Q

what investigation do you always do for a renal mass

why

A

CT

look for malignancy

137
Q

renal tumour filled with FAT, smooth muscle, blood vessels

is it malignant or benign

A

angiomyolipoma

benign

138
Q

which genetic condition is associated with angiomyolipoma

how does this present (derm)

A

tuberose sclerosis

shagreen patches
periungal fibromas
café au lait macules
infantile seizures

139
Q

complication of angiomyolipoma

A

massive haemorrhage if >4cm (wunderlichs syndrome)

bc its filled with fat and BLOOD VESSELS

140
Q

what does a juxtamedullary cell tumour produce

what does this cause

is it benign or malignant

A

renin

secondary hypertension

benign

141
Q

which benign renal tumour looks very similar to a renal cell carcinoma

how do you treat it

A

oncocytoma

nephrectomy - need to remove it to rule out renal cell carcinoma, biopsy not diagnostic

142
Q

renal tumour with ‘central scar on CT’

A

oncocytoma

143
Q

when do people present with a renal cyst

A

incidental finding on CT/US

144
Q

treatment of renal cyst

A

nothing - reassure patient they are fine!

145
Q

most common abdo mass in kids

is it benign or malignant

A

nephroblastoma (wilms tumour)

malignant

146
Q

most common renal tumour in adults

is it benign or malignant

A

renal cell carcinoma

malignant

147
Q

another name for renal cell carcinoma

A

grawitz tumour

148
Q

where is a renal cell carcinoma

A

in the tubules

149
Q

risk factors for renal cell carcinoma (grawitz tumour)

A

males
60 y/o
obesity (waist size)

150
Q

most common type of renal cell carcinoma on histology

what does it contain that it looks like this

A

clear cell

glycogen and lipids

151
Q

where can renal cell carcinomas extend into

A

renal vein

152
Q

which genetic condition is associated with renal tumours and phaeochromocytomas in young people

A

von hippel lindau

153
Q

classic triad of renal cell carcinoma presentation

A

haematuria
abdo mass
flank pain

154
Q

investigation for renal cell carcinoma

greater than what size is probs malignant

what dont you bother doing

why

A

CT, >3cm is probs malignant

renal biopsy - bc it can just looking like an oncocytoma

155
Q

treatment options for renal cell carcinoma (4)

A 
???? chekc this 
full nephrectomy - rare, if big 
PARTIAL NEPHRECTOMY - to retain some GFR 
radio ablation - if small 
tyrosinekinase inhibitors
156
Q

how does spread of renal cell carcinoma present in the lungs on CXR

how does it spread

A

cannonball metastasis

haematogenous (blood)

157
Q

prognosis of renal cell carcinoma

A

bad if late stage (stage 4)

158
Q

when does contrast induced nephropathy present

A

3-4 days after contrast

159
Q

most common imaging of kidneys

160
Q

what is US good for in kidneys

A

renal size, distension (fluid filled)

J Renal (12 decks)

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