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Nephrology Flashcards

1
Q

Define anuria

A

Urine output less than 100 ml per day

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2
Q

Define Oliguria

A

Urine output less than 400 ml per day

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3
Q

Define Polyuria

A

More than 3 L in adults or more than 50 ml/kg/day in children

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4
Q

Define microscopic Hematuria

A

More than 100 RBC/hpf
or
Less than 100 RBC/hpf with more than 3 occassions

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5
Q

If Eumorphic RBC in urine

A

Issue in collecting system
UTI/cystitis - ABs 2 weeks
Caliculi
Ca bladder (rare)

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6
Q

If Dysmorphic RBC

A

Indicates Glomerulonephritis

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7
Q

IOC Glomerulonephritis

A

Serum C3 levels
Low = repeat test - returns to normal means post infective Glomerulonephritis
or if stays low persistently = autoimmune disease - SLE

Normal = IgA nephropathy in adults or HSP in children

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8
Q

MC autoimmune cause of low Serum C3 level low

A

SLE

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9
Q

MC post infective cause of low Serum C3 level low

A

PSGN

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10
Q

MC physiological cause of Proteinuria

A

Overflow proteinuria, high protein diet or pregnancy

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11
Q

Normal proteinuria levels

A

0-150 mg/day

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12
Q

Proteinuria less than 2g/day

A

Tubular

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13
Q

Proteinuria more than 2g/day

A

Glomerular range

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14
Q

Less than 3g/day non-selective proteinuria (or 3.5 g/d/m2)

A

Nephritic syndrome

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15
Q

More than 3g/day selective proteinuria (3.4 g/d/m2)

A

Nephrotic syndrome (albuminuria)

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16
Q

MC cast present in urine

A

Hyaline cast

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17
Q

MC cast present in urine in case of Acute kidney injury

A

Hyaline cast

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18
Q

MC cast found in nephropathic renal disorder

A

Granular/cellular cast

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19
Q

Presence of RBC cast in Urine

A

Acute glomerulonephritis

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20
Q

Presence of WBC cast in Urine

A

pyelonephritis

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21
Q

Presence of Muddy brown cast in Urine

A

Acute tubular necrosis

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22
Q

Presence of Eosinophilic cast in Urine

A

Interstitial nephritis

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23
Q

define KDIGO criteria

A

used to diagnose acute kidney injury (one of below)
- Rise in serum creatinine by more than 1.5 times the baseline over 7 days
- Rise in serum creatinine by more than 0.3 from baseline over 48 hours
- Decrease in urine output less than 0.5 ml/kg/h over 6 consecutive hours

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24
Q

First step of acute renal failure is?

A

Exclude post renal cause
i.e. obstructive post renal uropathy, do USG-Kidney ureter bladder

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25
MC pre-renal cause of AKI
Hypovolemia - most common Rest are acute LVF, hepatorenal syndrome
26
MC renal cause of AKI
Acute Tubular necrosis > Acute interstitial nephritis >> Glomerulonephritis
27
Most sensitive test for differentiating pre-renal and renal cause of AKI
FeNa fractional excretion of Na
28
FeNa <1%
Pre-renal cause
29
FeNa >2%
Renal cause
30
Features of Pre-renal AKI
Urea:creatinine = 20:1 Urine osmolarity = >500 mosm/L Urine Na levels = <20mEq FeNa = <1%
31
Features of Renal AKI
Loss of concentration ability Urea:creatinine = <12:1 Urine osmolarity = <350 mosm/L Urine Na levels = >40 mEq FeNa = >2% (>4%: ATN)
32
MC cause of Nephritic syndrome in the world
IgA nephropathy - Burger's disease
33
Anti-DNAse/ASO titers for which disease?
PSGN - MC in india
34
Anti-dsDNA/Anti-SM
SLE - MC autoimmune cause
35
ANCA
Vasculitis syndrome
36
Anti-GBM ab
Goodpasture's syndrome
37
Hemoptysis + Hematuria Pulmo + Renal syndrome
Vasculitis syn Goodpasture's syn
38
Gold standard investigation for Nephritis
Renal biopsy - pattern and type of Ig deposits
39
Child <10 years old with edema, anasarca and no atypical symptoms
Minimal change disease
40
Why edema, anasarca happens in Nephrotic syn?
Hypo Albuminemia = Increased Na and H2O retention
41
Why Hypercoagulative stage happens in Nephrotic syn?
Anti-thrombin 3/Protein S&C def
42
Nephrotic condition in adult + HTN/diabetes causes?
Focal Segmental Glomerulosclerosis
43
Elderly patient + nephrotic condition + Hematuria
Membranous GN Renal vein thrombosis : worst
44
Indication for renal biopsy
if serology is inconclusive if treatment is not working if progresses to RPGN
45
Contraindication for renal biopsy
Single kidney coagulopathy uncontrolled HTN (>180/110 mm) Local site infection
46
CKD features?
Elevated serum creatinine GFR less than 60 ml/min for min or more than 3 months
47
MC cause CKD in world
Diabetic nephropathy
48
MC cause of of CKD in India
Diabetic Nephropathy
49
MC genetic cause of CKD
APKD adult polycystic kidney disease
50
CKD with increased Hb is seen in?
APKD adult polycystic kidney disease
51
CKD with enlarged kidneys
Early DM, APKD, HIV-AN, Amyloidosis
52
MC CNS manifestation in CKD
90% neuropathy
53
MC metabolic bone disease in CKD
OCF - osteitis cystica fibrosa
54
MC hematological manifestation in CKD
Anemia - normocytic - cause erythropoietin deficiency
55
CKD stages
1. & 2. = Micro-albuminuria, 30-300 mg (reversible), GFR - 90-120 ml/min and 60-89 ml/min, Tx: Control all risk factors, avoid NSAID, hydration, DOC ACE inhibitors 3. & 4. = Gross-albuminuria, >300 mg (irreversible), GFR - 30-59 ml/min and 15-29 ml/min 5. = Irreversible stage, <15 ml/min, >90% loss, END STAGE KIDNEY DISEASE
56
CKD stage 1&2 DOC
ACE inhibitors
57
CKD stage 3 DOC
+ Erythropoietin, correct mineral homeostasis (Ca++ and PO4--)
58
CKD stage 4 TOC
Prepare for renal replacement therapy, make AV fistula for dialysis, Hep B vacc, screen potential donors
59
CKD stage 5 TOC
RRT mandatory for survival
60
Indications for dialysis in CKD
Serious uremic manifestations Encephalopathy/convulsions Pericarditis shock coagulopathy Intractable vomiting (gastritis) Axonal peripheral neuropathy Severe Azotemia (urea>100) - Refractory pulmonary edema unresponsive to loop diuretics Refractory metabolic acidosis (<7.20 pH) - unresponsive to NaHCO3 IV Refractory K=>6.5 meq (risk of arrythmia) Ingested dialysable toxins - only loosely bound
61
MC suicidal toxin in the world that can be removed with dialysis
Salicylates (aspirin) Polyethylene glycol
62
MC accidental toxin in the world that can be removed with dialysis
Methanol Lithium overdose
63
MC symptom Systemic auto-immune disease
PUO + multi-system/organ involvement Joints, skin, eyes, renal, neuropathy
64
Single best AB in auto-immune testing
ANA testing 98% sensitive
65
ANA testing homogenous (diffuse) pattern indicates?
SLE
66
ANA testing speckled pattern indicates?
MC but non-specific
67
ANA testing nucleolar pattern indicates?
Diffuse systemin sclerosis
68
ANA testing centromere pattern indicates?
CREST syndrome
69
ANTI-NUCLEAR ANTIBODY clinical significance
MC, most sensitive and non-specific Essential criteria for SLE
70
ANTI-SM (smith) clinical significance
Most specific for SLE but rare
71
ANTI-DSDNA clinical significance
Both sensitive and specific for diagnosis of SLE
72
ANTI-CENTROMERE clinical significance
Specific for CREST syndrome
73
ANTI-TOPOISOMERASE 1 clinical significance
Specific for diffuse SSC
74
ANTI-RO/LA specific for?
Specific for SICCA syndrome
75
ANTI-JO
Specific for myositis syndromes Polymyositis
76
RA FACTOR IgM-type
Screening and prognostic for RA
77
ANTI-CCP/ACPA
cyclic citrullinated protein Ab Most specific for RA
78
ANCA
vasculitis syndrome
79
Inflammatory myopathy (idiopathic) + rash present Myositis syndrome
Dermatomyositis MC 30-50 females
80
Inflammatory myopathy (idiopathic) + rash absent + proximal
Polymyositis 20-30 yo more in females
81
Inflammatory myopathy (idiopathic) + rash absent + distal>proximal
Inclusion body myositis more than 50 yo males > females
82
Knuckles Rash in Dermatomyositis name?
Goltron's rash
83
Heliotropic rash Dermatomyositis
Eyelids
84
Rash over back in Dermatomyositis
Shawl sign
85
Rash over neck in Dermatomyositis
V-sign
86
Inflammatory polyarthritis how many joints involved?
5 or more
87
MC cause of Inflammatory polyarthritis
RA
88
Rare cause of Inflammatory polyarthritis
Spondyloarthritis
89
Genetic predisposition of RA?
RA can happen without family history
90
RA deformity
Swan-neck deformity
91
Vasculitis AB test?
ANCA
92
Causes of large vessel vasculitis?
Giant cell and Takayasu
93
Takayasu affects which age and gender?
10-20 yo females
94
Takayasu affects which vessel?
Subclavian artery (MC) Coronary artery (rare)
95
Takayasu Tx and prognosis?
Immunosuppressants and bad prognosis
96
Takayasu symptoms and dreaded features?
Upper limb claudication pain HTN + stroke + MI
97
Giant cell vasculitis affects which age and gender?
>50 yo female
98
Giant cell vasculitis affects which vessel?
Superficial temporal Artery
99
Giant cell vasculitis symptoms and dreaded features?
throbbing headache and blindness
100
Giant cell vasculitis Tx and prognosis?
Steroids and good prognosis if caught early
101
GN + vasculitis + c-ANCA positive
Wegener's Granulomatosis
102
GN + vasculitis + p-ANCA positive (anti-MPO)
If eosinophilia >1000 = Churg stroke syn If eosinophilia absent = Microscopic poly-angiitis
103
GN + vasculitis + ANCA negative
HSP
104
105
RBC cast is present in?
Acute glomerulonephritis

Medicine (6 decks)

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