Nephrology

Question 1

Nephritic syndrome

Answer 1

Damage to glomerular basement membrane
Renal failure: oliguria, atrial hypertension (Na retention), declined GFR
Peripheral periorbital edema
Tests: increase BUN and Creat
Urine: proteinuria, RBC casts, hematuria
24h protein collection

Different to nephrotic because <3.5g/day (can be over)
Causes: type 3 HS- post strept glomerulonephritis, IgA nephropathy
Alport syndrome
Bergers disease (IgA neph)

Question 2

Acute poststreptococcal glomerulonephritis

Answer 2

Children
2-4 weeks after group A strept of skin, pharynx
IgG and IgM form immune complexes with antigen
Tests : low C3 strept pos

Question 3

Nephrotic syndrome

Answer 3

Hypoalbuminemia 
Peripheral edema 
Massive proteinuria - 24h collection 
Hyperlipidemia 
Ascites and pleural effusion
HTN
Urinanaylsis repeated after 4 weeks 
SLE, minimal change disease, diabetic kidney, amyloidosis,

Question 4

Loop diuretics

Answer 4

Inhibits Na/k/Cl  co transporter 
Ascending loop of Henle
Reuse idea and bumetanide
First line for acute pulmonary edema 
And fluid overloaded Hf
And renal failure and liver failure 
Caution: hypovolaemia, hyponatraemia, hypokalaemia

Question 5

Most common cause of death in kidney failure dialysis patients

Answer 5

MI

From calcification and narrowing arteries

Question 6

Kidney transplant criteria

Answer 6

Gfr below 25 and falling
Often below 15
Ideally before they need to start dialysis

Question 7

Kidney transplant blood types

Answer 7

No Resus

O to everyone
A to a and ab
BTo b and ab
Ab to ab

Question 8

Immunosuppression kidney transplant drugs

Answer 8

Calcineurin inhibitors (cni)
Steroids
Antiproliferation drugs

For 3-6months.

Biological - basiliximab
Eculizumab

Question 9

Renal failure

Answer 9

Hyponatraemia 
Hyperkaleamia 
Sx: muscle cramps, sob, swollen ankles, weight loss, tired, blood on urine, itchy , erectile dysfunction, insomnia , headaches 
Stage 1-5 
1: >90
5: <15
Tx: lower BP - ACEI , STATINS 
dialysis 
Transplant 
Avoids NSAIDS 
Diuretics - frusemide

Question 10

AKI diagnosis

Answer 10

Rise in baseline creatinine by x3 for stage 3
Stage 1: rise by 26 from baseline within 48h or 1.5-1.9x

Urine output

1. <0.5 ml/kg/hr for >6hours
2. 0.5 for >12 hours
3. 0.3 >24hrs or Anuria for 12hrs

Question 11

Initial assessment of AKI patient

Answer 11

Urine dip and MSU and urine protein 
Creat ratio 
FBC , bone profile, LFT, CRP, clotting
ECG
CXR 

Only do Renal US if obstruction or pyelonephritis indicated, or if pre renal AKI is not improving with Tx.

Question 12

Prerenal causes of AKI

Answer 12

Heamodynamically- intracranial vasoconstriction
- meds : NSAIDS , ACEI, ARBS, cyclosporines, tacrolimus
-hypercalcemia
- cardiac failure
Systemic vasoconstriction
- sepsis, neurogenic shock

Volume depletion
-renal loss from overuse of diuretics, DKA
- extrarenal loss from vomiting, diarrhoea, Burns , sweating, blood loss
Dehydration

Question 13

Intrinsic causes of AKI

Answer 13

Glomerulonephritis / vasculitis 
Tubulointerstitial nephritis 
Acute tubular necrosis 
Rhabdomyolysis 
Myeloma 
Heamolytic ureamic syndrome 
Malignant HTN 

• blood on urine dip
• systemic Sx

Question 14

Postrenal causes of AKI

Answer 14

Obstruction 
Prostatic hypertrophy BPH
Renal stones 
Bladder overflow 
To ours 
Extrinsic compression 

• anuria, pain, heamaturia

Question 15

Iatrogenic drugs causing AKI

Answer 15

Nephrotoxic

NSAIDS
ACEI , ARBS
PPIs
Some antibiotics - gentamicin, ceftriaxone, vancomycin
Iodinated X-RAY contrast

Question 16

Hyperkaleamia due to AKI

Answer 16

Only treat Hyperkaleamia if ECG changes

6.5-6.9: and no ECG changes - insulin and dextrose
With ECG changes- calcium gluconate, insulin and dextrose
>7 : with or without ECG - calcium G, D, insulin