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Renal Flashcards

1
Q

Elevated PTH is a cause of hyperK in renal failure T/F

A

F - elevated PTH is a cause of hyperCa in renal failure

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2
Q

What is the treatment of idiopathic hypercalciuria?

A

Oral thiazide diuretics - they normalise Ca excretion by stimulating Ca reabsorption in the distal tubule

Note: dietary restriction of Ca is not rec as it is required for growth

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3
Q

Prune belly syndrome is assoc with that GU abnormality?

A

Undescended testes

Other important associations of undescended testes:
SMA
Myotonic dystrophy
X linked ichthyosis
Kallman syndrome
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4
Q

Joubert syndrome is assoc with what renal abnormality?

A

Nephronopthisis

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5
Q

Clinical features of fanconi anaemia?

A

Limb defects
Renal malformations
Bone marrow failure
Predisposition to malignancy

NB different to fanconi renal tubulopathy syndrome - proximal tubular defect with loss of electrolytes, AA and glucose in urine

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6
Q

Turner syndrome is assoc with horseshoe kidney T/F

A

T

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7
Q

Patient’s with nephrotic syndrome should follow a high protein diet T/F

A

F - mod protein, no salt added and fluid restricted diet in oedematous phase

Studies have shown there is no significant benefit on plasma albumin conc or growth from a high protein diet

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8
Q

Patients with Bartter syndrome are hypertensive T/F

A

F - normotensive

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9
Q

Lab abnormalities in Bartter syndrome?

A

Metabolic hypokalaemic alkalosis
Hypercalciuria
Increased renin and aldosterone

Note: normal Mg, normal BP

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10
Q

Nephrotic syndrome usually presents in those > 11 yrs T/F

A

F - age less than 1 or greater than 11 is atypical for nephrotic syndrome

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11
Q

Which RTA has hyperK?

A

Type 4

Note: type 2 and 1 have hypoK

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12
Q

Which RTA is assoc with RA and Sjogren’s?

A

Type 1

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13
Q

Which RTA is assoc with SLE or sickle cell disease?

A

Type 4

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14
Q

HypoCa in renal failure is due to skeletal resistance to PTH T/F

A

T

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15
Q

HypoCa in renal failure is due to hypophosphataemia

T\F

A

F - hyperphosphataemia is assoc with hypoCa

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16
Q

Renal dysplasia is usually assoc with posterior urethral valves T/F

A

T

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17
Q

How does medullary sponge kidney usually present?

A

Often asymptomatic and found incidentally on imaging.

But if symptomatic - UTI, kidney stones or haematuria

Note: it is not a heritable disorder

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18
Q

Medullary sponge kidney usually bilateral or unilateral?

A

Usually bilateral (75%)

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19
Q

Where are cysts found in medullary sponge kidney?

A

In the collecting system

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20
Q

Autosomal dominant polycystic kidney disease is on what Chr?

A

Chr 16 (85% of cases) and rest on Chr5

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21
Q

In post strep glomerulonephritis C3 is typically high T/F

A

F - C3 is typically low and normalizes after 2-4 months

Note: CH50 is also low

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22
Q

In post strep glomerulonephritis C3 is typically low T/F

A

T

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23
Q

Is post strep glomerulonephritis more common in males or females?

A

Males

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24
Q

What values would you expect urinary Na conc and FeNa to be in pre renal injury (compared to ATN)

A

Urinary Na conc < 20mmol and low FeNa (<1%)

This both indicate renal tubal function is intact

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25
Q

Likely causes of nephrocalcinosis in an otherwise healthy 6 month old?

A

Renal tubular acidosis, Bartter syndrome

Also prolonged loop diurectic use

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26
Q

Natural hx of multi cystic dysplastic kidney disease?

A

Can be seen on antenatal USS, has no function and most will involute with age

Note: no fxn on DMSA isotope scan is characteristic, they are usually unilateral

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27
Q

AR polycystic kidney disease vs AD on ultrasound

A

AR - enlarged and echogenic kidneys (cysts are so small and diffuse)
AD - discrete cysts

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28
Q

AR polycystic kidney disease is assoc with HTN and varying degrees of hepatic fibrosis T/F

A

T

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29
Q

In patients with nephrotic syndrome what ages should a referral to a nephrologist be considered?

A

Age < 12 month or >10 yrs

Other referral criteria: macroscopic or persistent microscopic haematuria; impaired renal function not attributable to hypovolaemia; persistent HTN; decreased C3; rash or arthropathy; failure to induce remission with 28 days of pred at 60mg/m2

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30
Q

In HSP serum IgA is often elevated T/F

A

True - it is an IgA medicated vasculitis

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31
Q

In children with HSP nephritic features are associated with a poor prognosis T/F

A

False - nephrotic syndrome is assoc with a poor prognosis; nephritic features is assoc with a poor prognosis in adults

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32
Q

What renal condition is levamisole used? Typical dosing and duration of therapy

A

Patient with frequent relapses of nephrotic syndrome

Dosing is every other day for 1-2 yrs

Note: MOA is antihelminth that has immune modulator effects

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33
Q

What monitoring is needed for pts on levamisole?

A

FBC every 3 months as it can cause neutropenia

34
Q

New onset gross haematuria in a patient newly diagnosed with nephrotic syndrome is concerning for what complication?

A

Renal vein thrombosis

Note: rare but important complication, the hypovolaemia can predispose them to thrombosis

35
Q

Compare timing of respiratory infection in IgA nephropathy and post strep glomerulonephritis?

A

IgA nephropathy happens at same time as URI

PSGN happens 1-2 weeks after strep infection

36
Q

Which type of DI will respond to desmopressin? Nephrogenic or central?

A

Central - as brain is not producing AHD

Note: in nephrogenic kidneys are resistant to ADH and hence desmopressin will have no effect

37
Q

In minimal change disease when biopsied the light microscopy will be normal and electron microscopy will show thinning of the capillary basement membrane T/F

A

F - electron micro will show fusion of foot processes of the glomerular epithelial cells (it is true light micro is normal)

38
Q

In a patient who has severe acute pain (eg secondary to a fracture) and CKD what analgesia is appropriate morphine or fentanyl?

A

Fentanyl - metabolised by the liver and has no active metabolites that could accumulate in CKD

Note: morphine is metabolised to multiple metabolites that can accumulate in CKD

39
Q

What are the lab abnormalities in Gitelman syndrome?

A

Met alkalosis
HypoK, hypocalciuria, hypoMg
Elevated plasma renin and aldosterone

Note: BP is normal

40
Q

Blood pressure in Liddle syndrome and Bartter syndrome

A

Liddle - elevated BP

Bartter - normal BP

41
Q

Renin and aldosterone in Liddle syndrome?

A

Low

Note: higher in Bartter and Gitelman

42
Q

Lab value to distinguish Gitelman from Bartter?

A

Mg - v low in Gitelman and normal/mild dec in Bartter

43
Q

How much and for how long must proteinuria be present to make a diagnosis of relapse in nephrotic syndrome?

A

3+ or more for 3 or more days in a row

44
Q

Do cystinuria and cystinosis cause renal stones?

A

Cystinuria causes renal stones

Cystinosis does not

45
Q

What are the 2 most common causes of acute renal failure from infancy to adolescence?

A

HUS and post strep GN

46
Q

What are red cell casts characteristic of?

A

Nephritic syndrome

Note: they indicate a microscopic amount of bleeding within the kidney

47
Q

Around what age and how does cystinosis typically present?

A

In infancy with failure to gain appropriate weight

48
Q

How does nephronophthisis typically present?

A

Polydipsia and polyuria

It then progresses to ESRD over months to years

49
Q

Extra renal manifestations of nephronophthisis?

A

Hepatic fibrosis
Cardiac anomalies
Situs inversus

50
Q

Plt transfusion is part of the typical mgmt of HUS T/F

A

F - it is theoretically contraindicated as it could accelerate thrombus formation

51
Q

Name 3 steroid resistant nephrotic syndromes?

A

FSGN
MPGN
Membranous nephropathy associated with Hep B infection

52
Q

What steroid resistant nephrotic syndrome is associated with hypocomplementaemia?

A

Membranoproliferative GN

53
Q

What is the pentad of symptoms in TTP (thrombotic thrombocytopenia purpura)

A 
Thrombocytopenia
Microangiopathic haemolytic anaemia with red cell fragmentation on a blood film
Fever
AKI
Neuro symptoms
54
Q

Which of these is associated with circulating immune complexes minimal change disease or membranoproliferative GN or both

A

Membranoproliferative

55
Q

What is the main clinical feature that differentiates RTA type 1 (distal) from type 2 (proximal)

A

Nephrolithiasis is present in type 1

Note: type 1 is due to failure of acidification of urine at the collecting ducts and hence urine pH is persistently alkaline and favours the precipitation of Ca phos leading to stone formation
type 2 is due to a failure of bicarb reabs but urine can still be acidified by the collecting ducts

56
Q

Describe the first 2 steps in vit D metabolism and where they occur

A

Vit D –> 25- hydroxyVit D (in liver) –> 1,25 dihydroxyVit D (in kidney)

57
Q

What effect, if any, does Vit D have on PTH?

A

Vit D inhibits PTH

Note: Vit D also increases Ca + phos absorption from the gut, increases reabsorption of Ca + phos from the kidneys and enhances bone turn over

58
Q

What values would be expected for PTH and Ca in untreated renal osteodystrophy?

A

Elevated PTH

Low Ca

59
Q

Is one kidney is more commonly affected in PUJ (pelvico-ureteric junction) obstruction?

A

Yes- left kidney (2 times as often as the right)

60
Q

How common is pelvico-ureteric junction obstruction?

A

1 in 750-1000 fetuses

Note: males and females are equally affected. Usually managed conservatively.

61
Q

What is the association between CKD and thyroid disease?

A

CKD is often associated with sick euthyroid state with a reduction in T3 and T4 levels

62
Q

What is the typical presentation of a duplex kidney

A

As there are 2 ureters for one kidney the 2nd ureter may insert inferior to the bladder neck a typical history is constant dribbling of urine despite normal voiding volume

Or can present with recurrent UTIs

63
Q

Hepatic fibrosis is associated with what renal pathology?

A

AR polycystic kidney disease

64
Q

Complement levels are low in IgA nephropathy T/F

A

F - they are normal

Contrast to post strep GN where C3 is low and C4 can be slightly low too

65
Q

Complement levels are low in post strep GN

A

T

66
Q

Low C3 levels are found in what GNs

A
  1. Renal limited: post strep; C3 glomerulonephropathy and mesangioproliferative
  2. Systemic: SLE, subacute bacterial endocarditis
67
Q

What is the most common cause of hypertension in infancy?

A

Renal parenchymal disease

68
Q

What are the main triggers for secretion of renin

A

Hypovolaemia and hypoNa

Note: fxn of RAA is to retain Na and water

69
Q

What are the indications for biopsy in HUS?

A
  1. Hypertension
  2. Proteinuria (UPCR > 200mg/mmol, with increasing trend, more than 4 weeks after diagnosis)
  3. Nephritic or nephrotic syndrome
  4. Macroscopic haematuria with proteinuria
70
Q

One absolute indication for biopsy in nephrotic syndrome?

A

Failure to respond to 60mg/m2 of oral prednisolone for 6 weeks

71
Q

Haemodialysis is the dialysis of choice for the haemodynamically unstable patient T/F

A

F - petitoneal dialysis is preferred in haemodynamical instability due to it’s slow and continuous nature in correcting fluid volumes

Note: peritoneal dialysis is 1/8 as effect as haemo at altering solute and 1/2 as effective in fluid removal

72
Q

Type 1 RTA is associated with what drugs?

A

Li
Amphotericin B
Cisplatin
Toluene

73
Q

Lab def of hypercalciuria?

A

> 0.2 random urine ca: cr

74
Q

Which RTA is associated with Fanconi syndrome?

A

Type 2

75
Q

In addition to SN hearing loss what is another extra renal manifestation of Alport syndrome?

A

Occular abnormalities

Such as perimacular pigment changes and lenticonus (a conical projection of the anterior or posterior surface of the lens of the eye)

76
Q

Those with a history of kidney stones should be advised to follow a low Calcium diet T/F

A

F - they should ensure they are eating enough Ca. Dietary calcium actually decreases the risk of stones by binding with oxalate in the stomach and intestines before oxalate reaches the kidneys/urine

Note: they should decrease foods that contain oxalate (spinach, rhubarb, cashews, almonds); also animal protein and soft drinks

77
Q

Those with a history of kidney stones should be advised to decrease vit C intake T/F

A

T

78
Q

Causes of spurious hyperK (pseudohyperK)

A

Haemolysis of serum sample
Thrombocytosis
Leukocytosis

79
Q

What happens to TBW (total body water), intra and extracellular water as a person goes from infancy to childhood?

A

Total body water decreases
Intracellular water increases
Extracellular water decreases

Note: TBW is inversely related to body fat, neonates have low body fat

80
Q

Clinical presentation of idiopathic hypercalciuria?

A 
Recurrent haematuria (may be painful)
Microscopic haematuria
Diffuse abdo pain
81
Q

Acute post strep glomerulonephritits associated with impetigo which antibody should be tested for?

A

Anti DNase B

Note: ASO titres do not rise as readily with skin infection as they do with pharyngitis

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