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4 MBCHB > RENAL 1 > Flashcards

RENAL 1 Flashcards

1
Q

proliferative GN vs

non prolif

A

heamaturia - proliferation of mesangial/endothelial cells

proteinuria - fusion of podocyte foot processes

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2
Q

RBC and casts

A

granular casts indicate active granular injury causing glomerual bleeding

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3
Q

crescentic GN

A

epithelial cell extra capillary proliferation

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4
Q 
minimal change nephropathy prolif?
commonest cause of what 
who 
causes
ix
rx
progressive renal failure?
A 
non proliferation
nephrotic syndrome in children 
children with atopy 0- follows URTI
idiopathic, NSAIDs, hodgkins
EM shows podocyte foot fusion 
steroids if relapse cyclophosphamide
no
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5
Q 
FCS prolif?
commonest cause of what 
who 
causes
ix
rx
progressive renal failure?
A

non prolif
nephrotic syndrome in adults
obese
genetics. idiopathic, HIV, heroin, sickle cell, alports
focal segmental scaring - contain ig and complement. podocyte foot fusion
steroids. relapse - cyclophosphamide/cyclosporin
50% -> ESRF in 10y

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6
Q 
membranous prolif?
commonest cause of what 
who 
causes
ix
rx
progressive renal failure?
A

non
2nd commonest cause of nephrotic syndrome in adults
esp older px
idiopathic, malignancy, hep B, SLE, gold/penicillamine
thickened BM and sub epithelial immune complex deposits in BM seen on silver stain. diffuse IgG uptake on IF
steroids. alkylating agents. B cell monoclonal ABs - rituximab
1/3 to ESRF in 10y. 1/3 chronic. 1/3 remission

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7
Q 
IgA prolif?
commonest cause of what 
who 
causes
ix
rx
progressive renal failure?
A

prolif
commonest GN worldwide
young man who develops macroscopic haematuria 1-2 days after URTI, proteinuria and progressive renal failure
idiopathic. HSP
mesangial cell proliferation. increase in mesangial matrix, IgA deposits in mesangium
BP control ACEI/ARB. steroids/cyclophosphamide
25% in 10-30y

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8
Q 
post strep prolif?
who 
causes
ix
rx
progressive renal failure?
A

prolif and non - heamaturia and proteinuria
young kids after viral infection usually strep progenies (tonsillitis) - 2w after infection - proteinuria, haematuria, htn, decreased c3, headache, malaise
proliferation of mesangial cells, neutrophils and monocytes. bowmen space is compressed. IF - granular.starry sky appearance
supportive - resolves in 2-4w
good prognosis

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9
Q 
RPGN prolif?
causes
ix
rx
progressive renal failure?
A 
prolif
ANCA pos: wegners, MPA
ANCE neg: GP, HSP, SLE
glomerular crescents seen on biopsy 
steroids, cytotoxic, monoclonal ABs, plasmapheresis
poor prognosis
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10
Q

nephritic syndrome

proliferation? non proliferation?

A

PROLIF

AKI, oliguria, htn, urine - RBC and casts, oedema

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11
Q

nephrotic syndrome

A

proteinuria >3g/24h
hypoalbuminaemia <30
oedema, increased cholesterol, normal renal function

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12
Q

what can nephrotic syndrome cause

A

infections, renal vein thrombosis, volume depletion, PE, vit D déficit, subclinical hypothyroidism

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13
Q

treatment of nephrotic syndrome

A

underlying, steroids (membranous, FCS, minimal), ACEI/ARB, anti coag, IV albumin (if volume depleted)

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14
Q

chronic kidney disease stages

A 
GFR >90 and kidney damage 
>60-90 and kidney damage 
3A 45-60 
3B 30-44
15-30
<15 OR on RRT
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15
Q

what can affect CK

A

muscle mass, pregnancy, eating red meat

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16
Q

what does CKD do to the cardiovascular risk

A

increases it

17
Q

causes of chronic kidney disease

A

DM, htn, vascular disease, chronic GN, reflux nephropathy, PKD, chronic pyelonephritis, idiopathic

18
Q

what increases the progression of chronic kidney disease

A

proteinuria

19
Q

symptoms of CKD and when do they occur

what occurs early

A

<20 GFR
itch, tired, poor appetite, sleep problems
impaired urine concentrating ability - nocturia

20
Q

how can progression be slowed

A

decrease proteinuria and BP - ACEI/ARB
good glycemic control
stop smoking

21
Q

how can the CVD risk be decreased

A

BP and proteinuria, smoking, simvastatin

22
Q

anaemia in CKD why does it occur
when does it become apparent
treatment first line and second line
what is the target Hb

A

decreased erythropoietin
when GFR <35
IV iron. 2 -> erythropoietin stimulating agents like erythropoietin, darbepoetin
10.5-12.5

23
Q

bone disease in CKD why
symptoms/signs
treatment

A

impaired vit D hydroxylation - decreases calcium absorption. secondary hyperparathyroidism

osteomalacia, osteoporosis, vascular calcification, heart vessels calcify

ergocebeferon, alfocolcadol, phosphate, cal citron (vit D)

24
Q

when should dialysis be started

A

resistant hyperkalaemia
urea <45
unresponsive acidosis
GFR <15

25
Q

restrictions of dialysis

A

fluid if anuric 1L/day
decreased salt/potassium
decrease phosphate - phosphate binders

26
Q

arteriovenous fistula
how long does it take to heal
good points
bad points

A

6 weeks
good blood flow. infection unlikely.
requires surgery, can limit blood flow distally - steal syndrome, can block

27
Q

tunneled venous catheter goes where
good points
bad points

A

large vein - femoral, subclavian, jugular
easy to insert and can be used immediately
damage to vein, can block, high risk of infection

28
Q

TVC infections of unrx
ix
rx

A

if infection is untreated it can lead to endocarditis
FBC, CRP, blood cultures, exit site swab
vancomycin, like removal/exchange

29
Q

starting haemodiaylysis

A

gradual build up if too quick can lead to cerebral disequilibrium syndrome
4 hours 3 times a week

30
Q

problems with haemodialysis

A

fluid overload, blood leaks, loss of vascular access, hypokalaemia and cardiac arrest, intradialytic hypotension

31
Q

peritoneal dialysis types

A

CAPD - 4 bad exchanges throughout the day 30m/exchange

APD - 1 bag stays in all day - overnight machine drains, fluid in and out over 9-10 hours or overnight

32
Q

starting PD

A

training - smaller fill volumes to begin with

33
Q

problems with PD - infection what
causes
ix
rx

A

peritonitis/exit site infection
contamination: SA, strep, diphtheroid. gut bacteria translocation: Coli, klebsiella
culture PD fluid
intraperitoneal ABs, catheter may have to be removed

34
Q

PD problems membrane failure

A

inability to remove enough water - fluid overload

may have to switch to HD

35
Q

PD problems hernia

A

due to increased abdominal pressure

smaller fill volumes and treat hernia

36
Q

metabolic complications of dialysis

A

bone mineral metabolism
anaemia
water and sodium retention
increased CDV disease

37
Q

what can long term dialysis lead to in the kidneys

A

simple cysts - no functional disturbance

4 MBCHB (80 decks)

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