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UKMLA > Nephrology/ renal > Flashcards

Nephrology/ renal Flashcards

1
Q

What can a high urea indicate?

A

Protein meal - can be due to nitrogenous waste products of protein metabolism

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2
Q

What can cause a protein meal?

A

GI bleed as blood gets broken down
Protein supplements

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3
Q

What the most common cause of intrinsic acute kidney injury?

A

Acute tubular necrosis

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4
Q

What causes acute tubular necrosis?

A

Ischaemic damage or direct toxicity to tubular epithelial cells

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5
Q

What can be seen in urine dip with acute tubular necrosis?

A

Muddy brown casts

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6
Q

Which type of haemorrhage is associated with autosomal dominant polycystic kidney disease?

A

Subarachnoid haemorrhage

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7
Q

What type of screening are people with ADPCK invited for in terms of if they have a family history of subarachnoid haemorrhage?

A

Berry aneurysm

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8
Q

What’s the diagnositc criteria for ADPCK in under 30’s with a family history? and what’s diagnostic criteria for 30-59 years?

A

At least 2 renal cysts
for people aged 30-59: more than 2 renal cysts on each kidney

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9
Q

Which class of medication can cause rhabdomyolysis?

A

Statins

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10
Q

How can statin induced rhabdomyolysis present?

A

Dark urine
Myalgia

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11
Q

What electrolyte abnormality is seen in rhabdomyolysis?

A

HYPOcalcaemia
HYPERkalaemia
HYPERphosphataemia
High LDH

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12
Q

What is the definition of nephrotic syndrome?

A

Increased permeability of renal glomerular BM leading to proteinuria - hypoalbuminaemia, hyperlipidaemia, lipiduria and MARKED OEDEMA

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13
Q

What’s the most common nephrotic syndrome in adults?

A

Membranous glomerulonephritis

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14
Q

What’s the most common nephrotic syndrome in children?

A

Minimal change

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15
Q

How can nephrotic syndrome present in children?

A

Protein uria
Marked facial oedema
Low albumin

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16
Q

When is a renal biopsy indicated in nephrotic syndrome?

A

Steroid unresponsive
Haematuria present
Under 1 year
Over 12 years

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17
Q

How is nephrotic syndrome managed?

A

Prednisolone

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18
Q

What qualifies stage 1 ckd?

A

Egfr under 90 at least 90 days apart on 2 seperate occasions + indications of kidney damage like haematuria or proteinuria

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19
Q

What egfr is stage 2 kidney disease?

A

60-89

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20
Q

What readings indicate stage 3 CKD?

A

30-59

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21
Q

What egfr indicates stage 4 ckd?

A

15-29

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22
Q

What’s treatment for rhabdomyolysis?

A

IV fluids
Treat hyperkalaemia with: calcium gluconate and insulin-dextrose infusion
Monitoring and correction of other electrolyte abnormalities’ hypocalcaemia, hyperphosphataemia

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23
Q

What causes the dark brown muddy casts in rhabdomyolysis?

A

Myoglobinuria

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24
Q

How can nephritic syndrome be differentiated from nephrotic syndrome?

A

Nephritic syndrome: presence of haematuria and hypertension. In nephrotic syndrome there is no haematuria or hypertension

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25
Q

What’s the most common type of glomerulonephritis?

A

IgA nephropathy

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26
Q

What is IgA nephropathy?

A

Immunoglobulin A deposition in mesangium causing haematuria often after a resp or GI infection - usually 12-72 hours

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27
Q

What is a bad prognostic sign in IgA nephropathy?

A

Proteinuria

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28
Q

What is the gold standard investigation for iGA nephropathy?

A

Renal biopsy to show diffuse mesangial IgA immune complex deposition

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29
Q

What is management for IgAN?

A

Diet salt restriction
Proteinuria management - ACE inhibitor or ARB
Hypertension treatment

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30
Q

What is a test that can confirm post-strep glomerulonephritis?

A

Anti-streptolysin O titre - confirms a preceding strep infection - though it can be falsely low in those treated with antibiotics

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31
Q

What is seen on biopsy with membranous nephropathy (nephrotic syndrome)?

A

Subepithelial immune complex deposits

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32
Q

Which cancer is membranous nephropathy commonly associated ith?

A

Lung
colon
Breast

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33
Q

What drug is a cause of acute interstitial nephritis?

A

PPI’s
Antibiotics e.g.: b lactams: ceclopsporins, penicillin
NSAID’s
Diuretics
Rifampicin
Allopurinol

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34
Q

What is the classic triad for acute interstitial nephritis?

A

Rash
Fever
Eosinophilia
THINK DRUG induced

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35
Q

Which conditions are associated with acute interstitial nephritis?

A

SLE
Sjogren’s

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36
Q

What is dialysis disequilibrium syndrome?

A

Fatal complication of haemodialysis esp in pt just starting. Cuases cerebral oedema

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37
Q

How does dialysis disequilibrium syndrome present?

A

Headache
Vomiting
Cushing’s triad

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38
Q

What is cushing’s triad?

A

Low heart rate
Raised BP
Irregular breathing

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39
Q

What is the most appropriate diagnostic test for evaluating patients at risk for ADPKD?

A

Renal ultrasound

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40
Q

What is haemolytic uraemic syndrome?

A

Type of thrombotic microangiopathy primarily affecting renal system

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41
Q

What are the two type of haemolytic uraemic syndrome?

A

Typical: caused by foodborne illness - associated with diarrhoea
Atypical: complement deficiencies

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42
Q

What’s the most common cause of typical haemolytic uraemic syndrome?

A

E.coli 0157

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43
Q

What’s the classic triad in haemolytic uraemic syndrome?

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI

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44
Q

Which medication is prescribed as a key part of immunosuppressive regime following renal transplant?

A

Tacrolimus

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45
Q

What is mechanism of action of tacrolimus?

A

Calcineurin inhibitor

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46
Q

How is tacrolimus helpful following kidney transplant?

A

Prevents acute and chronic rejection of transplanted kidney

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47
Q

What is seen on kidney biopsy in IgA nephropathy?

A

IgA deposition in mesangium

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48
Q

What is goodpasture’s disease?

A

Anti-glomerular BM disease occurs when anti-glomerular BM antibodies attack type 4 collagen in kidneys and lungs

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49
Q

What is a risk factor for Good pastures syndrome?

A

Exposure to solvents - so dry cleaners or lab people

50
Q

How can goodpasture’s disease present?

A

Haemoptysis
Haematuria

51
Q

What is alport’s syndrome?

A

Type 4 collagen in BM affected
Presents in kids
Hameaturia
Bilat senorineural hearing loss
Retinitis pigmentosa

52
Q

What are some examples of pulmonary renal syndromes?

A

Goodpastures
Granulomatosis with polyangiitis - WEGNRS
Microscopic polyangiitis

53
Q

What is the inheritance pattern of Alport’s?

A

X linked

54
Q

What is another name for IgA nephropathy?

A

Berger disease

55
Q

What can cause acute tubular necrosis?

A

Prolonged ischaemic event
Sepsis
Nephrotoxins - aminglycosides , radiological contrasts
Myoglobinuria inrhabdo

56
Q

What is a sign in end stage renal failure that it’s unresponsive to medical management (diuretics) and need renal replacement therapy?

A

Refractory fluid overload

57
Q

What is seen on biopsy with alport syndrome?

A

Longitudinal splitting of lamina causing basket weave appearance

58
Q

What on KUB US would confirm acute urinary retention?

A

Residual bladder volume of more than 300ml

59
Q

What are some complications found with ADPKD?

A

Liver cysts
Mitral valve prolapse
colonic diverticula

60
Q

What would post strep glomerulonephritis show on electron microscopy?

A

IgG and C3 subepithelial deposition - characteristic humps on electron microscopy

61
Q

What does prominent spikes and dome pattern on silver staining indicate?

A

Membranous glomerulopathy

62
Q

What would be seen on biopsy in memranoproliferative glomerulonephritis?

A

Tram-track or double contoured with silver stain of periodic acid schiff

63
Q

Which migraine medication can lead to urinary retention?

A

Amitriptyline

64
Q

What’s the difference between stage 3b and 3a kidney failure?

A

3a : 45-49 efgr
3b: 30-44 egfr

65
Q

What is treatment of focal segmental glomerulosclerosis?

A

Immunosuppressants like cyclophosphamide + corticosteroids

66
Q

What is target iron in CDK patients - and if they can’t reach that what should be intiated?

A

Over 100g/l
Start erythropoietin if transferrin and ferritin are both normal - as this suggests no further iron is needed

67
Q

What is peritoneal dialysis peritonitis?

A

Life threatening complication of peritoneal dialysis

68
Q

What bacteria causes peritoneal dialysis peritonitis?

A

Gram positive bacteria - staph epidermidis and staph aureus. Stap epidermidids is most common though

69
Q

What are the indications for initiating acute dialysis?

A

AEIOU
Acidosis below 7.1
Electrolyte imbalance: hyperkalaemia above 6.5
Intoxication - overdose
Overload - unresponsive to diuretics
Uraemia - that’s symptomatic

70
Q

What is the presentation of peritoneal dialysis?

A

Abdo pain
Fever
Cloudy dialysis bag

71
Q

At what level of egfr in AKI should metformin be stopped?

A

If Egfr is unver 30ml/min

72
Q

Why does trimethoprim increase serum creatinine?

A

It competitively inhibits the mechanism for tubular secretion of creatine

73
Q

Which drugs should be held in AKI?

A

Stop the ‘DAMN’ drugs so
Diuretics and digoxin
Ace inhibitors/ ARBS
Metformin
NSAID’s

74
Q

What would be found in urine in acute interstitial nephritis?

A

White cell casts

75
Q

What is renal tubular acidosis?

A

Disorder of acid handling in kidneys - manifesting as normal anion gap and normal kidney function

76
Q

What are the types of renal tubular acidosis?

A

Type 1 and type 2
Type - distal
Type 2 - proximal
Type 4 - hyperkalaemic

77
Q

What is type 1 distal renal tubular acidosis?

A

Inability to excrete hydrogen - hypokalaemia present

78
Q

What is type 2 renal tubular acidosis?

A

Defect in bicarbonate reabsorption in proximal tubule - often fanconi syndrome

79
Q

What is fanconi syndrome?

A

Disturbnace in proximal collecting tubules - function glycosuria and aminoaciduria and phosphaturia

80
Q

What electrolyte abnormalities are present in renal tubular acidosis type 2 ?

A

Hypokalaemia , hyperchloremic metabolic acidosis

81
Q

What is type 4 renal tubular acidosis?

A

Caused by hyporeninaemic hypoaldosteronism - which impairs ammonium secretion leading to acidosis

82
Q

What is treatment for type 1 and 2 renal tubular acidosis?

A

Urine alkalinization with potassium citrate or sodium bicarb and possibly diuretics

83
Q

What is RTA type 1 vs type 2?

A

Type 1 - pH is more than 5.4
Type 2 - pH is less than 5.4

84
Q

Avascular necrosis can occur after transplants, why?

A

Because after transplants a person will need immunosuppression with steroids to prevent rejection - long term steroids can cause avascular necrosis - presenting with bilateral hip pain

85
Q

What presentation would suggest renal TB?

A

Chronic infection
Sterile pyuria (white cell count elevated in urine but not bacteria present in urine)
Weight loss
Fever

86
Q

How does renal papillary necrosis due to analgesic nephropathy present?

A

Fever
Flank pain
Protein urea
Sloughed papillae may lead to acute ureteral obstruction - if pt has a uti as well - requires urgent drainage by nephrostomy or catheter

87
Q

What is diagnostic investigation for urogenital TB?

A

Urine myobacterial culture - shows tubercle bacilli in urine

88
Q

How do kidneys look like on US in chronic kidney disease?

A

Bilateral shrunken kidneys

89
Q

What is most common viral cause of FSGS?

A

HIV

90
Q

What’s the best pain relief for renal colic acutely?

A

IM/ PR diclofenac

91
Q

How can you differentiate between acute tubular necrosis and acute interstitial nephritis?

A

ATN presents with low sodium, raised urea and raised creatinine
AIN presents with: Hyperkalaemia and metabolic acidosis and is triggered by a hypersensitivity reaction

92
Q

In which disease do you use plasmaphoresisi?

A

Good pastures

93
Q

What is treatment of AKI caused by an obstructing stone?

A

Urgent cystoscopy with JJ stent insertion

94
Q

What’s the most common type of kidney stone?

A

Calcium oxalate

95
Q

What is seen on renal biopsy in rapidly progressive glomerulonephritis?

A

Epithelial crescents in glomeruli

96
Q

When is extracorporeal shock wave lithotripsy indiacated?

A

Smaller stones - less than 2cm in size

97
Q

When is uteroscopy indicated?

A

Mid-distal ureteral stones

98
Q

When is percutaneous nephrostomy indicated?

A

Stone larger than 2 cm

99
Q

What type of cancer is most prevalent in renal transplant patients?

A

Skin cancer

100
Q

Which chromosome is ADPKD gene found on?

A

Chromosome 16

101
Q

What is success of peritoneal dialysis dependent on?

A

Residual renal function , therefore it’s preferred when patients are younger and still have some residual renal function

102
Q

How often is peritoneal dialysis required?

A

Everyday

103
Q

What is best imaging for renal colic secondary to nephrolithiasis (kidney stones)?

A

CT KUB - Low dose non contrast

104
Q

What are the symptoms/ complications of uraemia that would indicate renal replacement?

A

Pericarditis or encephalopathy

105
Q

What does the plasmaphersis do in anti-gbm?

A

Removes circulating autoantibodies

106
Q

What is seen on renal biopsy in minimal change disease?

A

Diffuse loss of podocyte foot processes

107
Q

Which kidney stones are associate with hereditary condition?

A

Cystine stones

108
Q

What is the probability of two siblings inheriting the same set of HLA ?

A

25%

109
Q

What is treatment of lupus nephritis?

A

Cyclophosphamide and methylprednisolone- rapidly

110
Q

What are staghorn calculi made up of?

A

Struvite - magnesium ammonium phosphate

111
Q

Why are staghorn calculi so large?

A

Struvite is a substance that grows super quickly and is associated with UTI caused by proteus bacteria

112
Q

How can a renal vein thrombosis present?

A

Flank/ lower back pain
Haematuria
Decreased urine output
Worsening renal function
Oedema
Can progress to PE if untreated

113
Q

What is diagnostic test for renal vein thrombosis?

A

Renal doppler

114
Q

What is difference in timeframes between acute and chronic graft rejection?

A

Acute: in first few months
Chronic: More than 6 months

115
Q

What is the timeframe for ABO incompatibility with transplant donor?

A

Minutes to hours

116
Q

Which immunosuppressant can cause gingival hypertrophy and nephrotoxicity and hypertrichosis?

A

ciclosporin

117
Q

What is treatment for uraemic pericarditis? if patient is stable

A

haemodialysis

118
Q

If patient has uraemic pericarditis but not stable what is treatment?

A

haemofiltration on itu

119
Q

When does the ACE inhibitor need to be stopped when there’s a drop in GFR?

A

If the gfr drop is more than 25 % or serum creatinine increases more than 30%

120
Q

Which vitamin supplement increases risk of calcium oxalate stones and why?

A

Vitamin c increases the formation and excretion of oxalate in urine

121
Q
A

UKMLA (13 decks)

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