Nephrology Flashcards
what are the causes of cranial DI?
- idiopathic
- post head injury
- pituitary surgery
- craniopharyngiomas
- infiltrative histiocytosis X/sarcoidosis
- haemochromatosis
what are the causes of nephrogenic DI?
- genetic
- electrolytes (hypercalcaemia, hypokalaemia)
- lithium - desensitises kidney’s ability to respond to ADH in the collecting ducts
- demeclocycline
- tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis
investigations for DI?
- high plasma osmolality, low urine osmolality
- urine osmolal >700mOsm/kg excludes DI
- water deprivation test
what is the management of nephrogenic DI?
- thiazides
- low salt/protein diet
what is membranous glomerulonephritis?
presents with nephrotic syndrome or proteinuria
commonest type of glomerulonephritis in adults
3rd most common cause of ESRF
what are the causes of membranous glomerulonephritis?
idiopathic
infections - hep B, malaria, syphilis
malignancy - prostate, lung, lymphoma, leukaemia
drugs - gold, penicillamine, NSAIDs
autoimmune disease
what is seen on renal biopsy in membranous glomerulonephritis?
spike and dome appearance - BM thickened with subepithelial electron dense deposits
what is the management for membranous glomerulonephritis?
ACE-i or ARB
immunosuppression
consider anticoag
what is the triad of HUS?
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
-> usually post diarrhoeal illness
what is the management for proteinuria in CKD? (ACR >30)
ace inhibitor eg ramipril
what are the indications for haemodialysis in AKI?
hyperkalaemia
pulmonary oedema
acidosis
uraemia
how does minimal change disease present?
nephrotic syndrome
normotension
highly selective proteinuria
renal biopsy - EM shows fusion of podocytes and effacement of foot processes
how does IgA nephropathy present?
macroscopic haematuria in young people following an URTI
how is anaemia managed in CKD?
- correct iron deficiency
- start erythropoiesis-stimulating agents
What are the severe manifestations of uraemia?
Pericarditis
Encephalopathy
How is potassium removed from the body after the initial tx for hyperkalaemia?
Calcium resonium
Enemas more effective than oral
How does renal cell carcinoma present?
Triad - flank pain, flank mass and haematuria
What are varicoceles sometimes associated with?
Renal cell carcinomas
What medication should be used to prevent recurrent hyperkalaemia?
Calcium resonium
Which medications may be stopped in AKI (depending on circumstances)?
MELD - MEtformin, Lithium, Digoxin
Which medications should definitely be stopped in AKI?
NADA: NSAIDs, ACEI/ARBs, Diuretics (except some exceptions), aminoglycosides (eg gent)
What is the most common viral infection in solid organ transplant recipients?
Cytomegalovirus
When should aspirin be stopped in AKI?
When they’re on the 300mg analgesic dose not the 75mg prophylactic dose
What are the causes of minimal change disease?
Drugs - NSAIDs, rifampicin
Hodgkins lymphoma, thymoma
Infectious mononucleosis
What is 1st and 2nd line management for minimal change disease?
- Prednisolone
- Cyclophosphamide in steroid-resistant cases
What do hyaline casts on urinalysis suggest?
Normal, after exercise, during fever or with loop diuretics
What do brown granular casts suggest on urinalysis?
Acute tubular necrosis
What is seen on urinalysis in pre renal uraemia?
Bland urinary sediment
When are red cell casts seen?
Nephritic syndrome
What is the best investigation for ADPKD?
Ultrasound
What are the variables for calculating eGFR?
CAGE
Creatinine
Age
Gender
Ethnicity
What renal condition is associated with HIV?
HIVAN - causes collapsing focal segmental glomerulosclerosis - presents as a nephrotic syndrome
Which organism is most likely to cause peritonitis secondary to peritoneal dialysis?
Staph epiermidis (or other coagulase-negative staph)
What investigation is performed in diabetics to assess for diabetic nephropathy?
ACR early morning specimen
pulmonary haemorrhage, rapidly progressive glomerulonephritis
goodpasture’s syndrome/anti-GBM disease
findings on renal biopsy in anti-GBM?
linear IgG deposits along the basement membrane
management for hyperacute transplant rejection?
removal of the transplant
features of acute interstitial nephritis?
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
what is seen on urine microscopy in acute interstitial nephritis?
white cell casts
IgA nephropathy presentation?
URTI preceding presentation by a couple of DAYS
macroscopic haematuria
post-strep glomerulonephritis presentation?
develops 1-2 WEEKS after URTI
haematuria + proteinuria
low complement
screening test for adult PKD?
USS
renal failure, sensorineural hearing loss and ocular abnormalities in a child?
alport syndrome
management for minimal change disease?
prednisolone
drug causes of polyuria?
lithium
diuretics, caffeine, alcohol
most likely organism in peritonitis secondary to Peritoneal Dialysis?
staphylococcus epidermis
what is dialysis disequilibrium syndrome?
unclear mechanism
post dialysis
cerebral oedema
formula for calculating the anion gap?
sodium and potassium minus chloride and bicarb
(Na + K+) - (Cl + HCO3)
clinical features of acute interstitial nephritis?
triad of rash, fever and eosinophilia
