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AKT > Nephrology > Flashcards

Nephrology Flashcards

1
Q

ADPKD 1 and 2
Which is more common
Chrm?

A

ADPKD 1
Chrm 16 ADPKD 1
Chrm 4 ADPKD 2

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2
Q

Screening investigation of choice for ADPKD
Diagnostic criteria
<30
30-59
>60

A

US abdominal
two cysts, unilat or bilat <30
two cysts both kidney 30-59
four cysts in both kidneys >60

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3
Q

Mx ADPKD (1) on (3) conditions

A

Tolvaptan

IF
CKD stage 2 or 3 at start of treatment
AND
Evidence of rapidly progressing disease
AND
Company provides it with agreed discount

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4
Q

Features of ADPKD (6)

A

HTN
Recurrent UTIs
AP
Renal stones
Haematuria
CKD

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5
Q

Extra renal manifestations of ADPKD (4)

A

Liver cysts
Berry aneurysms
Mitral valve prolapse
Cysts in other places

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6
Q

What is Alport’s syndrome?
Inheritance

Gender

A

X linked dominant
Defect in gene coding for type IV collagen resulting in an abnormal GBM

M>F (more severe in male)

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7
Q

Features Alport’s syndrome (5)

A

Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus (protrusion of the lens surface)
Retinitis pigmentosa

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8
Q

Renal biopsy for Alport’s syndrome (2)

A

Longitudinal splitting of lamina densa of GBM
Basket weave appearance

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9
Q

MDRD uses what four variables for eGFR

A

Age
Serum creatinine
Gender
Ethnicity

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10
Q

Factors which can impact the eGFR (3)

A

Pregnancy
Muscle mass
Eating red meat 12 hours prior to sample being taken

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11
Q

CKD eGFR 1-5
Classification

A

1 >90 with some sign of kidney damage
2 60-90
3a 45-59
3b 30-44
4 15-29
5 <15

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11
Q

CKD
Mineral bone disease management (4)

A

Reduced dietary intake of phosphate
Phosphate binders
Vitamin D
Parathyroidectomy

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11
Q

ACR interpretation

A

3-70 repeat sample
If >70 then no repeat sample needed
Must be a first pass morning urine

If >3 then clinically important proteinuria

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12
Q

When to refer to nephrologist for CKD? (2)
Consider if (1)

A
  1. If ACR >70 (unless caused by DM)
  2. If ACR >30 with persistent haematuria

Consider if
ACR 3-29 with persistent haematuria and other RF

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13
Q

Mx of proteinuria (2)

A
  1. ACE inhib if co-existent HTN and CKD if ACR >30
  2. If >70 then ACE inhib even if no raised BP
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14
Q

Visible haematuria
Loin pain
Proteinuria
=

A

Renal papillary necrosis

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15
Q

Post Strep GN
Which bacteria?
Typically occurs when?
Prognosis

A

7-14 days post group A beta haemolytic strep infection (Strep pyogenes)
Good prognosis

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16
Q

Post Strep GN features (6)

A

Young children
Proteinuria more than haematuria
HTN
Oliguria
Low C3
Raised ASO titre

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17
Q

IgA nephropathy features (3)

A

Develops 1-2 days post URTI
Young males
Macroscopic haematuria

18
Q

Renal biopsy post strep GN

A

Granular/ starry sky

19
Q

IgA nephropathy associated conditions (3)

A

Alcoholic cirrhosis
Coeliac
Henoch-Schonlein purpura

20
Q

IgA nephropathy histology

A

Mesangial hypercellularity

21
Q

IgA nephropathy prognosis
Markers for good prognosis (1)
Poor prognosis (5)

A

25% have ESRF
Frank haematuria

  1. Male
  2. proteinuria >2g/day
  3. HTN
  4. Smoking
  5. Hyperlipidaemia
22
Q

Henoch Schonlein purpura overlaps with?
Features (4)

A

IgA nephropathy

Features:
1. Palpable purpuric rash over buttocks and extensor surface of arms and legs
2. AP
3. Polyarthritis
4. Features of IgA nephropathy e.g haematuria

23
Q

HSP prognosis
What two things should be monitored?
How many relapse?

A

Self limiting
Very good prognosis
BP and urinalysis should be monitored
1/3 have a relapse

24
Q

Minimal change disease
Causes (5)

A

drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
infectious mononucleosis

25
Q

Difference between nephrotic and nephritic syndrome

A

Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine

Nephrotic syndrome is a condition involving the loss of significant volumes of protein via the kidneys (proteinuria) which results in hypoalbuminaemia. The definition of nephrotic syndrome includes both massive proteinuria (≥3.5 g/day) and hypoalbuminaemia (serum albumin ≤30 g/L).

26
Q

Cranial versus nephrogenic DI

A

Cranial - decreased secretion of ADH
Nephrogenic - insensitivity to ADH

27
Q

Causes of cranial DI (4)

A

Idiopathic
Post head injury
Pituitary surgery
Haemochromatosis

28
Q

What is DIDMOAD?

A

the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)

29
Q

Causes of nephrogenic DI (4)

A

Genetic
Hypercalcaemia
Hypokalaemia
Lithium

30
Q

Ix DI
High/low plasma osmolality high/low urine osmolality
A urine osmolality of what excludes DI
What other investigation can be done?

A

high plasma osmolality, low urine osmolality
a urine osmolality of >700 mOsm/kg excludes diabetes insipidus
water deprivation test

31
Q

Diabetes insipidus mx (2)

Central DI can be treated with? (1)

A

Thiazides
Low salt/ protein diet

Desmopressin

32
Q

Nephrotic syndrome examples (4)

A

Minimal change
Membranous GN
FSGM
Diabetic nephropaathy

33
Q

Nephritic syndrome examples (3)

A

Rapidly progressive GN
IgA nephropathy
Alport syndrome

34
Q

Most common cause of GN in children

A

Minimal change

34
Q

Causes of transient non visible haematuria (4)

A

UTI
Menstruation
Vigorous exercise (settles after 3 days)
Sexual intercourse

35
Q

Which drugs can cause red/orange urine? (2)

A

Rifampicin
Doxorubicin

36
Q

How do you define persistent non visible haematuria?

A

Blood being present in 2 out of 3 samples tested 2-3 weeks apart

37
Q

Who should be referred under the 2 week wait?

A

=>45yo with unexplained visible haematuria w/o UTI
OR
visible haematuria that persists after successful treatment of UTI
OR
>= 60yo with unexplained non visible haematuria AND dysuria/ raised WCC

38
Q

Who should get a non urgent referral to urology regarding haematuria?

A

> =60yo with recurrent or persistent unexplained UTI

39
Q

Minimal change prognosis

A

1/3 have just one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood

40
Q

Minimal change mx (2)

A

steroids
cyclophosphamide

41
Q

Minimal change
Features (3)
BP
Nephritic or nephrotic

A

Normotension
Nephrotic syndrome
Highly selective proteinuria

42
Q

Minimal change
Renal biopsy
Light microscopy (1)
Electron microscopy (1)

A

normal glomeruli on light microscopy
electron microscopy shows fusion of podocytes and effacement of foot processes

AKT (52 decks)

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