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Royal College Exam > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Causes of glomerulonephritis associated with low C3 (immune complex deposition)

A
  • Lupus nephritis
  • post-strep nephritis
  • cryoglobulinemic GN
  • other immune complex GN (MPGN)
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2
Q

Causes of glomerulonephritis associated with anti-GBM autoantibodies

A

goodpastures, anti-GBM nephritis

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3
Q

most common cause of microscopic hematuria

A

benign familial hematuria (autosomal dominant) 63%

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4
Q

Alport’s disease

A

usually x-linked (85%) defect in COL4A5 gene, presents with microscopic hematuria, sensorineural hearing loss, ESRD by 4th decade (males)

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5
Q

gross hematuria presenting 1-3 days after a URTI

A

IgA nephropathy

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6
Q

gross hematuria presenting 7-21 days after a pharyngitis

A

post-strep GN

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7
Q

methods to measure proteinuria

A

protein:creatinine ratio (normal < 20 mg/mmol)
OR
24 hour protein collection (normal < 4 mg/m2/hr, nephrotic > 40 mg/m2/hr)
DO NOT DO URINANALYSIS

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8
Q

Hematuria: 4 tests on urinanalysis that would indicate a glomerular origin

A
  • colour = tea or cola-coloured
  • dysmorphic RBCs (acanthocytes)
  • RBC casts
  • proteinuria
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9
Q

Triad seen with post-strep GN

A

gross hematuria
generalized edema
hypertension

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10
Q

Long term complications of Fanconi syndrome

A

FTT, growth failure, intellectual impairment, ocular abnormalities (cataracts, glaucoma), enamel defects

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11
Q

Medical treatment of overactive bladder

A

treat constipation (PEG), anticholinergic (oxybutynin) or alpha-blockers (doxazosin)

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12
Q

Definition of nephrotic range proteinuria

A

> 40 mg/m2/hr

> 50 mg/kg/day

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13
Q

Most common cause of nephrotic syndrome

A

Minimal change disease

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14
Q

Nephrotic syndrome, finding on biopsy of glomerulus

A

effacement of podocyte foot processes

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15
Q

What organisms are patients with nephrotic syndrome at increased risk of?

A

Streptococcus pneumoniae and haemophilus influenza - due to loss of complement factor C3b, opsonins and immunoglobulins

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16
Q

What should you do before starting a patient with nephrotic syndrome on immunosuppressant medication?

A

PPD, give polyvalent pneumococcal vaccine (23-serotype and 7-valent conjugate vaccines)

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17
Q

Treatment of nephrotic syndrome

A

prednisone x 4-6 weeks

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18
Q

Most common cause of peritonitis in nephrotic syndrome

A

strep pneumoniae

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19
Q

Secondary infectious causes of nephrotic syndrome

A

malaria, schistosomiasis, hep B/C, HIV

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20
Q

Options for surgical repair of urinary reflux - 2 methods

A

Deflux (injection of stuff into ureter), reimplanation of ureter

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21
Q

Gross hematuria, nephrotic syndrome. what to worry about?

A

renal vein thrombosis

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22
Q

Five criteria of nephritis

A
  • hematuria (gross, red cell casts)
  • hypertension
  • azotemia (elevated urea, cr)
  • edema (fluid overload, high JVP)
  • proteinuria
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23
Q

Alports - extra-renal manifestations

A

eye - anterior lenticonus, recurrent corneal erosions, macular flecks

ear - deafness (bilateral)

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24
Q

BP tables depend on…

A

height
age
gender

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25
What is cysteinuria?
Urinary loss of COLA amino acids (cysteine, ornithine, lyseine and arginine)
26
Diagnosis of cystinosis
leukocyte cysteine levels
27
Usual cause of renal vein thrombosis in infant
IDM
28
In gestation, when is formation of nephrons complete?
36-40 weeks GA
29
Approx how many nephrons are in the kidney?
1 million
30
What factors modify glomerular filtration?
- glomerular hydrostatic pressure - glomerular oncotic pressure - rate of flow - permeability of glomerular capillary wall
31
Definition of hematuri
>= 5 RBCs/hpf
32
Causes of false positive for hematuria on dipstick
``` oxidizing agents (ie. H2O2 used to clean perineum prior to obtaining sample) betadine alkaline urine (pH >9) rhabdomyolysis ```
33
causes of false negative for hematuria on dipstick
presence of formalin in sample high concentrations of ascorbic acid (as a result of high vit c intake)
34
what does a dipstick read as positive for blood?
hemoglobin RBCs myoglobin
35
What can differentiate glomerular vs non-glomerular hematuria on urinanalysis?
presence of RBC casts and dysmorphic RBCs = glomerular origin!
36
what condition should you think of with isolate microscopic hematuria (on repeated samples)
hypercalciuria (test by checking calcium:creatinine ratio)
37
most common form of primary GN
IgA nephropathy
38
Pathology characteristics of IgA nephropathy
mesangial proliferation, crescents/sclerosis, IgA deposition + C3
39
IgA nephropathy can present as....
gross hematuria microscopic hematuria nephritic nephrotic
40
What is the C3 in IgA nephropathy?
NORMAL
41
What can decrease the rate of progression of IgA nephropathy in adults
fish oil (omega 3)
42
what proportion of IgA nephropathy patients progress to have significant renal disease?
30%
43
Alports - pathology
mesangial proliferation | lipid-laden cells (foam cells)
44
How do you work-up / diagnose alports?
Fam hx Audiogram Ophtho - presence of anterior lenticonus is pathognomonic!
45
Risk of ESRD in Alports
High! 75% of males (x-linked hemizygotes) and homozygotes (AR form) develop ESRD by age 30 Tx: control hypertension, ACEi
46
Recurrent episodes of hematuria with occasional gross hematuria post-URTI Family members w/ same sxs No hearing loss What syndrome?
Thin basement membrane disease! AKA benign familial hematuria
47
post-strep GN | clinical situations and latency period
strep pharyngitis: 5-21 days pyoderma/impetigo: 3-6 weeks
48
natural hx of post-strep GN
acute phase resolves in 6-8 weeks, can have persistent microscopic hematuria x 1-2 yrs
49
Lab tests for post-strep GN
decreased C3 normal C4 low CH50 confirmation of strep diagnosis (positive throat cx, rising ASOT or anti-DNase B, streptozyme screen)
50
Types of GN with a normal C3
``` Alports IgA nephropathy ANCA-positive GN Goodpastures Anti-GBM ```
51
Types of GN with a LOW C3
``` post-strep post-infectious shunt nephritis MPGN cryoglobulinemia SLE bacterial endocarditis ```
52
Common causes of membranous nephropathy in children
SLE Hep B Congenital syphilis
53
Most common cause of membranous nephropathy world wide
malaria
54
What can cause membranoproliferative GN?
Think of infections! | Hep B/C, syphilis, endocarditis
55
If someone has a low C3 GN which doesn't improve after 2 months, what conditions should you think of?
SLE MPGN cryoglobulinemia
56
When should you biopsy a patient with SLE and evidence of renal involvement?
always! no correlation between SLE disease activity and severity of renal involvement. the extent of disease will be used to guide therapy
57
How do you treat lupus nephritis?
prednisone x 4-6 mos (or azathioprine as steroid-sparing agent) if very severe, can tx with cyclophosphamide
58
which class of lupus nephritis has the highest risk of progression to ESRD?
Class IV lupus nephritis
59
Henoch Schonlein Purpura | Clinical features
palpable purpura abdominal pain arthritis 50% develop nephritis
60
How should you monitor for nephritis in patients with HSP?
Urinanalysis weekly during period of active disease, then monthly x 6 mos If anything abnormal - refer to nephro!
61
Which types of GNs are associated with crescenteric / rapidly progressive GN?
SLE HSP (if severe) ANCA positive granulomatosis with polyangiitis (formerly, Wegeners)
62
Clinical features of Goodpasture's disease
pulmonary hemorrhage glomerulonephritis (due to antibodies against GBM)
63
HUS - triad
"RAT" renal failure anemia (MAHA) thrombocytopenia
64
TTP - features
``` "FAT RN" fever anemia (MAHA) thrombocytopenia renal failure neurologic sxs ```
65
Diagnostic criteria of HUS
An acute illness with HUS features (renal failure, MAHA, thrombocytopenia) occurring within 3 wks after an episode of acute or bloody diarrhea
66
Common bacterial etiologies of diarrhea in HUS
Vero-toxin producing e.coli (0157:H7) Shiga-toxin producing Shigella
67
Common foods contaminated with e.coli 0157:H7
unpasteurized milk undercooked meat (beef) apple cider
68
Genetic forms of HUS are due to...
Deficiencies in ADAMTS13 Complement factor H, I or B
69
Intestinal complications of HUS
``` severe inflammatory colitis ischemic enteritis bowel perforation intussusception pancreatitis ```
70
Should you give platelets in HUS?
NO! They are immediately consumed, may worsen clinical course
71
Should you give RBCs in HUS?
Maybe! If you suspect pneumococcus-associated HUS, then you should wash the RBCs before transfusion (IgM on cell surface can worsen course)
72
Treatment of HUS
Supportive care (NO PLATELETS) Plex if ADAMTS13 or factor H deficient Eculizumab for atypical HUS
73
Nephrotic syndrome characteristics
Nephrotic range proteinura Hypoalbuminemia Edema Hyperlipidemia
74
Definition of nephrotic range proteinuria
> 40 mg/m2/hr on a 24 hr collection
75
Genetic disorders causing nephrotic syndrome
Finnish-type congenital nephrotic syndrome Denys-Drash Alport syndrome Nail-patella syndrome
76
Causes of idiopathic nephrotic syndrome
Minimal change disease FSGS Membranous nephropathy
77
Hallmark pathologic finding of idiopathic nephrotic syndrome
Effacement of podocyte foot processes
78
Why is nephrotic syndrome a hypercoagulable state?
Vascular stasis (due to 3rd spacing, low intravascular volume) Increase in clotting factor production (due to increased hepatic protein synthesis) Loss of anti-coagulants via kidneys
79
Immunofluorescence in FSGS
IgM and C3 deposits
80
Natural history of FSGS
does not respond well to steroids, often leads to ESRD
81
What should you do before starting tx for nephrotic syndrome?
PPD | Pneumococcal vaccine
82
Tx for nephrotic syndrome
Prednisone DAILY x 4-6 weeks
83
relapse rate of nephrotic syndrome (if given 4-6 weeks of initial steroids at diagnosis)
30-40%
84
what is steroid dependent nephrotic syndrome?
kids that relapse while steroids are being weaned (on alternate day schedule) OR within 28 days of completing steroid course
85
definition of frequent relapser in nephrotic syndrome?
relapse >= 4x in 12 mos
86
definition of steroid resistant nephrotic syndrome
fail to respond to 8 weeks of steroid tx (usually FSGS)
87
how can you treat steroid-dependent and frequently relapsing nephrotic syndrome?
cyclophosphamide | monitor for neutropenia
88
how can you treat steroid resistant nephrotic syndrome?
cyclosporine, tacrolimus
89
side effects of cyclosporine
nephrotoxicity hirsutism gingival hypertrophy PRES
90
Bugs causing SBP in nephrotic syndrome
strep pneumo | e.coli
91
Clinical features of Denys-Drash
early-onset nephrotic syndrome wilms tumour ambiguous genitalia progressive renal insufficiency
92
Child with suspected proteinuria - how do you test?
First void urine protein to creatinine ratio (abnormal > 20) or 24 hr urine collection (> 40 mg/m2/hr = nephrotic)
93
Causes of transient proteinuria
``` fever dehydration exercise cold stress seizures ```
94
what is orthostatic proteinuria?
Increased urinary protein excretion when in the upright position
95
how do you diagnose orthostatic proteinuria?
first void spot protein:creatinine ratio x 3 demonstrating absence of proteinuria (other evaluations showing + proteinuria)
96
definition of hypertension
SBP or DBP >= 95th %ile on 3 occasions
97
when should you start measuring BP in kids? how often?
at every visit in children > 3 yrs should measure at EVERY visit regardless of age if prem, NICU, CHD, UTIs, kidney anomaly, malignancy, BMT, etc

Royal College Exam (32 decks)

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