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AMK > Nephrology Pathology > Flashcards

Nephrology Pathology Flashcards

1
Q

What is autosomal dominant polycystic kidney disease

A

Mutation on chromosome 16
Causes flank pain and subarachnoid haemorrhage

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2
Q

Charcots triad

A

Right upper quadrant pain, jaundice and rigors

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3
Q

What is acute cholangitis

A

Bile duct infection

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4
Q

necrotising enterocolity

A

bilious vomiting and rectal bleeding

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5
Q

signs of lithium toxicity

A

slurred speech
coarse tremor
dry mouth
more thirst
increased urination

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6
Q

stage 1 CKD characteristics

A

creatinine rise of x1.5 and urine output of <0.5ml/kg for 6 hours

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7
Q

stage 2 CKD characteristics

A

creatinine rise x2
urine output of <0.5 over 12 hours

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8
Q

stage 3 CKD characteristics

A

creatinine rise x3
urine output <0.3 over 24 hours

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9
Q

why should NSAIDS (naproxen) be avoided in AKI

A

because they cause vasoconstriction of the afferent renal arterioles - cause toxicity

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10
Q

renal failure, low o2, low RR

which painkiller can cause this

A

opiates

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11
Q

what can be the side effects of renal cell carcinoma

A

obstruction of the gondola vein can cause varicocele

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12
Q

patient presents with jaundice, fatigue and anorexia

what can it be

A

autoimmune heptatitis

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13
Q

management of autoimmune hepatitis

A

immunosuppressant azathioprine

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14
Q

where do loop diuretics work

A

loop of henle

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15
Q

thiazide diuretics - where do they work

A

work on the DCT

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16
Q

what are kidney stones

A

severe acute flank pain
radiates to the groin
nausea
vominiting

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17
Q

management of kidney srtones

A

NSAIDS for pain
under 5mm wait and watch
over 5mm and asymptomatic wait and watch

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18
Q

investigations of kidney stones

A

non contrast CT KUB - within 24 hours
ultrasound in children and pregnant women

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19
Q

aldosterone antagonist - spinolactone
where does it work

A

works on the collecting duct

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20
Q

preventing reoccurrence of kidney stones

A

calcium

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21
Q

what is haemolytic urinic syndrome

A

e.coli
signs: jaundice
pallor, bruising and oliguria

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22
Q

what does haemolytic urinic syndrome do

A

apoptosis of the Renal epithelium cells
platelet plus and mini clots form in the kidneys
circulatory platelets decrease
damage to the kidney

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23
Q

investigation for haemolytic urinic syndrome

A

urine dip - proteinuria and heamturia
and bloods

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24
Q

treatment haemolytic urinic syndrome

A

not antibiotics - expresses more of the toxins so give supportive treatment

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25
Q

diabetic nephropathy

A

increase in glucose
damages kidneys

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26
Q

features of diabetic nephropathy

A

asymptomatic
thickened GBM
kimmel-wilson nodules
disruption of podocytes

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27
Q

polycystic kidney disease - what is it

A

genetic
polycystin proteins prevent cell proliferation
protein cysts develop
they fill with fluid and forw
these cysts can obstruct blood flow and can cause hypertension as it actives RAAS

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28
Q

autosomal dominant PKD what is it

A

hypertension
kidney stones
recurrent UTIs
flank pain haematruria
can cause liver cysts
do ultrasound

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29
Q

autosomal recessive PKD

A

can cause renal failure before birth
foetus produces less urine
potter sequence
can cause varices

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30
Q

what is nephrotic syndrome

A

protein loss
proteiuria
less albumin in the blood
more lipids in the blood

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31
Q

what is nephritic syndrome

A

inflammation
haematruia
hypertension

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32
Q

nephrotic syndrome - what is ir

A

podocytes get damaged
proteins get into the urine
this causes less albumin to be in the blood lower oncotic pressure
water leaks into tissues
oedema and lipids in blood increase

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33
Q

features of nephrotic syndrome

A

oedema
frothy urine
muehrckes lines - lines on nails
protein in urine
PCR >300mg

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34
Q

minimal change disease - what is it

A

common in children
cytokines in the podocytes causes swelling of the face
associated with upper RTI

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35
Q

treatment for minimal change disease

A

corticosteroids
fluid restriction and low salt
cyclophosphamide - give if they are not responding to rest of the treatment

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36
Q

Focal Segmental Glomerulosclerosis what is it

A

scar tisse in the glomeruli of the kidneys

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37
Q

Membranous Glomerulonephritis - what is it

A

immune complexes deposit in the basement membrane
antibodies against the podocytes

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38
Q

Membranoproliferative glomerulonephritis what is

A
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39
Q

nephritic syndrome

A

inflammation of the glomerulus
RBCS leak out
causes blood In urine
GFR decreases as there’s decrease in renal function due to inflammation
RAAS is activated

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40
Q

features of nephritic syndrome

A

coco cola coloured urine
protein in urine
fatigue
nausea

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41
Q

IgA neuropathy Bergers - what is it

A

type 3 hypersensitivity
deposit of magnesia
happens after UTI or GI infection due to increase in antibodies

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42
Q

Post Streptococcal ​
Glomerulonephritis - what is it

A

children are affected
type 3 hypersensitivity
immune sustem damafes GBM
6 weeks after impetigo infection

43
Q

Rapidly Progressive​
(Crescentic) Glomerulonephritis - what is it

A

damage to GBM causes RBC and WBC and plasma proteins to enter Bowmans capsule

44
Q

Rhabdomyolysis - what is it

A

injury
causes muscles to break down
myoglobin is released
this is toxic to the kidneys
causes acute kidney injury

45
Q

features of rhabdomyolosis

A

muscles aches
pains
oedema
fatigue
confusion

46
Q

what is acute tubular necrosis

A

ischeamia of nephrotoxins - due to lead
myoglobin

47
Q

features of acute tubular necrosis

A

oliguria
raised urea and creatinine

48
Q

acute interstitial nephritis

A

common in drug users
inflammation of the interstitial
hypersensitivity to drugs or infection

49
Q

features of acute interstitial nephritis

A

fever
rash
slow progressing AKI
white cells in the urine

50
Q

what is pre renal acute kidney injury

A

lack of blood flow to the kidneys
anything that causes hypovolaemia
like dehydration etc
heart failure
stenosis

51
Q

what is renal AKI

A

damage to the kidneys
rhabdomyolysis

52
Q

what is post renal AKI

A

kidney stones
cancer
anything that grows

53
Q

criteria for AKI

A

RISE IN CREATINING 25 IN 48 HOURS
RISE IN CREATININE OF 50% IN 7 DAYS
URINE OUTPUT LESS THAT 0.5/KG/HOUR FOR 6 HOURS

54
Q

risk factors for AKI

A

kidney failiure
heart failure
diabetes insipidus
liver disease
drugs

55
Q

features of AKI

A

oedema
arrhythmia

56
Q

managemen for AKI

A

stop AKI
s- septic screen
T- toxic screen, stop the toxins
O - optimise volume status
P-prevent hard

57
Q

medications to stop in AKI

A

diuretics
ACE Inhibs
metformin
NSAIDS
Lithium
digoxin

58
Q

what is CKD

A

chronic reduction in the kidney function
loss of appetitie
nausea
oedema
hypertension

59
Q

complications of CKD

A

loss of calcium cause bone disease - secondary hyperparathyroidism - calcium is being lost so it is taken from bone s

60
Q

diabetes insipidus - cranial

A

ADH is not being released

61
Q

nephrogenic diabetes insipidus

A

kidneys are resistant to ADH - lithium causes the resistence

62
Q

what is Henoch-Schonlein ​
Purpura

A

seen in children
purpuric rash over butt and lower limbs
abdo pain
arthralgia
heamaturia

63
Q

gosspature syndrome - what is it

A

anti GBM antibodies -

64
Q

having high levels of urea and creatinine along with high potassium levels show what?

A

poor renal function = CKD

especially if the person has had it ongoing for a while

65
Q

what investigation is done to test for CKD?

A

renal biopsy

66
Q

what is the most common form of PKD

A

PKD 1 autosomal dominant

67
Q

tumour marker for liver cancer?

A

AFP - alpha fetoprotein

68
Q

ca 19-9 - marker for?

A

pancreatic and gallbladder cancer

69
Q

CEA marker for?

A

colorectal cancer

70
Q

nephrotic syndrome - what is it

A

kidneys pass too much protein into the urine

mainly due to damage to the blood vessels that filter the blood and urine and excrete the waste

presents with a classic triad - frothy urine, less albumin and puffy eyes and swollen ankles

71
Q

minimal change disease

A

there is damage to the glomeruli which can lead to nephrotic syndrome

  • most common cause behind nephrotic syndrome
72
Q

what is tumour lysis syndrome

A

generally happens after chemotherapy
the cancer cells are broken down and this releases a lot of intracellular content into the circulation like nucleic acids
this gets broken down to uric acid and phosphate
this uric acid can cause acute kidney injury
which can cause anuria
the raised phosphate can reduce the CA ions

73
Q

where does a renal cell carcinoma arise from

A

proximal renal tubular epithelium

74
Q

most common composition of renal stone?

A

calcium oxate

75
Q

causes of AKI

A

pre renal - blood supply issues/ dehydration/hypotension/ JVP pressure is increased
post renal - blockage leaving the kindeys - kidney stones

76
Q

what happens to urine levels in pre renal AKI

A

urine osmolality increases

77
Q

post renal Aki features

A

protenuria
flank pain due to kidney stones

78
Q

AKI symptoms

A

dehydration - dry membranes
thirst
postural drop

overload - raised JVP
bibasal crackles

79
Q

investigation for AKI

A

ultrasound to see stones
CT KUB and urinalysis

80
Q

changes in AKI in the blood

A

increased plasma urea and creatinine
hyperkalameia
increased plate phosphate
decreased calcium
low plasma sodium
metabolic acidosis

81
Q

SEPSI 6

A

TAKE 3 - TAK BLOOD, URINE
GIVE 3 - ANTIBIOTICS

82
Q

MANAGEMENT of AKI

A

stop any nephrotoxic drugs
catherisation

83
Q

symptoms of CKD

A

coma, seizures
dizziness

84
Q

how is CKD diagnosed

A

monitor eGFR
U&E blood test ( 2 tests done 3 months apart)
proteinuria check albumin:creatinine ratio

85
Q

what are the indications for dialysis

A

Acidosis
Electrolyte abnormalities
I
O
U

86
Q

what are AV fistulas and complications

A

AV fistulas are an abnormal connection between an artery and vein - the blood flows directly from an artery into a vein, bypassing the capillaries

increased blood flow and pressure in the veins - swelling, pain, and the formation of aneurysms

sometimes made surgically to provide vascular access for dialysis in kidney failure.

AV fistulas allow for a high blood flow rate, making it easier and safer for dialysis to be performed.

AV fistulas can have complications such as infection, clotting, bleeding, and aneurysm formation.

87
Q

side effect of renal transplant

A

tacrolimus - can cause a tremor

88
Q

what PKD

A

autosomal dominant condition that causes cysts on the kindneys

can cause pain and put pressure on the nephrons

89
Q

PKD symptoms

A

dysruia
flank pain
renal colic
polyuria
fever
haematuria

all these can be due to the cysts putting pressure on the kidney

90
Q

investigation of PKD

A

generally found by accident
ultrasonographic screening

if <30 and family history with >3 or more cysts

91
Q

management of PKD

A

ACE inhibitors to control BP

tolvaptan (vasopressin)

avoid NSAIDS

92
Q

renal stones investigation

A

NON contrats CT KUB
then ultrasound KUB
hypercalacemua can cause renal stones

93
Q

main causes of renal stones

A

hyper calcium
hyperparathyroidism
cancer

94
Q

management of renal stones

A

NSAIDS - diclofenac
of IV paracetamol
metocloprmie for vomiting
tamsulosin - for helping the passage of stones

95
Q

renal stones management based on stone size

A

stones<5mm, pass spontaneously
stones >5mm - surgery
shockwave
or nephrectomy

96
Q

symptoms of rabhomyolyss

A

dark urine
fever
Nasseau
altered mental status
muscle weakness
abdo pain
CK levels will be high
skin changes - ischamia

97
Q

investigation for rhambomyolosus

A

serum CK stays high in the blood for longer

myoglobinurea - myoglobin in the urine
gives a red/brown colour

Urea and electrolyse will show hyperkalaemia

98
Q

complications of rhabdomyolysis

A

high potassium and phosphate
but low calcium levels

99
Q

pyelonephritis investigation

A

mid stream urine sample
E.COli most likely cause

raised CRPs will be seen in blood tests

100
Q

management of pyelonephritis

A

be careful of sepsis

1st line antibiotics - 7/10 days
cefalexin
co amoxiclav
trimethoprim ( do not give with methotrexate)
ciprofloxacin

for women - give nitrofuratonin (can cause pulmonary fibrosis)

101
Q

most common type of Renal cancer

A

renal cell carcinoma - clear cell

mainly involves renal vein invasion
can cause left sided varicocele

102
Q

complications of renal cancer

A

hypertension
high calcium levels
staffers syndrome - abnormal liver tests
hyper calcaemia
polychthaema - to many hb - causes itching

most common site of metastases is the lungs

103
Q

when os renal cancer referred

A

over 45 with unexplained haematruia
refer with 2 ww

104
Q

management of renal cell cancer

A

surgery
radial nephrectomy

less invasive procedure - percutaneous cyrotherapy

AMK (27 decks)

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