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Nephrology > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Drugs causing acute interstitial nephritis

A

Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide

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2
Q

Non drug causes of acute interstitial nephritis

A

SLE
sarcoidosis
Sjogrens
Hanta virus, staph infections

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3
Q

Features of acute interstitial nephritis and investigations

A

Fever, rash, arthralgia
Eosinophilia
Mild renal impairment
HTN

Sterile pyuria
White cell casts

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4
Q

Tubulointerstitital nephritis with uveitis

A

Young females
Fever, weight loss, painful red eyes
Urinalysis- leucocytes and protein

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5
Q

Rhabdomyolysis and tumour lysis cause what type of aki?

A

Intrinsic (renal)

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6
Q

What drugs should be stopped in AKI?

A

NSAIDs (excluding 75mg aspirin)
Aminoglycosides
ACEi
ARB
Diuretics

Metformin
Lithium
Digoxin

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7
Q

Prerenal uraemia Vs acute tubular necrosis

A

Kidneys hold on to sodium to preserve volume
Higher urine osmolality, lower urine sodium
Good response to fluid challenge
Raised urea:creat

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8
Q

Brown granular casts in urine

A

Acute tubular necrosis

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9
Q

AKI diagnostic criteria

A

Creatinine rise 26 in 48h
or creatinine rise 50% in 7 days
Or urine output 0.5ml/kg/hour for 6 hours
Or 25% fall in egfr in children for 7 days

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10
Q

Stages of AKI according to creatinine rise

A

1: 1.5-1.9 x
2: 2-2.9 x
3: 3x

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11
Q

Stages of AKI according to urine output

A

1: < 0.5ml/kg/hour for 6h
2: < 0.5ml/kg/hour for 12h
3: < 0.3ml/kg/hour for 24h

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12
Q

When to refer AKI to nephrology?

A

Renal transplant
ITU patient and unknown cause of aki
Vasculitis/glomerulonephritis/tubulointerstitital nephritis/myeloma
AKI no known cause
Inadequate response to treatment
Complications of AKI
Stage 3
CKD stage 4/5

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13
Q

ADPKD genetics

A

Type 1- chromo 16
Type 2- chromo 4

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14
Q

USS diagnostic criteria for ADPKD

A

< 30y with 2 cysts
30-59y with 2 cysts both kidneys
> 60y with 4 cysts both kidneys

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15
Q

Managing ADPKD

A

Tolvaptan if already ckd3/4 and evidence of rapidly progressing disease

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16
Q

Features of ADPKD

A

HTN
Recurrent UTI
Flank pain
Haematuria
Palpable kidneys
Renal impairment
Renal stones

Liver cysts
Berry aneurysms
Mitral prolapse, aortic dilatation/dissection
Cysts in pancreas, spleen, thyroid, oesophagus, ovary

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17
Q

Alports genetics and pathology

A

X linked dominant
Defective type IV collagen
Results in abnormal GBM

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18
Q

Why might transplant fail in an alports patient?

A

Anti GBM antibodies
Leads to goodpastures like picture

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19
Q

Alports syndrome features

A

Presents in childhood
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa

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20
Q

Renal biopsy: splitting of lamina densa resulting in basket weave appearance

A

Alports syndrome

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21
Q

Components of amyloid

A

Fibrillar protein
Amyloid p component
Apoplipoprotein E
Heparin sulfate proteoglycans

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22
Q

Diagnosing amyloidosis

A

Apple green birefringence with Congo red staining
Serum amyloid precursor scan (SAP)
Biopsy of skin, rectal mucosa, abdo fat

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23
Q

Congo red staining: apple red birefringence

A

Amyloidosis

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24
Q

Most common type of amyloidosis

A

AL amyloidosis

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25
Q

Causes and features of AL amyloidosis

A

Myeloma, waldenstrom, MGUS

Nephrotic syndrome
Cardiac and neuro
Macroglossia
Periorbital eccymoses

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26
Q

What protein is involved AA amyloid?

A

Precursor serum amyloid A protein (acute phase reactant)

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27
Q

Causes and features of AA amyloid

A

TB, Bronchiectasis, RA

Renal involvement

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28
Q

Beta 2 microglobulin amyloidosis is associated with what?

A

Renal dialysis

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29
Q

How to calculate anion gap

A

(Na + K) - (HCO3 + Cl)

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30
Q

Normal anion gap

A

8-14

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31
Q

Causes of normal anion gap or hyperchloremic metabolic acidosis

A

GI bicarb loss
Renal tubular acidosis
Acetazolamide
Ammonium chloride injection
Addison’s disease

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32
Q

Causes of raised anion gap metabolic acidosis

A

Lactate (shock, hypoxia)
Ketones (ketoacidosis, alcohol)
Urate (renal failure(
Salicylates, methanol
5 ocoproline (chronic paracetamol use)

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33
Q

What is goodpastures syndrome?

A

Anti GBM disease
Small vessel vasculitis

AntiGBM abs against type IV collagen

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34
Q

HLA DR2 is associated with what?

A

AntiGBM

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35
Q

Features of antiGBM

A

Pulmonary haemorrhage
Rapidly progressive glomerulonephritis (rapid AKI, proteinuria, haematuria)

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36
Q

Renal biopsy: igG deposits along basement membrane

A

AntiGBM disease

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37
Q

Raised transfer factor secondary to pulmonary haemorrhage

A

AntiGBM disease

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38
Q

Managing AntiGBM disease

A

Plasma exchange
Steroids
Cyclophosphamide

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39
Q

ARPKD genetics

A

Less common than autosomal dominant
Chromo 6 fibrocystin

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40
Q

Diagnosing ARPKD

A

Prenatal uss or early infancy
Abdo masses and renal failure
End stage renal failure in childhood
Liver involvement

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41
Q

Renal biopsy: multiple cylindrical lesions perpendicular to cortical surface

A

ARPKD

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42
Q

Examples of alpha 1 antagonists

A

Tamsulosin
Alfuzosin

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43
Q

Managing BPH

A

Alpha 1 antagonists if mod-severe voiding symptoms
5 alpha reductase inhibitor if significantly enlarged and high risk of progression

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44
Q

Adverse effects of alpha 1 antagonists

A

Dizziness
Postural hypotension
Dry mouth
Depression

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45
Q

5 alpha reductase inhibitor side effects

A

ED, ejaculation problems
Gynaecomastia

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46
Q

Risk factors for transitional cell ca of bladder

A

Smoking
Aniline dyes
Rubber manufacture
Cyclophosphamide

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47
Q

Risk factors for squamous cell bladder ca

A

Schistosomiasis
Smoking

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48
Q

Calciphylaxis

A

Rare complication of end stage renal failure
Deposition of calcium in arterioles
Microvascular occlusion
Necrosis of tissue
Painful necrotic skin lesions

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49
Q

Risk of calciphylaxis is linked with what?

A

Hypercalcaemia
Hyperphosphataemia
Hyperparathyroidism
Warfarin may exacerbate

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50
Q

Causes of anaemia in renal failure

A

Reduced epo
Reduced epo due to toxic effects of uraemia
Reduced iron absorption
Anorexia/nausea
Reduced RBC survival
Blood loss from capillary fragility and poor platelet function
Stress ulceration

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51
Q

Managing anaemia in renal disease

A

Oral iron for those not on ESAs or haemodialysis
Switch to IV iron if not reached target Hb within 3 months
Patients on ESA/haemodialysis generally require IV iron
Target Hb 10-12

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52
Q

Bone disease in ckd

A

Low vit D
High po4
Low calcium
Secondary hyperparathyroidism

Osteitis fibrosa cystica
Osteomalacia
Reduction in bone cellular activity
Osteosclerosis
Osteoporosis

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53
Q

Causes of ckd

A

Diabetic nephropathy
Chronic glomerulonephritis
Chronic pyelonephritis
HTN
Adult polycystic kidney disease

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54
Q

What factors may affect eGFR?

A

Pregnancy
Muscle mass
Red meat 12h before sample

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55
Q

CKD stages

A

1: egfr > 90
2: 60-90
3a: 45-59
3b: 30-44
4: 15-29
5: < 15

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56
Q

Managing HTN in CKD

A

ACEi first line (can expect small rise in creatinine)
Egfr drop up to 25% or creatinine rise up to 30% acceptable
Furosemide useful egfr < 45

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57
Q

What is the issue with high phosphate?

A

Drags calcium from bones
Osteomalacia

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58
Q

Managing bone disease in ckd

A

Reduced dietary po4
Po4 binders
Vit D
Parathyroidectomy

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59
Q

Sevelamer

A

Non calcium based po4 binder
Also reduces uric acid levels and improves lipid profile

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60
Q

Interpreting ACR samples

A

First pass morning urine
Confirm with a subsequent sample if first one is 3-70

Refer:
ACR > 70
ACR > 30 and haematuria and no UTI
ACR 3-29 with haematuria and other risk factor e.g declining gfr or cvd

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61
Q

Managing proteinuria in CKD

A

ACEi or arb if ACR > 70 or ACR > 30 and HTN
SGLT2 inhibitor

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62
Q

How does SGLT2 inhibitor work?

A

Reduces glucose reabsorption at PCT
Reduces sodium reabsorption which causes natiuresis and reduces intravascular volume and BP
Increases sodium reaching macula densa which normalises tubuloglomerular feedback and reduces intraglomerular pressure

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63
Q

Features of chronic pyelonephritis

A

Blunted calyx
Corticomedullary scarring and atrophy of tubules
Eosinophilic casts in tubules

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64
Q

Hyperacute organ rejection

A

Occurs immediately
Preformed antibodies
Major HLA mismatch or ABO incompatibility

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65
Q

Acute organ rejection

A

Occurs in first 6 months
T cell mediated
Most cases can be managed medically

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66
Q

Chronic organ rejection

A

Occurs after first 6 months
Vascular changes predominate
Myointimal proliferation
Organ ischaemia

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67
Q

Features and treatment of renal artery thrombosis

A

Sudden complete loss of urine output

Immediate surgery

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68
Q

Features and treatment of renal artery stenosis

A

Uncontrolled HTN, oedema, allograft dysfunction

Angioplasty

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69
Q

Features and treatment of renal vein thrombosis

A

Pain and swelling over graft site
Haematuria
Oliguria

Graft usually needs removing

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70
Q

Features and management of urine leaks post transplant

A

Diminished urine output
Rising creatinine
Fever
Abdo pain

Anastamosis revision

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71
Q

Features and management of lymphocoele post transplant

A

May present as mass, may compress ureter

Drain

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72
Q

Cystinuria genetics

A

Autosomal recessive
Chromo 2 SLC3A1
Chromo 19 SLC7A9
Defect in COLA membrane transport (cystine, ornithine, lysine, arginine)

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73
Q

Features of cystinuria

A

Recurrent stones
Classically yellow crystalline, semi opaque on xr

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74
Q

Diagnosing cystinuria

A

Cyanide nitroprusside test

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75
Q

Managing cystinuria

A

Hydration
D penicillamine
Urinary alkalinisation

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76
Q

Causes of cranial diabetes insipidus

A

Idiopathic
Head injury
Pituitary surgery
Craniopharyngiomas
Histiocytosis X, sarcoidosis
DIDMOAD
haematochromatosis

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77
Q

Causes of nephrogenic diabetes insipidus

A

Genetic (ADH receptor or aquaporin 2 channel)
High Ca
Low K
Lithium
Demeclocyline
Tubulointerstitital disease

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78
Q

Managing diabetes insipidus

A

Nephrogenic: thiazides, low salt and protein diet
Cranial: desmopressin

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79
Q

Stages of diabetic nephropathy

A

1: hyperfiltration, increase gfr
2: gfr elevated, microalbuminaemia after several years
3: (incipient) microalbuminaemia 30-300 dip negative
4: (overt) proteinuria, HTN, glomerulosclerosis
5: end stage

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80
Q

Kimmelstiel Wilson modules

A

Stage 4 diabetic nephropathy

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81
Q

Unknown organism STI abx

A

Ceftriaxone 500mg IM
Doxycycline 100mg BD 10-14 days

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82
Q

EPO side effects

A

HTN
Bone aches
Flu like symptoms
Skin rashes, urticaria
Pure red cell aplasia
Raised pcv increases thrombosis risk
Iron deficiency

83
Q

Why might EPO therapy fail?

A

Iron deficiency
Inadequate dose
Concurrent infection/inflammation
Hyperparathyroid bone disease
Aluminium toxicity

84
Q

Fanconi syndromr

A

Reabsorption disorder in pct
Type 2 renal tubular acidosis
Polyuria
Aminoaciduria
Glycosuria
Phosphaturia
Osteomalacia

85
Q

Causes of fanconi syndrome

A

Cystinosis
Sjogrens
Multiple myeloma
Nephrotic syndrome
Wilsons

86
Q

Fibromuscular dysplasia features

A

Next most common cause of renovascular disease after atherosclerosis
HTN
CKD
Flash pulmonary oedema

87
Q

Maintenance fluid requirements

A

25-30ml/kg/day water
1mmol/kg/day K, Cl, Na
50-100g/day glucose

88
Q

Risk of giving lots of 0.9% saline

A

Hyperchloremic metabolic acidosis

89
Q

Causes of focal segmental glomerulosclerosis

A

Idiopathic
Other renal pathology (igA, reflux)
HIV
Heroin
Alports
Sickle cell

90
Q

Investigating and managing focal segmental glomerulosclerosis

A

Renal biopsy: hyalinosis, effacement if foot processes
Steroids/immunosuppressants
High rate of recurrence with transplants

91
Q

What can cause nephrotic syndrome?

A

Rapidly progressive glomerulonephritis (Incl goodpastures, ANCA)
IgA nephropathy (Berger’s, mesangioproliferative)
Alport

92
Q

IgA nephropathy features

A

Nephrotic syndrome
Haematuria
HTN
Young adult post URTI
overlap with HSP

93
Q

Nephrotic Vs nephritic syndrome

A

Nephrotic: proteinuria, oedema
Nephritic: haematuria, HTN

94
Q

What can cause mixed nephrotic/nephritic syndrome?

A

Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis

95
Q

Diffuse proliferative glomerulonephritis

A

Post strep
Nephritic syndrome/AKI

96
Q

Most common form of renal disease in SLE

A

Diffuse proliferative glomerulonephritis

97
Q

Membranoproliferative glomerulonephritis

A

Type 1: cryoglobulinemia, hep c
Type 2: partial lipodystrophy

Causes mixed nephrotic/nephritic

98
Q

Causes of nephrotic disease

A

Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulosclerosis
Amyloidosis
Diabetic nephropathy

99
Q

Causes of min change disease

A

NSAIDs
Hodgkin’s

100
Q

Causes of membranous glomerulonephritis

A

Infection
Malignancy
Rheumatoid drugs

101
Q

Membranous glomerulonephritis prognosis

A

1/3 resolve
1/3 respond to cytotoxics
1/3 develop ckd

102
Q

What conditions are associated with low complement and glomerulonephritis

A

Post strep GN
Subacute bacterial endocarditis
SLE
Membranoproliferative GN

103
Q

What drugs can cause red/orange urine?

A

Rifampicin
Doxorubicin

104
Q

Referral guidelines for haematuria

A

2WW:
> 45y and unexplained visible haematuria without UTI or persisting after UTI treatment

> 60y and unexplained non visible haematuria and dysuria or raised WBC on FBC

Non urgent:
> 60y recurrent or persistent UTI

105
Q

AKI + microangiopathic haemolytic anaemia + thrombocytopenia

A

Haemolytic uraemic syndrome

106
Q

What causes haemolytic uraemic syndrome?

A

Shiga producing ecoli 0157:H7
Pneumococcal
HIV
SLE, drugs, cancer

107
Q

Features of HSP

A

IgA mediated
Rash
Abdo pain
Polyarthritis
Features of iga nephropathy

108
Q

Haemolytic uraemic syndrome management

A

Plasma exchange if severe and no diarrhoea associated
Eculizumab C5 inhibitor

109
Q

What might precipitate intratubular crystal obstruction?

A

Indinavir

110
Q

Features of HIV associated nephropathy

A

Massive proteinuria, nephrotic syndrome
Normal/large kidneys
Focal segmental glomerulosclerosis
Elevated u+es
Normotension

111
Q

ECG changes in hyperkalaemia

A

Tall tented t
Loss of p
Broad qrs
Sinusoidal pattern

112
Q

What drugs might exacerbate hyperkalaemia?

A

ACEi

113
Q

IgA nephropay

A

Berger’s disease
Nephritic syndrome post URTI
Overlap with HSP
Mesangial hypercellularity

114
Q

IgA nephropathy Vs post strep GN

A

Post strep has low complement and main symptom is proteinuria
Typically interval between URTI and onset of renal problems with post strep

115
Q

IgA nephropathy associated conditions

A

HSP
Alcoholic cirrhosis
Coeliac
Dermatitis herpetiformis

116
Q

Managing IgA nephropathy

A

Conservative if normal gfr and minimal proteinuria
ACEi if persistent proteinuria, normal or slightly reduced gfr
Immunosuppression if falling gfr

117
Q

Managing urinary voiding symptoms in men

A

Moderate/severe: alpha blocker
Prostate enlarged and risk of progression: 5alpha reductase inhibitor
Enlarged prostate and mod/severe symptoms: alpha blocker + 5alpha reductase inhibitor

118
Q

Managing overactive bladder in men

A

Bladder retraining
Antimuscarinics (oxybutynin, tolterodine, darifenacin)
Mirabegron

119
Q

Type 1 membranoproliferative GN

A

Nephrotic/nephritic picture
Cryoglobulinemia, hep c
Biopsy: subendothelial and mesangium immune deposits, tram track appearance

120
Q

Type 2 membranoproliferative GN

A

Nephrotic/nephritic picture
Partial lipodystrophy, low factor H
Low C3
Biopsy: intramembranous immune deposits

121
Q

C3b nephritic factor

A

Membranoproliferative GN type 2

122
Q

Causes of type 3 membranoproliferative GN

A

Hep B, C

123
Q

What is the commonest type of GN in adults?

A

Membranous GN

124
Q

BM thickened with subepithelial electron dense deposits- spike and dome appearance

A

Membranous glomerulonephritis

125
Q

Anti phospholipase A2 antibodies

A

Membranous glomerulonephritis

126
Q

What drugs can cause membranous glomerulonephritis

A

Gold
Penicillamine
NSAIDs

127
Q

Managing membranous glomerulonephritis

A

ACEi or arb
Corticosteroids+ cyclophosphamide if severe/progressive
Anticoagulation if high risk

128
Q

Causes of minimal change disease

A

Idiopathic
NSAIDs
Rifampicin
Hodgkin’s, thymoma
EBV

129
Q

Min change disease pathology

A

T cells and cytokines mediate damage to BM
Polyanion loss
Increased permeability to albumin

130
Q

Fusion of podocytes and effacement of foot processes

A

Minimal change disease

131
Q

Managing min change diseasd

A

PO corticosteroids (80% respond)
Cyclophosphamide

132
Q

Min change disease prognosis

A

1/3 just one episode
1/3 infrequent relapses
1/3 frequent relapses stopping before adulthood

133
Q

Complications of nephrotic syndrome

A

Thromboembolism (loss of antithrombin III and plasminogen)
Hyperlipidemia
CKD
Infection
Hypocalcemia

134
Q

How to manage patients high risk for contrast induced nephropathy?

A

Withhold Metformin 48hours
0.9% saline 1mg/kg/hour for 12 hours pre and post procedure

135
Q

Causes of papillary necrosis

A

Chronic analgesia
Sickle cell
TB
Acute pyelonephritis
Diabetes

136
Q

Antibiotics for dialysis

A

Vanc + ceftazidime
Or
Vanc + PO cipro

137
Q

Indications for plasma exchange

A

Guillain barre
Myasthenia gravis
Goodpastures
ANCA vasculitis
Ttp/hus
Cryoglobulinemia
Hyperviscosity

138
Q

Complications of plasma exchange

A

Hypocalcaemia due to citrate
Metabolic alkalosis
Removal of systemic meds
Coag factor and immunoglobulins depletion

139
Q

What immune complexes are involved in post strep GN?

A

IgG
IgM
C3

140
Q

Subepithelial humps of lumpy immune complex deposits
Granular or starry sky immunofluorescence

A

Post strep GN

141
Q

Loss of nuclei and detachment of tubular cells from BM

A

Acute tubular necrosis

142
Q

Alkaptonuria pathology

A

Autosomal recessive
Lack of homogentisic dioxygenase
Disordered tyrosine and phenylalanine metabolism
Build up of homogentisic acid

143
Q

Alkaptonuria features and management

A

Black urine
Pigmented sclera
Back pain from disc calcification
Renal stones

High dose vit D
Low dietary phenylalanine and tyrosine

144
Q

How does angiotensin II affect ADH?

A

Increases secretion

145
Q

How does temperature affect ADH?

A

Reduces secretion

146
Q

Where is ADH made and stored?

A

Made in supraoptic nuclei of hypothalamus
Secreted by posterior pituitary

147
Q

Kimmelstiel Wilson nodules

A

Diabetic nephropathy

148
Q

hormone therapy for prostate ca

A

GnRH agonist (gosrelin)- causes rise then fall of androgens
use anti androgen for first couple weeks to counteract androgen rise
bicalutamide
cyproterone acetate
abiraterone

149
Q

bicalutamide

A

non steroidal anti androgen

150
Q

cyproterone acetate

A

steroidal anti androgen
prevents DHT binding

151
Q

abiratone

A

androgen synthesis inhibitor

152
Q

chemotherapy for prostate ca

A

docetaxel

153
Q

PSA upper limits

A

50-59y: 3
60-69y: 4
> 70y: 5

154
Q

causes of rapidly progressive glomerulonephritis

A

goodpastures
wegeners
microscopic polyarteritis
SLE

155
Q

features of rapidly progressive glomerulonephritis

A

nephritic syndrome
epithelial crescents in glomeruli

156
Q

where does renal cell ca arise from ?

A

proximal tubular epithelium

157
Q

renal cell ca associations

A

von hippel lindau
tuberous sclerosis
smoking
ADPCKD

158
Q

features of renal cell ca

A

haematuria, loin pain, abdo mass
pyrexia
endocrine effects
paraneoplastic hepatic dysfunction
varicocoele
stauffer syndrome

159
Q

endocrine effects of renal ca

A

EPO
PTHrP
renin
ACTH

160
Q

stauffer syndrome

A

paraneoplastic disorder associated with renal cell ca
cholestasis/hepatosplenomegaly
increased IL6

161
Q

renal cell ca staging

A

T1 < 7cm
T2 > 7cm confined to kidney
T3 extends to major veins or perinephric tissues but not into adrenal gland or beyond gerota’s fascia
T4 beyond gerota’s fascia

162
Q

renal cell ca treatment

A

nephrectomy for T1
alpha IFN and IL2 to reduce size and treat mets
receptor tyrosine kinase inhibitors (sorafenib, sunitinib)

163
Q

imaging for renal stones

A

non contrast CTKUB within 14h
immediate CTKUB if fever/solitary kidney or uncertain diagnosis

164
Q

treatment of renal stones

A

< 2cm lithotripsy
< 2cm and pregnant uteroscopy
complex stone and staghorn percutaneous nephrolithotomy
< 5mm conservative

165
Q

preventing calcium stones

A

fluid intake
low animal protein
thiazides

166
Q

preventing oxalate stones

A

cholestyramine
pyridoxine

167
Q

preventing uric acid stones

A

allopurinol
bicarb

168
Q

what drugs can promote calcium stones?

A

loop diuretics
steroids
acetazolamide
theophylline

169
Q

which chromosome is HLA on?

A

6

170
Q

which HLA antigens are most important for matching a transplant?

A

DR > B > A

171
Q

ciclosporin mechanism

A

inhibits calcineurin, phosphatase involved in T cell activation

172
Q

tacrolimus vs ciclosporin

A

lower incidence of acute rejection
less HTN and hyperlipidaemia
higher incidence impaired glucose tolerance

173
Q

mycophenolate mofetil mechanism

A

inhibits IMPDH, blocks purine synthesis
inhibits B and T proliferation

174
Q

sirolimus mechanism

A

blocks IL2 receptor
blocks T proliferation

175
Q

monoclonal abs mechanism for immunosuppresion

A

IL2 receptor inhibitors
daclizumab, basiliximab

176
Q

string of beads on angiography

A

fibromuscular dysplasia

177
Q

investigating renal vascular disease

A

MR angio
CT angio

178
Q

retroperitoneal fibrosis is associated with what?

A

riedels thyroiditis
radiotherapy
sarcoidosis
inflammatory AAA
methysergide

179
Q

features of rhabdomyolysis

A

CK 5x upper limit of normal
AKI
myoglobinuria
hypocalcaemia
elevated PO4
hyperkalaemia
metabolic acidosis

180
Q

why do you get hypocalcaemia in rhabdomyolysis?

A

myoglobin binds calcium and is raised in rhabdo

181
Q

what is associated with epididymal cysts?

A

PCKD
CF
VHL

182
Q

hydrocoeles may develop secondary to what?

A

epididymo-orchitis
testicular torsion
testicular tumour

183
Q

classes of SLE lupus nephritis

A

1: normal
2: mesangial glomerulonephritis
3: focal segmental proliferative GN
4: diffuse proliferative GN
5: diffuse membranous GN
6: sclerosing GN

184
Q

most common class of lupus nephritis

A

4 (diffuse proliferative GN)
also most severe

185
Q

endothelial and mesangial proliferation, wire loop appearance of glomeruli
subendothelial immune complex deposits on electron microscopy

A

diffuse proliferative GN

186
Q

managing lupus nephritis

A

treat HTN
glucocorticoids and mycophenolate or cyclophosphamide for class 3 and 4

187
Q

germ cell testicular tumours

A

seminomas
embyronal
yolk sac
teratoma
choriocarcinoma

188
Q

non germ cell testicular tumours

A

leydig
sarcoma

189
Q

risk factors for testicular ca

A

infertility
cryptorchidism
FHx
klinefelters
mumps orchitis

190
Q

why does gynaecomastia occur in testicular ca?

A

raised oestrogen:androgen ratio
germ cell tumours secrete HCG
leydig tumours convert androgen precursors to oestrogens

191
Q

hCG is a marker of what?

A

seminoma

192
Q

AFP and beta hCG are markers of what?

A

non seminomas

193
Q

LDH is marker of what?

A

germ cell tumour

194
Q

thin basement membrane disease is a disorder of what?

A

type IV collagen

195
Q

features of thin BM disease

A

persistent haematuria and normal kidney function

196
Q

renal scar may produce what?

A

increased renin which causes HTN

197
Q

investigating vesicoureteric reflux

A

micturating cystourethrogram
DMSA scan for renal scarring

198
Q

grading of vesicoureteric reflux

A

1: reflux into ureter, no dilatation
2: reflux into pelvis, no dilatation
3: dilatation of ureter, pelvis, calyces
4: dilatation of pelvis and calyces with moderate ureteral tortuosity
5: gross dilatation of ureter, pelvis, calyces, ureteral tortuosity

199
Q

wilms tumour

A

nephroblastoma
typically child < 5y
abdo pass, painless haematuria, flank pain

200
Q

managing wilms tumour

A

nephrectomy
chemo
radiotherapy
80% cure rate

201
Q

foamy macrophages

A

xanthogranulomatous pyelonephritis

202
Q

tolvaptan mechanism

A

vasopressin 2 receptor antagonist

203
Q

antiphospholipase A2 antibodies

A

membranous GN

Nephrology (2 decks)

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