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FCPS Preperation > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Nerve supply of Urinary Bladder

A

Sympathetic: T10- L2 = Detrusor muscle relaxation + Bladder neck contraction
Parasympathetic: S2- S4= Detrusor muscle contraction + inhibit internal sphincter
Somatic: S2- S4= External Sphincter control

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2
Q

GFR measured Directly by

A
  1. Inulin
  2. EDTA

Though it’s not performed routinely usually reserved for special circumstances such as assessment of kidney function in potential live kidney donor

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3
Q

What are the factors affecting GFR

A
  1. S. Creatinine
  2. Age
  3. Gender
  4. Ethnicity

CAGE

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4
Q

GFR over- estimate in?

A

Patient with low muscle mass e.g. cachexia, amputees

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5
Q

eGFR is not valid in

A
  • Assessing AKI
  • Under 18s
  • During pregnancy
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6
Q

What are the dynamic tests of tubular function?

A
  1. Concentrating ability
  2. Ability to excrete water load
  3. Ability to excrete acid
  4. Calculation of fractional calcium, phosphate, sodium
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7
Q

Which test is used to differentiate between pre-renal uraemia (volume depletion) and ATN in AKI?

A

FENa typically less than 1.0 in volume depletion and more than 1.0 in ATN

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8
Q

Feature of CKD + raised ALP dx?

A

Renal Osteodystrophy

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9
Q

Urea level increased in?

A

CKD
High protein intake
GI Haemorrhage
Catabolic State

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10
Q

Urea level decreased in

A

Chronic liver disease
Anorexia
Malnourished patients

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11
Q

Electrolyte findings on CKD

A
  1. ↓ calcium
  2. ↑ Phosphate
  3. ↑ PTH
  4. ↓ 1,25 dihydroxyvitamin D
  5. ↑ ALP
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12
Q

Up To which level of GFR the patient can be asymptomatic?

A

45

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13
Q

What are the USG criteria of CKD

A
  1. Increased Ecogenicity
  2. Corticomedullary differentiation will be poor
  3. Reduced size
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14
Q

Dialysis should be initiated when eGFR falls below

A

10

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15
Q

First sign of CKD shows when eGFR

A

45-59 at stage 3B

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16
Q

First symptoms arise on CKD

A

GFR < 20

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17
Q

Gold standard investigation for upper urinary tract pathology

A

CTU ( computed tomography urography)

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18
Q

Method of choice for investigating renal stones

A

CT KUB

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19
Q

Indication of renal arteriography

A
  1. RAS
  2. Haemorrhage following trauma
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20
Q

Radionuclide agents and their function

A

TcMAG3 → perfusion+ obstruction
DPTA → perfusion + GFR measurement
DMSA → Morphology + individual function of each kidney

21
Q

Risk factor for radiological investigation

A
  1. Pre-existing renal impairment (eGFR>45)
  2. DM
  3. Myeloma
  4. Ionic contrast media
  5. Repetitive dosing in short time span
22
Q

Indication of renal biopsy

A
  1. AKI or CKD with uncertain etiology
  2. Nephrotic syndrome or glomerular proteinuria in adults
  3. Nephrotic syndrome in children that has atypical features or does not respond to treatment
  4. Nephritic syndrome
  5. Renal Transplant dysfunction
23
Q

What are the contraindications for Renal biopsy?

A
  1. Disordered coagulation or thrombocytopenia
  2. Uncontrolled hypertension
  3. Kidney less than 60% of predicted size
  4. Solitary kidney
24
Q

Causes of Anuria

A

Urinary Obstruction
1. Urinary retention due to prostatic enlargement, urethral stenosis, Bladder tumor
2. Bilateral ureteric obstruction due to fibrosis, stone, cancer, radiation injury
3. Bilateral renal stones ( usually staghorn calculi)
4. Massive crystalluria

Lack of renal perfusion
1. Aortic dissection involving renal arteries
2. Severe ATN
3. Severe functional hypoperfusion

Rapidly Progressing Glomerulonephritis
1. Anti-GBM Disease
2. Severe ANCA Vasculitis

25
Q

What is the most common cause of dysuria?

A

UTI

26
Q

Causes of non pitting oedema

A
  1. Lymphatic obstruction
  2. Hypothyroidism
  3. Systemic sclerosis
27
Q

Causes of visible haematuria

A
  1. Malignancy
  2. Infection
  3. Stone
  4. IgA nephropathy
28
Q

What is the investigation of choice in visible haematuria?

A

Cystoscopy

29
Q

Features of nephritic syndrome

A
  1. Haematuria
  2. Hypertension
  3. Oliguria
  4. Fluid retention
  5. Reduced renal function
30
Q

What are the causes of painless haematuria?

A
  1. Glomerulonephritis especially nephritic presentation (most common)
  2. Interstitial nephritis
  3. Vasculitis
  4. BEP
  5. Prostate Cancer
  6. Tumor in urogenital tract
31
Q

What is the normal level of protein in urine?

A

0-150 mg

32
Q

What is the protein that is derived from tubular cells in healthy individuals? And which gene encodes it?

A

Tamm Horsfall protein (uromodulin) encoded by the UMOD gene

33
Q

What is the Rx of orthostatic proteinuria?

A

It is a benign condition that does not require any treatment

34
Q

What is the best time for taking a sample of proteinuria?

A

Early morning sample

35
Q

What are rapidly progressing glomerulonephritis?

A
  1. Post infectious glomerulonephritis
  2. Ani- GBM Disease
  3. Lupus nephritis
  4. Small vessel vasculitis
36
Q

The most sensitive marker of glomerular pathology is-

A

Albuminuria

37
Q

Causes of transient proteinuria

A
  1. Fever
  2. UTI
  3. Vigorous Exercise
  4. Heart failure
38
Q

What are the features of nephrotic syndrome?

A
  1. Overt proteinuria
  2. Hypoalbuminaemia
  3. Oedema and generalised fluid retention
  4. Possible intravascular volume depletion with hypotension, or intravascular expansion with hypertension
39
Q

The most common cause of nephrotic syndrome in children

A

Minimal Change Disease

40
Q

What are the nephrito-nephritic presentation

A
  1. SLE
  2. IgA nephropathy
  3. MCGN/ MPGN
  4. FCGS
  5. Diabetic Nephropathy
41
Q

What is the early and universal feature of nephrotic syndrome?

A

Renal sodium retention

42
Q

What is the mechanism of nephrotic syndrome?

A
  1. Injury to podocytes
  2. Changed architecture
    - Scarring
    - Deposition of matrix or other elements (amyloid)
43
Q

What is the mechanism of nephritic syndrome?

A
  1. Inflammation
  2. Reactive cell proliferation
  3. Breaks in GBM
  4. Crescent formation
44
Q

Indication of renal biopsy according protein quantification in urine

A
  • More than 1 gm protein excreted in urine within 24 hours
  • ACR is 70 - 300
  • PCR is 100 - 350

This indicates glomerular disease more likely

45
Q

What are the features of ACR

A
  • Highly sensitive
  • More expensive
  • Can detect the early stage of diabetic nephropathy
  • Helpful to identify the type of protein in urine
46
Q

Bence jones protein found in

A
  1. AL amyloidosis
  2. Plasma cell / B-cell Dyscrasias
  3. Myeloma
47
Q

Hallmark of glomerular disease

A

Proteinuria

48
Q

What are the consequences of nephrotic syndrome?

A
  1. Hypoalbuminaemia
  2. Avid sodium retention
  3. Hypercholesterolaemia
  4. Hypercoagulability
  5. Infection
49
Q

Poor prognostic feature in nephrotic syndrome

A
  1. Hypertension
  2. Male sex
  3. Persistent and severe proteinuria
  4. Elevated creatinine at the time of presentation
  5. Rapid rate of decline in renal function
  6. Tubulo-interstitial fibrosis observed on renal biopsy

FCPS Preperation (5 decks)

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