Renal Flashcards
Elevated PTH is a cause of hyperK in renal failure T/F
F - elevated PTH is a cause of hyperCa in renal failure
What is the treatment of idiopathic hypercalciuria?
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
Prune belly syndrome is assoc with that GU abnormality?
Undescended testes
Other important associations of undescended testes: SMA Myotonic dystrophy X linked ichthyosis Kallman syndrome
Joubert syndrome is assoc with what renal abnormality?
Nephronopthisis
Clinical features of fanconi anaemia?
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
Turner syndrome is assoc with horseshoe kidney T/F
T
Patient’s with nephrotic syndrome should follow a high protein diet T/F
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
Patients with Bartter syndrome are hypertensive T/F
F - normotensive
Lab abnormalities in Bartter syndrome?
Metabolic hypokalaemic alkalosis
Hypercalciuria
Increased renin and aldosterone
Note: normal Mg, normal BP
Nephrotic syndrome usually presents in those > 11 yrs T/F
F - age less than 1 or greater than 11 is atypical for nephrotic syndrome
Which RTA has hyperK?
Type 4
Note: type 2 and 1 have hypoK
Which RTA is assoc with RA and Sjogren’s?
Type 1
Which RTA is assoc with SLE or sickle cell disease?
Type 4
HypoCa in renal failure is due to skeletal resistance to PTH T/F
T
HypoCa in renal failure is due to hypophosphataemia
T\F
F - hyperphosphataemia is assoc with hypoCa
Renal dysplasia is usually assoc with posterior urethral valves T/F
T
How does medullary sponge kidney usually present?
Often asymptomatic and found incidentally on imaging.
But if symptomatic - UTI, kidney stones or haematuria
Note: it is not a heritable disorder
Medullary sponge kidney usually bilateral or unilateral?
Usually bilateral (75%)
Where are cysts found in medullary sponge kidney?
In the collecting system
Autosomal dominant polycystic kidney disease is on what Chr?
Chr 16 (85% of cases) and rest on Chr5
In post strep glomerulonephritis C3 is typically high T/F
F - C3 is typically low and normalizes after 2-4 months
Note: CH50 is also low
In post strep glomerulonephritis C3 is typically low T/F
T
Is post strep glomerulonephritis more common in males or females?
Males
What values would you expect urinary Na conc and FeNa to be in pre renal injury (compared to ATN)
Urinary Na conc < 20mmol and low FeNa (<1%)
This both indicate renal tubal function is intact
Likely causes of nephrocalcinosis in an otherwise healthy 6 month old?
Renal tubular acidosis, Bartter syndrome
Also prolonged loop diurectic use
Natural hx of multi cystic dysplastic kidney disease?
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
AR polycystic kidney disease vs AD on ultrasound
AR - enlarged and echogenic kidneys (cysts are so small and diffuse)
AD - discrete cysts
AR polycystic kidney disease is assoc with HTN and varying degrees of hepatic fibrosis T/F
T
In patients with nephrotic syndrome what ages should a referral to a nephrologist be considered?
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
In HSP serum IgA is often elevated T/F
True - it is an IgA medicated vasculitis
In children with HSP nephritic features are associated with a poor prognosis T/F
False - nephrotic syndrome is assoc with a poor prognosis; nephritic features is assoc with a poor prognosis in adults
What renal condition is levamisole used? Typical dosing and duration of therapy
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
What monitoring is needed for pts on levamisole?
FBC every 3 months as it can cause neutropenia
New onset gross haematuria in a patient newly diagnosed with nephrotic syndrome is concerning for what complication?
Renal vein thrombosis
Note: rare but important complication, the hypovolaemia can predispose them to thrombosis
Compare timing of respiratory infection in IgA nephropathy and post strep glomerulonephritis?
IgA nephropathy happens at same time as URI
PSGN happens 1-2 weeks after strep infection
Which type of DI will respond to desmopressin? Nephrogenic or central?
Central - as brain is not producing AHD
Note: in nephrogenic kidneys are resistant to ADH and hence desmopressin will have no effect
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
F - electron micro will show fusion of foot processes of the glomerular epithelial cells (it is true light micro is normal)
In a patient who has severe acute pain (eg secondary to a fracture) and CKD what analgesia is appropriate morphine or fentanyl?
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
What are the lab abnormalities in Gitelman syndrome?
Met alkalosis
HypoK, hypocalciuria, hypoMg
Elevated plasma renin and aldosterone
Note: BP is normal
Blood pressure in Liddle syndrome and Bartter syndrome
Liddle - elevated BP
Bartter - normal BP
Renin and aldosterone in Liddle syndrome?
Low
Note: higher in Bartter and Gitelman
Lab value to distinguish Gitelman from Bartter?
Mg - v low in Gitelman and normal/mild dec in Bartter
How much and for how long must proteinuria be present to make a diagnosis of relapse in nephrotic syndrome?
3+ or more for 3 or more days in a row
Do cystinuria and cystinosis cause renal stones?
Cystinuria causes renal stones
Cystinosis does not
What are the 2 most common causes of acute renal failure from infancy to adolescence?
HUS and post strep GN
What are red cell casts characteristic of?
Nephritic syndrome
Note: they indicate a microscopic amount of bleeding within the kidney
Around what age and how does cystinosis typically present?
In infancy with failure to gain appropriate weight
How does nephronophthisis typically present?
Polydipsia and polyuria
It then progresses to ESRD over months to years
Extra renal manifestations of nephronophthisis?
Hepatic fibrosis
Cardiac anomalies
Situs inversus
Plt transfusion is part of the typical mgmt of HUS T/F
F - it is theoretically contraindicated as it could accelerate thrombus formation
Name 3 steroid resistant nephrotic syndromes?
FSGN
MPGN
Membranous nephropathy associated with Hep B infection
What steroid resistant nephrotic syndrome is associated with hypocomplementaemia?
Membranoproliferative GN
What is the pentad of symptoms in TTP (thrombotic thrombocytopenia purpura)
Thrombocytopenia Microangiopathic haemolytic anaemia with red cell fragmentation on a blood film Fever AKI Neuro symptoms
Which of these is associated with circulating immune complexes minimal change disease or membranoproliferative GN or both
Membranoproliferative
What is the main clinical feature that differentiates RTA type 1 (distal) from type 2 (proximal)
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
Describe the first 2 steps in vit D metabolism and where they occur
Vit D –> 25- hydroxyVit D (in liver) –> 1,25 dihydroxyVit D (in kidney)
What effect, if any, does Vit D have on PTH?
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
What values would be expected for PTH and Ca in untreated renal osteodystrophy?
Elevated PTH
Low Ca
Is one kidney is more commonly affected in PUJ (pelvico-ureteric junction) obstruction?
Yes- left kidney (2 times as often as the right)
How common is pelvico-ureteric junction obstruction?
1 in 750-1000 fetuses
Note: males and females are equally affected. Usually managed conservatively.
What is the association between CKD and thyroid disease?
CKD is often associated with sick euthyroid state with a reduction in T3 and T4 levels
What is the typical presentation of a duplex kidney
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
Hepatic fibrosis is associated with what renal pathology?
AR polycystic kidney disease
Complement levels are low in IgA nephropathy T/F
F - they are normal
Contrast to post strep GN where C3 is low and C4 can be slightly low too
Complement levels are low in post strep GN
T
Low C3 levels are found in what GNs
- Renal limited: post strep; C3 glomerulonephropathy and mesangioproliferative
- Systemic: SLE, subacute bacterial endocarditis
What is the most common cause of hypertension in infancy?
Renal parenchymal disease
What are the main triggers for secretion of renin
Hypovolaemia and hypoNa
Note: fxn of RAA is to retain Na and water
What are the indications for biopsy in HUS?
- Hypertension
- Proteinuria (UPCR > 200mg/mmol, with increasing trend, more than 4 weeks after diagnosis)
- Nephritic or nephrotic syndrome
- Macroscopic haematuria with proteinuria
One absolute indication for biopsy in nephrotic syndrome?
Failure to respond to 60mg/m2 of oral prednisolone for 6 weeks
Haemodialysis is the dialysis of choice for the haemodynamically unstable patient T/F
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
Type 1 RTA is associated with what drugs?
Li
Amphotericin B
Cisplatin
Toluene
Lab def of hypercalciuria?
> 0.2 random urine ca: cr
Which RTA is associated with Fanconi syndrome?
Type 2
In addition to SN hearing loss what is another extra renal manifestation of Alport syndrome?
Occular abnormalities
Such as perimacular pigment changes and lenticonus (a conical projection of the anterior or posterior surface of the lens of the eye)
Those with a history of kidney stones should be advised to follow a low Calcium diet T/F
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
Those with a history of kidney stones should be advised to decrease vit C intake T/F
T
Causes of spurious hyperK (pseudohyperK)
Haemolysis of serum sample
Thrombocytosis
Leukocytosis
What happens to TBW (total body water), intra and extracellular water as a person goes from infancy to childhood?
Total body water decreases
Intracellular water increases
Extracellular water decreases
Note: TBW is inversely related to body fat, neonates have low body fat
Clinical presentation of idiopathic hypercalciuria?
Recurrent haematuria (may be painful) Microscopic haematuria Diffuse abdo pain
Acute post strep glomerulonephritits associated with impetigo which antibody should be tested for?
Anti DNase B
Note: ASO titres do not rise as readily with skin infection as they do with pharyngitis
