Renal Flashcards
Which infection is most likely in renal transplant patients?
CMV
Mode of inheritance in Alport’s syndrome
X linked dominant
Screening for Adult PKD
USS Abdomen
Cause/MOA
Fanconi syndrome
Liddle syndrome
Gitelman syndrome
Bartter syndrome
Fanconi syndrome - global resorptive defect in PCT
- Hypokalaemia, Type 2 renal tubular acidosis
Liddle syndrome - unable to degrade Na channels in DCT –> re-absorb lots Na
- Mimics hyperaldosteronism (Liddle Conn’s)
Gitelman syndrome - mutation in Thiazide sensitive NaCl in DCT
- Hypokalaemia + Normotension
Bartter syndrome - defective Na/K/Cl in ascending LoH
- Hypokalaemia + Normotension
Painful skin lesions
On Haemodialysis
Punch biopsy of a lesion shows calcification of the middle layer of the arterioles
Calciphylaxis lesion
intensely painful, purpuric patches
area of black necrotic tissue
may form bullae, ulcerate, and leave a hard, firm eschar
Ix to DDx acute tubular necrosis vs pre-renal uraemia
Urine MC&S
Granular, muddy-brown urinary casts
Red cell casts
Urinary eosinophil count >5%
Granular, muddy-brown urinary casts –> Acute Tubular Necrosis
Red cell casts –> nephritic syndrome
Urinary eosinophil count >5% –> interstitial nephritis
New drug (NSAID / Antibiotic)
Rash (Maculopapular or Macular rash)
Arthralgia (joint pain)
Eosinophillia
Tubulo-interstitial nephritis (TIN)
Indications for RRT / dialysis
AEIOU
- Acidosis (pH < 7.2)
- Electrolytes (persistent K > 7.0)
- Intoxication
- Overload of fluid (refractory to treatment)
- Uremic pericarditis / encephalopathy
Most common infection in haemodialysis
Staphylococcus epidermidis
Nephrotic syndrome with sudden deterioriation in renal function
Diagnosis?
Renal vein thrombosis
Causes of Nephrotic syndrome + Nephritic syndrome
Young female patients develop AKI after starting ACE inhibitor
Diagnosis?
Fibromuscular dysplasia
Recent MI 1 month ago and started on ACEi –> presents with flash pulmonary oedema
Renal artery stenosis
Renal tubular acidosis
Type 1-4
Type 1 RTA : H+ = (+1)
- Excess H+ –> Hypokalaemia + Metabolic acidosis
Type 2 RTA : HCO3(-1) = 3-1 = 2
- Loss of HCO3 –> Hypokalaemia + Metabolic acidosis
Type 3 RTA
- Type 1 + Type 2
Type 4 RTA (Aldo = 4)
- No aldosterone
- Hyperkalaemia + Metabolic acidosis
Prevention of renal stones
Tx of renal stones
Renal stones
Cyanide-nitroprusside test: positive
Diagnosis?
Cystinuria
BPH - Tx
(1) α blocker (Tamsulosin, Doxazosin)
(1) 5‑α reductase inhibitor (Finasteride)
- Takes 3-6 months before improvement
- S/E: Gyaecomastia, ED
(1) Phosphodisteraise-5 inhibitor (Sildenafil)
(1) Anticholinergic (Tolterodine, Oxybutynin)
Prostate < 80g –> TURP
Prostate > 80g –> Laser enucleation
Epididymo-orchitis
- cause?
Tx?
Adults < 35 years
-
STI infection (most common)
- Chlamydia trachmatis
- Neisseria gonorrhoeae
- Tx: IM Ceftriaxone + Doxycycline
Adults > 35 years
-
Enteric organisms
- E. coli (following UTI)
- Tx: Quinolone (Levofloxacin)
Scrotal swelling
Separate from body of testicle
Able to get above the lump
Diagnosis? Ix?
Epididymal cyst
USS
Painless, scrotal mass
NOT separate to the testis
Able to get above the mass
Transillumination of swelling
Diagnosis? Complications?
Hydrocoele
Consider Ix for malignancy (10%)
Types of Rapidly progressive Glomerulonephritis
- Type 1 (Antibody mediated)
- Goodpasture’s = anti-GBM Ab (IgG) mediated
- Type 2 (Immune complex mediated):
- IgA nephropathy / Henoch-Scholein purpura
- SLE
- Type 3 = ANCA +ve
- Granulomatosis with polyangiitis (Wegener’s granulomatosis)
- Eosinophilic granulomatosis with polyangiitis (Churg-Straus)
- Microscopic polyangiitis
Types of Glomerulonephritis - based on histology
Types of Glomerulonephritis - based on cause
