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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
Q

What is the inheritance pattern for Alport syndrome?

A

X-linked autosomal dominant

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26
Q

What is the clinical manifestation for Alport syndrome?

A

Nephritic Syndrome + Sensorineural deafness + eye disorders (lens dislocation, cataracts).

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27
Q

Which genetic cause is associated with asymptomatic haematuria?

A

Benign Family Haematuria

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28
Q

What is the causative organism for haemolytic uraemic syndrome?

A

E. coli O157:H7

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29
Q

What is the triad of symptoms observed in haemolytic uraemic syndrome?

A

thrombocytopenia, microangiopathic-haemolytic anaemia, and AKI

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30
Q

What are the risk factors for acquiring haemolytic uraemic syndrome?

A

consumption of contaminated food products (e.g., undercooked beef, unpasteurised milk) and through person-to-person contact + petting zoos.

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31
Q

Which deficiency is associated with haemolytic uraemic syndrome?

A

ADAMTS13 deficiency

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32
Q

What is observed on a peripheral blood smear for haemolytic uraemic syndrome?

A

Schistocytes and helmet cells

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33
Q

Creatinine rise from baseline in Stage 1 AKI?

A

x1.5-1.9 from baseline within 7 days

34
Q

What is the creatinine rise from baseline in Stage 2 AKI?

A

2-2.9x from baseline within.7 days

35
Q

What is the creatinine rise from baseline in stage 3 AKI?

A

> 3x from baseline within 7 days

36
Q

Calculation of potassium requirement in a patient?

A

1 mmol/lkg/day

37
Q

What is the commonest cause of renal AKI?

A

Acute tubular injury/necrosis

38
Q

What is the main cause of ATN?

A

Pre-renal ischaemia e.g., sepsis, hypotension

39
Q

Which drugs are associated with causing acute tubular necrosis?

A

Aminoglycosides, amphotericin B, iodinated contrast, sulfa drugs, acyclovir, calcineurin inhibitors, vancomycin.

40
Q

Brown muddy casts are associated with what?

A

Acute tubular necrosis

41
Q

Eosinophilia and drug-induced AKI, is associated with what?

A

Tubulointerstitial nephritis

42
Q

Which drugs should be discontinued in AKI?

A

Diuretics
ACE inhibitors/aminoglycosides/ARBs
Metformin (<30)
NSAIDs

43
Q

Which eGFR contraindicates the use of metformin?

A

<30

44
Q

What i the definition of stage 1 CKD?

A

eGFR>90 ml/min with signs of kidney injury e.g., proteinuria

45
Q

What is the eGFR range for stage 2 CKD?

A

60-80 mL/min

46
Q

What is the eGFR range for stage 3a CKD?

A

45-60

47
Q

What is the eGFR range for stage 3b CKD?

A

45-30

48
Q

What is the eGFR range for stage 4 CKD?

A

30-15

49
Q

What is the eGFR range for stage 5 CKD?

A

<15

50
Q

What is the most common cause of CKD in the UK?

A

Diabetes

51
Q

Which line is used to administer haemodialysis?

A

Central venous catheter

52
Q

Where is a central venous line typically inserted?

A

Subclavian vein/internal jugular vein

53
Q

What are the two types of dialysis?

A

Peritoneal dialysis
Haemodialysis

54
Q

Which scar is associated with a renal transplant?

A

Rutherford–Morrison scar

55
Q

What is a renal transplant indicated in CKD patients?

A

<20 mL/min

56
Q

What is the largest cause of mortality in CKD?

A

Atherosclerosis

57
Q

Which gene is involved in adult polycystic kidney disease?

A

PKD1

58
Q

What is the inheritance pattern for polycystic kidney disease?

A

Autosomal dominant

59
Q

What is the clinical presentation for PKD?

A
  • 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
Q

What cardiac complication is observed in PKD?

A

Mitral valve prolapse

61
Q

What is the most common extra-renal manifestation associated with PKD?

A

Hepatic cysts

62
Q

What is the commonest composition of renal stones?

A

Calcium oxalate

63
Q

Which drugs increase renal stone formation?

A

Loop diuretics, steroids, acetazolamide, theophylline

64
Q

What is the stone composition of struvite stones?

A

Magnesium ammonium phosphate

65
Q

What do struvite stones typically form as?

A

Staghorn calculi

66
Q

What is a common hereditary renal stone?

A

Cystine stones

67
Q

What is the most common site of renal stones?

A

pelvic-ureteric junction

68
Q

What is the gold-standard imaging for renal stones?

A

Non-contrast CT KUB within 24 hours of admission

69
Q

What is the first line investigation for patients with suspected renal stones?

A

Urine dipstick

70
Q

What is the management for small asymptomatic stones <5 mm

A

Watchful waiting , consider alpha-blockers

71
Q

What is the management for renal stones measuring 5 -10 mm?

A

Shockwave lithotripsy

72
Q

What is the management for renal stones measuring 10-20 mm?

A

Shockwave lithotripsy or ureteroscopy

73
Q

What is the management for renal stones >20 mm?

A

Percutaneous nephrolithotomy

74
Q

What is the management of renal stones causing ureteric obstruction with infection?

A

Surgical decompression with nephrostomy tube placement.

75
Q

What is the first line analgesia management for renal stones?

A

NSAID (e.g., diclofenac, ibuprofen) – intramuscular diclofenac is indicated for rapid relief of severe pain in patients that require admission.

76
Q

If NSAIDs are contraindicated in renal stone management, what is next?

A

IV paracetamol

77
Q

What is the most common type of renal cancer?

A

Renal cell carcinoma (clear cell)

78
Q

What are the indications for starting renal replacement therapy?

A

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
Q

Frequency of haemodialysis/week?

A

3x/week

80
Q

What are the complication of an AV fistula?

A

 Complications:
* Aneurysm
* Infection
* Thrombosis
* Stenosis
* STEAL syndrome – inadequate blood flow to the limb distal to the fistula.
* High-output heart failure

81
Q

Which drug can cause post-renal AKI due to crystalluria?

A

Acyclovir

MLA Flashcards (19 decks)

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