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MLA Flashcards > MLA Renal > Flashcards

MLA Renal Flashcards

1
Q

Nephrotic syndrome is characterised as a triad of what?

A
  1. Proteinuria (>3g/24h / protein: creatinine ratio >300 mg/mmol) – frothy urine.
  2. Hypoalbuminaemia (<30 g/L)
  3. Oedema – Classically = periorbital
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2
Q

What are the primary causes of nephrotic syndrome (3)?

A
  • Minimal change disease
  • Membranous glomerular disease
  • Focal segmental glomerulosclerosis
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3
Q

What are the secondary causes of nephrotic syndrome?

A

diabetes, amyloidosis, SLE.

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4
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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5
Q

What changes are observed on electron microscopy in nephrotic syndrome?

A

Loss of podocyte foot processes

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6
Q

What is the first line management for minimal change disease?

A

Steroids

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7
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous glomerular disease

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8
Q

Which autoantibody is associated with membranous glomerular disease?

A

Anti-phospholipase A2 type M receptor (Anti-PLA2R)

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9
Q

A spike and dome appearance on electron microscopy is associated with which type of nephrotic sydrome?

A

membranous glomerular disease

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10
Q

Which type of nephrotic syndrome is associated with HIV?

A

Focal Segmental Glomerulosclerosis

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11
Q

Kimmelstiel Wilson nodules are observed in which type of secondary nephrotic syndrome (include stage)?

A

Stage 3 Diabetic nephropathy

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12
Q

Which type of amyloidosis is observed in multiple myeloma?

A

Al amyloidosis

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13
Q

Which stain is used in amyloidosis?

A

Congo red stain (apple green birefringence)

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14
Q

Nephritic syndrome is characterised by what symptoms (PHAROH)?

A
  • Proteinuria
  • Haematuria (coke-coloured urine)
  • Azotaemia – raised urea and creatinine.
  • Red cell casts – In urine – red cell accumulation and leaks into the tubules.
  • Oliguria
  • Hypertension
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15
Q

When does post-infectious glomerulonephritis typically arise?

A

Within 1-3 weeks after a streptococcal infection

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16
Q

What specific investigations are indicated for suspected post-infectious glomerulonephritis?

A

ASOT titre (raised)
Complement C3 (low)

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17
Q

What is type 1 rapidly progressive crescentic nephritic disease?

A

Goodpasture’s syndrome

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18
Q

Which autoantibody is associated with Goodpasture’s syndrome?

A

Anti-GBM

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19
Q

What additional organ involvement is associated with Goodpasture’s syndrome?

A

Pulmonary haemorrhage

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20
Q

What is type 2 nephritic syndrome?

A

Immune complex-mediated e.g., SLE, IgA nephropathy, Alport’s syndrome, HSP

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21
Q

What is type 3 nephritic syndrome?

A

Pauci-immune e.g.,
c-ANCA: Wegener’s granulomatosis
p-ANCA: Microscopic polyangiitis

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22
Q

What is the rule of thirds for IgA nephropathy?

A

1/3rd are asymptomatic, 1/3rd develop CKD, 1/3rd develop progressive CKD requiring dialysis

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23
Q

What typically precedes IgA nephropathy?

A

Upper respiratory tract infections

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24
Q

Which type of collagen is affected in Goodpasture’s disease?

A

Type IV collagen

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25
What is the inheritance pattern for Alport syndrome?
X-linked autosomal dominant
26
What is the clinical manifestation for Alport syndrome?
Nephritic Syndrome + Sensorineural deafness + eye disorders (lens dislocation, cataracts).
27
Which genetic cause is associated with asymptomatic haematuria?
Benign Family Haematuria
28
What is the causative organism for haemolytic uraemic syndrome?
E. coli O157:H7
29
What is the triad of symptoms observed in haemolytic uraemic syndrome?
thrombocytopenia, microangiopathic-haemolytic anaemia, and AKI
30
What are the risk factors for acquiring haemolytic uraemic syndrome?
consumption of contaminated food products (e.g., undercooked beef, unpasteurised milk) and through person-to-person contact + petting zoos.
31
Which deficiency is associated with haemolytic uraemic syndrome?
ADAMTS13 deficiency
32
What is observed on a peripheral blood smear for haemolytic uraemic syndrome?
Schistocytes and helmet cells
33
Creatinine rise from baseline in Stage 1 AKI?
x1.5-1.9 from baseline within 7 days
34
What is the creatinine rise from baseline in Stage 2 AKI?
2-2.9x from baseline within.7 days
35
What is the creatinine rise from baseline in stage 3 AKI?
>3x from baseline within 7 days
36
Calculation of potassium requirement in a patient?
1 mmol/lkg/day
37
What is the commonest cause of renal AKI?
Acute tubular injury/necrosis
38
What is the main cause of ATN?
Pre-renal ischaemia e.g., sepsis, hypotension
39
Which drugs are associated with causing acute tubular necrosis?
Aminoglycosides, amphotericin B, iodinated contrast, sulfa drugs, acyclovir, calcineurin inhibitors, vancomycin.
40
Brown muddy casts are associated with what?
Acute tubular necrosis
41
Eosinophilia and drug-induced AKI, is associated with what?
Tubulointerstitial nephritis
42
Which drugs should be discontinued in AKI?
Diuretics ACE inhibitors/aminoglycosides/ARBs Metformin (<30) NSAIDs
43
Which eGFR contraindicates the use of metformin?
<30
44
What i the definition of stage 1 CKD?
eGFR>90 ml/min with signs of kidney injury e.g., proteinuria
45
What is the eGFR range for stage 2 CKD?
60-80 mL/min
46
What is the eGFR range for stage 3a CKD?
45-60
47
What is the eGFR range for stage 3b CKD?
45-30
48
What is the eGFR range for stage 4 CKD?
30-15
49
What is the eGFR range for stage 5 CKD?
<15
50
What is the most common cause of CKD in the UK?
Diabetes
51
Which line is used to administer haemodialysis?
Central venous catheter
52
Where is a central venous line typically inserted?
Subclavian vein/internal jugular vein
53
What are the two types of dialysis?
Peritoneal dialysis Haemodialysis
54
Which scar is associated with a renal transplant?
Rutherford–Morrison scar
55
What is a renal transplant indicated in CKD patients?
<20 mL/min
56
What is the largest cause of mortality in CKD?
Atherosclerosis
57
Which gene is involved in adult polycystic kidney disease?
PKD1
58
What is the inheritance pattern for polycystic kidney disease?
Autosomal dominant
59
What is the clinical presentation for PKD?
* Hypertension * Microalbuminuria, proteinuria and haematuria * Abdominal mass * Infected cysts * Stones (Renal in 20% - uric and calcium oxalate). * Haematuria – Cyst haemorrhage – cyst communicates with the collecting system. * Aneurysms (Berry) * Polyuria and nocturia * Extra-renal cysts e.g., liver, ovaries, pancreas, seminal vesicles. - Prevalence of hepatic cysts increases with age. * Systolic murmur – due to mitral valve prolapse.
60
What cardiac complication is observed in PKD?
Mitral valve prolapse
61
What is the most common extra-renal manifestation associated with PKD?
Hepatic cysts
62
What is the commonest composition of renal stones?
Calcium oxalate
63
Which drugs increase renal stone formation?
Loop diuretics, steroids, acetazolamide, theophylline
64
What is the stone composition of struvite stones?
Magnesium ammonium phosphate
65
What do struvite stones typically form as?
Staghorn calculi
66
What is a common hereditary renal stone?
Cystine stones
67
What is the most common site of renal stones?
pelvic-ureteric junction
68
What is the gold-standard imaging for renal stones?
Non-contrast CT KUB within 24 hours of admission
69
What is the first line investigation for patients with suspected renal stones?
Urine dipstick
70
What is the management for small asymptomatic stones <5 mm
Watchful waiting , consider alpha-blockers
71
What is the management for renal stones measuring 5 -10 mm?
Shockwave lithotripsy
72
What is the management for renal stones measuring 10-20 mm?
Shockwave lithotripsy or ureteroscopy
73
What is the management for renal stones >20 mm?
Percutaneous nephrolithotomy
74
What is the management of renal stones causing ureteric obstruction with infection?
Surgical decompression with nephrostomy tube placement.
75
What is the first line analgesia management for renal stones?
NSAID (e.g., diclofenac, ibuprofen) – intramuscular diclofenac is indicated for rapid relief of severe pain in patients that require admission.
76
If NSAIDs are contraindicated in renal stone management, what is next?
IV paracetamol
77
What is the most common type of renal cancer?
Renal cell carcinoma (clear cell)
78
What are the indications for starting renal replacement therapy?
Indications for initiating dialysis: * eGFR: 5-7 mL/min/1.73 m2 * Acidosis (severe and not responding to treatment; pH <7.1) * Electrolyte abnormalities (Refractory hyperkalaemia >6.5 mmol/L) * Intoxication (methanol, ethylene glycol, lithium, salicylates, theophylline) * Overload (e.g., pulmonary oedema) * Uraemia (Encephalopathy, pericarditis, severe nausea, vomiting, anorexia, platelet dysfunction and bleeding).
79
Frequency of haemodialysis/week?
3x/week
80
What are the complication of an AV fistula?
 Complications: * Aneurysm * Infection * Thrombosis * Stenosis * STEAL syndrome – inadequate blood flow to the limb distal to the fistula. * High-output heart failure
81
Which drug can cause post-renal AKI due to crystalluria?
Acyclovir

MLA Flashcards (19 decks)

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