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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
Q

MC pre-renal cause of AKI

A

Hypovolemia - most common
Rest are acute LVF, hepatorenal syndrome

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26
Q

MC renal cause of AKI

A

Acute Tubular necrosis > Acute interstitial nephritis&raquo_space; Glomerulonephritis

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27
Q

Most sensitive test for differentiating pre-renal and renal cause of AKI

A

FeNa fractional excretion of Na

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28
Q

FeNa <1%

A

Pre-renal cause

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29
Q

FeNa >2%

A

Renal cause

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30
Q

Features of Pre-renal AKI

A

Urea:creatinine = 20:1
Urine osmolarity = >500 mosm/L
Urine Na levels = <20mEq
FeNa = <1%

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31
Q

Features of Renal AKI

A

Loss of concentration ability
Urea:creatinine = <12:1
Urine osmolarity = <350 mosm/L
Urine Na levels = >40 mEq
FeNa = >2% (>4%: ATN)

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32
Q

MC cause of Nephritic syndrome in the world

A

IgA nephropathy - Burger’s disease

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33
Q

Anti-DNAse/ASO titers for which disease?

A

PSGN - MC in india

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34
Q

Anti-dsDNA/Anti-SM

A

SLE - MC autoimmune cause

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35
Q

ANCA

A

Vasculitis syndrome

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36
Q

Anti-GBM ab

A

Goodpasture’s syndrome

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37
Q

Hemoptysis + Hematuria
Pulmo + Renal syndrome

A

Vasculitis syn
Goodpasture’s syn

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38
Q

Gold standard investigation for Nephritis

A

Renal biopsy - pattern and type of Ig deposits

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39
Q

Child <10 years old with edema, anasarca and no atypical symptoms

A

Minimal change disease

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40
Q

Why edema, anasarca happens in Nephrotic syn?

A

Hypo Albuminemia = Increased Na and H2O retention

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41
Q

Why Hypercoagulative stage happens in Nephrotic syn?

A

Anti-thrombin 3/Protein S&C def

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42
Q

Nephrotic condition in adult + HTN/diabetes causes?

A

Focal Segmental Glomerulosclerosis

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43
Q

Elderly patient + nephrotic condition + Hematuria

A

Membranous GN
Renal vein thrombosis : worst

44
Q

Indication for renal biopsy

A

if serology is inconclusive
if treatment is not working
if progresses to RPGN

45
Q

Contraindication for renal biopsy

A

Single kidney
coagulopathy
uncontrolled HTN (>180/110 mm)
Local site infection

46
Q

CKD features?

A

Elevated serum creatinine
GFR less than 60 ml/min for min or more than 3 months

47
Q

MC cause CKD in world

A

Diabetic nephropathy

48
Q

MC cause of of CKD in India

A

Diabetic Nephropathy

49
Q

MC genetic cause of CKD

A

APKD adult polycystic kidney disease

50
Q

CKD with increased Hb is seen in?

A

APKD adult polycystic kidney disease

51
Q

CKD with enlarged kidneys

A

Early DM, APKD, HIV-AN, Amyloidosis

52
Q

MC CNS manifestation in CKD

A

90% neuropathy

53
Q

MC metabolic bone disease in CKD

A

OCF - osteitis cystica fibrosa

54
Q

MC hematological manifestation in CKD

A

Anemia - normocytic - cause erythropoietin deficiency

55
Q

CKD stages

A
  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
  2. & 4. = Gross-albuminuria, >300 mg (irreversible), GFR - 30-59 ml/min and 15-29 ml/min
  3. = Irreversible stage, <15 ml/min, >90% loss, END STAGE KIDNEY DISEASE
56
Q

CKD stage 1&2 DOC

A

ACE inhibitors

57
Q

CKD stage 3 DOC

A

+ Erythropoietin, correct mineral homeostasis (Ca++ and PO4–)

58
Q

CKD stage 4 TOC

A

Prepare for renal replacement therapy, make AV fistula for dialysis, Hep B vacc, screen potential donors

59
Q

CKD stage 5 TOC

A

RRT mandatory for survival

60
Q

Indications for dialysis in CKD

A

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
Q

MC suicidal toxin in the world that can be removed with dialysis

A

Salicylates (aspirin)
Polyethylene glycol

62
Q

MC accidental toxin in the world that can be removed with dialysis

A

Methanol
Lithium overdose

63
Q

MC symptom Systemic auto-immune disease

A

PUO + multi-system/organ involvement
Joints, skin, eyes, renal, neuropathy

64
Q

Single best AB in auto-immune testing

A

ANA testing 98% sensitive

65
Q

ANA testing homogenous (diffuse) pattern indicates?

66
Q

ANA testing speckled pattern indicates?

A

MC but non-specific

67
Q

ANA testing nucleolar pattern indicates?

A

Diffuse systemin sclerosis

68
Q

ANA testing centromere pattern indicates?

A

CREST syndrome

69
Q

ANTI-NUCLEAR ANTIBODY clinical significance

A

MC, most sensitive and non-specific
Essential criteria for SLE

70
Q

ANTI-SM (smith) clinical significance

A

Most specific for SLE but rare

71
Q

ANTI-DSDNA clinical significance

A

Both sensitive and specific for diagnosis of SLE

72
Q

ANTI-CENTROMERE clinical significance

A

Specific for CREST syndrome

73
Q

ANTI-TOPOISOMERASE 1 clinical significance

A

Specific for diffuse SSC

74
Q

ANTI-RO/LA specific for?

A

Specific for SICCA syndrome

75
Q

ANTI-JO

A

Specific for myositis syndromes
Polymyositis

76
Q

RA FACTOR IgM-type

A

Screening and prognostic for RA

77
Q

ANTI-CCP/ACPA

A

cyclic citrullinated protein Ab
Most specific for RA

78
Q

ANCA

A

vasculitis syndrome

79
Q

Inflammatory myopathy (idiopathic) + rash present
Myositis syndrome

A

Dermatomyositis
MC 30-50 females

80
Q

Inflammatory myopathy (idiopathic) + rash absent + proximal

A

Polymyositis
20-30 yo more in females

81
Q

Inflammatory myopathy (idiopathic) + rash absent + distal>proximal

A

Inclusion body myositis
more than 50 yo males > females

82
Q

Knuckles Rash in Dermatomyositis name?

A

Goltron’s rash

83
Q

Heliotropic rash Dermatomyositis

84
Q

Rash over back in Dermatomyositis

A

Shawl sign

85
Q

Rash over neck in Dermatomyositis

86
Q

Inflammatory polyarthritis how many joints involved?

87
Q

MC cause of Inflammatory polyarthritis

88
Q

Rare cause of Inflammatory polyarthritis

A

Spondyloarthritis

89
Q

Genetic predisposition of RA?

A

RA can happen without family history

90
Q

RA deformity

A

Swan-neck deformity

91
Q

Vasculitis AB test?

92
Q

Causes of large vessel vasculitis?

A

Giant cell and Takayasu

93
Q

Takayasu affects which age and gender?

A

10-20 yo females

94
Q

Takayasu affects which vessel?

A

Subclavian artery (MC)
Coronary artery (rare)

95
Q

Takayasu Tx and prognosis?

A

Immunosuppressants and bad prognosis

96
Q

Takayasu symptoms and dreaded features?

A

Upper limb claudication pain
HTN + stroke + MI

97
Q

Giant cell vasculitis affects which age and gender?

A

> 50 yo female

98
Q

Giant cell vasculitis affects which vessel?

A

Superficial temporal Artery

99
Q

Giant cell vasculitis symptoms and dreaded features?

A

throbbing headache and blindness

100
Q

Giant cell vasculitis Tx and prognosis?

A

Steroids and good prognosis if caught early

101
Q

GN + vasculitis + c-ANCA positive

A

Wegener’s Granulomatosis

102
Q

GN + vasculitis + p-ANCA positive (anti-MPO)

A

If eosinophilia >1000 = Churg stroke syn
If eosinophilia absent = Microscopic poly-angiitis

103
Q

GN + vasculitis + ANCA negative

105
Q

RBC cast is present in?

A

Acute glomerulonephritis

Medicine (6 decks)

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