NEPHROLOGY Flashcards
VBG in salicylate poisoning?
raised anion gap
metabolic acidosis
what is good pastures/anti glomerular basement memberane syndrome
CFs
Management
small vessel vasculitis
causes:
- pulmonary haemorrhages
- rapid glomerulonephritis
Ix; anti glomerular basement membrane antibodies against type 4 collagen
Management:
- plasma exchange (plasmaphoresis)
- Steroids
- Cyclophosphamide
Ix anti glomerular basement membrane disease
Linear IgG deposits along basement membrane
Pulmonary haemorrhages- causing raised transfer factor
what can membranoproliferative glomerulonephritis present as? (3)
- nephrotic syndrome
- haematuria
- proteinuria
3 types of membranoproliferative glomerulonephritis
Type 1= 90% cases
EMM- tram track
cause: cryoglobulinaemia, hepatitis C
type 2=
dense deposits
causes:
partial lipodystrophy factor H deficiency#
Type 3
causes: hepatitis B and C
What type of metabolic abnormality does diarrhoea most commonly cause
normal anion gap metabolic acidosis
how to calculate anion gap
(Na+ + K+) - (Cl- + HCO-3).
Post-streptococcal glomerulonephritis onset timeline
and caused by what organism
and appearance on immunofloresence
Post-streptococcal glomerulonephritis typically occurs 7-14 days following a group A beta-haemolytic Streptococcus infection
usually strep pyogenes
GRANULAR appearance
difference between IgA nephropathy and post strep GAS glomerulonephritis
post strep glomerulonephritis= 1-2 weeks and proteinuria
IgA nephropathy=1-2 days
and macroscopic haematuria
What type of metabolic abnormality does acetazolamide most commonly cause?
normal anion gap metabolic acidosis
what is cystinuria
#i heritance pattern
CFs
management
autosomal recessive
Features
recurrent renal stones
are classically yellow and crystalline, appearing semi-opaque on x-ray
Management
hydration
D-penicillamine
urinary alkalinization
what is cystinuria
inheritance pattern
CFs
management
autosomal recessive (exception to MR DS)
recurrent renal stones. defect in the membrane transport of cystine, ornithine, lysin, arginine . COLA!!!!
Features
recurrent renal stones
are classically yellow and crystalline, appearing semi-opaque on x-ray
Management
hydration
D-penicillamine
urinary alkalinization
cyanide-nitroprusside test
test for cystinuria
first choice investigation for reflux nephropathy
Micturating cystography
what type of immunogloblin responsible for graft rejection
IgG
and DR
how to distinguish between nephrogenic DI and cranial DI
administer nasal desmopressin
nephrogenic DI: no response.
cranial DI:
alport syndrome inheritance
X linked dominant
defect in type 4 collagen
CFs alport syndrome
usually young boys
microscopic haemiaturia
renal progressive failure
BIL Sensorineural hearning loss
retinal pigmentosa
what does renal biopsy and EMM show in alport syndrome;
SPLITTING OF LAMINA DENSA
X LINKED DOMINANT
WHAT IS a staghorn calculus made of
Magnesium ammonium phosphate, (also known as struvite),
congo red staining
amyloidoisis
renal complication of SLE and the 6 types
lupus nephritis
I normal kidney
II: mesangial glomerulonephritis
III: focal segmental glomerulonephritis
IV: diffuse proliferative glomerulonephritis
V: diffuse membranous
VI: sclerosing glomerulonephritis
most severe and and COMMON and dangerous type of SLE renal involvement
type 4- diffuse proliferative glomerulonephritis
mneumonic for 6 types of SLE nephritis
Normal Angels Focus on Diffusing Profits to Members of Sceciety
what is calciphylaxis
area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar
deposition of calcium deposits in intimal arterioles
most common bacteria for peritonitis infection during peritoneal dialysis
staph epidermis
is strep epidermis coagulase positive or negatvie
coagulase NEGATVE
treatment for peritonitis from peritoneal dialysis
vancomycin (or teicoplanin) + ceftazidime a
which type of glomerulonephritis associated with wegeners granulomatosis(ANCA)
rapidly progressive glomerulonephritis
most common type of glomerulonephritis in adults
and its Tx
membranous glomerulonephritis
Tx
ACEi and immunisuppression with corticosteroids eg pred
anti phospholipase A2 associated with which type of glomerulonephritis
membranous glomerulonephritis
‘The basement membrane is thickened with subepithelial electron dense deposits, creating a ‘spike and dome’ appearance.’
causes of renal papillary necrosis
- severe acute pyelonephritis
- diabetic nephropathy
- obstructive nepropathy
- NSAIDs
- sickle cell anaemia
what type of cancer is associated with
Polycythaemia secondary to erythropoietin secretion
renal cell cancer
minimal change disease light microscopy findings?
normal findings
fanconi syndrome CFs
(3 main)
type 2 (proximal) renal tubular acidosis,
rickets/osteomalacia, polyuria
Type 2 (proximal) renal tubular acidosis
polyuria
aminoaciduria
glycosuria
phosphaturia
osteomalacia
acute tubular necrosis
Urine osmolality < 350 mOsm/kg
Autosomal dominant polycystic kidney disease type 2 is caused by a gene mutation on which chromosome?
Chromosome 4
Huntington’s disease
autosomal dominant polycystic kidney disease type 2
diffuse proliferative glomerulonephritis on light microscopy
wire loop appearance
which type of antibiotic can cause acute interstitial nephritis
CFs
penicillin/ antibiotics
CFs triad of
eosinophilia
rash
fever
+ STERILE PYURIA, WHITE CELL CASTS
Autosomal dominant polycystic kidney disease type 1 caused by which chromosome
chromosome 16
What type of cancer is most associated with schistosomiasis?
SCC of bladder
nephrogenic DI gene mutation
causes of nephrogenic DI- electrolytes
avpr2 aquaporin 2
Hypercalcaemia
Hypo kalemia
Genetic
lithium
sickle cell
polycystic kidney disease cardic problem
mitral valve prolapse
Disorders associated with glomerulonephritis and low serum complement levels
-post-streptococcal glomerulonephritis
-subacute bacterial endocarditis
-systemic lupus erythematosus
-mesangiocapillary glomerulonephritis
post renal transplant RUQ pain and fever diagnosis l=most likely
CMV
bicalutamide MOA
androgen receptor blocker
foot processes on EMM
minimal change syndrome on electron microscopy
Tx minimal change syndrome
80% treated by prednisolone corticosteroid\
20% steroid resistant- treat with cyclophos[hamide
tolvaptan MOA and used for?
vasopressin receptor 2 antagonist
PCKD
nephrotic syndrome
CFs
associated bleeding problem
causes
Tx
CFs HOP
Hypoalbuminaemia
Oedema
Proteinuria
ass’d with antithrombin 3 deficiency
minimal change GN
membranous GN
Focal segmental GN
Amyloidosis
Diabetes
MINI MEMBERS FOCUS ON AMYS DIABETES
Tx- ACEi
nephritic syndrome
CFs
causes
CFs haematuria, HTN
Causes:
IgA
Alports
Rapid progressive GN
Renal vascular disease:
CFs
Ix gold standard
Tx
CFs
Flash pulmonary oedema- string of beads
HTN
Chronic renal failure
Ix of choice for Renal vascular disease= MR angiography
Tx= balloon angioplasty
HUS
triad of cfs
causes
Ix
tx
Triad of:
thrombocytopenia
microangiopathic haemolytic anaemia
AKI
Cause :
usually secondary to Ecoli infection , pneumococcal infec, HIV, SLE
Ix
FBC- thrombocytopaenia
low Hb , negative coombs test
U+E= AKI
stool culture
Mx= supportive
no need Abx
plasma exchange for PTS WITH NO DIARRHOEA
how to remember if renal stones are x ray opaque or not
all the ones that are OOOOOpaque contain an o (phosphate (incl stag horn struvite), oxalate),
radiolucent don’t have O (urate and xanthine)
remember that cystine are semi-opaque (the c looks like half an o)
mutation in the gene that encodes the aquaporin 2 channel causes/????
causes DI
how long does it take an V fistula develop
6-8 weeks
MOA bicalutamide used in prostate ca
Bicalutamide is an androgen recept blocker
how can APCKD affect the heart
Mitral valve prolapse
what medication out of tamsulosin or finasteride will DECREASE PSA (give false negative)
finasteride= 5ht REDUCtase will REDUCE psa
Which one of the following types of glomerulonephritis is most characteristically associated with streptococcal infection in children?
diffuse proliferative
d
causes of cranial DI
brain injury, pit adenoma, craniopharymgioma
histocytiosis
sarcoidosis
haemachromotasis
post brain surgery
what happens if you give too much 0.9% nacl VBG wise
hyperchloraemic met acid`
high calcium and renal stones to reduce stones
what decreases oxalate stones
thiazide- hypercalcium
cholestyramine= oxalate stones
common electryolyte complication of plasma exchange
hypocalcemia
how can alcohol bingeing affect ADH
Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria
how does ADH suppression affect urine
polyuria
Proteus mirabilis infection predisposes to ??type of kidney stone
STRUVITE staghorn
how does calcium resonium decrease k
increases excretion
spironolactone, aldosterone antag MOA
Inhibition of the mineralocorticoid receptor in the cortical collecting ducts
function of erythropoetin injections in CKD
improve exercise tolerance - does NOT improve renal function
amyloid biopsy findings
Congo red stain shows apple-green birefringence under polarised light
when does contrast nephropathy happen- time frame to develop
2-3 days
what is it important to co prescribe for 3 weeks when starting gosrelin
cyproterone acetate= steroid anti androgen
gosrelin= gnrh agonist
eGFR= what does the calculation depend on
and what affects and invalidates gfr calc
CAGE
creatinine, age, gender, ethnicity
invalidates: pregnancy, large muscle mass, red meat in 12 hrs
fibromuscular dysplasia
type of renal vascular disease
risk factors smoker, young female
poorly controlled HTN
assymmetric kidneys
FLASH PULM OEDEMA
pre renal uraemia vs ATN
Pre-renal uraemia
; Anything related to excretion is low (low urine sodium, low Fractional sodium excretion, low Fractional urea excretion)
Anything in a ratio is high (Serum urea:creatinine ratio, Urine:plasma osmolality, Urine:plasma urea)
HOW TO differentiaite between the 2 types of amyloidosis
AA AND AL
AA, A for autoimmune such as RA and SLE
AL for light chains (associated with WM, MM etc)
how long till finasteride starts takin effect
up to 6 months
heroin use risk factor for which type of renal condition
Heroin is a known cause of focal segmental glomerulosclerosis.
normal anion gap
A normal anion gap is 8-14 mmol/L
Causes of a normal anion gap or hyperchloraemic metabolic acidosiis
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
Raised anion gap causes
Raised anion gap
lactate:
shock
sepsis
hypoxia
ketones:
diabetic ketoacidosis
alcohol
urate: renal failure
acid poisoning: salicylates, methanol
how does gentamicin cause nephrotoxicity
proximal tubular dysfunction
what is c3 nephritic factor
anti C3BBBB antibody
HLA matching process
DR A B
DR > B > A
normal anion gap
10-18
normal anion gap met acid causes
AAA GR
Addisons
Acetazolomide
Ammonim chloride injection
GI loss (diarrhoea, ureterosigmoidostomy, fistrula)
Renal Tubular acidosis
what causes pseudoparathyroidism
target cell insensitivity to parathyroid hormone (PTH) due to a mutation in a G-protein
insulin stress test used for ?
diagnose hypopituitarism
paroxysmal nocturnal haematuria
acquired conditio n
CD55 AND CD59
CFs
haematuria - dark urine in the morning
pancytopenia
can develop aplastic anaemia
thrombosis
haemolytic anaemia
Ix = flow cytometry first line
also could do hams test
HTN and asymmetrical kidneys =
bIL small kidneys=?
renal artery stenosis
Bil small kidneys= renal papillary necrosis
HIV nephropathy
massive proteinuria
large kidneys
focal segmental glomerulosclerosis
elevated urea and creatinine
normotension
types of rapidly progressive GN
polyangitis and granulomatosis= wegners
nazis had moustaches gave them recurrent sinusitis
Anti basement membrane disease (good pastures)
recurrent UTIs in childhood= ?
vesicoureteric reflux
how does polycystic kidney disease affevt heart
MITRAL VALVE PROLAPSE
