Nephrology Flashcards
Pathophysiology and renal histology of Anti-GBM disease.
Type 2 immune response of IgG against alpha 3 subunit of type 4 collagen. Linear deposits of IgG on immunoflorescence.
Pathophysiology and renal histology of Lupus Nephritis.
Type 3 immune complex formation (anti-DNA) deposition. Full house deposition in mesangium and subendothelial layer.
Pathophysiology and renal histology of ANCA Vasculitis.
Autoantibodies against neutrophil granule proteins. Pauci-immune crescentic glomerulonephritis.
Pathophysiology and renal histology of Membranous glomerulonephritis.
Type 3 immune complex deposition disease. Subepithelial dense deposits in electron microscopy and spikes on silver staining.
Pathophysiology and renal histology of IgA vasculitis.
Type 3 IgA immune complex mediated disease. Globular IgA deposits in the mesangium.
Pathophysiology and renal histology of FSGS.
Injury to podocytes through permeability factors. Segmental sclerosis seen on renal biopsy.
Contraindications to renal biopsy.
Small hyperechoic kidneys (less than 9 cm), which are generally indicative of chronic irreversible disease
Solitary native kidney
Multiple, bilateral cysts or a renal tumor
Uncorrectable bleeding diathesis
Severe hypertension, which cannot be controlled with antihypertensive medications
Hydronephrosis
Active renal or perirenal infection
Anatomic abnormalities of the kidney which may increase risk (see above)
Skin infection over the biopsy site
An uncooperative patient
Absolute contraindications to renal transplant.
Active infections.
Active malignancy.
Active substance abuse.
Reversible renal failure.
Uncontrolled psychiatric disease.
Documented active and ongoing treatment nonadherence.
significantly shortened life expectancy.
Relative contraindications to renal transplant.
Significant sun damage Significant vascular disease History of non adherence Malnutrition Oxalosis Potential for recurrent kidney disease
What is meltzers triad and what does it indicate?
Triad of palpable purpura, arthralgia and myalgia indicating cryoglobulinaemic vasculitis.
Describe Liddles Syndrome
Autosomal dominant condition of increased sodium reabsorption and potassium excretion. ClassicL triad of hypertension hypokalaemia and metabolic acidosis. Low renin and aldosterone are seen.
Alport Syndrome Summary
X linked disorder characterised by defect in alpha 5 chain of type 4 collagen.
What are the most common causes of hypokalaemic periodic paralysis?
Autosomal dominant condition resulting from mutations in sodium and calcium channels
What is a chloride responsive metabolic alkalosis? And what causes it?
Urine chloride <20
Gastric losses
CMV prophylaxis agent post high risk renal transplant?
Valganciclovir
What are the indications for stenting in bilateral renal artery stenosis?
Medical therapy failure
Flash pulmonary oedema
Progressive renal failure
Short duration of hypertension prior to diagnosis
Does aminoglycoside induced kidney injury result in oliguric or non-oliguric kidney injury?
Non-oliguric
Does AIN result in oliguric or non-oliguric kidney injury? I
Non oliguric
Empiric therapy for peritoneal dialysis associated peritonitis?
Gentamicin IP
Cephazolin IP or Vancomycin IP (if MRSA colonised)
Add Metronidazole PO/IV of concern re diverticula disease
What are the indications for catheter removal with peritoneal dialysis associated peritonitis?
Refractory disease (>4 days)
Relapsing disease
Refractory exit site infection
Fungal peritonitis
A patient has polymicrobial peritonitis associated with peritoneal dialysis. What are the next steps in management?
Add metronidazole to empiric therapy
Surgical referral ?intra-abdominal pathology (ischaemic bone or diverticulitis)
What are the five features of HIV associated nephrotic syndrome?
Massive proteinuria Normal or large kidneys FSGS Elevated urea and creatinine Normotension
