Nephrology

Question 1

Causes of acute renal failure - pre-renal

Answer 1

1. Pre-renal

SHOCK

Septic
Haemorrhagic 
Cardiogenic
hypOvolaemic
anaphylaxis; blood transfusion reaction

Renovascular - STENTABLE

Stenosis
Thrombosis
Embolism
NSAIDS
Toxins
Autoimmune eg sceroderma, Vasculitis 
Blood pressure - malignant hypertension
Liver failure
Electrolyte - Hypercalcaemia 
Eclampsia, pre-

Question 2

Causes of acute renal failure - Renal

Answer 2

1. Glomerulonephritis - PAINT

Primary eg proliferative, membranoproliferative
Autoimmune eg SLE, Vasculitis, anti-GBM, IgA nephropathy
Infective eg post streptococcal, HIV, HBV, HCV, malaria
Neoplasia - myeloma, lymphoma
Toxins - penicillamine, heroin

2. Tubulo-interstitial nephritis - TIN
   Toxins- allergic, antibiotics, ACEi, NSAIDS
   Infection - legionnaires, CMV
   Neoplasia - lymphoma, leukaemia
3. Acute tubular necrosis - ATN
   ABP low
   Toxins - aminoglycosides, cephalosporins, NSAIDS, contrast
   Neoplasia - tumour lysis, myeloma
   Necrosis - rhabdomyolysis, intravascular haemolysis
   Nephritis-pyelo

Question 3

Causes acute renal failure - post renal

Answer 3

Ureteric obstruction or urinary retention

SNIPPING

Stone
Neoplasia
Infection
Papillary necrosis, pregnancy, prostate
Inflammation - stricture or fibrosis
Neurological - toxins, cord or psychological
Genetic/ congenital - stenosis, valves

Question 4

Chronic renal failure causes

Answer 4

Renovascular (STENTABLE)

Renal - glomerulonephritis (PAINTS) or tubulo-interstitial (TUBULAR-PH)

Structural - developmental agenesis, polycystic kidneys, neoplasia

Question 5

Chronic renal failure - PC and O/E

Answer 5

SCARRING TUBES

Skin - uraemia (pruritis, brown nails), underlying cause (Vasculitis, scleroderma), complications (anaemia, tophi- gout)

Cardiac - fluid overload, oedema, pericarditis, IHD

ABP - high

Respiratory - pulmonary oedema, effusion, fibrosis

Respiratory pattern - hiccups, kussmauls breathing

Immuno-compromise - pneumonia

Neurological - encephalopathy, peripheral neuropathy

GIT - gastric ulcers, bleeding

Thrombocytopenia - purpura, git haemorrhage,

Urine - frequency, nocturia, loin pain

Bones - osteomalacia and porosis

Endocrine - amenorrhoea, impotence, growth retardation

Systemic - anaemia, anorexia

Question 6

Chronic renal failure - complications

Answer 6

CRF HEALS

CVD
Renal osteodystrophy
Fluid 
HTN
Electrolyte disturbance
Anaemia
Leg restlessness
Sensory neuropathy

Question 7

Causes of renal enlargement

Answer 7

PHONE

Polycystic kidneys
Hypertrophy secondary to renal agenesis
Obstruction
Occlusion
Neoplasia - RCC, myeloma, lymphoma, amyloid
Endocrine - DM

Question 8

APKD - presenting complaint

Answer 8

MISHAPEN (autosomal dominant)

Mass effect - abdo mass or flank pain
Infection
Stones
Haematuria
ABP - hypertension
Polyruria, nocturia
Extra renal cysts - liver, pancreas, lungs, ovaries
Extra - inguinak herniae, colonic diverticula
Neuro - cerebral berry aneuryms, subarachnoid haemorrhage, aortic aneurysm, mitral valve prolapse

Question 9

Urothelial cell carcinoma risk factors

Answer 9

Age
Alcohol
Carcinogens: P-SAC

Phenacetin
Smoking (#1)
Analine - rubbers and dyes
Cyclophosphamide