Nephrology/ renal Flashcards
What can a high urea indicate?
Protein meal - can be due to nitrogenous waste products of protein metabolism
What can cause a protein meal?
GI bleed as blood gets broken down
Protein supplements
What the most common cause of intrinsic acute kidney injury?
Acute tubular necrosis
What causes acute tubular necrosis?
Ischaemic damage or direct toxicity to tubular epithelial cells
What can be seen in urine dip with acute tubular necrosis?
Muddy brown casts
Which type of haemorrhage is associated with autosomal dominant polycystic kidney disease?
Subarachnoid haemorrhage
What type of screening are people with ADPCK invited for in terms of if they have a family history of subarachnoid haemorrhage?
Berry aneurysm
What’s the diagnositc criteria for ADPCK in under 30’s with a family history? and what’s diagnostic criteria for 30-59 years?
At least 2 renal cysts
for people aged 30-59: more than 2 renal cysts on each kidney
Which class of medication can cause rhabdomyolysis?
Statins
How can statin induced rhabdomyolysis present?
Dark urine
Myalgia
What electrolyte abnormality is seen in rhabdomyolysis?
HYPOcalcaemia
HYPERkalaemia
HYPERphosphataemia
High LDH
What is the definition of nephrotic syndrome?
Increased permeability of renal glomerular BM leading to proteinuria - hypoalbuminaemia, hyperlipidaemia, lipiduria and MARKED OEDEMA
What’s the most common nephrotic syndrome in adults?
Membranous glomerulonephritis
What’s the most common nephrotic syndrome in children?
Minimal change
How can nephrotic syndrome present in children?
Protein uria
Marked facial oedema
Low albumin
When is a renal biopsy indicated in nephrotic syndrome?
Steroid unresponsive
Haematuria present
Under 1 year
Over 12 years
How is nephrotic syndrome managed?
Prednisolone
What qualifies stage 1 ckd?
Egfr under 90 at least 90 days apart on 2 seperate occasions + indications of kidney damage like haematuria or proteinuria
What egfr is stage 2 kidney disease?
60-89
What readings indicate stage 3 CKD?
30-59
What egfr indicates stage 4 ckd?
15-29
What’s treatment for rhabdomyolysis?
IV fluids
Treat hyperkalaemia with: calcium gluconate and insulin-dextrose infusion
Monitoring and correction of other electrolyte abnormalities’ hypocalcaemia, hyperphosphataemia
What causes the dark brown muddy casts in rhabdomyolysis?
Myoglobinuria
How can nephritic syndrome be differentiated from nephrotic syndrome?
Nephritic syndrome: presence of haematuria and hypertension. In nephrotic syndrome there is no haematuria or hypertension
What’s the most common type of glomerulonephritis?
IgA nephropathy
What is IgA nephropathy?
Immunoglobulin A deposition in mesangium causing haematuria often after a resp or GI infection - usually 12-72 hours
What is a bad prognostic sign in IgA nephropathy?
Proteinuria
What is the gold standard investigation for iGA nephropathy?
Renal biopsy to show diffuse mesangial IgA immune complex deposition
What is management for IgAN?
Diet salt restriction
Proteinuria management - ACE inhibitor or ARB
Hypertension treatment
What is a test that can confirm post-strep glomerulonephritis?
Anti-streptolysin O titre - confirms a preceding strep infection - though it can be falsely low in those treated with antibiotics
What is seen on biopsy with membranous nephropathy (nephrotic syndrome)?
Subepithelial immune complex deposits
Which cancer is membranous nephropathy commonly associated ith?
Lung
colon
Breast
What drug is a cause of acute interstitial nephritis?
PPI’s
Antibiotics e.g.: b lactams: ceclopsporins, penicillin
NSAID’s
Diuretics
Rifampicin
Allopurinol
What is the classic triad for acute interstitial nephritis?
Rash
Fever
Eosinophilia
THINK DRUG induced
Which conditions are associated with acute interstitial nephritis?
SLE
Sjogren’s
What is dialysis disequilibrium syndrome?
Fatal complication of haemodialysis esp in pt just starting. Cuases cerebral oedema
How does dialysis disequilibrium syndrome present?
Headache
Vomiting
Cushing’s triad
What is cushing’s triad?
Low heart rate
Raised BP
Irregular breathing
What is the most appropriate diagnostic test for evaluating patients at risk for ADPKD?
Renal ultrasound
What is haemolytic uraemic syndrome?
Type of thrombotic microangiopathy primarily affecting renal system
What are the two type of haemolytic uraemic syndrome?
Typical: caused by foodborne illness - associated with diarrhoea
Atypical: complement deficiencies
What’s the most common cause of typical haemolytic uraemic syndrome?
E.coli 0157
What’s the classic triad in haemolytic uraemic syndrome?
Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI
Which medication is prescribed as a key part of immunosuppressive regime following renal transplant?
Tacrolimus
What is mechanism of action of tacrolimus?
Calcineurin inhibitor
How is tacrolimus helpful following kidney transplant?
Prevents acute and chronic rejection of transplanted kidney
What is seen on kidney biopsy in IgA nephropathy?
IgA deposition in mesangium
What is goodpasture’s disease?
Anti-glomerular BM disease occurs when anti-glomerular BM antibodies attack type 4 collagen in kidneys and lungs
What is a risk factor for Good pastures syndrome?
Exposure to solvents - so dry cleaners or lab people
How can goodpasture’s disease present?
Haemoptysis
Haematuria
What is alport’s syndrome?
Type 4 collagen in BM affected
Presents in kids
Hameaturia
Bilat senorineural hearing loss
Retinitis pigmentosa
What are some examples of pulmonary renal syndromes?
Goodpastures
Granulomatosis with polyangiitis - WEGNRS
Microscopic polyangiitis
What is the inheritance pattern of Alport’s?
X linked
What is another name for IgA nephropathy?
Berger disease
What can cause acute tubular necrosis?
Prolonged ischaemic event
Sepsis
Nephrotoxins - aminglycosides , radiological contrasts
Myoglobinuria inrhabdo
What is a sign in end stage renal failure that it’s unresponsive to medical management (diuretics) and need renal replacement therapy?
Refractory fluid overload
What is seen on biopsy with alport syndrome?
Longitudinal splitting of lamina causing basket weave appearance
What on KUB US would confirm acute urinary retention?
Residual bladder volume of more than 300ml
What are some complications found with ADPKD?
Liver cysts
Mitral valve prolapse
colonic diverticula
What would post strep glomerulonephritis show on electron microscopy?
IgG and C3 subepithelial deposition - characteristic humps on electron microscopy
What does prominent spikes and dome pattern on silver staining indicate?
Membranous glomerulopathy
What would be seen on biopsy in memranoproliferative glomerulonephritis?
Tram-track or double contoured with silver stain of periodic acid schiff
Which migraine medication can lead to urinary retention?
Amitriptyline
What’s the difference between stage 3b and 3a kidney failure?
3a : 45-49 efgr
3b: 30-44 egfr
What is treatment of focal segmental glomerulosclerosis?
Immunosuppressants like cyclophosphamide + corticosteroids
What is target iron in CDK patients - and if they can’t reach that what should be intiated?
Over 100g/l
Start erythropoietin if transferrin and ferritin are both normal - as this suggests no further iron is needed
What is peritoneal dialysis peritonitis?
Life threatening complication of peritoneal dialysis
What bacteria causes peritoneal dialysis peritonitis?
Gram positive bacteria - staph epidermidis and staph aureus. Stap epidermidids is most common though
What are the indications for initiating acute dialysis?
AEIOU
Acidosis below 7.1
Electrolyte imbalance: hyperkalaemia above 6.5
Intoxication - overdose
Overload - unresponsive to diuretics
Uraemia - that’s symptomatic
What is the presentation of peritoneal dialysis?
Abdo pain
Fever
Cloudy dialysis bag
At what level of egfr in AKI should metformin be stopped?
If Egfr is unver 30ml/min
Why does trimethoprim increase serum creatinine?
It competitively inhibits the mechanism for tubular secretion of creatine
Which drugs should be held in AKI?
Stop the ‘DAMN’ drugs so
Diuretics and digoxin
Ace inhibitors/ ARBS
Metformin
NSAID’s
What would be found in urine in acute interstitial nephritis?
White cell casts
What is renal tubular acidosis?
Disorder of acid handling in kidneys - manifesting as normal anion gap and normal kidney function
What are the types of renal tubular acidosis?
Type 1 and type 2
Type - distal
Type 2 - proximal
Type 4 - hyperkalaemic
What is type 1 distal renal tubular acidosis?
Inability to excrete hydrogen - hypokalaemia present
What is type 2 renal tubular acidosis?
Defect in bicarbonate reabsorption in proximal tubule - often fanconi syndrome
What is fanconi syndrome?
Disturbnace in proximal collecting tubules - function glycosuria and aminoaciduria and phosphaturia
What electrolyte abnormalities are present in renal tubular acidosis type 2 ?
Hypokalaemia , hyperchloremic metabolic acidosis
What is type 4 renal tubular acidosis?
Caused by hyporeninaemic hypoaldosteronism - which impairs ammonium secretion leading to acidosis
What is treatment for type 1 and 2 renal tubular acidosis?
Urine alkalinization with potassium citrate or sodium bicarb and possibly diuretics
What is RTA type 1 vs type 2?
Type 1 - pH is more than 5.4
Type 2 - pH is less than 5.4
Avascular necrosis can occur after transplants, why?
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
What presentation would suggest renal TB?
Chronic infection
Sterile pyuria (white cell count elevated in urine but not bacteria present in urine)
Weight loss
Fever
How does renal papillary necrosis due to analgesic nephropathy present?
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
What is diagnostic investigation for urogenital TB?
Urine myobacterial culture - shows tubercle bacilli in urine
How do kidneys look like on US in chronic kidney disease?
Bilateral shrunken kidneys
What is most common viral cause of FSGS?
HIV
What’s the best pain relief for renal colic acutely?
IM/ PR diclofenac
How can you differentiate between acute tubular necrosis and acute interstitial nephritis?
ATN presents with low sodium, raised urea and raised creatinine
AIN presents with: Hyperkalaemia and metabolic acidosis and is triggered by a hypersensitivity reaction
In which disease do you use plasmaphoresisi?
Good pastures
What is treatment of AKI caused by an obstructing stone?
Urgent cystoscopy with JJ stent insertion
What’s the most common type of kidney stone?
Calcium oxalate
What is seen on renal biopsy in rapidly progressive glomerulonephritis?
Epithelial crescents in glomeruli
When is extracorporeal shock wave lithotripsy indiacated?
Smaller stones - less than 2cm in size
When is uteroscopy indicated?
Mid-distal ureteral stones
When is percutaneous nephrostomy indicated?
Stone larger than 2 cm
What type of cancer is most prevalent in renal transplant patients?
Skin cancer
Which chromosome is ADPKD gene found on?
Chromosome 16
What is success of peritoneal dialysis dependent on?
Residual renal function , therefore it’s preferred when patients are younger and still have some residual renal function
How often is peritoneal dialysis required?
Everyday
What is best imaging for renal colic secondary to nephrolithiasis (kidney stones)?
CT KUB - Low dose non contrast
What are the symptoms/ complications of uraemia that would indicate renal replacement?
Pericarditis or encephalopathy
What does the plasmaphersis do in anti-gbm?
Removes circulating autoantibodies
What is seen on renal biopsy in minimal change disease?
Diffuse loss of podocyte foot processes
Which kidney stones are associate with hereditary condition?
Cystine stones
What is the probability of two siblings inheriting the same set of HLA ?
25%
What is treatment of lupus nephritis?
Cyclophosphamide and methylprednisolone- rapidly
What are staghorn calculi made up of?
Struvite - magnesium ammonium phosphate
Why are staghorn calculi so large?
Struvite is a substance that grows super quickly and is associated with UTI caused by proteus bacteria
How can a renal vein thrombosis present?
Flank/ lower back pain
Haematuria
Decreased urine output
Worsening renal function
Oedema
Can progress to PE if untreated
What is diagnostic test for renal vein thrombosis?
Renal doppler
What is difference in timeframes between acute and chronic graft rejection?
Acute: in first few months
Chronic: More than 6 months
What is the timeframe for ABO incompatibility with transplant donor?
Minutes to hours
Which immunosuppressant can cause gingival hypertrophy and nephrotoxicity and hypertrichosis?
ciclosporin
What is treatment for uraemic pericarditis? if patient is stable
haemodialysis
If patient has uraemic pericarditis but not stable what is treatment?
haemofiltration on itu
When does the ACE inhibitor need to be stopped when there’s a drop in GFR?
If the gfr drop is more than 25 % or serum creatinine increases more than 30%
Which vitamin supplement increases risk of calcium oxalate stones and why?
Vitamin c increases the formation and excretion of oxalate in urine
