Nephrology Flashcards
What is the most common mechanism for primary hyperuricaemia
A. Increase cell turnover
B. Increased GIT absorption
C. Inherited defects in adenosine triphosphate metabolism
D. Reduced renal uric acid excretion
D
First change occur in diabetic nephropathy
Increased GFR
50F with RA with intermittent use of DMARDs. She has been poorly compliant with treatment. She now presents with progressive proteinuria with 24h > 4g and hyaline casts. Serum alb 30, normotensive 120/80. Serum Cr 60. Most likely cause of proteinuria
A. IgA GN
B. Membranous nephropathy
C. Anti-GBM disease
D. Secondary amyloidosis
D
71M with HTN, COPD and previous CABG. P/w 3/7 history of anuria and dyspnea. Taking ramipril. atorvastatin, amlodipine, clopidogrel and aspirin, amoxicillin, pantoprazole and inhaled steroid. BP 200/105, ECG shows previous anterior MI. Renal US shows a 6cm R kidney and 11cm L kidney. No urine noted. Cr 600
A. AIN
B. Renal thromboembolism
C. Renal dissection
D. Pyelonephritis
B
Strong indicator for renal biopsy
65M with T2DM and proteinuria (urine ACR 250g/mol Cr)
A. Positive ANCA Abs specific for MPO
B. Persistent microscopic haematuria
C. Positive ANA 1:1640
D. Increase in Cr from 90 to 170 over 2 months
A - look for inflammatory changes
S/E sirolimus
Pneumonitis, mouth ulcers, proteinuria
Flash pulmonary oedema, EUC worse on ACEI, asymmetrical kidney
Suspect RAS - do MR angiography
Binds to FK binding protein located in T cells and ultimate the gene transcription of IL-2
Tacrolimus
Least likely to cause leukopenia in the post transplant period
Bactrim, Valcyte (CMV prophylaxis), Thymoglobulin, MF, Tac
Tac
Papillary necrosis - causes
- Chronic analgesia use
- Sickle cell disease
- TB
- Acute pyelonephritis
- DM
Fanconi syndrome - causes
- Cystinosis (most common cause in children)
- Sjogren
- MM
- Nephrotic syndrome
- Wilson’s disease
Fanconi syndrome - manifestations
- Type 2 (proximal) RTA
- Polyuria
- Aminoaciduria
- Glycosuria
- Phosphaturia
- Osteomalacia
Risk factor of calciphylaxis
- HyperCa
- HyperPO4
- HyperPTH
- Warfarin
Management of Ca stone
- High fluid
- Low animal protein, low salt diet
- Thiazide diuretics
Genetics of ADPKD
ADPKD type 1 (PKD 1, chromosome 16, 85%)
ADPKD type 2 (PKD 2, chromosome 4, 15%)
Mechanism of tolvaptan
Vasopressin receptor 2 antagonist
- found on basolateral membrane of the principal cells in the collecting ducts of the kidney
- Reduce water absorption and increases aquaresis without sodium loss
Least likely seen in HSP
- Abdo pain
- renal failure
- Polyarthritis
- Thrombocytopenia
- Purpuric rash over buttocks
Thrombocytopenia
Extra renal features of ADPKD
- Hepatic cysts 70% (hepatomegaly)
- Diverticulosis
- Intracranial aneurysms
- CV: MVP, mitral/tricuspid incompetence, aortic root dilatation, aortic dissection
- Cysts in other organs: ovary, pancreas, thyroid, oesophagus
Pre-renal uraemia vs ATN
- Prerenal uraemia: hold on to Na to preserve volume
- <1% Fractional sodium excretion, <35% fractional urea excretion, Urine Na < 20mmol
Side effects of finasteride (5 alpha-reductase inhibitor) for BPH
Erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
MOA block conversion of testosterone to dihydrotestosterone (DHT) - induce BPH
Nephrogenic DI
Low urine osmolality post water deprivation and failure to respond to desmopressin
Factors increase pulmonary haemorrhage in GBM disease
- Smoking
- Lower resp tract infection
- Pulmonary oedema
- Inhalation of hydrocarbons
- Young males
Genetic mutation in nephrogenic DI
- More common form: affecting vasopressin (ADH) receptor
- Less common form: mutation in the gene that encodes the aquaporin 2 channel
Which one not a RF for renal stone
A. RTA
B. Cadmium
C. HyperPTH
D. Dehydration
E. Cystinosis
E. it is cystinuria not cystinosis
Electrolyte derangement causing nephrogenic DI
- HyperCa or hypoK
AutoAbs for membranous glomerulonephritis
Anti-phospholipase A2
Which least a/w retroperitoneal fibrosis
A. Riedel’s thyroiditis
B. Previous radiotherapy
C. Inflammatory abdominal aortic aneurysm
D. Methysergide
E. Sulphonamides
E.
Renal biopsy of membranous glomerulonephritis
EM - the basement membrane is thickened with subepithelial electron dense deposits. This creates a “spike and dome”appearance
Cystinuria
Autosomal recessive
Recurrent stones (yellow, crystalline, semi-opaque)
Dx with cyanide-nitroprusside test
HypoK + high plasma aldosterone + high plasma renin
Bilateral renal artery stenosis
If low renin -> primary hyperaldosteronism
Alport syndrome - genetics
X-linked dominant, defect in gene codes for type IV collagen -> abnormal GBM
Alport syndrome - clinical
- Microscopic haematuria
- Progressive renal failure
- Bilateral sensorineural deafness
- Lenticonus: protrusion of the lens surface into the anterior chamber
- Retinitis pigmentosa
- Renal biopsy: splitting of lamina densa seen on EM
Not a feature of HIv-associated nephropathy
- Small kidneys
- Normotension
- Elevated urea and Cr
- Proteinuria
- FSGS
A: normally normal or large kidney
Most likely cause of death in CKD on HD
- IHD
