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Finals Revision - Last Min > Renal > Flashcards

Renal Flashcards

1
Q

SE of EPO therapy?

Why might someone not respond?

A
  • Accelerated hypertension (encephalopathy and seizures)
  • Bone ache
  • Flu-like symptoms
  • Pure red cell aplasia
  • Iron deficiency due to increased erythropoiesis

Non-responsive:

  • iron deficiency
  • inadequate dose
  • infection
  • hyperparathyroid bone disease
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2
Q

Alport syndrome?

A

X-linked
Congenital renal failure and bilateral sensorineural deafness
Lenticonus - lens protrudes into anterior chamber

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3
Q

How can nephrotic syndrome cause hypocalcaemia?

A

VitD lost to urine

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4
Q

How to tell intrinsic AKI from pre/post renal?

How to tell between pre and post?

A

Proteinuria in intrinsic

Increased urea:creat ratio in pre

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5
Q

How to tell primary from secondary hyperaldosteronism?

A

Renin will be high in secondary

e.g. due to renal artery stenosis or heart failure causing low GFR

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6
Q

50 y/o patient with progressive weakness, and dyspnoea, hepatomegaly, reduced renal function, T2DM, COPD, no FHx?
Diagnosis?

A

Amyloidosis

Rectal biopsy - congo red staining shows apple-green birefringence

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7
Q

What should you think of in young woman who develops AKI in response to ACEI?
What is seen on renal USS?
What is seen on duplex scan?
What is next Ix?

A

Fibromuscular dysplasia

USS: normal kidneys and urinary system

Duplex: stenotic arteries

MR angiography: ‘string of beads’ appearance

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8
Q

Why is lupus nephritis different from other nephritic syndromes?
There are 6 different types of lupus nephritis - what is the most common?

A

All patients with lupus nephritis will have proteinuria

Diffuse proliferative glomerulonephritis

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9
Q

4 causes of transient non-visible haematuria?

A
  • UTI
  • menstruation
  • vigorous exercise (settles after 3 days)
  • sex
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10
Q

Acute interstitial nephritis:

  • what is it?
  • causes?
  • features?
  • Ix?
A

allergic-type reaction involving kidneys, causing interstitial oedema and infiltrates in the connective tissue between renal tubules - accounts for 25% of all drug-induced AKI

Most commonly drugs, usually antibiotics (penicillin, rifampicin) - also NSAIDs, allopurinol, furosemide

Features:

  • fever, rash, arthralgia
  • Eosinophilia
  • mild renal impairment
  • hypertension

Ix:

  • sterile pyuria (WCC on dipstick but no culture)
  • white cell casts
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11
Q

Commonest GN in adults?

Management?

A

Membranous

ACEI/ARB, immunosuppression, anticoagulation

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12
Q

Stages of CKD?

Definition of CKD?

A 
1 - GFR >90
2 - GFR 60-90
3a - GFR 45-59
3b - GFR 30-44
2 - GFR 15-29
1 - GFR <15 - RRT if uraemia present

Reduced GFR and evidence of kidney damage for at least 3 months. Evidence:
proteinuria, haematuria, abnormal U&E, abnormal imaging. More proteinuria = more damage

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13
Q

General management of CKD?

A

Slow progression with ACEI/ARB +/- Spironolactone

Aim for BP <130/80 to reduce proteinuria

Optimise glycaemia

Counsel on RRT once GFR <15

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14
Q

Management of CKD anaemia?

A

Target Hb 10.5-12.5
Optimise Fe status - many require IV Fe
EPO injections weekly

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15
Q

How does renal bone disease occur?
What are the manifestations?
Management?

A
  1. high phosphate ‘drags’ Ca from bones –> osteomalacia
  2. Low vitD (no activation in kidney) causing low Ca –> secondary hyperparathyroidism

Manifest:

  • osteoporosis
  • osteomalacia
  • osteitis fibrosa cystica (due to unchecked hyperparathyroidism)
  • osteosclerosis

Rx:

  • reduce dietary phosphate
  • phosphate binders (calcium carbonate, sevelamer)
  • VitD (calcitriol)
  • parathyroidectomy in some cases
  • Alendronic acid to prevent osteomalacia/osteoporosis
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16
Q

What is seen on biopsy of diabetic nephropathy?
Does it cause nephritic/nephrotic syndrome?
What should be checked annually?
3 main management points in diabetic nephropathy?

A

Nodular glomerulosclerosis - kimmelstein-wilson lesions

Nephrotic syndrome

Urinary albumin:creatinine ratio

  1. Tight glycaemic control
  2. BP <130/80 (ACEI)
  3. Statin
17
Q

What 3 things cause nephritic syndrome (haematuria, hypertension)?

A

Rapidly progressive GN
IgA nephropathy
Alport syndrome

18
Q

What 5 things cause nephrotic syndrome (proteinuria, oedema)?

A 
Minimal change
Membranous GN
Focal segmental glomerulosclerosis
Amyloidosis
Diabetic nephropathy
19
Q

What 3 things can cause a mixed picture of nephritic/nephrotic syndrome?

A

Diffuse proliferative GN
Membranoproliferative GN
Post-streptococcal GN

20
Q

Focal segmental glomerulosclerosis:

  • typical Hx?
  • assoc?
A

young adult with nephrotic syndrome and CKD

HIV, reflux nephropathy, heroin, sickle cell

21
Q

Membranous nephropathy:

  • typical Hx?
  • Assoc?
A

Adult with proteinuria and nephrotic syndrome

Primary - anti-phospholipid A2 Ig (PLA2R)
Secondary - cancer, infection, systemic disease

22
Q

What is low on blood test of post-strep GN?

A

Low C3

23
Q

How to tell AKI from longstanding CKD in patient who newly presents?

A

Renal US - bilateral small kidneys <9cm suggests longstanding CKD

Exceptions - ADPKD, diabetic nephropathy, amyloid - kidneys may enlarge/stay normal size

In which case: high phosphate, low calcium, high PTH

Only true way to tell is previous blood tests

24
Q

4 indications for dialysis in AKI?

A

Hyperkalaemia >7 resistant to Rx

Severe acidosis ph <7.15

Fluid overload

Urea >40

25
Q

ECG hyperkalaemia

A
  • loss of P waves
  • Prolonged QRS
  • tall, tented T waves
  • ectopics/escapes
    If severe: sine wave
26
Q

When should ACEI be stopped in CKD?

What other drug may be useful as an antihypertensive?

A
  • fall in GFR by 25%
  • rise in creatinine by 30%
  • GFR <15

Furosemide - has added benefit of lowering K - higher doses usually needed in CKD

27
Q

Below which eGFR should patients not be given bisphosphonates?

A

35

28
Q

What biochemical disturbance points to chronic rather than acute kidney disease?

A

Low Ca

29
Q

Plasma and urine osmolality and sodium levels in pre-renal and renal AKI?
How can you tell if it’s post-renal?

A

Pre-renal:

  • try to retain sodium and water, so:
  • urine osmolality high, urine Na low

Renal:

  • loss of ability to concentrate urine or retain sodium, so:
  • urine osmolality low, urine Na high

(most common = ATN due to hypoxia/toxins, rarer causes are acute GN and acute IN)

Post-renal:
Hydronephrosis on renal USS

Finals Revision - Last Min (12 decks)

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