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Clinical Medicine > nephrology 🏥 > Flashcards

nephrology 🏥 Flashcards

1
Q

pre-renal causes of AKI

A

hepatorenal syndrome

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2
Q

intra-renal causes of AKI

A

acute tubular necrosis
nephrotoxic drugs
acute pyelonephritis
intratubular obstruction
coagulopathies

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3
Q

post renal causes of AKI

A

renal tract obstruction -e.g stones or tumours

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4
Q

presentation of hepatorenal syndrome

A

renal failure and liver disease

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5
Q

what causes acute tubular necrosis

A

ischaemic event or nephrotoxic drugs
Rhabdomylosis
Cisplatin
Methotrexate
Ethylene glycol

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6
Q

examples of nephrotoxic drugs

A

ct contrast medium
NSAIDs
abx
analgesics
ACEis
ARBs
gentamicin

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7
Q

presentation of acute tubular necrosis

A

muddy brown cast on urinalysis
poor response to fluid challenge
hyponatraemia

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8
Q

how does acute pyelonephritis present

A

UTI sx
flank pain
messed up kidney function tests
cloudy urine

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9
Q

tx pyelonephritis

A

ceflasporin

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10
Q

distinguish between nephritic and nephrotic

A

nephritic - protein and blood in urine
nephrotic - protein in urine

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11
Q

name nephritic contidions

A

IgA nephropathy
post-strep glomerulonephritis
Granulomatosis with polyangiitis (wegener)
Eosinophilic (churg-strauss)
Anti GMB antibody disease(good pasture syndrome)
Alpert syndrome

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12
Q

how does IgA nephropathy present

A

Gross haematuria 1-2 days after URTI

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13
Q

how does post strep glomerulonephritis present

A

7-14 days after a strep infection - unlike IgA nephropathy this occurs weeks after an infection
Usually occurs in children unlike IgA too
Tea urine

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14
Q

how does rapidly progressive glomerulonephritis present

A

renal failure
haematuria
OLIGOURIA
hypertension

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15
Q

what would a renal biopsy show for progressive glomerulonephritis

A

severe inflammation with necrotising crescent formation

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16
Q

tx rapidly progressive glomerulonephritis

A

high dose immunosuppression

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17
Q

causes of rapidly progressive glomerulonephritis

A

goodpastures syndrome
Wegeners granulomatosis

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18
Q

features of good pastures syndrome

A

anti glomerular basement membrane antibodies attach the kidney and lungs
Antibodies against type IV collagen results in in pulmonary haemorrhage - haemopytsis and haematuria as the collagen in the lung and glomerular basement membrane are damaged

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19
Q

mx good pastures syndrome

A

steroids, plasma exchange and cyclophosphamide

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20
Q

name nephrotic syndromes

A

minimal change nephropathy
membranous glomerulonephritis

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21
Q

describe minimal change nephropathy

A

80% of nephrotic syndromes in children
typically present with oedema and facial swelling
Proteinuria

22
Q

mx minimal change nephropathy

A

high dose prednisolone

23
Q

describe membranous glomerulonephritis

A

most common nephrotic syndrome in adults
biopsy will show thickening of basement membrane
circulating phospholipase A2 receptor antibody

24
Q

tx membranous glomerulonephritis

A

ACEis
ARBs

25
Q

What is acute interstitial nephritis

A

Inflammation of extra-glomerular tissue

26
Q

How would acute interstitial nephritis present

A

Characteristic triad is rash, fever and eosinophilia (uncommon)

27
Q

Tx acute interstitial nephritis

A

Discontinue drugs and add fluids
treating underlying cause
steroids

28
Q

What can cause acute interstitial nephritis

A

PPIs are a common cause
Antibiotics
NSAIDs
Infections
Autoimmune conditions
NOT STEROIDS they are safe

29
Q

Features of haemolytic uraemic syndrome

A

Children under 5
Triad; thrombocytopenia, normocytic anaemia, AKI
Caused by enterohaemorrhagic E.coli from undercooked meat or petting farms
Diarrhoea

30
Q

Mx haemolytic uraemic syndrome

A

IV Fluids

31
Q

Features of wegener granulomatosis

A

cANCA positive
Renal failure
Nasopharyngeal involvement - SADDLE NOSE DEFORMITY
Haemoptysis
Palpable purpura
65-74 y/o

32
Q

Features of churg strauss syndrome

A

pANCA positive
Severe asthma
Blood eosinophilia
Sinusitis
Purpura
38-54 y/o

33
Q

Tx of wegener granulomatosis and churg strauss syndrome

A

Steroids

34
Q

Features of alport syndrome

A

X linked dominant
Nephritis
Hearing loss
Eye problems

35
Q

In good pastures syndrome what are antibodies made against

A

Type IV collagen

36
Q

Complications of nephrotic syndromes to watch out for

A

Venous thromboembolism
Infection
Hyperlipidaemia

37
Q

With a patient with minimal change disease what would you see on light microscopy

A

Normal glomerular architecture

38
Q

With a patient with minimal change disease what would you see on electron microscopy

A

Effacement of podocyte foot processes

39
Q

what is henoch-schonlein purpura

A

IgA mediated small vessel vasculitis
HSP usually seen in children following an infection

40
Q

features of henoch-schonlein purpura

A

palpable purpuric rats with localised oedema over buttocks and extensor surfaces of arms and legs

41
Q

for post-strep glomerulonephritis what would you see on a biopsy sample

A

IgG, IgM and C3 immune complex deposition
endothelial proliferation with neutrophils
subepithelial “hump” appearance on electron microscopy

42
Q

for post-strep glomerulonephritis what would you see on immunofluorescence

A

a granular or “starry sky” appearance

43
Q

stage 1 AKI

A

increase in creatinine to 1.5-1.9x baseline
increase in creatinine by >=26.5 mmol/l
reduction in urine output to <0.5 ml/kg/hour for >= 6 hours

44
Q

stage 2 AKI

A

increase in creatinine 2.0 to 2.9x the baseline
reduction in urine output to <0.5 ml/kg/hour for >= 12 hours

45
Q

stage 3 AKI

A

increase in creatinine to >= 3x baseline
increase in creatinine to >=353.6mmol/l
reduction in urine output to <0.3ml/kg/hours for >= 24 hours
pt requires renal replacement therapy

46
Q

indications for dialysis

A

persistent hyperkalaemia
uraemia
fluid overload

47
Q

features of Pyelonephritis

A

UTI sx and The patient may be vomiting, febrile, and complain of loin pain.
Clinical examination will reveal pyrexia and renal angle tenderness.

48
Q

mx of pyelonephritis

A

The patient should be admitted to hospital for intravenous antibiotics (broad-spectrum cephalosporin/a quinolone/gentamicin)

49
Q

whats a common complication of peritoneal dialysis

A

peritoneal dialysis peritonitis
typically caused by staph epidermidis
presents with abdominal pain, fever and a cloudy dialysis bag

50
Q

A 56-year-old man with nephrotic syndrome presents to his GP complaining of swelling around the eyes and swelling of the scrotum and the legs. What is the most likely cause of this?

A

hypoalbuminaemia

51
Q

what is rapidly progressive glomerulonephritis

A

a spectrum of conditions associated with severe glomerular injury

characterised by a nephritic picture associated with a rapid and progressive loss of renal function

patients are often significantly oliguric

can be broadly grouped into 3 categories

Clinical Medicine (26 decks)

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