Renal Flashcards
1
Q
what is the urine sodium in pre-renal AKI
A
<20
2
Q
what is the urine osmolality in ATN?
A
<350
3
Q
what is seen on renal biopsy of ARPKD
A
multiple cylindrical lesions
4
Q
What defect is present in Alport’s syndrome
A
Type IV collagen
5
Q
What are the ocular complications of Alport’s syndrome
A
lenticonus, corneal ulceration, retinitis pigmentosa, cataracts
6
Q
What is seen on microscopy in Alport’s syndrome
A
Splitting of the lamina densa
7
Q
What is significant proteinuria in non-diabetics?
A
ACR >30mg/mmol
8
Q
What is significant proteinuria in diabetics?
A
ACR >2.5mg/mmol (3.5 in women) indicates clinically significant microalbuminaemia
9
Q
What type of hypersensitivity is hyperacute renal transplant rejection?
A
Type II
10
Q
What is the mechanism of acute graft rejection?
A
cytotoxic T cells
11
Q
What viral infection is most significant in transplant patients?
A
CMV
12
Q
Which renal pathology occurs most frequently to cause chronic graft rejection?
A
Membranoproliferative GN
13
Q
What kidney disease is a heroin user likely to develop?
A
Focal segmental glomerulosclerosis
14
Q
What does gold exposure cause in the kidneys
A
membranous glomerulonephritis
15
Q
What is the most common renal disease in SLE
A
Diffuse proliferative glomerulonephritis
16
Q
What is the most common renal disease after a streptococcal infection
A
Diffuse proliferative glomerulonephritis
17
Q
What gives a ‘tram-track’ appearance on biopsy of the kidney
A
Type 1 membranoproliferative glomerulonephritis
18
Q
What is the commonest cause of nephrotic syndrome in adults?
A
membranous glomerulonephritis
19
Q
what type of hypersensitivity is goodpastures
A
type II
20
Q
What increases the risk of pulmonary haemorrhage in goodpastures
A
pulmonary oedema, young male, smoking, LRTI, inhaled hydrocarbons
21
Q
what is seen on lung biopsy in goodpastures
A
haemosiderin-laden macrophages in alveoli
22
Q
what is an indication for plasmapheresis in goodpastures
A
severe haemoptysis
23
Q
What is seen on renal biopsy in Wegeners granulomatosis
A
epithelial crescents in Bowmans capsule
24
Q
What is seen on renal biopsy in Goodpastures
A
linear IgG deposits
25
What is seen on microscopy in post-streptococcal glomerulonephritis
wire-loop lesions and humps in subendothelial space
26
What is the main pathological finding in rapidly progressive glomerulonephritis
fibrinoid necrosis
27
What is seen on renal biopsy in acute tubulointerstitial nephritis
interstitial oedema with a heavy infiltrate of inflammatory cells
28
What is the main cause of acute tubulointerstitial nephritis
Drugs
29
What is eosinophiuria pathognomic of
acute tubulointerstitial nephritis
30
Which drug can prevent calcium renal stones
thiazide diuretics (increases distal tubular Ca reabsorption)
31
Which renal stones are radiolucent on Xray
urate, xanthine
32
Which stones form in proteus and klebsiella infections
struvite (ammonium magnesium phosphate)
33
Which renal stones are semi opaque on Xray
Cystine
34
What is the medical treatment of renal stones to aid stone passage
alpha blockers
35
What is the GS investigation of renal stones
Non contrast CT
36
Which amino acids are unable to be reabsorbed in cystinuria
cystine, ornithine, lysine, arginine
37
what is the treatment of cystinuria
d-penicillamine, urinary alkalisation
38
what is the treatment of homocystinuria
Vit B6, folic acid
39
What appearance does fibromuscular dysplasia have on angiography
'string of beads' appearance
40
Which drug is contraindicated in renal artery stenosis
ACE inhibitors
41
What is the most likely cause of flash pulmonary oedema and hypertension in a young patient
fibromuscular dysplasia
42
What electrolyte abnormalities are seen in type 1 RTA
hypokalaemia, hypercalciuria, hyperphosphaturia
43
What deficiency gives rise to type 3 RTA
carbonic anhydrase II
44
What is the mechanism of action of tolvaptan
vasopressin receptor 2 antagonist
45
How long does it take for an AV fistula to form
6 weeks
46
What is the likely cause of macroscopic haematuria in coeliac disease
IgA nephropathy
47
Which one of the following types of glomerulonephritis is most characteristically associated with partial lipodystrophy
Mesangiocapillary glomerulonephritis (membranoproliferative)
48
where does spironolactone act
cortical collecting duct
49
What electrolyte abnormalities cause nephrogenic diabetes insipidus
hypokalaemia, hypercalcaemia
50
Where does most of Na reabsorption take place?
Via active transport in the loop of Henle
51
What does HSP show on renal biopsy
Mesangial hypercellularity
52
Which antibody is idiopathic membranous glomerulonephritis related to?
Anti-phospholipase A2 antibodies
53
What would a renal biopsy show in IgA nephropathy?
Mesangial hypercellularity
| + positive immunoflourescence for IgA and C3
54
Which chromosome does 85% of mutations occur in ADPKD?
Chromosome 16
| 15% occur on Chr 4
55
What condition creates a ‘spike and dome’ appearance on electron microscopy due to deposits of IgG and C3
Membranous glomerulonephritis
56
What is the most common extra-renal manifestation in ADPKD
hepatic cysts (causing hepatomegaly)
57
What immunoglobulins are responsible for hyperacute graft rejection
IgG (pre-existent antibodies)
58
Which organs are affected in VHL syndrome
Intracranial (CNS haemangioblastoma), eye (retinal haemangiomata) and renal (phaeochromocytoma, renal cell ca, renal cysts)
59
What is the first stage of diabetic nephropathy
Hyperfiltration - raised GFR
60
Which condition is associated with Kinmelsteil-Wilson nodules
Diabetic nephropathy
61
Which kind of renal stones are associated with renal tubular acidosis
Calcium phosphate stones
62
What is the diagnostic test for homocystinuria
Cyanide nitroprusside test
63
What is the treatment of renal vascular disease
Stop ACEi, start aspirin and statin
64
Where does renal cell carcinoma arise from
Proximal renal tubular epithelium
65
Which cancer is associated with Beckwith-Wiedemann syndrome and WAGR syndrome
Wilm’s tumour
66
What is the most common organism that causes peritoneal dialysis peritonitis
Coagulase negative staph
67
What is the treatment of peritoneal dialysis peritonitis
IP vancomycin +/- PO ciprofloxacin
68
Which condition is characterised by raised phenylalanine and musty odour
PKU
69
What is the most common type of bladder cancer
Transitional cell carcinoma
70
Which causes of CKD show enlarged kidneys on imaging
Amyloidosis, PKD, diabetic glomerulosclerosis, scleroderma, RPGN
71
Where is renin secreted
Renal juxtaglomerular cells
72
Which cells are damaged in nephrotic syndrome
Podocytes, can also be due to basement membrane damage
73
Which causes of nephritic syndrome have a normal C3 level
IgA nephropathy, HSP
74
Which renal disease is seen in Hodgkin’a lymphoma
Minimal change disease
75
Which type of membranoproliferative GN is associated with low C4
Type 1 (cryoglobulinaemia, HCV)
76
Which type of membranoproliferative GN is associated with low C3
Type 2 (partial lipodystrophy)
77
Which ethnicity has the highest prevalence of BPH
Black
78
What is the screening test for ADPKD
Renal USS
79
What are stag-horn calculi composed of
Struvite
80
What type of anti-androgen therapy is bicalutamide
Non-steroidal anti-androgen (blocks androgen receptor)
81
What is the MOA of cyproterone acetate in treatment of prostate cancer
Steroidal anti-androgen
82
What is the MOA of abiraterone in treatment of prostate cancer
Androgen synthesis inhibitor (blocks cytochrome P450 17 alpha-hydroxylase)
83
What is the best treatment for rheumatological conditions in pregnancy that are not responsive to steroids
Azathioprine
84
Which drug can be used to slow the growth of cysts in ADPKD
Tolvaptan
85
What should be started 3 days before a GnRH agonist in the treatment of prostate cancer
Anti-androgen treatment (cyproterone acetate/bicalutamide) - reduces risk of tumour flare
86
Which nephropathy is malignancy most associated with
Membranous glomerulopathy
87
Which antibodies are associated with primary membranous glomerulopathy
Anti-phospholipase A2 (Anti-PLA2R)
88
What is the risk associated with large volumes of 0.9% NaCl
Hyperchloraemic metabolic acidosis
89
How much potassium is required for routine maintenance over 24hrs
1 mmol/kg
90
How much water is required for routine maintenance over 24hrs
30ml/kg
91
How much glucose is required for routine maintenance over 24hrs
50-100g
92
Which electrolyte imbalance is commonly seen after plasma exchange
Hypocalcaemia
93
Which RTA causes bone demineralisation due to phosphate wasting
Fanconi syndrome (type 2 RTA)
94
What is Stauffer syndrome
Paraneoplastic hepatic dysfunction syndrome in renal cell cancer - typically presents as cholestasis/hepatosplenomegaly
95
Which inherited disorder of type IV collagen causes persistent haematuria with normal kidney function
Thin basement membrane disease
96
What are the causes of transient microscopic haematuria
UTI, menstruation, vigorous exercise, sexual intercourse
97
What are the causes of persistent microscopic haematuria
Cancer, stones, BPH, prostatitis, urethritis, intrinsic renal disease
98
What kidney complication causes extremely painful, purpuric patches with black necrotic tissue in the lower limbs
Calciphylaxis
99
Which cancer is a kidney transplant patient most at risk of
Squamous cell carcinoma (due to long-term steroids)
100
What are the endocrine effects of renal cell carcinoma
Erythropoietin, PTH, renin, ACTH
101
What are the 5 features of HIV-associated nephropathy
```
Massive proteinuria/nephrotic syndrome
Normal or large kidneys
FSGS with capillary collapse on biopsy
Elevated urea and Cr
Normotension
```
102
Which drugs are associated with retroperitoneal fibrosis
Ergot derived drugs and beta blockers
103
What is the treatment of HIV-associated nephropathy
Aggressive antiretroviral therapy and ACEi
104
Which renal pathology is plasmodium malariae associated with
Membranous glomerulonephritis
105
What is the most common cause of nephrotic syndrome in older adults
FSGS
106
What causes carpal tunnel syndrome and bony cysts with conventional dialysis >5 years
Beta 2 microglobulin amyloidosis
107
What presents with pigmentation of the sclera, urine and connective tissues
Alkaptonuria
108
What type of GN is associated with HIV nephropathy
FSGS
109
What does xanthogranulomatous pyelonephritis show on biopsy
Lipid-laden macrophages with lymphocytes and PMNs
110
What is the treatment of scleroderma renal crisis
ACEi
111
What is mortality related to in familial Mediterranean fever
Deteriorating renal function
112
Which renal pathology is most likely to recur after renal transplant
Membranoproliferative glomerulonephritis
113
What are kimmelstein-Wilson nodules suggestive of on renal biopsy
Nodular sclerosis - Diabetic nephropathy, amyloidosis, cigarette smoking
114
Which disease occurs after gadolinium exposure in impaired renal function
Nephrogenic systemic fibrosis
115
Which renal condition is associated with atanazavir use in HIV
Crystal nephropathy
116
What presents with hypokalaemic alkalosis, suppressed renin and aldosterone, and hypertension
Liddle’s syndrome
117
Which type of RTA causes severe metabolic acidosis and a urinary pH >5.5
Type 1 (distal) RTA
118
Which RTA presents with nephrocalcinosis
Type 1 (distal) RTA
119
Which type of RTA is due to failure to absorb bicarbonate
Type 2 (proximal) RTA
120
What is the management of acute pyelonephritis due to obstructive stones
Emergency surgery for ureteral calculus with stenting
121
What condition presents with nodularity and diffuse tenderness on PR exam + mildly raised PSA
Chronic intermittent prostatitis
122
What presents with symptoms similar to systemic sclerosis but with no autoimmune antibodies in dialysis patients
Nephrogenic systemic fibrosis (after gadolinium exposure)
123
What type of dialysis membrane is useful for dialysis amyloidosis due to excess beta-2 microglobulin
High-flux dialysis membranes
124
What is the treatment of flexor synovitis due to dialysis amyloidosis
Incision of the flexor retinaculae
125
Which familial condition causes hepatosplenomegaly, nephrotic syndrome and progressive renal disease
Familial renal amyloidosis
126
What cause of seizure is seen within 90 days of starting erythropoietin
Erythropoietin-induced epilepsy
127
What is the target Hb of patients on Epo
110g/L
