Nephro Flashcards
Causes of Acute interstitial nephritis
- drugs: the most common cause, particularly antibiotics
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
- systemic disease: SLE, sarcoidosis, and Sjögren’s syndrome
- infection: Hanta virus , staphylococci
Features of Acute interstitial nephritis
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
Investigations of acute interstitial nephritis
sterile pyuria
white cell casts
Tubulointerstitial nephritis with uveitis(TINU) usually occurs in ……?
young females.
Criteria to diagnose AkI
- rise in serum creatinine of >= 26 micromol/litre within 48 hours
- 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
- urine output < 0.5 ml/kg/hourfor > 6 hours in adults and more than
Stage 1 of AKI
- urine output to<0.5mL/kg/hour for≥ 6 hours
Or
2. Increase in creatinine to1.5-1.9times baseline
Or
- Increase in creatinine by ≥26.5 µmol/L
Stage 2 of AKI
- urine output to<0.5mL/kg/hour for≥12 hours
Or
- Increase in creatinine to2.0 to 2.9times baseline
Stage 3 of AKi
- urine output <0.3mL/kg/hour for≥24 hours
Or
- Increase in creatinine to≥ 3.0times baseline
Or
- Increase in creatinine to ≥353.6 µmol/L
ADPKD type 1 vs ADPKD type 2
Which Chromosome ….?
Type 1 : Chromosome 16
Type 2: Chromosome 4
Ultrasound diagnostic criteria of ADPKD (in patients with positive family history)
- Age < 30 years ; 2 cysts uni/ bilateral
- Age 30 - 59 years ; 2 cysts in each kidneys
- Age > 60 ; 4 cysts in each kidneys
Management of ADPKD
tolvaptan(vasopressin receptor 2 antagonist) may be an option. For select patients
Extra-renal manifestations of ADPKD
- Liver cysts may cause hepatomegaly
- berry aneurysms (8%): rupture can cause subarachnoid haemorrhage
- cardiovascular system:mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
- cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary
Causes of a raised anion gap metabolic acidosis
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss:diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
ARPKD is due to a defect in a gene located on chromosome ….. which encodes ………
Chromosome 6
encodes fibrocystin
Autosomal recessive polycystic kidney disease (ARPKD) on biopsy
Renal biopsy typically shows multiple cylindrical lesions at right angles to the cortical surface.
The time taken for an arteriovenous fistula to develop is …….?
6 to 8 weeks.
Calciphylaxis presents with ……?
painful necrotic skin lesions.
The risk of developing calciphylaxis is linked with
hypercalcaemia,
hyperphophataemia and
hyperparathyroidism.
Treatment of calciphylaxis
reducing calcium and phosphate levels, controlling hyperparathyroidism and avoiding contributing drugs such as warfarin and calcium containing compounds.
What is the most common presenting feature of Retroperitoneal fibrosis?
Lower back/flank pain
Retroperitoneal fibrosis is associated with (4)
Riedel’s thyroiditis
previous radiotherapy
sarcoidosis
inflammatory abdominal aortic aneurysm
drugs: methysergide
Indications for plasma exchange
Guillain-Barre syndrome
myasthenia gravis
Goodpasture’s syndrome
ANCA positive vasculitis if rapidly progressive renal failure or pulmonary haemorrhage
TTP/HUS
cryoglobulinaemia
hyperviscosity syndrome e.g. secondary to myeloma
Complications of plasma exchange
hypocalcaemia: due to the presence of citrate used as an anticoagulant for the extracorporeal system
metabolic alkalosis
removal of systemic medications
coagulation factor depletion
immunoglobulin depletion