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FRACP Shuyu > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Most common electrolyte abnormality in post obstructive diuresis

A

hypokalaemia

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2
Q

Commonest cause of intrinsic renal failure in hospital

A

ATN

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3
Q

Urine MCS in AKI: Bland urine sediment

A

Favours pre-renal/ATN/MM/interstitial renal disease

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4
Q

Urine MCS in AKI: Active urine sediment

A

Acute GN

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5
Q

Urine MCS in AKI: hyaline/granular/tubular/epithelial casts

A

ATN

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6
Q

Urine proteinuria > 1g/d (Pr/Cr >0.1) in AKI

A

suggests glomerular/intrinsic renal disease

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7
Q

Difference in timing of recovery between pre-renal AKI and ATN

A

Pre-renal AKI resolves in 24-48hr after underlying insulin is treated ATN takes days to weeks due to time for renal tubules to re-generate

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8
Q

Metabolic acidosis in AKI - what HCO3 cut off is an indication for dialysis

A

HCO3<10

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9
Q

What UEC marker rises first in new anuria

A

Instantaneous risk in K+ but creatinine takes days

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10
Q

what marker do you dialyse to in pregnant women requiring dialysis

A

urea - aim <16; may require 6x dialysis/week

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11
Q

Kidney anatomical site

A

T12 - L3 Retroperitoneal R) kidney lower because it’s pushed lower by the liver

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12
Q

What separates the blood and filtrate in the glomerulus/bowman’s capsule

A

Endothelium, basement membrane, epithelium

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13
Q

Juxtaglomerular complex location

A

Between distal convoluted tubule and afferent arterial

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14
Q

What is the juxtaglomerular complex composed of and what do those cells do

A

Macular dense - in distal convoluted tubules; senses when sodium and chloride are low; in hypotension, the sodium and chloride levels are low and they communicate to the juxtaglomerular cells (facilitated by the extraglomerular mesengial cells) Juxtaglomerular cells- produce renin in response to low sodium/chloride and increases vascular constriction

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15
Q

sphincters in the bladder

A

internal sphincter (involuntary) external sphincter (voluntary)

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16
Q

where is the micturition centre in the spinal cord

A

S2-3

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17
Q

What is the micturition centre and how is it regulated

A

Micturition reflexion causes contraction of the bladder and relaxation of sphincters It is controlled by the pontine storage centre which stops the micturition reflex and pontine micturition centre can allow the micturition reflex to happen

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18
Q

What cells are linked to IgA nephropathy?

A

Mesangial cells

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19
Q

What cells are linked to Membranous nephropathy

A

Podocytes

20
Q

What cells are linked to ANCA assos GN

A

Endothelial cells

21
Q

What cells are linked to FSGS

A

Podocytes

22
Q

What cells are linked to minimal change

A

Podocytes

23
Q

Diagnosis

A

Fibromuscular dysplasia

“String of beads”

24
Q

Is renin elevated in unilateral or bilateral renal-artery stenosis hypertension?

A

Unilateral - but not a specific finding

25
Q

Management of renal artery stenosis

A
  • Fibromuscular dysplasia - readily treatable with angioplasty (but RAS is mainly caused by atherosclerotic disease)
  • Mild to mod - abundant evidence that medical intervention offers no added benefit
  • High risk may benefit from intervention
    • Bilateral high grade RAS
    • Soliatry functioning kidney
    • Recurrent APO
    • Deterioriating renal function
26
Q

Tacrolimus Vs cyclosplorin

A

less rejection
better renal function
increased graft survival
more Diabetes…………….~ 1.3 to 1.5x

27
Q

What kind of AKI does aminoglycosides cause?

A

ATN

Aminoglycosides is filtered and taken up by tubular cells (saturable process so single large dose is less toxic)

28
Q

What is the difference between medullary sponge kidneys and medullary cystic kidneys?

A

Medullary sponge kidneys

  • Often an incidental finding following nephroliathiasis
  • Mostly sporatic
  • Generally benign

Medullary cystic kidney

  • Renal cysts not evidence on imaging normally
  • Tubulo-interstitial disorders characterised by:
    • Hyperkalaemia, hyperuricaemia, progression to ESRD
  • Autosomal dominant inheritance
29
Q

Autosomal dominant polycystic kidney disease PKD1 vs PKD 2

A

PKD-1

  • Chromosome 16
  • Encodes protein polycystin-1
  • Earlier age of cysts and ESKD

PKD-2

  • Chromosome 3
  • Encodes protein polycystin-2
  • More indolent
30
Q

Diagnosis of autosomal dominant polycystic kidney disease

A

Ultrasound

DNA analysis mainly reserved for people whose offsprings are being considered for transplant donors

31
Q

What antihypertensive is first line in ADPCKD

A

ACEI/ARB

32
Q

Which ADPCKD patients to screen for cerebral aneurysms for?

A
  • Family history of cerebral aneurysm/SAH or CVA
  • New onset headache or neurological symptoms or signs
  • High risk professions (e.g. : pilot)
  • ?repeat screening every 5 years
33
Q

MOA and use of tolvaptan

A
  • Vasopressin receptor antagonists
    • Suppression of vasopressin release reduces second messenger systems (cAMP) identified as promoters of kidney- cyst cell proliferation and luminal fluid secretion

ADPCKD

34
Q

Diagnostic hallmark of IgA nephropathy

A

IgA deposits in the glomerular mesangium

35
Q

Treatment of IgA nephropathy

A
  • Long-term ACE-I or ARB whe proteinuria is >0.5g/d or aim BP <130/80mmHg
  • Corticosteroids if persistent proteinuria >1g/d for 3-6 months of optimized supportive care and eGFR >50mL/min
  • Add cyclophosphamide in rapidly progressive crescentic IgAN
36
Q

Membranous GN biopsy findings

A
  • Diffuse thickening of the GBM
  • Deposition of IgG and C3 along the GBM
  • Immuno complex seen on GBM on EM
37
Q

Membranous nephropathy management

A
  • Spontaneous remission in up to 20%
  • Parial remission in up to 40%
  • Treat
    • Heavy proteinuria
    • Renal dysfunction
  • Cyclophosphamide and steroid based regimens currently first line
  • Rituximab emerging as 1st line
38
Q

anti-PLA2R antibody test

A

HIgh predictivity for primary membranous nephropathy

Can be used to monitor disease activity

39
Q

Proliferative lupus nephritis induction agents

A
  • Steroids
    • IV methylpred pulses
  • Cyclophosphamide
    • IV less toxic than oral
    • Minimise dosing by using monthly for 3-6 months then switching to MMF or aza
  • Mycophenolate
    • As effective as cyclophosphamide at inducing remission
    • Minimises gonadal toxicity (but also cannot conceive on it)
  • Rituximab
    • Less evidence
  • Tacrolimus + Mycophenolate
40
Q

Lupus nephritis treatment in pregnancy

A
  • Lupus nephritis should be in remission for 6 months prior conception
  • MMF should be switched to azathioprine at least 6 weeks before conception is attempted
  • Cyclosplorine and tacrolimus can also be used during pregnancy
41
Q

Indications for plasma exchange in pauci-immune RPGN

A
  • Severe renal failure
  • Concurrent anti-GBM antibodies
  • Pulmonary haemorrhage
42
Q

What type of RTA has an inability to acidify urine?

A

Type 1/distal RTA because distal defect -> decreased H+ secretion

Urine pH >5.5

43
Q

Most common cause of type 4 RTA

A

Diabetic nephropathy

44
Q

Blood pressure and survival in dialysis patients

A

Survival disadvantage with lower BP

45
Q
A

FRACP Shuyu (65 decks)

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