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Y4 Nephrology/Urology > Printed notes > Flashcards

Printed notes Flashcards

1
Q

what are mesangial cells?

A

specialised smooth muscle cells that support the glomerulus and regulate blood flow and GFR

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2
Q

how is the GBM charged?

A

negatively

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3
Q

what is the anion gap ?

A

difference between total cations and total anions

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4
Q

what charge are cations and anions?

A 
cations = + 
anions = -
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5
Q

can negatively charged particles such as albumin pass through the GBM?

A

no

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6
Q

what substance does baroreceptors control the release of ?

A

ADH

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7
Q

what are the specialised cells in the afferent arteriole called?

A

juxtaglomerular cells

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8
Q

where is the most Na reabsorbed in the nephron?

A

PCT

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9
Q

what ion channel is present in the ascending limb ?

A

Na/K/2Cl triple symporter

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10
Q

what is Ca reabsorption under the control of?

A

PTH

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11
Q

what is Na reabsorption under the control of?

A

aldosterone

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12
Q

where in the nephron does pH and K regulation occur?

A

medullary collecting duct

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13
Q

what channels does water pass through in the cortical collecting duct?

A

aquaporin 2- channel

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14
Q

what paraneoplastic effects can renal cancers have?

A

EPO - polycythaemia
Renin - HTN
ACTH - cushings
PTHrP - hypercalcaemia

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15
Q

give an example of carbonic anhydrase inhibitor that is used for glaucoma ?

A

acetazolamide

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16
Q

what affect does carbonic anhydrase inhibitors have on the kidneys ?

A

decreases bicarbonate reabsorption

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17
Q

give an example of a loop diuretic?

A

furosemide

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18
Q

what is the mechanism of action of thiazide diuretics ?

A

inhibit NaCl in DCT

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19
Q

what is the mechanism of action of loop diuretics ?

A

inhibit Na/K/2Cl symporter in thick ascending limb

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20
Q

what is the mechanism of action of K sparing diuretics ?

A

Spiro: aldosterone antagonist

􏰁Amiloride: blocks DCT/CD luminal Na channel

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21
Q

what is a side effect of carbonic anhydrase inhibitors ?

A

drowsiness
renal stones
metabolic acidosis

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22
Q

what is a side effect of thiazide diuretic ?

A

hypokalaemia
hyperglycaemia
increased urate

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23
Q

what condition is contra indicated with thiazide diuretics ?

A

gout

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24
Q

what two molecules can give a false positive for haematuria ?

A

myoglobin, porphyria

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25
Q

what molecule can give a false positive for proteinuria ?

A

bence jones proteins

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26
Q

what are causes of proteinuria?

A 
DM
minimal change 
membranous GN
amyloidosis 
SLE 
HTN 
UTI
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27
Q

when is creatinine synthesised?

A

during muscle turn over

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28
Q

what is urea produced form and in what cycle?

A

produced form ammonia by liver in ornithine cycle

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29
Q

what would an isolated increased urea suggest?

A

hypo perfusion

dehydration

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30
Q

state some post renal causes of renal disease ?

A 
􏰁 Stone
􏰁 Neoplasm
􏰁 Inflammation: stricture
􏰁 Prostatic hypertrophy
􏰁 Posterior urethral valves
􏰁 Infection: TB, schisto
􏰁 Neuro: post-op, neuropathy
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31
Q

state some uraemia symptoms ?

A 
pruritus 
weight loss 
lethargy 
confusion 
metallic taste 
paraesthesia 
restless legs 
chest pain
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32
Q

state some symtpoms of Na retention ?

A

polyuria, polydipsia, breathlessness

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33
Q

state some signs of fluid overload ?

A

oedema
increased JVP
HTN

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34
Q

what breathing is seen in acidosis ?

A

kussmauls breathing

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35
Q

what are some symptoms of hyperkalaemia ?

A

palpitations
chest pain
weakness

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36
Q

what sign is seen on X-rays with osteomalacia ?

A

looser zones

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37
Q

what is Urethral Syndrome?

A

symptomatic but no bacteriuria

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38
Q

what are the different types of urolithiasis ?

A

calcium oxalate
triple phosphate
urate

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39
Q

what antibiotic is used for pyelonephritis ?

A

Cefotaxime

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40
Q

what investigations should be done for GN?

A

Basic: FBC, U+E, ESR

􏰀 Complement (C3 and C4)

􏰀 Abs: ANA, dsDNA, ANCA, GBM

􏰀Serum protein electrophoresis and Ig

􏰀 Infection: ASOT, HBC and HCV serology

Dipstick: proteinuria ± haematuria
􏰀 Spot PCR
􏰀 MCS
􏰀 Bence-Jones protein

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41
Q

what are the causes of GN?

A 
Idiopathic
􏰀 Immune: SLE, Goodpastures, vasculitis
􏰀 Infection: HBV, HCV, Strep, HIV
􏰀 Drugs: penicillamine, gold
􏰀 Amyloid
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42
Q

what would be seen on IgA nephropathy biopsy ?

A

IgA deposition in mesangium

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43
Q

what is the treatment for IgA nephropathy?

A

steroids

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44
Q

what are some complications of nephrotic syndrome ?

A

infection - from reduced Ig, complement activity

VTE

hyperlipidaemia

45
Q

will nephrotic syndrome have an increased or decreased JVP?

A

decreased

- fluid deplete

46
Q

what is the treatment for proliferative GN?

A

supportive

47
Q

what is the treatment for crescentic GN?

A

plasmapheresis and immunosuppression

48
Q

state some systemic diseases that can cause nephrotic syndrome?

A

GM - glomerulosclerosis

SLE - membraneous

amyloidosis

49
Q

what is the treatment for minimal change GN?

A

steroids

50
Q

what does the biopsy of minimal change should?

A

normal light micro, fusion of podocytes on EM

51
Q

what does the biopsy of membraneous nephropathy should?

A

subepithelial immune complex deposits

52
Q

what immunoglobulin is deposited in FSGS?

A

IgM

53
Q

what causes acute interstitial nephritis ?

A

Immune-mediated hypersensitivity ̄c either drugs or other Ag acting as haptans

54
Q

what is the commonest cause of acute interstitial nephritis ?

A

drug hypersensitivity

55
Q

what drugs can cause of hypersensitivity and acute interstitial nephritis?

A

NSAIDs
􏰁 Abx: Cephs, penicillins, rifampicin, sulphonamide 􏰁 Diuretics: frusemide, thiazides
􏰁 Allopurinol
􏰁 Cimetidine

56
Q

what immune disorders can cause acute interstitial nephritis

A

SLE, Sjogrens

57
Q

what is the presentation of acute interstitial nephritis ?

A

Fever, arthralgia, rashes
􏰀 AKI → olig/anuria
􏰀 Uveitis

58
Q

what does urinalysis show for acute interstitial nephritis ?

A

haematuria, proteinuria, sterile pyuria

59
Q

what immunoglobulin will be increased with acute interstitial nephritis ?

A

IgE

60
Q

what is the treatment for acute interstitial nephritis ?

A

Stop offending drug

􏰀 Prednisolone

61
Q

what will CT show for analgesic nephropathy?

A

CT w/o contrast (papillary calcifications)

62
Q

what is chronic TIN (tubulo-interstitial nephropathy)

A

fibrosis and tubular loss

63
Q

what causes chronic TIN?

A

Reflux and chronic pyelonephritis 􏰁 DM

􏰁 SCD or trait

64
Q

what can cause nephrocalcinosis ?

A 
Malignancy
􏰁 ↑PTH
􏰁 Myeloma
􏰁 Sarcoidosis
􏰁 Vit D intoxification 􏰁 
RTA
65
Q

state three endogenous nephrotoxins ?

A

Haemoglobin, myoglobin
􏰀 Urate
􏰀 Ig: e.g. light chains in myeloma

66
Q

what medication is nephrotoxic?

A

NSAIDs

􏰀 Antimicrobials: AVASTA
􏰁 Aminoglycosides 􏰁 
Vancomycin
􏰁 Aciclovir
􏰁 Sulphonamides 􏰁 
Tetracycline
􏰁 Amphotericin 􏰀 
ACEi

􏰀 Immunosuppressants 􏰁 Ciclosporin
􏰁 Tacrolimus 􏰀

Contrast media

􏰀 Anaesthetics: enflurane

67
Q

what increases in the blood with rhabdomyolysis ?

A

K+, PO4, urate

􏰁 Myoglobin, CK

68
Q

what causes rhabdomyolysis ?

A

Ischaemia: embolism, surgery

􏰀 Trauma: immobilisation, crush, burns, seizures,
compartment syndrome

􏰀 Toxins: statins, fibrates, ecstasy, neuroleptics

69
Q

what colour is the urine with rhabdomyolysis ?

A

red/brown

70
Q

what is present in the urine with rhabdomyolysis ?

A

Hb but not RBCs

71
Q

what is the treatment of rhabdomyolysis

A

Rx hyperkalaemia

􏰀 IV rehydration: 300ml/h

72
Q

what blood tests should be done for CKD?

A

↓Hb, U+E, ESR, glucose, ↓Ca/↑PO4, ↑ALP, ↑PTH
􏰀 Immune: ANA, dsDNA, ANCA, GBM, C3, C4, Ig, Hep
􏰀 Film: burr cells

73
Q

what is found in the urine with myeloma?

A

BJP (Bence jones proteins)

74
Q

what are some complications of CKD?

A 
􏰀 Cardiovascular disease
􏰀 Renal osteodystrophy
􏰀 Fluid (oedema)
􏰀 HTN
􏰀 Electrolyte disturbances: K, H
􏰀 Anaemia
􏰀 Leg restlessness
􏰀 Sensory neuropathy
75
Q

what condition is Rugger Jersey spine seen?

A

osteosclerosis

76
Q

what is a bone complication of CKD?

A

renal osteodystrophy

77
Q

what is the mechanism of renal osteodystrophy?

A

↓ 1􏰆-hydroxylase → ↓ vit D activation → ↓ Ca → ↑ PTH

􏰀Phosphate retention → ↓ Ca and ↑ PTH (directly)

􏰀 ↑ PTH → activation of osteoclasts ± osteoblasts

􏰀 Also acidosis → bone resorption (phosphate lost to excrete H ion in kidneys)

78
Q

what life style changes can be made for CKD?

A

Exercise
􏰀 Healthy wt.
􏰀 Stop smoking
􏰀 Na, fluid and PO4 restriction

79
Q

what is HTN treated with in DM kidney disease?

A

ACEi

ARB

80
Q

what four medications can be given to help with renal bone disease ?

A

Phosphate binders: sevelamer, calcichew
􏰀 Vit D analogues: alfacalcidol (1 OH-Vit D3)
􏰀 Ca supplements
􏰀 Cinacalcet: Ca mimetic

81
Q

what can be given for restless legs with CKD?

A

clonazepam

82
Q

what could cause rising Cr in transplant patient ?

A

Rejection
􏰀 Obstruction
􏰀 ATN
􏰀 Drug toxicity

83
Q

state the pathology of DM renal disease which results in HTN?

A

Hyperglycaemia → renal hyperperfusion → hypertrophy and ↑ renal size
􏰀 Hypertrophy and metabolic defects inc. ROS production → glomerulosclerosis and nephron loss
􏰀 Nephron loss → RAS activation → HTN

84
Q

how is a diagnosis of amyloid kidney disease?

A

large kidneys in US

biopsy

85
Q

what renal disease does sarcoidosis result in ?

A

TIN

↑Ca

86
Q

what renal disease does myeloma result in ?

A

ATN - damage from light chains

87
Q

what is the treatment of myeloma renal disease?

A

Ensure fluid intake of 3L/d to prevent further impairment

88
Q

what renal disease does NSAIDs result in ?

A

ATN

89
Q

SLE renal disease proteinuria should be treated with?

A

ACEI

90
Q

SLE renal disease aggressive GN should be treated with?

A

immunosuppression

91
Q

what rheumatological condition can have renal crisis as a complication?

A

diffuse systemic sclerosis

  • other complications include small bowel bacteria overgrowth, pulmonary fibrosis
92
Q

what is a renal crisis?

A

malignant HTN + ARF

93
Q

what is the treatment for renal crisis?

A

ACEi

94
Q

what is the gold standard investigation for renovascular disease?

A

renal angiography

95
Q

what is the treatment for renovascular disease?

A

angiography and stenting

96
Q

what organism causes HUS?

A

E. coli O157:H7: verotoxin

97
Q

what does HUS stand for ?

A

Haemolytic Uraemic Syndrome

98
Q

what cells are seen on blood film for HUS?

A

􏰀 Schistocytes

99
Q

does HUS have normal clotting ?

A

yes

100
Q

what is the treatment for HUS?

A

Usually resolves spontaneously

􏰀 Dialysis or plasma exchange may be needed

101
Q

what condition has Genetic or acquired deficiency of ADAMTS13?

A

Thrombotic Thrombocytopenia Purpura (TTP)

102
Q

what is the treatment for Thrombotic Thrombocytopenia Purpura (TTP)?

A

Plasmapheresis, immunosuppression, splenectomy

103
Q

what are the features of thrombotic thrombocytopenia purpura?

A 
Fever
􏰁 CNS signs: confusion, seizures 􏰁
 MAHA
􏰁 Thrombocytopenia
􏰁 Renal failure
104
Q

what does MAHA stand for?

A

microangiopathic hemolytic anemia

105
Q

what is Fanconi Syndrome?

A

Disturbance of PCT function → generalised impaired reabsorption

106
Q

what are the features of Fanconi syndrome ?

A

Polyuria (osmotic diuresis)

􏰁 Hypophosphataemic rickets (Vit D resistant) 􏰁 Acidosis, ↓K

107
Q

what is Bartter’s Syndrome?

A

Blockage of NaCl reabsorption in loop of Henle (as if taking frusemide)
􏰁 Congenital salt wasting

108
Q

what is Gitelman Syndrome?

A

Blockage of NaCl reabsorption in DCT (as if taking thiazides)
􏰁 Congenital salt wasting

Y4 Nephrology/Urology (17 decks)

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