Nephrology Flashcards
1
Q
Drugs causing acute interstitial nephritis
A
Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide
2
Q
Non drug causes of acute interstitial nephritis
A
SLE
sarcoidosis
Sjogrens
Hanta virus, staph infections
3
Q
Features of acute interstitial nephritis and investigations
A
Fever, rash, arthralgia
Eosinophilia
Mild renal impairment
HTN
Sterile pyuria
White cell casts
4
Q
Tubulointerstitital nephritis with uveitis
A
Young females
Fever, weight loss, painful red eyes
Urinalysis- leucocytes and protein
5
Q
Rhabdomyolysis and tumour lysis cause what type of aki?
A
Intrinsic (renal)
6
Q
What drugs should be stopped in AKI?
A
NSAIDs (excluding 75mg aspirin)
Aminoglycosides
ACEi
ARB
Diuretics
Metformin
Lithium
Digoxin
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
8
Q
Brown granular casts in urine
A
Acute tubular necrosis
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
10
Q
Stages of AKI according to creatinine rise
A
1: 1.5-1.9 x
2: 2-2.9 x
3: 3x
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
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
13
Q
ADPKD genetics
A
Type 1- chromo 16
Type 2- chromo 4
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
15
Q
Managing ADPKD
A
Tolvaptan if already ckd3/4 and evidence of rapidly progressing disease
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
17
Q
Alports genetics and pathology
A
X linked dominant
Defective type IV collagen
Results in abnormal GBM
18
Q
Why might transplant fail in an alports patient?
A
Anti GBM antibodies
Leads to goodpastures like picture
19
Q
Alports syndrome features
A
Presents in childhood
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa
20
Q
Renal biopsy: splitting of lamina densa resulting in basket weave appearance
A
Alports syndrome
21
Q
Components of amyloid
A
Fibrillar protein
Amyloid p component
Apoplipoprotein E
Heparin sulfate proteoglycans
22
Q
Diagnosing amyloidosis
A
Apple green birefringence with Congo red staining
Serum amyloid precursor scan (SAP)
Biopsy of skin, rectal mucosa, abdo fat
23
Q
Congo red staining: apple red birefringence
A
Amyloidosis
24
Q
Most common type of amyloidosis
A
AL amyloidosis
25
Causes and features of AL amyloidosis
Myeloma, waldenstrom, MGUS
Nephrotic syndrome
Cardiac and neuro
Macroglossia
Periorbital eccymoses
26
What protein is involved AA amyloid?
Precursor serum amyloid A protein (acute phase reactant)
27
Causes and features of AA amyloid
TB, Bronchiectasis, RA
Renal involvement
28
Beta 2 microglobulin amyloidosis is associated with what?
Renal dialysis
29
How to calculate anion gap
(Na + K) - (HCO3 + Cl)
30
Normal anion gap
8-14
31
Causes of normal anion gap or hyperchloremic metabolic acidosis
GI bicarb loss
Renal tubular acidosis
Acetazolamide
Ammonium chloride injection
Addison's disease
32
Causes of raised anion gap metabolic acidosis
Lactate (shock, hypoxia)
Ketones (ketoacidosis, alcohol)
Urate (renal failure(
Salicylates, methanol
5 ocoproline (chronic paracetamol use)
33
What is goodpastures syndrome?
Anti GBM disease
Small vessel vasculitis
AntiGBM abs against type IV collagen
34
HLA DR2 is associated with what?
AntiGBM
35
Features of antiGBM
Pulmonary haemorrhage
Rapidly progressive glomerulonephritis (rapid AKI, proteinuria, haematuria)
36
Renal biopsy: igG deposits along basement membrane
AntiGBM disease
37
Raised transfer factor secondary to pulmonary haemorrhage
AntiGBM disease
38
Managing AntiGBM disease
Plasma exchange
Steroids
Cyclophosphamide
39
ARPKD genetics
Less common than autosomal dominant
Chromo 6 fibrocystin
40
Diagnosing ARPKD
Prenatal uss or early infancy
Abdo masses and renal failure
End stage renal failure in childhood
Liver involvement
41
Renal biopsy: multiple cylindrical lesions perpendicular to cortical surface
ARPKD
42
Examples of alpha 1 antagonists
Tamsulosin
Alfuzosin
43
Managing BPH
Alpha 1 antagonists if mod-severe voiding symptoms
5 alpha reductase inhibitor if significantly enlarged and high risk of progression
44
Adverse effects of alpha 1 antagonists
Dizziness
Postural hypotension
Dry mouth
Depression
45
5 alpha reductase inhibitor side effects
ED, ejaculation problems
Gynaecomastia
46
Risk factors for transitional cell ca of bladder
Smoking
Aniline dyes
Rubber manufacture
Cyclophosphamide
47
Risk factors for squamous cell bladder ca
Schistosomiasis
Smoking
48
Calciphylaxis
Rare complication of end stage renal failure
Deposition of calcium in arterioles
Microvascular occlusion
Necrosis of tissue
Painful necrotic skin lesions
49
Risk of calciphylaxis is linked with what?
Hypercalcaemia
Hyperphosphataemia
Hyperparathyroidism
Warfarin may exacerbate
50
Causes of anaemia in renal failure
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
51
Managing anaemia in renal disease
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
52
Bone disease in ckd
Low vit D
High po4
Low calcium
Secondary hyperparathyroidism
Osteitis fibrosa cystica
Osteomalacia
Reduction in bone cellular activity
Osteosclerosis
Osteoporosis
53
Causes of ckd
Diabetic nephropathy
Chronic glomerulonephritis
Chronic pyelonephritis
HTN
Adult polycystic kidney disease
54
What factors may affect eGFR?
Pregnancy
Muscle mass
Red meat 12h before sample
55
CKD stages
1: egfr > 90
2: 60-90
3a: 45-59
3b: 30-44
4: 15-29
5: < 15
56
Managing HTN in CKD
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
57
What is the issue with high phosphate?
Drags calcium from bones
Osteomalacia
58
Managing bone disease in ckd
Reduced dietary po4
Po4 binders
Vit D
Parathyroidectomy
59
Sevelamer
Non calcium based po4 binder
Also reduces uric acid levels and improves lipid profile
60
Interpreting ACR samples
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
61
Managing proteinuria in CKD
ACEi or arb if ACR > 70 or ACR > 30 and HTN
SGLT2 inhibitor
62
How does SGLT2 inhibitor work?
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
63
Features of chronic pyelonephritis
Blunted calyx
Corticomedullary scarring and atrophy of tubules
Eosinophilic casts in tubules
64
Hyperacute organ rejection
Occurs immediately
Preformed antibodies
Major HLA mismatch or ABO incompatibility
65
Acute organ rejection
Occurs in first 6 months
T cell mediated
Most cases can be managed medically
66
Chronic organ rejection
Occurs after first 6 months
Vascular changes predominate
Myointimal proliferation
Organ ischaemia
67
Features and treatment of renal artery thrombosis
Sudden complete loss of urine output
Immediate surgery
68
Features and treatment of renal artery stenosis
Uncontrolled HTN, oedema, allograft dysfunction
Angioplasty
69
Features and treatment of renal vein thrombosis
Pain and swelling over graft site
Haematuria
Oliguria
Graft usually needs removing
70
Features and management of urine leaks post transplant
Diminished urine output
Rising creatinine
Fever
Abdo pain
Anastamosis revision
71
Features and management of lymphocoele post transplant
May present as mass, may compress ureter
Drain
72
Cystinuria genetics
Autosomal recessive
Chromo 2 SLC3A1
Chromo 19 SLC7A9
Defect in COLA membrane transport (cystine, ornithine, lysine, arginine)
73
Features of cystinuria
Recurrent stones
Classically yellow crystalline, semi opaque on xr
74
Diagnosing cystinuria
Cyanide nitroprusside test
75
Managing cystinuria
Hydration
D penicillamine
Urinary alkalinisation
76
Causes of cranial diabetes insipidus
Idiopathic
Head injury
Pituitary surgery
Craniopharyngiomas
Histiocytosis X, sarcoidosis
DIDMOAD
haematochromatosis
77
Causes of nephrogenic diabetes insipidus
Genetic (ADH receptor or aquaporin 2 channel)
High Ca
Low K
Lithium
Demeclocyline
Tubulointerstitital disease
78
Managing diabetes insipidus
Nephrogenic: thiazides, low salt and protein diet
Cranial: desmopressin
79
Stages of diabetic nephropathy
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
80
Kimmelstiel Wilson modules
Stage 4 diabetic nephropathy
81
Unknown organism STI abx
Ceftriaxone 500mg IM
Doxycycline 100mg BD 10-14 days
82
EPO side effects
HTN
Bone aches
Flu like symptoms
Skin rashes, urticaria
Pure red cell aplasia
Raised pcv increases thrombosis risk
Iron deficiency
83
Why might EPO therapy fail?
Iron deficiency
Inadequate dose
Concurrent infection/inflammation
Hyperparathyroid bone disease
Aluminium toxicity
84
Fanconi syndromr
Reabsorption disorder in pct
Type 2 renal tubular acidosis
Polyuria
Aminoaciduria
Glycosuria
Phosphaturia
Osteomalacia
85
Causes of fanconi syndrome
Cystinosis
Sjogrens
Multiple myeloma
Nephrotic syndrome
Wilsons
86
Fibromuscular dysplasia features
Next most common cause of renovascular disease after atherosclerosis
HTN
CKD
Flash pulmonary oedema
87
Maintenance fluid requirements
25-30ml/kg/day water
1mmol/kg/day K, Cl, Na
50-100g/day glucose
88
Risk of giving lots of 0.9% saline
Hyperchloremic metabolic acidosis
89
Causes of focal segmental glomerulosclerosis
Idiopathic
Other renal pathology (igA, reflux)
HIV
Heroin
Alports
Sickle cell
90
Investigating and managing focal segmental glomerulosclerosis
Renal biopsy: hyalinosis, effacement if foot processes
Steroids/immunosuppressants
High rate of recurrence with transplants
91
What can cause nephrotic syndrome?
Rapidly progressive glomerulonephritis (Incl goodpastures, ANCA)
IgA nephropathy (Berger's, mesangioproliferative)
Alport
92
IgA nephropathy features
Nephrotic syndrome
Haematuria
HTN
Young adult post URTI
overlap with HSP
93
Nephrotic Vs nephritic syndrome
Nephrotic: proteinuria, oedema
Nephritic: haematuria, HTN
94
What can cause mixed nephrotic/nephritic syndrome?
Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis
95
Diffuse proliferative glomerulonephritis
Post strep
Nephritic syndrome/AKI
96
Most common form of renal disease in SLE
Diffuse proliferative glomerulonephritis
97
Membranoproliferative glomerulonephritis
Type 1: cryoglobulinemia, hep c
Type 2: partial lipodystrophy
Causes mixed nephrotic/nephritic
98
Causes of nephrotic disease
Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulosclerosis
Amyloidosis
Diabetic nephropathy
99
Causes of min change disease
NSAIDs
Hodgkin's
100
Causes of membranous glomerulonephritis
Infection
Malignancy
Rheumatoid drugs
101
Membranous glomerulonephritis prognosis
1/3 resolve
1/3 respond to cytotoxics
1/3 develop ckd
102
What conditions are associated with low complement and glomerulonephritis
Post strep GN
Subacute bacterial endocarditis
SLE
Membranoproliferative GN
103
What drugs can cause red/orange urine?
Rifampicin
Doxorubicin
104
Referral guidelines for haematuria
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
AKI + microangiopathic haemolytic anaemia + thrombocytopenia
Haemolytic uraemic syndrome
106
What causes haemolytic uraemic syndrome?
Shiga producing ecoli 0157:H7
Pneumococcal
HIV
SLE, drugs, cancer
107
Features of HSP
IgA mediated
Rash
Abdo pain
Polyarthritis
Features of iga nephropathy
108
Haemolytic uraemic syndrome management
Plasma exchange if severe and no diarrhoea associated
Eculizumab C5 inhibitor
109
What might precipitate intratubular crystal obstruction?
Indinavir
110
Features of HIV associated nephropathy
Massive proteinuria, nephrotic syndrome
Normal/large kidneys
Focal segmental glomerulosclerosis
Elevated u+es
Normotension
111
ECG changes in hyperkalaemia
Tall tented t
Loss of p
Broad qrs
Sinusoidal pattern
112
What drugs might exacerbate hyperkalaemia?
ACEi
113
IgA nephropay
Berger's disease
Nephritic syndrome post URTI
Overlap with HSP
Mesangial hypercellularity
114
IgA nephropathy Vs post strep GN
Post strep has low complement and main symptom is proteinuria
Typically interval between URTI and onset of renal problems with post strep
115
IgA nephropathy associated conditions
HSP
Alcoholic cirrhosis
Coeliac
Dermatitis herpetiformis
116
Managing IgA nephropathy
Conservative if normal gfr and minimal proteinuria
ACEi if persistent proteinuria, normal or slightly reduced gfr
Immunosuppression if falling gfr
117
Managing urinary voiding symptoms in men
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
Managing overactive bladder in men
Bladder retraining
Antimuscarinics (oxybutynin, tolterodine, darifenacin)
Mirabegron
119
Type 1 membranoproliferative GN
Nephrotic/nephritic picture
Cryoglobulinemia, hep c
Biopsy: subendothelial and mesangium immune deposits, tram track appearance
120
Type 2 membranoproliferative GN
Nephrotic/nephritic picture
Partial lipodystrophy, low factor H
Low C3
Biopsy: intramembranous immune deposits
121
C3b nephritic factor
Membranoproliferative GN type 2
122
Causes of type 3 membranoproliferative GN
Hep B, C
123
What is the commonest type of GN in adults?
Membranous GN
124
BM thickened with subepithelial electron dense deposits- spike and dome appearance
Membranous glomerulonephritis
125
Anti phospholipase A2 antibodies
Membranous glomerulonephritis
126
What drugs can cause membranous glomerulonephritis
Gold
Penicillamine
NSAIDs
127
Managing membranous glomerulonephritis
ACEi or arb
Corticosteroids+ cyclophosphamide if severe/progressive
Anticoagulation if high risk
128
Causes of minimal change disease
Idiopathic
NSAIDs
Rifampicin
Hodgkin's, thymoma
EBV
129
Min change disease pathology
T cells and cytokines mediate damage to BM
Polyanion loss
Increased permeability to albumin
130
Fusion of podocytes and effacement of foot processes
Minimal change disease
131
Managing min change diseasd
PO corticosteroids (80% respond)
Cyclophosphamide
132
Min change disease prognosis
1/3 just one episode
1/3 infrequent relapses
1/3 frequent relapses stopping before adulthood
133
Complications of nephrotic syndrome
Thromboembolism (loss of antithrombin III and plasminogen)
Hyperlipidemia
CKD
Infection
Hypocalcemia
134
How to manage patients high risk for contrast induced nephropathy?
Withhold Metformin 48hours
0.9% saline 1mg/kg/hour for 12 hours pre and post procedure
135
Causes of papillary necrosis
Chronic analgesia
Sickle cell
TB
Acute pyelonephritis
Diabetes
136
Antibiotics for dialysis
Vanc + ceftazidime
Or
Vanc + PO cipro
137
Indications for plasma exchange
Guillain barre
Myasthenia gravis
Goodpastures
ANCA vasculitis
Ttp/hus
Cryoglobulinemia
Hyperviscosity
138
Complications of plasma exchange
Hypocalcaemia due to citrate
Metabolic alkalosis
Removal of systemic meds
Coag factor and immunoglobulins depletion
139
What immune complexes are involved in post strep GN?
IgG
IgM
C3
140
Subepithelial humps of lumpy immune complex deposits
Granular or starry sky immunofluorescence
Post strep GN
141
Loss of nuclei and detachment of tubular cells from BM
Acute tubular necrosis
142
Alkaptonuria pathology
Autosomal recessive
Lack of homogentisic dioxygenase
Disordered tyrosine and phenylalanine metabolism
Build up of homogentisic acid
143
Alkaptonuria features and management
Black urine
Pigmented sclera
Back pain from disc calcification
Renal stones
High dose vit D
Low dietary phenylalanine and tyrosine
144
How does angiotensin II affect ADH?
Increases secretion
145
How does temperature affect ADH?
Reduces secretion
146
Where is ADH made and stored?
Made in supraoptic nuclei of hypothalamus
Secreted by posterior pituitary
147
Kimmelstiel Wilson nodules
Diabetic nephropathy
148
hormone therapy for prostate ca
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
bicalutamide
non steroidal anti androgen
150
cyproterone acetate
steroidal anti androgen
prevents DHT binding
151
abiratone
androgen synthesis inhibitor
152
chemotherapy for prostate ca
docetaxel
153
PSA upper limits
50-59y: 3
60-69y: 4
> 70y: 5
154
causes of rapidly progressive glomerulonephritis
goodpastures
wegeners
microscopic polyarteritis
SLE
155
features of rapidly progressive glomerulonephritis
nephritic syndrome
epithelial crescents in glomeruli
156
where does renal cell ca arise from ?
proximal tubular epithelium
157
renal cell ca associations
von hippel lindau
tuberous sclerosis
smoking
ADPCKD
158
features of renal cell ca
haematuria, loin pain, abdo mass
pyrexia
endocrine effects
paraneoplastic hepatic dysfunction
varicocoele
stauffer syndrome
159
endocrine effects of renal ca
EPO
PTHrP
renin
ACTH
160
stauffer syndrome
paraneoplastic disorder associated with renal cell ca
cholestasis/hepatosplenomegaly
increased IL6
161
renal cell ca staging
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
renal cell ca treatment
nephrectomy for T1
alpha IFN and IL2 to reduce size and treat mets
receptor tyrosine kinase inhibitors (sorafenib, sunitinib)
163
imaging for renal stones
non contrast CTKUB within 14h
immediate CTKUB if fever/solitary kidney or uncertain diagnosis
164
treatment of renal stones
< 2cm lithotripsy
< 2cm and pregnant uteroscopy
complex stone and staghorn percutaneous nephrolithotomy
< 5mm conservative
165
preventing calcium stones
fluid intake
low animal protein
thiazides
166
preventing oxalate stones
cholestyramine
pyridoxine
167
preventing uric acid stones
allopurinol
bicarb
168
what drugs can promote calcium stones?
loop diuretics
steroids
acetazolamide
theophylline
169
which chromosome is HLA on?
6
170
which HLA antigens are most important for matching a transplant?
DR > B > A
171
ciclosporin mechanism
inhibits calcineurin, phosphatase involved in T cell activation
172
tacrolimus vs ciclosporin
lower incidence of acute rejection
less HTN and hyperlipidaemia
higher incidence impaired glucose tolerance
173
mycophenolate mofetil mechanism
inhibits IMPDH, blocks purine synthesis
inhibits B and T proliferation
174
sirolimus mechanism
blocks IL2 receptor
blocks T proliferation
175
monoclonal abs mechanism for immunosuppresion
IL2 receptor inhibitors
daclizumab, basiliximab
176
string of beads on angiography
fibromuscular dysplasia
177
investigating renal vascular disease
MR angio
CT angio
178
retroperitoneal fibrosis is associated with what?
riedels thyroiditis
radiotherapy
sarcoidosis
inflammatory AAA
methysergide
179
features of rhabdomyolysis
CK 5x upper limit of normal
AKI
myoglobinuria
hypocalcaemia
elevated PO4
hyperkalaemia
metabolic acidosis
180
why do you get hypocalcaemia in rhabdomyolysis?
myoglobin binds calcium and is raised in rhabdo
181
what is associated with epididymal cysts?
PCKD
CF
VHL
182
hydrocoeles may develop secondary to what?
epididymo-orchitis
testicular torsion
testicular tumour
183
classes of SLE lupus nephritis
1: normal
2: mesangial glomerulonephritis
3: focal segmental proliferative GN
4: diffuse proliferative GN
5: diffuse membranous GN
6: sclerosing GN
184
most common class of lupus nephritis
4 (diffuse proliferative GN)
also most severe
185
endothelial and mesangial proliferation, wire loop appearance of glomeruli
subendothelial immune complex deposits on electron microscopy
diffuse proliferative GN
186
managing lupus nephritis
treat HTN
glucocorticoids and mycophenolate or cyclophosphamide for class 3 and 4
187
germ cell testicular tumours
seminomas
embyronal
yolk sac
teratoma
choriocarcinoma
188
non germ cell testicular tumours
leydig
sarcoma
189
risk factors for testicular ca
infertility
cryptorchidism
FHx
klinefelters
mumps orchitis
190
why does gynaecomastia occur in testicular ca?
raised oestrogen:androgen ratio
germ cell tumours secrete HCG
leydig tumours convert androgen precursors to oestrogens
191
hCG is a marker of what?
seminoma
192
AFP and beta hCG are markers of what?
non seminomas
193
LDH is marker of what?
germ cell tumour
194
thin basement membrane disease is a disorder of what?
type IV collagen
195
features of thin BM disease
persistent haematuria and normal kidney function
196
renal scar may produce what?
increased renin which causes HTN
197
investigating vesicoureteric reflux
micturating cystourethrogram
DMSA scan for renal scarring
198
grading of vesicoureteric reflux
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
wilms tumour
nephroblastoma
typically child < 5y
abdo pass, painless haematuria, flank pain
200
managing wilms tumour
nephrectomy
chemo
radiotherapy
80% cure rate
201
foamy macrophages
xanthogranulomatous pyelonephritis
202
tolvaptan mechanism
vasopressin 2 receptor antagonist
203
antiphospholipase A2 antibodies
membranous GN
