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Phase 3B > Nephrology 2 > Flashcards

Nephrology 2 Flashcards

1
Q

What are the subtypes of nephritis?

A

Glomerulonephritis

Interstitial nephritis/tubulo-interstitial nephritis

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2
Q

How does nephritis present?

A 
Nephrotic syndrome
Nephritic syndrome
AKI
CKD
Renal pain and dysuria
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3
Q

What are the clinical features of nephritic syndrome?

A

Haematuria and proteinuria
Oliguria
Oedema
Uraemic symptoms

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4
Q

What symptoms suggest elevated levels of urea?

A

Anorexia
Pruritus
Lethargy
Nausea

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5
Q

What are some causes of nephritis?

A

Post Group A strep infection
EBV/Hep B infection
SLE/HSP

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6
Q

How is suspected nephritis managed?

A

Urine dipstick for protein and blood

Refer to secondary care

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7
Q

What is nephrotic syndrome?

A

A type of glomerulopathy where there is immunologically mediated injury to glomeruli

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8
Q

What are the 3 cardinal signs of nephrotic syndrome?

A

Large proteinuria (>3.5g/day)
Oedema
Hypoalbuminaemia (serum albumin <30g/L)

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9
Q

How do the signs of nephrotic syndrome come about?

A

Increased permeability of serum protein through the damaged basement membrane of the renal glomerulus

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10
Q

What are some other problems in nephrotic syndrome?

A

Dyslipidaemia
Coagulation/fibrinolysis abnormalities
Immunological disorders

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11
Q

What percentage of nephrotic patients progress to end stage renal failure?

A

25%

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12
Q

What is the most common cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

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13
Q

Name three secondary causes of nephrotic syndrome.

A

Diabetic nephropathy
SLE
Multiple myeloma

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14
Q

How does hyperlipidaemia occur in nephrotic syndrome?

A

In response to hypoalbuminaemia, the liver commences a compensatory mechanism, synthesizing proteins

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15
Q

Describe the oedema of nephrotic syndrome.

A

Children - facial/periorbital then spreads to whole body
Adults - starts with peripheral and spreads to whole body
Genital

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16
Q

Other than oedema, what are the other symptoms of nephrotic syndrome?

A

Frothy urine
Hypercoagulability
Fatigue etc
Xanthomata

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17
Q

How is nephrotic syndrome diagnosed?

A

Urine dipstick for haematuria and proteinuria, quantify using early morning urinary PCR or ACR
Renal biopsy and USS
eGFR
FBC and biochemistry

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18
Q

How is nephrotic syndrome managed?

A

Sodium and fluid restriction
High dose diuretics
PO prednisolone 6 months

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19
Q

What is the treatment of relapsed nephrotic syndrome?

A

Cyclophosphamide/ciclosporin

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20
Q

What are the different glomerulonephritides?

A 
Minimal change
Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
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21
Q

What is the cause of minimal change disease?

A

Idiopathic/infection/neoplasm

Loss of podocytes and fusion of foot processes

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22
Q

When is the peak incidence of minimal change disease?

A

2-3 years males

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23
Q

How do most glomerulonephritides present?

A

Nephrotic syndrome

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24
Q

What is the treatment of minimal change disease?

A

High dose prednisolone

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25
Q

What is the name of infection within the renal pelvis/parenchyma?

A

Pyelonephritis

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26
Q

What are the risk factors for chronic pyelonephritis (from repeated attacks of acute pyelonephritis)?

A

Vesicoureteric reflux
Diabetes
Structural renal tract anomalies

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27
Q

Which organisms cause pyelonephritis?

A

The same as for lower UTI: E.coli, klebsiella, proteus, enterococcus.

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28
Q

What are risk factors for acute pyelonephritis and cystitis?

A 
Female
Children and elderly
Abnormalities of the renal tract
Calculi
Immunocompromised
Incomplete bladder emptying
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29
Q

How does pyelonephritis present?

A 
Loin/suprapubic/back pain
Fever and rigors
V+D, malaise, anorexia
LUTS
Tenderness without guarding
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30
Q

Name some LUTS.

A

Frequency
Hesitancy
Dysuria
Gross haematuria

31
Q

What is found on urinalysis in pyelonephritis?

A

Urine cloudy with offensive smell
Dipstick positive for blood, protein, leukocyte esterase, nitrite
Pyuria in MCS

32
Q

What are other investigations in pyelonephritis?

A

Raised CRP and WCC
+ve cultures
USS in men, children, and recurrent cases

33
Q

Which antibiotic is recommended for pyelonephritis?

A

Ciprofloxacin or co-amoxiclav

If culture confirms sensitivity then trimethoprim.

34
Q

Which bacteria are sensitive to trimethoprim?

A 
E.coli
Proteus
Klebsiella
Enterococcus
HIB
Strep.pneumoniae
35
Q

What are three complications of pyelonephritis?

A

Pyonephrosis
Perinephric/renal abscess
Sepsis

36
Q

Which types of E.coli are associated with pyelonephritis, and cystitis?

A

Pyelonephritis - type p fimbriae (PapG adhesin)

Cystitis - type 1 fimbriae (FimH adhesin)

37
Q

When is a UTI a relapse, and a reinfection?

A

Relapse: same organism, within 7 days
Reinfection: same or different organisms, after 14 days

38
Q

How is UTI diagnosed?

A

Nitrites and leukocyte esterase on dipstick

MCS - leukocytes

39
Q

How is UTI treated?

A

Trimethoprim or nitrofurantoin

3d women, 7d men

40
Q

From where does renal cell carcinoma arise?

A

Proximal tubule epithelium

41
Q

What is the most common type of RCC?

A

Clear cell

42
Q

Where does RCC spread?

A

Adrenal glands, liver, spleen, colon, pancreas

Most common site of metastases - lungs, cannon ball secondaries

43
Q

What are the risk factors for RCC?

A

Smoking and obesity
Renal disease
Von Hippel Lindau syndrome (AD inheritance, multiple tumours developed)

44
Q

What is the classic triad of RCC?

A

Haematuria
Loin pain
Loin mass
But often asymptomatic

45
Q

How may a left sided varicocele develop in RCC?

A

If the tumour has invaded the left renal vein, the left testicular vein is obstructed.

46
Q

Why might hypertension occur in RCC?

A

Tumour secretes renin

47
Q

30% RCC patients have paraneoplastic symptoms such as…

A 
Neuromyopathy
Anaemia
Polycythaemia
Amyloidosis
Hypercalcaemia
48
Q

What is the best investigation initially for RCC?

A

Abdominal CT with contrast

49
Q

What is the gold standard treatment of RCC?

A

Laparoscopic partial nephrectomy

50
Q

What is the gold standard treatment of metastatic RCC?

A

Tumour nephrectomy with IFN-alpha chemotherapy

51
Q

What is the syndrome of inappropriate ADH secretion?

A

Excess release of ADH from posterior pituitary or ectopic source

52
Q

Why is ADH released normally?

A

In response to hyperosmolality.

53
Q

What is the function of ADH?

A

Increases the amount of water reabsorbed in the kidney

Constricts arterioles, which increases peripheral vascular resistance and arterial blood pressure

54
Q

What is the pathophysiology of SIADH?

A

Patient drinks water, plasma osmolality decreases, but ADH continues to be released, leading to a hypo-osmolar state

55
Q

Which tumours may secrete ADH?

A

GI
Lung small cell
GU
Lymphoma

56
Q

Which conditions may increase ADH secretion?

A

CNS infection, mass, or bleed
Hydrocephalus
MS
Pneumonia or asthma

57
Q

Which drugs may increase ADH secretion?

A

Diuretics
SSRIs
PPIs
ACEIs

58
Q

How does SIADH present?

A

Stems from water retention and hyponatraemia:

  • Confusion, coma, seizures
  • Nausea
  • Muscle weakness and ataxia
  • Cheyne Stokes respiration
59
Q

How is SIADH diagnosed?

A

Serum hypoosmolality<275mOsm/kg (low)

Urine osmolality>100mOsm/kg and sodium>30mmol/L (high)

60
Q

What should be excluded in SIADH investigations?

A

Hypothyroidism

Addison’s disease

61
Q

Which formula should be used to calculate electrolyte free water clearance?

A

Furst formula

62
Q

What are the principles of management of SIADH?

A

Fluid restriction in most cases

Increase sodium levels

63
Q

What drug can be used for SIADH?

A

Tolvoptan or demeclocycline

64
Q

What are the symptoms of IgA nephropathy?

A

Recurrent episodes of macroscopic haematuria, 1-2 days after URTI

65
Q

How does IgA nephropathy differ from post-strep glomerulonephritis?

A

Post-strep occurs weeks after URTI

66
Q

What is the treatment of ascites in patients with chronic liver disease?

A

Aldosterone antagonists - spironalactone

67
Q

How do you calculate anion gap?

A

(Na + K) - (Cl + HCO3)

68
Q

What is the normal range for anion gap?

A

8-16mEq/L

69
Q

How can you differ dehydration from AKI?

A

In dehydration, the urea is proportionally higher than a rise in creatinine

70
Q

What is the management of acute clot (urinary) retention?

A

Continuous bladder irrigation via a 3 way urethral catheter

71
Q

What is the usual first line option of renal replacement therapy?

A

Peritoneal dialysis

72
Q

How does autosomal dominant polycystic kidney disease present?

A

Usually in 3rd to 4th decade

Haematuria/hypertension
Polycythaemia
Liver cysts
Berry aneurysms
MV prolapse
73
Q

How does autosomal recessive polycystic kidney disease present?

A

In childhood

Haematuria/HTN
Hepatic fibrosis and portal hypertension

74
Q

Name three chronic metabolic complications of haemodialysis treated end stage renal failure.

A

Amyloidosis
Secondary or tertiary hyperparathyroidism
Dyslipidaemia

Phase 3B (20 decks)

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