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Les deux ennemis > Nephro : Glomerular Disease / AKI / CKD > Flashcards

Nephro : Glomerular Disease / AKI / CKD Flashcards

1
Q

ANCA disease : nephrotic or nephritic ?

A

Nephritic disease

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2
Q

ANCA vasculitis, when should you choose rituximab over cyclophosphamide ?

A
  • Premenopausal women, men interested in preserving fertility
  • Frail older adults
  • Relapsed disease
  • If no evidence of RPGN

IF RPGN / Cr > 354 : CYCLOP

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3
Q

ANCA vasculitis, when should you consider PLEX ?

A
  • Anti GBM (double positive / overlap)
  • if ANCA + GN vital organ / life threatening, Cr > 500
  • Pt at high risk of progression to ESRD (and accept a potential higher risk of infection)
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4
Q

AntiGBM disease : nephrotic or nephritic ?

A

Nephritic / RPGN

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5
Q

Do you need biopsy in case of IgA nephropathy ?

A

Rarely need biopsy
Diagnosis is clinical

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6
Q

Does sodium bicarb decrease decline in GFR ?

A

Yes !

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7
Q

For which nephropathy should you screen for malignancies ?

A

Membranous
Age-based screen + pretest probability

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8
Q

FSGS nephropathy : nephrotic or nephritic ?

A

Nephrotic

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9
Q

HBV renal disease : associated with which nephropathy ?

A

Membranous, MPGN, polyarteritis nodosa (PAN)
** 1-5% of patients with HBV develop PAN
Clinically pre renal AKI

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10
Q

HCV renal disease : how are the labs ?

A

MPGN +/- cryo
Classically low C4 (but not always) and high RF

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11
Q

HCV renal disease : MPGN +/- cryoglobulinemia : what is the clinical presentation ?

A

nephritic/proliferative picture, palpable purpura, arthralgias, weakness, peripheral neuropathies

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12
Q

Henoch-Schönlein purpura : what is the presentation ?

A

SYSTEMIC IgA vasculitis with arthritis, purpura, GI symptoms

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13
Q

Hepato renal syndrome : hematuria or proteinuria ?

A

Neither or minimal
Tubular function is preserved

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14
Q

High K foods to watch out for ?

A

Fruits : oranges, tropical fruits
Avocado, tomato, potatoes
beans, green leafy vegetables
nuts/seeds/milks

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15
Q

High PO4 foods to watch out for ?

A

Dairy : cheese, milk
Protein : shellfish, liver, deli meats

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16
Q

How are the electrolytes in rhabdomyolysis ?

A

HyperK and hyperPO4
HypoCa
Uricemia
Metabolic acidosis

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17
Q

How can you start metformin to a CKD patient ?

A

OK if GFR > 30
eGFR 30-44 : initiate at 1/2 dose and titrate upwards to half of max recommended dose

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18
Q

How do you deal with hyperkaliemia for CKD-Db patients on ACE / ARB ?

A

Accept up to 20% rise of creatinine within 4 weeks
Consider K binder before altering RASi dose + dietary change

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19
Q

How do you diagnose hepatorenal syndrome ?

A

Discontinue diuretics / antihypertensives and give albumine 1g/kg and you will not see an improvement

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20
Q

How do you diagnose post streptococcal / infectious GN ? What labs?

A

LOW C3 and N C4
+ ASOT 70%
+ anti DNase B 90%

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21
Q

How do you treat hypocalcemia in CKD ?

A

Calcium carbonate and calcitriol (1,25 vit D)
Can’t use vitamin D if hyperphosphatemic

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22
Q

How do you treat IgA nephropathy ?
Name 3 points.

A
  • ACEi or ARB if proteinuria > 0.5g/d, titrate to proteinuria < 500mg-1g/d
  • Adequate BP control (SBP < 120)
  • Consider steroids x 6 months if high risk of progressive CKD (refractory proteinuria >0.75-1g despite tx with RAASi x 90d)
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23
Q

How do you treat nephrotic syndrome ?

A
  • Edema : Na restriction + loop diuretics
  • DLP : statins, diet
  • Proteinuria : ACEi, BP control (SGLT2 NOT studied)
  • Thombosis : consider full dose anticoag w warfarin if certain criterias

Definitive management with immunosuppresion in most 1e cases

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24
Q

How does post streptococcal / infectious GN present ?

A

Varies from:
- Microscopic hematuria
- Proliferative GN : red/brown urine, proteinuria, edema, HTN, AKI

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25
Q

How is calcemia in rhabdomyolysis ?

A

Hypocalcemia

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26
Q

How is the complement in cholesterol emboli syndrome ?

A

Low C3/C4

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27
Q

How is urine sodium in hepatorenal syndrome?

A

Na U < 10

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28
Q

How long do you give cyclophosphamide in anti GBM therapy ?

A

2-3 months

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29
Q

How long do you give steroids in anti GBM disease ?

A

6 months usually

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30
Q

How much proportion of albuminuria is normal ?

A

Generally, minimum 50% proteinuria is albumin

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31
Q

How should you manage anticoagulants for a kidney biopsy ?
- Warfarin
- IV heparin
- LMWH
- DOAC

A

STOP ANTIPLATELET 5 DAYS before and resu;e 5 DAYS after biopsy

  • Warfarin : allow INR < 1.5, bridge depends on patient
  • IV heparin : stop 6h prior and allow aPTT to N, resume 12-24h later
  • LMWH : stop the day prior and resume 48-72h later
  • DOAC : no data
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32
Q

How should you manage antiplatelets for a kidney biopsy ?

A

Stop antiplatelets 5 days before and resume 5 days post biopsy
Research shows that no increased bleeding with continuing ASA

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33
Q

Hyaline cast : etiology ?
RBC cast : etiology ?
Granular cast : etiology ?
Tamm Horsfall : etiology ?

A

Hyaline cast in CKD
RBC cast in GN
Granular cast in ATN
Tamm Horsfall is normal

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34
Q

In case of ANCA vasculitis : treatment of induction ?

A
  • Methylprednisolone up to 1g x 3 days
    • Cyclophophamide or rituximab
      RPGN and creat > 354 : cyclo preferred
      Ritux preferred if men/women wanting preserved fertility, frail older adults, relapsed disease, no RPGN
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35
Q

Is drug related acute interstitial nephritis dose dependent ?

A

Not a dose dependent effect

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36
Q

Landmark trials :
- Is accelerated renal replacement therapy associated with lower risk of death ?
- Is postponing of RRT associated with benefits ?

A
  • No not associated with lower risk of death at 90 days
  • No longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm
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37
Q

Management of GN disorders : what to advise concerning diet ?

A

Na < 2g
Heart healthy
**Adequate protein if nephrotic range proteinuria (0.8-1g/kg/d)

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38
Q

Membranous nephropathy : nephrotic or nephritic ?

A

Nephrotic

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39
Q

Minimal change nephropathy : nephrotic or nephritic ?

A

Nephrotic

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40
Q

MPGN (membro proliferative), what are the complement values ?

A

LOW C4 and normal C3 (but can be low too)

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41
Q

MPGN : underlying etiology ?

A

HCV, HIV, cryos
Other infection, complement dysregulation, monoclonal gammapathies
AI disorders, TMS, APLS, sicke cell, polycythemia

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42
Q

Nephritic syndrome : typical etiology if..
- Low C3 ?
- Low C4 ?
- Low C3 and C4 ?
- Normal complement ?

A

C3 : post streptococcal/infectious GN
C4 : MPGN
C3/C4 : SLE
Normal : IgA

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43
Q

Nephritic syndrome and low C3 / C4 : etiology ?

A

SLE most common

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44
Q

Nephritic syndrome and LOW C4 : etiology ?

A

MPGN : membrano proliferative
Multiple etiologies : HCV, HIV, cryo, infections, complement dysreg, AI…..

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45
Q

Nephritis syndrome and LOW C3 : diagnosis ?

A

Post streptococcal / infectious GN

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46
Q

SLE nephritis : treatment principles for class III/IV ?

A
  • Hydroxychloroquine for all
  • Induction with steroids (IV pulse x 3 days then pred)
  • ADD CYC or MMF
    (Choose MMF if at risk of infertility / fertility consideration or Asian/African/Hispanic ancestry)
  • ACEi for proteinuria

Maintenance with same agent to induce unless CYC : MMF or ASA

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47
Q

SLE nephritis : treatment principles for class V ?

A

Hydroxychloroquine for all
ACEi/ARB for proteinuria and good BP control
Statin
If nephrotic range proteinuria : add glucocorticoid + 1 of MMF/ASA/CYC/Ritux/ASA/Cnl

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48
Q

SLE nephritis type V and progressive renal dysfunction : what should you R/O ?

A

R/O renal vein thrombus with renal US
Consider repeating renal biopsy (possible concurrent class)
Need additional immunosuppresion

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49
Q

TARGETS IN CKD :
- K
- HCO3
- PO4 / Ca
- PTH

A
  • K < 5
  • HCO3 > 22
    **RCT evidence to slow decline in GFR
  • PO4 and Ca toward normal range
  • PTH target unknown for pre dialysis CKD
    PTH target for dialysis patients is 2-9 x ULN
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50
Q

TARGETS IN CKD : Hb ?

A

Hb 100-110 with tsat > 30 %

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51
Q

What are 3 causes of + blood on dipstick with negative erythrocytes ?

A

Rhabdomyolysis, hemolysis, mechanical valve

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52
Q

What are 4 causes of ketones on urinalysis dipstick ?

A

Starvation
DKA
Alcohol
Poisoning

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53
Q

What are common drugs causing acute interstitial nephritis ?

A

«ANTI»
- inflammatory : NSAIDs, COX 2 i
- biotics : penicillins, cephalo, rifampin, cipro, septra
- gout : allopurinol
- acid : PPI’s
- edema : loop and thiazides
- immunotherapy

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54
Q

What are secondary causes of FSGS ?

A

Infx : HIV, parvo 19, EBV
Drugs : heroin, pamidronate…
HYPERFILTRATION with obesity, single kidney, reflux nephropathy

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55
Q

What are secondary causes of membranous nephropathy ? Name 5 causes.

A

SLE
CANCER solid tumors > heme (CLL)
Drugs : NSAIDs, anti TNFs
Sarcoidosis
Infection : HBV, HCV, syphilis, HIV

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56
Q

What are secondary causes of minimal change nephropathy ?

A

Heme cancer : HODGKINS, leukemia
Drugs : NSAIDs, COX2i
Infections rare like TB

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57
Q

What are the antibodies in EGPA ?

A

p ANCA / anti MPO in 40 %

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58
Q

What are the antibodies in MPA ?

A

P ANCA and C ANCA

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59
Q

What are the antibodies positive in GPA ?

A

C ANCA / anti PR3 in 80 %

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60
Q

What are the CI to a kidney biopsy ?

A

UTI, uncooperative pt, bleeding diathesis
Uncontrolled HTN, poor visualization
Infection

RELATIVE : solitary kidney, hydronephrosis, small kidneys

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61
Q

What are the clinical features of ANCA vasculitis ?

A

Constitutional sx
Arthalgies, rash
Sinusitis, asthma, pulmonary hemorrhage
Nephritis
Mononeuritis multiplex

62
Q

What are the diagnostic level for albuminuria in diabetes ?

A

Microalbuminuria :
Urine dipstick for protein -
ACR 2-20 mg/mmol
30-300mg/d on 24 h collection
Overt nephropathy :
Urine dipstick for protein +
ACR > 20
> 300mg/day on 24h collection

63
Q

What are the different types of hepato renal syndromes ?

A

Type 1 HRS : two fold increase in creat to a level > 221 umol/L over less than 2 weeks

Type 2 HRS : gradual kidney decline with ascites refractory to diuretics

64
Q

What are the DLP recommendations in case of CKD ?

A

Age ≥ 50 years and non dialysis eGFR < 60 or ACR > 3 : STATIN

65
Q

What are the grades of albuminuria ?

A

Grade I : ACR < 3
Grade II : ACR 3-30
Grade III : ACR > 30

66
Q

What are the indications of iron in CKD ?

A

IRON STUDIES IF HB < 100
Ferritin ≤ 500, Tsat ≤ 30 %
Prefer IV iron if feasible

67
Q

What are the indications of urgent dialysis ? AEIOU

A

Acidosis (severe)
Electrolyte problems (hyperK)
Intox : methanol, ethylene glycol, Li, ASA
Overload
Uremia (pericarditis, encephalopathy/seizures)

68
Q

What are the indications to start non steroidal MRA (finerenone) in CKD patients ?

A

For DM2, GFR > 25, normal K, albuminuria ≥ 30mg/g ( ≥ 3 mg/mmol) despite max RASi

69
Q

What are the lab findings in cholesterol emboli syndrome ?

A

Urine eosinophils
Elevated ESR
Peripheral eosinophilia
Decreased C3/C4

70
Q

What are the main 4 CATEGORIES of nephrotic syndrome on the algorithm ?

A
  • Minimal change
  • FSGS
  • Membranous
  • Other / nodular (amyloid / MGRS / db)
71
Q

What are the risks of kidney biopsy ?

A

Bleeding (hematuria is expected), pain at site
1% need for transfusion
< 1% need intervention to control bleeding
0.06% death

72
Q

What are the SGLT2 and GLP1 that have shown reduced MACE in Db and CKD ?

A

SGLT2 : empa and cana
GLP 1 : liraglutide, semaglutide

73
Q

What are the three causes of acute interstitial nephritis ?

A
  • Drugs #1 cause
  • Infections
  • Systemic illnesses : the S’s : SLE, sarcoid, Sjogren, IgG4 disease
74
Q

What are the THREE conditions on the algorithm, typical of nephritic syndrome ?

A
  • Anti-GBM / Goodpasture
  • ANCA (GPA, EGPA, drugs, microscopic poluyangiitis, rarely infection)
  • Immune complex
    LOW COMPLEMENT : infection, malignancy, MPGN, SLE…
    NORMAL COMPLEMENT : IgA, some monoclonal diseases
75
Q

What causes AKI in amyloid patients ?

A

Fibril deposition
Congo red positive + nephrotic range proteinuria

76
Q

What causes AKI in Waldenstrom patients ?

A

Hyperviscosity

77
Q

What do you do with SGLT2 when you reach dialysis ?

A

Continue until dialysis or transplant

78
Q

What does SGLT2 prevent in CKD ?

A

Prevent composite of decline in eGFR,progression to ESRD, kidney death, all cause mortality, non fatal MI, hosp for HF (CCS 2022)

79
Q

What ethnicity linked to IgA nephropathy ?

A

Asians > Caucasians, rare if African descent

80
Q

What if PTH is >9x ULN in dialysis patients ?

A
  • Calcitriol but only if PO4 and Ca are not high
  • Cinecalcet (calcimimetic, activates Ca-sensing receptor to shut off PTH secretion)
  • Surgical parathyroidectomy in selected patients
81
Q

What is generally the acceptable GFR for biphosphonates ?

A

eGFR 30-35

82
Q

What is IgA nephropathy associated with ?

A

Celiac disease, AI disease, hepatitis, HIV, cirrhosis …

83
Q

What is the acid base disorder seen in rhabdomyolysis ?

A

Metabolic acidosis

84
Q

What is the antibody in primary membranous ?

A

PLA2R and THSD7A

85
Q

What is the BP target for IgA nephropathy ?

A

SBP < 120

86
Q

What is the BP target of GN disease patients ?

A

Target < 120 if safe (no HTO, not frail…)

87
Q

What is the BP target before a kidney biopsy ?

A

Should be controlled < 160 pre biopsy

88
Q

What is the clinical picture of nephrotic syndrome ?

A
  • Nephrotic range proteinuria > 3.5g
  • Edema
  • Hypoalbuminemia
  • DLP and lipiduria
89
Q

What is the clinical presentation of acute interstitial nephritis ?

A

AKI, sometimes with fever/rash
Hematuria, non nephrotic range proteinuria
Pyuria, WBC casts
Eosinophs may be increased in blood/urine (not always)

90
Q

What is the clinical presentation of cholesterol emboli syndrome / atheroemboli disease ?

A

Subacute, STEP WISE decline
TAKES WEEKS
Livedo reticularis, blue toes

91
Q

What is the clinical presentation of hepatorenal syndrome ?

A

Rise in serum creat with normal urine sediment
Tubular function is preserved (no/minimal hematuria or proteinuria)
Urine sodium < 10

92
Q

What is the clinical presentation of SLE nephropathy ?

A

Presents as nephritic and or nephrotic
Requires bx
Elevated ds DNA

93
Q

What is the definition of CKD per KDIGO ?

A

Abnormalities in either kidney structure or function for > 3 MONTHS :
- Albuminuria ACR > 3 mg/mmol
- Urine sediment abnormalities
- E+ abnormalities due to tubular disorders
- Structural abnormalities detected by imaging
- Kidney transplant hx
- eGFR < 60

94
Q

What is the definition of Goodpasture ?

A

RPGN accompanied by pulmonary hemorrhage

95
Q

What is the first line for HTN in CKD ?

A

ACEi or ARB first line
Diuretics if evidence of increased salt/water retention

96
Q

What is the GFR cut off for :
EMPAgliflozin
DAPAgliflozin
CANAgliflozin

A

EMPA : 10 daily, GFR > 20
DAPA : 10 daily, GFR > 25
CANA : 100 daily, GFR > 30

97
Q

What is the GFR cut off to be able to start SGLT2 ?

A

GFR ≥ 20

98
Q

What is the imaging modality in case of kidney stone ?

A

Non contrast CT

99
Q

What is the infectious disease associated with PAN ?

A

HBV
1-5% patients with HBV develop PAN

100
Q

What is the link between IgA nephropathy and infection ?

A

Flares with ANY infection ‘syn pharyngitic’

101
Q

What is the maintenance therapy in ANCA vasculitis ?

A
  • AZA or continue rituximab if induction agent
  • Taper glucocorticoids (1mg/kg/d first week then taper)

No maintenance therapy in dialysis dependent pts x 3 months with no extra renal manifestations

102
Q

What is the maintenance therapy in antiGBM disease ?

A

No maintenance therapy

103
Q

What is the management of hyperPO4 in CKD ?

A

Target NORMAL PO4
Low PO4 diet
Oral phosphate binders WITH meals
- TUMS / calcium carb 1s line
avoid if hyperCa, adynamic bone disease, vascular calcification
- non Ca containing : sevelamer

104
Q

What is the management of post streptococcal/infectious GN ?

A

Supporte care
Diuresis if edema
Tx infection if still active
Resolves in 3-4 weeks

Bx ONLY if considering other glomerular disorders or varies from typical trajectory

105
Q

What is the most common GN worlwide ?

A

IgA nephropathy

106
Q

What is the most common primary nephrotic syndrome ?

A

Membranous most common overall
FSGS most common in african/american

107
Q

What is the nephropathy associated with HCV ?

A

MPGN +/- cryoglobulinemia

– Classically low C4 (but not always); high RF
– Clinically: nephritic/proliferative picture, palpable purpura, arthralgias, weakness, peripheral neuropathies

108
Q

What is the pathophysio of AKI with ACEi/ARB ?

A

Failure of efferent arteriole to constrict if volume contracted
Usually concomitant hx of poor PO intake and/or GI losses

109
Q

What is the pathophysio of AKI with NSAIDs ?

A

Prostaglandin inhibition : constriction of afferent arteriole (mechanism of pre renal)

110
Q

What is the pre immunosuppresion workup in GN disease ?

A

TBST, Hep serologies, HIV
Strongyloides if endemic risk

111
Q

What is the presentation of IgA nephropathy ?

A

Various : microscopic hematuria, gross hematuria, proteinuria, RPGN or nephrotic syndrome
** CAN MIMIC nephrolithiasis presentation
** FLARES with ANY infection (syn pharyngitis)

112
Q

What is the prognosis of IgA nephropathy ?

A

Dependent on degree of proteinuria and HTN control
- < 0.5 g/d : low risk of progression
- overt proteinuria and/or high Cr : progression to ESRD 15-25% at 10 years

113
Q

What is the PTH target in CKD management ?

A

Unknown for pre dialysis CKD
2-9x ULN for dialysis patients

114
Q

What is the risk of osteoporosis drugs in CKD patients ?

A

Beware of the risk of severe hypocalcemia with biphosphonates or denosumab in CKD

115
Q

What is the signification of epithelial cells on urinarlysis microscopy ?

A

Squamous : contamination
Renal tubular epithelial : ATN
Transitional : ureters

116
Q

What is the target Hb while on ESA for CKD ?

A

No higher than 115 as associated with stroke, CAD, HTN

117
Q

What is the timing of acute interstitial nephritis ? (when does is occur)

A

1 weeks to weeks / months following
If previous exposure to drug, can occur sooner

118
Q

What is the timing of cholesterol emboli syndrome ?

A
  • IRA en 1-2 semaine post athéroembolie massive péri-procédure
    OU
    -IR progressive en palier d’escaliers dont le pic est 3-8 semaines post-procédure secondaire à embolies continues ou avec occlusion incomplète (réaction inflammatoire et atrophie ischémique)
119
Q

What is the timing of contrast induced nephropathy ? How long for it resolve?

A

1-3 days post contrast load
Most self resolve in 1-2 weeks

120
Q

What is the treatment for PRIMARY minimal change or FSGS nephropathy ?

A

STEROIDS

121
Q

What is the treatment of acute interstitial nephritis ?

A

Remove offending agent
Is severe renal failure : often biopsy and consider empiric glucocorticoids

122
Q

What is the treatment of anti GBM disease ?

A
  • Pulse corticosteroids x 6 months
  • Cyclophosphamide x 2-3 months
  • Plasma exchange (until titers are no longer detectable)
    Then no maintenance therapy

Exceptions: conservative tx if 85-100% crescents, no pulm hemorrhage, tx w dialysis at presentation (risk of immunosuppresion > benefits as ESRD already)

123
Q

What is the treatment of HIV associated nephropathy ?

A

HAART and RAS blockade

124
Q

What is the treatment of rhabdomyolysis ?

A

IV fluids (diuresis 200cc/h)
Management of electrolytes but DO NOT treat hypocalcemia

125
Q

What is the tx of hepatorenal syndrome ?

A

Stop diuretics, restrict sodium and water
Tx with albumin + vasoconstrictor (terlipressin not available, midodrine + octreotide)
Liver transplant or TIPS

126
Q

What is the typical mimicker of IgA nephropathy ?

A

Nephrolithiasis presentation

127
Q

What is the typical presentation in PAN nephropathy ?

A

Renal infarcts

128
Q

What is the typical presentation of HIV associated nephropathy ?

A

COLLAPSING FSGS
Black males, advanced HIV (CD4<200), nephrotic, high Cr

129
Q

What is the volemic state goal before giving contrast? Precaution if CKD ?

A

Ensure euvolemia : 3 ml/hg/hr 1 hour before procedure, 1ml/kg/hr 6 hours after procedure for CKD

130
Q

What is your proteinuria target in IgA nephropathy ?

A

Titrate ACEi or ARB to proteinuria < 500mg-1g / day

131
Q

What is the proteinuria goal in CKD ?

A

< 500 mg - 1g/d with ACEi/ARB
DM2 : proteinuria as low as possible

132
Q

What medication is often given to prevent bleeding during a kidney biopsy ?

A

DDAVP

133
Q

What should you advise concerning smoking in glomerular disease ?

A

SMOKING CESSATION FOR ALL

134
Q

What should you monitor annually if patient on metformin for 4 + years ?

A

B12 annually

135
Q

What will multiple myeloma do on urine dipstick ?

A

Proteinuria +
Glycosuria + if tubular dysfunction

136
Q

What will you see on urine microscopy if ATN ?

A

Muddy brown cast

137
Q

What will you see on urine microscopy if nephritic syndrome ?

A

RBC casts and dysmorphic RBC

138
Q

What will you see on urine microscopy if nephrotic syndrome ?

A

Oval fat bodies or fatty casts

139
Q

When does post streptococcal / infectious GN occur?

A

2-3 weeks post infection (strep throat, strep cellulitis, chronic abscess, endocarditis …)

140
Q

When is ESA indicated in CKD ?

A

If Hb < 100 and iron replete or after trial : eprex or aranesp

141
Q

When is SGLT2 indicated in CKD ? What are the pre requisite ?

A

Indicated for ALL CKD
+/- diabetes, eGFR ≥ 20, ACR > 20 mg/mmol

142
Q

When should CKD patients be screened for Hep C ?

A

At diagnosis of CKD and at time of initiation of renal replacement therapy
All patients should be evaluated for HCV

143
Q

When should you consider biopsy with a nephrotic syndrome ?

A

Bx usually required for diagnosis
UNLESS PLA2R antibody + normal renal function, can forego bx but still screen for 2 causes

144
Q

When should you consider prophylactic full dose anticoagulation in nephrotic syndrome ?
Name 6 reasons.

A

Warfarin if albumin < 20-25 AND any of :

  • BMI > 35
  • Inherited thrombophilia
  • NYHA 3-4
  • Prolonged immobilization
  • Proteinuria >10g/d
  • Recent ortho or abdo surgery

If high bleeding risk : suggest ASA 81mg instead

145
Q

When should you consider steroids in IgA nephropathy ?

A

Steroids x 6 months if high risk of progressive CKD (refractory proteinuria > 0.75-1g despite optimal medical therapy with RAAASi x 90d)

146
Q

When should you introduce ACE or ARB for DM/CKD patients ?

A

If HTN + albuminuria
Consider for albuminuria without hypertension

147
Q

Which agent should you choose if anticoagulation is indicated in nephrotic syndrome ?

A

Warfarin
DOAC not studied and protein bound : not ideal in hypoalbuminemia

148
Q

Which condition is characterized by nephritic syndrome and normal complement ?

A

IgA

149
Q

Which nephropathy is associated with anti TNFs ?

A

2nd membranous

150
Q

Which nephropathy is associated with HIV ?

A

FSGS

151
Q

Which nephropathy is associated with Hodgkins ?

A

2nd minimal change

152
Q

Which nephropathy is associated with NSAIDs ?

A

2nd minimal change
2nd membranous
Also possible : AIN, ATN, pre renal

Les deux ennemis (7 decks)

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