Nephrology Flashcards
what is the most common nephrological affliction in ageing?
membranous nephropathy which is when glomeruli become damaged and thickened and allow proteins to pass through
what is ageing?
a slow inflammatory process
give examples of drugs given post-renal transplant and their effects
basiliximab - anti CD25 anti-lymphocyte ab - against T cells campath/alemtuzumab - anti-CD52 Rituximab - anti CD20 ecilizumab - anti C5
what drugs are given as maintenance therapy for post-renal transplant
tacrolimus (cyclosporin)
antiproliferative: mycophenolate
prednisolone
mTOR inhibitors
what are the signs of acute renal rejection?
abrupt rise in serum creatinine, fluid retention, fever, graft tenderness
what is the management for acute renal rejection
pulse steroids and increase immunosupression
what are absolute contraindications of renal transplantation patient
- untreated current infection
- maligancy with short lifespan
- lifespan<1yr
- active psychosis
- active substance abuse
- bilateral severe peripheral vascular occlusive disease
what are contraindications of transplant donation
<18yrs HTN with end organ damage diabetes active malignancies evidence of donor coercion low GFR by age
what is gold standard treatment of CMV
IV ganciclovir or oral vlganciclovir
when should one start dialysis
eGRF < 15ml/min per 1.73m2 intractable fluid overload, hyperkalemia malnutrition due to uremia uremic neurologic dysfunction uremic sierostitis
during dialysis are we giving acid or alkali to the patients
alkali
where does the blood and dialysis fluid first meet
in the dialyser
what is disequilibrium syndrome
a set of systemic, neurologic symptoms occur during/after dialysis. nausea, vomiting, restlessness, seizures, headaches. It is thought to be due to an acute increase in brain water content
how is water purified?
treat with a water softener and carbon adsorption. Reverse osmosis and deionization. Distilation
what is ADPKD
It is an inherited disorder that presents as cyst developing on the kidney surface
what genes are associated with ADPKD and what proteins do they code for?
PKD1 (codes for PC1)
PKD2 (codes for PC2)
what is the function of PC1?
it acts as a mechanosensor on cilium of the kidney. They can sense urine flow rate and convey this information to intracellular calcium signalling. These changes in calcium affect gene transcription
relate ADPKD and corresponding levels of intracellular calcium
in ADPKD the levels of intracellular calcium are decreased due to loss of function of PC complex.
what is another role of PC1
it helps formation of desmosomal junctions, adherens junctions.
relate cAMP levels to ADPKD. Name a drug used for treatment
cAMP levels are increased in ADPKD. Tolvaptan
list some extrarenal manifestations of ADPKD
Hepatic cysts
diverticulosis
pancreatic cysts, abdominal hernia, cholangiocarcinoma, liver fibrosis, cardiac valve abnormalities, aortic aneurysm, intracranial aneurysm
what are vaptans
are vasopressin receptor 2 antagonists
define hepatorenal syndrome type 1
acute, functional AKI developing close to deterioration of other organs.
define hepatorenal syndrome type 2
renal imapairment that is less severe than that of type 1. Most common sign is ascites that is resistant to diuretics
what do the kidneys look like in type 1 hepatorenal syndrome
normal. You must diagnose based on exclusion of other syndromes
what are percipitating factors of type 1 HRS
severe alcoholic hepatitis, infection, large volume paracentesis w/out plasma expansion, GI bleed
what are diagnosis criteria for HRS type1
cirrhosis with ascites, serum creatinine >133mmol/L, no shock, no parenchymal kidney disease
signs of ANCA associated renal vasculitis
cutaneous purpura, nodules, ulceration, peripheral neuropathy, abdominal pain, blood in stool, hematuria, protienuria, necrotizing sinusitis, myalgia
list histology findings of ANCA associated renal vasulitis
LM: necrotizing GN
IF: neccrotizing vasculitis
EM: diffuse foot process effacement
what is the target of ANCA’s
myeloperoxidase or proteinase 3
how do you treat vasculitis
corticosteroids
pathogenesis of lupus glomerulonephritis
autoantibodies against self DNA weird clearance of cellular debris loss of immune tolerance increase in cell death inflammation fibrosis and proliferation of endothelial and mesangial cells
treatments of SLE nephritis
plasmapheresis, cyclophosphamide (rituximab), corticosteroids
hypoalbuminema levels
less than 3.5g/dL
presentation of Nephrotic syndrome
edema in legs, xanthelasma, periorbital edema in morning
what are the 2 causes of nephrotic syndrome
glomerulonephritis, and systemic diseases
what med do you give for alports
ACEi
name the 3 benign renal tumors
renal papillary adenoma, angiomyolipoma, oncocytoma
renal cell carcinoma is due to mutation in what gene
VHL
prostate tumors are most often in the
peripheral zone
