Nephrology Flashcards
Causes of anaemia in CKD ?
Decreased erythropoietin production
Increased Hepcidin level (Acute phase reactant )
Steps to avoid contrast induced nephropathy ?
Stop Metformin
Fluid prescription : how to give pottasium, sodium, glucose ?
Sodium - 1mmol/kg
Potassium - 1 mmol/kg
Water - 30ml/Kg
Glucose - 50-100g
Sodium in 1L 0.9% saline ?
154 mmol/l
Glucose in 1L of 5% Dextrose ?
50 mmol/l
Sodium in 1L of Hartman’s ?
130mmol/l
Pottasium in 1 L of hartmans?
5
Renal Biopsy in HIV Nephropathy :
Focal Segmental Glomerulosclerosis
Nephrotic or nephritic in HIV Nephropathy ?
Nephrotic picture
Kidney size in HIV ass Nephropahty ?
Normal or large kidneys
Wegner’s Renal Biopsy :
Glomerular Crescents.
In Wegner’s, Which ANCA is positive ?
C- ANCA positive.
Recurrent sinusitis + Hematuria + Oliguria + C ANCA Positive. Dx?
Wegner’s
Renal biopsy= Glomerular crescents.
Wegner’s
Recurrent sinusitis/Epistaxis + Hematuria + Oliguria + C ANCA Positive + Renal Biopsy—Glomerular Crescents.
Partial Lipodystrophy( loss of subcutaneous tissue in fat) is seen in :
Membranoproliferative glomerulonephritis Type 2.
Membranoproliferative glomerulonephritis Type 2 causes:
Partial lipodystrophy
Membranoproliferative Glomerulonephritis Type 1 causes :
cryoglobulinaemia, hepatitis C
Spironolactone acts on :
Collecting ducts.
Post streptococcal infection is ass with which glomerulonephritis ?
Diffuse Proliferative glomerulonephiritis
Diffuse Proliferative glomerulonephiritis Association :
SLE
Post streptococcal infection in children.
Calcium oxalate stone prevention ?
Thiazide diuretics—It increases reabsorption of calcium—so less calcium excretion in urine—so less chance of calcium oxalate stones.
AKI criteria :
a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days.
a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
Paraneoplastic hepatic dysfunction syndrome :
K/C/O Renal cell carcinoma + C/o- Abdominal discomfort + RUQ pain +
Elevated ALP+ GGT+ Increased prothrombin time + Hepatosplenomegaly + without hepatic mets.
Use of 0.9% Sodium Chloride for fluid therapy in patients requiring large volumes = risk of developing :
Risk of hyperchloraemic metabolic acidosis.
Contrast-induced nephropathy occurs___
2 -5 days after administration
Aldosterone and renin ratio :
BOTH high ? >
-both low ? >
-high aldosterone and renin is low :
Renal artery stenosis.
Liddel’s syndrome. L=Low=Liddle
Primary hyperaldosteronism.
CKD stage 1 , 2 and 5 :
CKD stage 1 : > 90
CKD stage 2: > 60-90
CKD stage 5 : < 15ml/min
Nephritic syndrome causes mnemonic :
Gm Dear RIA :
Good pasture
Membranoproliferative
Diffuse proliferative
IgA Nephropathy
Alport syndrome.
SLE is associated with :
Diffuse proliferative
Diffuse proliferative glomerulonephritis associated with :
SLE
Streptococcal infection in children.
Graft rejection is mediated by :
IgG
G=Graft rejection= IgG
Wilm’s tumour is ass with :
Beckwith Wiedmann Syndrome.
Renal biopsy findings in IgA nephropathy ?
Mesangial hypercellularity
Which lab findings will be normal in Goodpasture ?
Complement levels are normal
A 72-year-old man is diagnosed with prostate cancer and goserelin (Zoladex) is prescribed. Which one of the following is it most important to co-prescribe for the first three weeks of treatment?
Anti-androgen treatment such as cyproterone acetate should be co-prescribed when starting gonadorelin analogues due to the risk of tumour flare.
The recent history of tonsillitis + Urine dipstick- protein 1+, blood 3+, nitrites negative.
Post streptococcal glomerulonephritis.
Henoch-Schonlein purpura?
HSP
Hinge pain—Joint pain
Stomach pain
Purpura—palpable purpura ( Non thrombocytopenia )
Kidney—Hematuria/Proteinuria—Kidney failure.
Is thrombocytopenia a feature of HSP ?
No.
Stage 1 of Diabetic Nephropathy:
Hyperfilteration—Increase in GFR
Stage 4 of Diabetic Nephropahty:
Persistent Proteinuria + Hypertension.
Diffuse Glomerulosclerosis and Kimmelstein Wilson nodules.
Hematuria + Hemoptysis , Dx?,
Goodpasture syndrome
Which Ig deposits in Goddasture?
Linear IgG deposits in Goodpasture.
C/o DVT—Sudden onset loin pain+ deteriorating renal function +
Renal vein thrombosis.
Minimal change disease electron microscopy :
Effacement of foot podocytes.
Or podocyte fusion.
Effacement of foot podocytes.
Or podocyte fusion.
Minimal change disease.
Rx for Minimal change disease :
Oral prednisolone.
Binge alcohol can lead to which electrolyte imbalance ?
Binge alcohol—act on Posterior pituitary—ADH suppression—polyuria—Hypernatremia.
SIADH ( will cause high adh , due to which , urine will be concentrated and serum dilute)
Alcohol binge will cause ADH suppression , due to which urine will be dilute and serum concentrated
H/o Malignancy + Pitting oedema + Frothy urine
Membranous Glomerulonephritis
Membranous Glomerulonephritis association :
idiopathic: due to anti-phospholipase A2 antibodies
infections: hepatitis B, malaria, syphilis
malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
drugs: gold, penicillamine, NSAIDs
autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
Membranous Glomerulonephritis biopsy findings :
Basement membrane is thickened with subepithelial electron dense deposits. This creates a ‘spike and dome’ appearance
Finasteride treatment of BPH may take___ before results are seen
6 Months.
Diagnosing test of Vesicoureteric reflux disease ?
Micturating cystography(MCUG)
H/o recurrent sinusitis + Hematuria + Oliguria + worsening urea and creatinine :
Granulomatosis with polyangitis. ( Wegner’s )
Granulomatosis with polyangitis. ( Wegner’s )
H/o recurrent sinusitis + Hematuria + Oliguria + worsening urea and creatinine
Non-seminoma germ cell testicular tumours (e.g. teratomas) are associated with:
Raised hCG and AFP.
Pre renal uraemia : Urinary sodium :
< 20 ( Kidney is normal, absorbs back all the Na, H20, Urea)
Pre renal uraemia: FeNA ( fractional excretion of Na )
<1 % ( Kidney is normal, absorbs back all the Na, H20, Urea)
Pre renal uraemia : Fractional Urea excretion :
< 35 % (Kidney is normal, absorbs back all the Na, H20, Urea)
Pre renal Uraemia : BUN(Urea) / Creat :
Kidney is normal, absorbs back all the Na, H20, Urea)
Urea is absorbed—So numerator decrease— Ratio increases.
Infection ass with renal transplant :
Cytomegalovirus.
Heroin use is a risk factor for:
focal segmental glomerulosclerosis.
focal segmental glomerulosclerosis
Heroin use
Granulomatosis with polyangitis(Wegner’s) ass with which Glomerulonephritis ?
It’s ass with : Rapidly progressive Glomerulonephritis (crescentic)
Testicular seminomas Is ass with :
Non Seminoma germ cell t
seminoma—Raised HCG ( semen causes pregnancy , bHCG is raised in pregnancy—so seminomas have high Hcg level )
Non seminoma—alpha fetoprotein
Intrinsic AKI is caused by which antibiotic ?
Gentamycin.
No preceding illness—sudden onset malaise + pallor + —No diarrhoea+ abd pain — microangiopathic haemolytic anaemia (Coombs negative) + Schistocytes + Thrombocytopenia+ Renal failure
Atypical Hemolytic Uraemic syndrome.
Differentiate Atypical HUS with HUS and TTP
TTP: pentad.
HUS: Preceding diarrhoea + Abdomen pain
Interstitial nephritis Common cause :
NSAIDs
Interstial nephritis features :
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
Which part has defect in fanconi :
PCT
Electrolyte imbalance in Fanconi :
Increased urinary excretion of glucose and phosphate.
Hypokalemia
Low calcium and phosphate.
K/C/O Renal cell carcinoma + C/o- Abdominal discomfort + RUQ pain +
Elevated ALP+ GGT+ Increased prothrombin time + Hepatosplenomegaly + without hepatic mets.
Paraneoplastic hepatic dysfunction syndrome
Tacrolimus common side effect:
Hand tremors
vitamin D supplement in end-stage renal Disease :
Alfacalcidol is used as a vitamin D supplement in end-stage renal disease because it does not require activation in the kidneys
Proteus mirabilis infection predisposes To :
Struvite stones
Struvite stones Is ass with which microbe :
Proteus mirabilis infection
Productive cough + sputum—Jt pain + abd pain + constipation + increased calcium in blood—Lt sided varicocele. Dx?
Renal Cell Carcinoma
Does RCC cause Increase in growth hormone ?
No.
Does RCC cause increase in renin ?
Yes—Leads to aldosterone—absorbs Na and H2O—Secondary Hypertension.
Does RCC cause increase Parathyroid ?
Yes—Increase in serum calcium
Does Rcc cause increase in ACTH production ?
Yes—Ectopic ACTH production—Increase in serum Cortisol—Cushing’s syndrome.
Autosomal Recessive Polycystic Kidney diagnosed how?
Can be diagnosed on prenatal ultrasound.
Marker of poor prognosis in IgA Nephropathy ?
Male gender.
Proteinuria (especially > 2 g/day), Hypertension,
Smoking.
Hyperlipidaemia.
ACE genotype
Marker of good prognosis in IgA Nephropathy ?
Frank Hematuria.
Infections causing Membranous nephropathy ?
hepatitis B, malaria, syphilis
Drugs causing Membranous Nephropathy ?
Gold, Penicillamine, NSAIDs
Mnemonic for causes of papillary necrosis :
POSTCARDS
Pyelonephritis.
Obstruction of the urogenital tract, Sickle cell disease.
Tuberculosis.
Cirrhosis of the liver, Analgesia/alcohol abuse,
renal vein thrombosis.
Diabetes mellitus, and systemic vasculitis.
Does syphilis cause Papillary necrosis ?
Syphilis
Drugs causing retroperitoneal fibrosis ?
Methysergide
Causes of Retroperitoneal Fibrosis ?
Riedel’s thyroiditis
previous radiotherapy
sarcoidosis
inflammatory abdominal aortic aneurysm
Which SLE meds is safe in pregnancy ?
Azathioprine
Which Med causes false negative PSA ?
Finasteride
Abiraterone acetate MOA:
Blocks cytochrome P450 17 alpha-hydroxylase— It blocks androgen production in the testes and adrenal glands, and in prostatic tumour tissue.
Calcium resonium MOA:
Removal of potassium from the body—By by preventing enteral absorption— It exchanges potassium for the Ca++
Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys.
Dx and Ix :
Renal artery stenosis.
Ix: MR Angiography.
Renal artery stenosis Ix ?
MR Angiography.
Renal Artery Stenosis Clinical Feature :
Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys.
Which antibodies in Membranous Glomerulonephritis ?
anti-phospholipase A2 antibodies
Diabetes insipidus in patients taking lithium mechanism:
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
Young female, hypertension and asymmetric kidneys
Fibromuscular dysplasia.
Fibromuscular Dysplasia Ultrasound:
Assymetric kidneys
K/C/O End renal Disease + intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar:
Calciphylaxis.
Calciphylaxis.
K/C/O End renal Disease + intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar:
Urinary incontinence 1st line :
Oxybutinin
A 45-year-old woman presents to the Emergency Department with generalised weakness, bone pain, and frequent urination. On examination, she exhibits mild tenderness in her back.
+ Hypokalemia + Hypocalcemia + Hypoposphatemia + increased urinary excretion of glucose + increased urinary excretion of phosphate :
Fanconi Syndrome—defect in PCT.
Fanconi syndrome defect where ?
Defect in PCT ( Shoe—RTA 2 very proximally located to FAN )
Fanconi syndrome features :
Adult + Fatigue + Bone pain
Hypokalemia + Hypocalcemia + Hypoposphatemia + increased urinary excretion of glucose + increased urinary excretion of phosphate.
Which RTA in Fanconi ?
RTA type 2
Bicalutamide MOA :
Androgen receptor Blocker.
Used in CA prostrate.
Renal Biopsy in Goodpasture’s :
IgG Deposits in basement membrane.
Main Rx of Rhabdomylosis :
IV Fluids.
eGFR variables:
CAGE
Creatinine
Age
Gender
Ethnicity
Is Serum Urea a eGRF Variable ?
No
Acute management of renal colic
IM Diclofenac
Membranoproliferative glomerulonephritis secondary to partial lipodystrophy. Which type of complement is likely to be low?
C3
SLE is ass with which Glomerulonephritis ?
Class 4 Diffuse Proliferative Glomerulonephritis.
Hemolytic Uraemic Syndrome causative organism ?
E coli.
HUS Triad :
AKI + Microangiopathic Hemolytic anaemia + Thrombocytopenia
Drugs to be avoided in AKI :
DAMN drugs
Diuretics
Ace inhibitors/ARBs
Metformin
NSAID
Is aspirin safe in AKI ?
Yes
In urine dip, lack of nitrates rules out what ?
Rules out Infection
In urine dip, Presence of protein rules out what ?
Presence of protein rules out—Pre renal and post renal causes of AKI
3 causes of Intrinsic AKI:
Glomerulonephritis—Proteinuria & Hematuria.
Acute interstial Nephritis—Inflamatory process—Therefore presence of WBC.
Acute tubular Necrosis—Not inflammatory process—No WBC
On Spironolactone—Develops Painful Gyanaecomastia. Next step ?
Switch from Spironolactone to Eplerenone
Which cancer in Transplant patients ?
Squamous cell carcinoma
Tolvaptan MOA :
Vasopressin receptor 2 antagonist.
Toll Gate preventing(Antagonist) cars from crossing
ADPKD Rx:
Tolvaptan—Vasopressin receptor 2 antagonist.
Which medication removes potasium from the body rather than shifting potassium between fluid compartments in the short-term?
Cacium Resonium
Normal anion gap acidosis cause :
Diarrhoea
TPN
Rental Tubular Acidosi—Can’t hold on to Bicarbonate
Fistula
HIV ass Nephropathy Rx:
Anti retroviral therapy
Rx for Squamous cell carcinoma ?
Surgical Excision and biopsy
Nephrogenic DI mutation ?
Mutation in Vasopressin receptor 2
Family H/o recurrent stones + patient- C/o Recurrent stones. Dx:
Cystinuria
Cystinuria or Homocystinuria. Which is the cause of recurrent renal stones ?
Cystinuria
Apart from IV Fluids, what is the Rx of HUS ?
Plasma Exchange.
Prognosis of Minimal change disease in 10 year old child ?
Good prognosis but with later relapses.
Goserelin MOA :
GnRH Agonist.
Which test is positive in Cystinuria ?
Cyanide Nitropruside test.
Cyanide Nitroprusside test is positive in ?
Cystinuria and Homocystinuria
Cause of transient non visible Hematuria ?
Sex
UTI
Periods
Exercise
Long term benefit of Erythropoietin injection ?
Improved Exercise Tolerance
Rx for Membranous Nephropathy :
ACE inhibitor
Holiday history + Tender swollen right testis. Dx and Rx:
Epididymo orchitis
Rx: IM Ceftriaxone + doxycycline for 2 weeks
Electrolyte cause of Nephrogenic DI :
Hypercalcemia— Calcium deposits in the kidneys interfere with their ability to concentrate urine.
Hypokalemia
Does Demeclocyline cause Nephrogenic DI ?
Yes—By Blocing V2 receptor
Is long bone fracture side effect of Erythropoietin ?
No—Bone ache is the side effect.
Is pure red cell aplasia the side effect of Erythropoietin ?
Yes
Is hypertension the side effect of erythropoietin ?
Yes
Fanconi, which RTA ?
RTA type 2–proximal RTA
AA Amyloidosis is ass with ?
Rheumat condition
AL Amyloidsosis is ass with ?
AL—Liquid—Hemat condition
Which stain in amyloidosis ?
Congo red stain—Apple green Birefringes
Which inheritance in Alport ?
X Linked Dominant( Large X shaped Fighter Jet)
Renal Biopsy in Alport ?
Basket weave appearance
splitting on the lamina densa resulting in an abnormal glomerular-basement membrane.
Progressive renal failure + SNHL+ Opthal—Lenticonus. Dx?
Alport
Screening for adult polycystic kidney ?
Ultrasound
Kidney issues + Bleed on brain
ADPKD
Which hearing loss in Alport ?
SNHL
Renal transplant HLA matching, which one reduces risk of rejection ?
HLA DR
HIV is ass with which Glomerulonephritis?
Focal Segmental Glomerulosclerosis
Nephrotic syndrome in children / young adults:
Minimal Change Disease
How to prevent the formation of ascites in patients with chronic liver disease?
Spironolactone—Aldosterone antagonist
Which antibodies in Goodpasture?
Anti Glomerular Basement membrane antibodies
Goodpasture—Anti GBM
Calcium Oxalate stones prevention ?
Pyridoxine
Which chromosome in ADPKD ?
Chromosome 16
Suspected Rhabdomylosis, which blood test to do ?
Plasma Creatine Kinase.
Nephritic picture + Coeliac’s disease. Dx ?
IgA Nephropathy is ass with Coeliac’s
the most common glomerulonephropathy linked to renal vein thrombosis?
Membranous Glomerulonephritis
Most common nephrotic syndrome ass with thrombosis ?
Membranous Glomerulonephritis
K/C/O Membranous Glomerulonephritis + Deteriorating renal function + Left Flank Pain. Dx?
Renal Vein Thrombosis
Kidney shape in HIV Nephropathy ?
Normal or Large kidneys
Which gene defect in ADPKD ?
PKD1 gene defect
Is Hypertension a feature of Minimal Change Disease ?
No
Why do patients with chronic kidney disease have a raised phosphate level?
Decreased Renal Excretion
First line in BPH ?
Alpha 1 antagonist ( Tamsulosin )—then give 5 alpha reductase inhibitor
if the initial ACR is between 3 mg/mmol and 70 mg/mmol, Then ?
Repeat the test
ADPKD Inheritance ?
Autsomal Dominant
Wegner’s Glomerulonephritis ?
Crescentric Glomerulonephritis
Factors which affect eFGR variables?
Pregnancy
Muscle Mass
In HUS, what will the blood work show ?
Fragmented red blood cells
Recovery in HSP ?
Full Renal Recovery
Aquaporin 2 channel defect can lead to :
Diabetes Insipidous
Confirmatory test for renal stones ?
NCCT
ADPKD is ass with which gene ?
Chromosome 4
Hematuria + < 40 years. Referral to ?
Nephrology
Hematuia + > 40. Referral to ?
Urology
Staghorn calculus composition ?
Ammonium Magnesium
What deficiency in nephrotic syndrome leads to hypercoaguable state ?
Anti Thrombin 3 deficiency
Another name for Goodpasture :
Anti Glomerular basement membrane disease
Which collagen defect in Alport ?
Collagen 4
preferred method of access for haemodialysis
Arteriovenous Fistula
Nephrotic features—left sided flank pain and Hematuria. Dx:
Renal vein thrombosis—D/t Hypercoaguable state.
URTI infection 3 weeks ago—Now Hematuria.
PSGN
IgA occurs in 3 days.
Most common infection in peritoneal dialysis :
Staph epidermidis
Alpha 1 Antagonist example :
Doxazosin
Tamsulosin
Alpha 1 Antagonist side effects :
Postural hypotension
Dizziness
How to differentiate Wegner’s from Goodpasture :
While Wegner’s can cause similar symptoms to Goodpasture’s syndrome, such as haemoptysis, cough and renal impairment, it would typically also present with systemic features such as fever, weight loss and malaise. Furthermore, GPA often leads to an elevation in inflammatory markers like ESR or CRP which is not evident in this case.
Hyperkalemia. Most appropriate method to lower pottasium level :
Insulin/dextrose
Not calcium gluconate—it stabilises the myocardium, hence it’s an adjunct therapy, not primary.
Complication of plasma exchange :
Hypocalcemia
CKD on haemodialysis - most likely cause of death is
IHD
Cystine stones what kind of shadow in X-ray ?
Cystine=cysti=50-50—Semi Opaque in appearance
Complications in ADPKD :
Hepatomegaly due to hepatic cyst
Mitral valve prolapse
Uric acid stone is :
Radio lUcent—so requires usg or CT-KUB
Indicator for renal replacement therapy In AKI :
hyperkalaeamia which is refractory to medical management
following factors is most associated with an increased risk of developing bladder cancer
Aniline dye
