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Renal Flashcards

1
Q

what is the urine sodium in pre-renal AKI

A

<20

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2
Q

what is the urine osmolality in ATN?

A

<350

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3
Q

what is seen on renal biopsy of ARPKD

A

multiple cylindrical lesions

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4
Q

What defect is present in Alport’s syndrome

A

Type IV collagen

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5
Q

What are the ocular complications of Alport’s syndrome

A

lenticonus, corneal ulceration, retinitis pigmentosa, cataracts

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6
Q

What is seen on microscopy in Alport’s syndrome

A

Splitting of the lamina densa

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7
Q

What is significant proteinuria in non-diabetics?

A

ACR >30mg/mmol

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8
Q

What is significant proteinuria in diabetics?

A

ACR >2.5mg/mmol (3.5 in women) indicates clinically significant microalbuminaemia

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9
Q

What type of hypersensitivity is hyperacute renal transplant rejection?

A

Type II

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10
Q

What is the mechanism of acute graft rejection?

A

cytotoxic T cells

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11
Q

What viral infection is most significant in transplant patients?

A

CMV

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12
Q

Which renal pathology occurs most frequently to cause chronic graft rejection?

A

Membranoproliferative GN

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13
Q

What kidney disease is a heroin user likely to develop?

A

Focal segmental glomerulosclerosis

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14
Q

What does gold exposure cause in the kidneys

A

membranous glomerulonephritis

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15
Q

What is the most common renal disease in SLE

A

Diffuse proliferative glomerulonephritis

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16
Q

What is the most common renal disease after a streptococcal infection

A

Diffuse proliferative glomerulonephritis

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17
Q

What gives a ‘tram-track’ appearance on biopsy of the kidney

A

Type 1 membranoproliferative glomerulonephritis

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18
Q

What is the commonest cause of nephrotic syndrome in adults?

A

membranous glomerulonephritis

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19
Q

what type of hypersensitivity is goodpastures

A

type II

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20
Q

What increases the risk of pulmonary haemorrhage in goodpastures

A

pulmonary oedema, young male, smoking, LRTI, inhaled hydrocarbons

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21
Q

what is seen on lung biopsy in goodpastures

A

haemosiderin-laden macrophages in alveoli

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22
Q

what is an indication for plasmapheresis in goodpastures

A

severe haemoptysis

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23
Q

What is seen on renal biopsy in Wegeners granulomatosis

A

epithelial crescents in Bowmans capsule

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24
Q

What is seen on renal biopsy in Goodpastures

A

linear IgG deposits

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25
Q

What is seen on microscopy in post-streptococcal glomerulonephritis

A

wire-loop lesions and humps in subendothelial space

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26
Q

What is the main pathological finding in rapidly progressive glomerulonephritis

A

fibrinoid necrosis

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27
Q

What is seen on renal biopsy in acute tubulointerstitial nephritis

A

interstitial oedema with a heavy infiltrate of inflammatory cells

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28
Q

What is the main cause of acute tubulointerstitial nephritis

A

Drugs

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29
Q

What is eosinophiuria pathognomic of

A

acute tubulointerstitial nephritis

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30
Q

Which drug can prevent calcium renal stones

A

thiazide diuretics (increases distal tubular Ca reabsorption)

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31
Q

Which renal stones are radiolucent on Xray

A

urate, xanthine

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32
Q

Which stones form in proteus and klebsiella infections

A

struvite (ammonium magnesium phosphate)

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33
Q

Which renal stones are semi opaque on Xray

A

Cystine

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34
Q

What is the medical treatment of renal stones to aid stone passage

A

alpha blockers

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35
Q

What is the GS investigation of renal stones

A

Non contrast CT

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36
Q

Which amino acids are unable to be reabsorbed in cystinuria

A

cystine, ornithine, lysine, arginine

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37
Q

what is the treatment of cystinuria

A

d-penicillamine, urinary alkalisation

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38
Q

what is the treatment of homocystinuria

A

Vit B6, folic acid

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39
Q

What appearance does fibromuscular dysplasia have on angiography

A

‘string of beads’ appearance

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40
Q

Which drug is contraindicated in renal artery stenosis

A

ACE inhibitors

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41
Q

What is the most likely cause of flash pulmonary oedema and hypertension in a young patient

A

fibromuscular dysplasia

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42
Q

What electrolyte abnormalities are seen in type 1 RTA

A

hypokalaemia, hypercalciuria, hyperphosphaturia

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43
Q

What deficiency gives rise to type 3 RTA

A

carbonic anhydrase II

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44
Q

What is the mechanism of action of tolvaptan

A

vasopressin receptor 2 antagonist

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45
Q

How long does it take for an AV fistula to form

A

6 weeks

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46
Q

What is the likely cause of macroscopic haematuria in coeliac disease

A

IgA nephropathy

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47
Q

Which one of the following types of glomerulonephritis is most characteristically associated with partial lipodystrophy

A

Mesangiocapillary glomerulonephritis (membranoproliferative)

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48
Q

where does spironolactone act

A

cortical collecting duct

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49
Q

What electrolyte abnormalities cause nephrogenic diabetes insipidus

A

hypokalaemia, hypercalcaemia

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50
Q

Where does most of Na reabsorption take place?

A

Via active transport in the loop of Henle

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51
Q

What does HSP show on renal biopsy

A

Mesangial hypercellularity

52
Q

Which antibody is idiopathic membranous glomerulonephritis related to?

A

Anti-phospholipase A2 antibodies

53
Q

What would a renal biopsy show in IgA nephropathy?

A

Mesangial hypercellularity

+ positive immunoflourescence for IgA and C3

54
Q

Which chromosome does 85% of mutations occur in ADPKD?

A

Chromosome 16

15% occur on Chr 4

55
Q

What condition creates a ‘spike and dome’ appearance on electron microscopy due to deposits of IgG and C3

A

Membranous glomerulonephritis

56
Q

What is the most common extra-renal manifestation in ADPKD

A

hepatic cysts (causing hepatomegaly)

57
Q

What immunoglobulins are responsible for hyperacute graft rejection

A

IgG (pre-existent antibodies)

58
Q

Which organs are affected in VHL syndrome

A

Intracranial (CNS haemangioblastoma), eye (retinal haemangiomata) and renal (phaeochromocytoma, renal cell ca, renal cysts)

59
Q

What is the first stage of diabetic nephropathy

A

Hyperfiltration - raised GFR

60
Q

Which condition is associated with Kinmelsteil-Wilson nodules

A

Diabetic nephropathy

61
Q

Which kind of renal stones are associated with renal tubular acidosis

A

Calcium phosphate stones

62
Q

What is the diagnostic test for homocystinuria

A

Cyanide nitroprusside test

63
Q

What is the treatment of renal vascular disease

A

Stop ACEi, start aspirin and statin

64
Q

Where does renal cell carcinoma arise from

A

Proximal renal tubular epithelium

65
Q

Which cancer is associated with Beckwith-Wiedemann syndrome and WAGR syndrome

A

Wilm’s tumour

66
Q

What is the most common organism that causes peritoneal dialysis peritonitis

A

Coagulase negative staph

67
Q

What is the treatment of peritoneal dialysis peritonitis

A

IP vancomycin +/- PO ciprofloxacin

68
Q

Which condition is characterised by raised phenylalanine and musty odour

69
Q

What is the most common type of bladder cancer

A

Transitional cell carcinoma

70
Q

Which causes of CKD show enlarged kidneys on imaging

A

Amyloidosis, PKD, diabetic glomerulosclerosis, scleroderma, RPGN

71
Q

Where is renin secreted

A

Renal juxtaglomerular cells

72
Q

Which cells are damaged in nephrotic syndrome

A

Podocytes, can also be due to basement membrane damage

73
Q

Which causes of nephritic syndrome have a normal C3 level

A

IgA nephropathy, HSP

74
Q

Which renal disease is seen in Hodgkin’a lymphoma

A

Minimal change disease

75
Q

Which type of membranoproliferative GN is associated with low C4

A

Type 1 (cryoglobulinaemia, HCV)

76
Q

Which type of membranoproliferative GN is associated with low C3

A

Type 2 (partial lipodystrophy)

77
Q

Which ethnicity has the highest prevalence of BPH

78
Q

What is the screening test for ADPKD

79
Q

What are stag-horn calculi composed of

80
Q

What type of anti-androgen therapy is bicalutamide

A

Non-steroidal anti-androgen (blocks androgen receptor)

81
Q

What is the MOA of cyproterone acetate in treatment of prostate cancer

A

Steroidal anti-androgen

82
Q

What is the MOA of abiraterone in treatment of prostate cancer

A

Androgen synthesis inhibitor (blocks cytochrome P450 17 alpha-hydroxylase)

83
Q

What is the best treatment for rheumatological conditions in pregnancy that are not responsive to steroids

A

Azathioprine

84
Q

Which drug can be used to slow the growth of cysts in ADPKD

85
Q

What should be started 3 days before a GnRH agonist in the treatment of prostate cancer

A

Anti-androgen treatment (cyproterone acetate/bicalutamide) - reduces risk of tumour flare

86
Q

Which nephropathy is malignancy most associated with

A

Membranous glomerulopathy

87
Q

Which antibodies are associated with primary membranous glomerulopathy

A

Anti-phospholipase A2 (Anti-PLA2R)

88
Q

What is the risk associated with large volumes of 0.9% NaCl

A

Hyperchloraemic metabolic acidosis

89
Q

How much potassium is required for routine maintenance over 24hrs

90
Q

How much water is required for routine maintenance over 24hrs

91
Q

How much glucose is required for routine maintenance over 24hrs

92
Q

Which electrolyte imbalance is commonly seen after plasma exchange

A

Hypocalcaemia

93
Q

Which RTA causes bone demineralisation due to phosphate wasting

A

Fanconi syndrome (type 2 RTA)

94
Q

What is Stauffer syndrome

A

Paraneoplastic hepatic dysfunction syndrome in renal cell cancer - typically presents as cholestasis/hepatosplenomegaly

95
Q

Which inherited disorder of type IV collagen causes persistent haematuria with normal kidney function

A

Thin basement membrane disease

96
Q

What are the causes of transient microscopic haematuria

A

UTI, menstruation, vigorous exercise, sexual intercourse

97
Q

What are the causes of persistent microscopic haematuria

A

Cancer, stones, BPH, prostatitis, urethritis, intrinsic renal disease

98
Q

What kidney complication causes extremely painful, purpuric patches with black necrotic tissue in the lower limbs

A

Calciphylaxis

99
Q

Which cancer is a kidney transplant patient most at risk of

A

Squamous cell carcinoma (due to long-term steroids)

100
Q

What are the endocrine effects of renal cell carcinoma

A

Erythropoietin, PTH, renin, ACTH

101
Q

What are the 5 features of HIV-associated nephropathy

A 
Massive proteinuria/nephrotic syndrome 
Normal or large kidneys 
FSGS with capillary collapse on biopsy
Elevated urea and Cr
Normotension
102
Q

Which drugs are associated with retroperitoneal fibrosis

A

Ergot derived drugs and beta blockers

103
Q

What is the treatment of HIV-associated nephropathy

A

Aggressive antiretroviral therapy and ACEi

104
Q

Which renal pathology is plasmodium malariae associated with

A

Membranous glomerulonephritis

105
Q

What is the most common cause of nephrotic syndrome in older adults

106
Q

What causes carpal tunnel syndrome and bony cysts with conventional dialysis >5 years

A

Beta 2 microglobulin amyloidosis

107
Q

What presents with pigmentation of the sclera, urine and connective tissues

A

Alkaptonuria

108
Q

What type of GN is associated with HIV nephropathy

109
Q

What does xanthogranulomatous pyelonephritis show on biopsy

A

Lipid-laden macrophages with lymphocytes and PMNs

110
Q

What is the treatment of scleroderma renal crisis

111
Q

What is mortality related to in familial Mediterranean fever

A

Deteriorating renal function

112
Q

Which renal pathology is most likely to recur after renal transplant

A

Membranoproliferative glomerulonephritis

113
Q

What are kimmelstein-Wilson nodules suggestive of on renal biopsy

A

Nodular sclerosis - Diabetic nephropathy, amyloidosis, cigarette smoking

114
Q

Which disease occurs after gadolinium exposure in impaired renal function

A

Nephrogenic systemic fibrosis

115
Q

Which renal condition is associated with atanazavir use in HIV

A

Crystal nephropathy

116
Q

What presents with hypokalaemic alkalosis, suppressed renin and aldosterone, and hypertension

A

Liddle’s syndrome

117
Q

Which type of RTA causes severe metabolic acidosis and a urinary pH >5.5

A

Type 1 (distal) RTA

118
Q

Which RTA presents with nephrocalcinosis

A

Type 1 (distal) RTA

119
Q

Which type of RTA is due to failure to absorb bicarbonate

A

Type 2 (proximal) RTA

120
Q

What is the management of acute pyelonephritis due to obstructive stones

A

Emergency surgery for ureteral calculus with stenting

121
Q

What condition presents with nodularity and diffuse tenderness on PR exam + mildly raised PSA

A

Chronic intermittent prostatitis

122
Q

What presents with symptoms similar to systemic sclerosis but with no autoimmune antibodies in dialysis patients

A

Nephrogenic systemic fibrosis (after gadolinium exposure)

123
Q

What type of dialysis membrane is useful for dialysis amyloidosis due to excess beta-2 microglobulin

A

High-flux dialysis membranes

124
Q

What is the treatment of flexor synovitis due to dialysis amyloidosis

A

Incision of the flexor retinaculae

125
Q

Which familial condition causes hepatosplenomegaly, nephrotic syndrome and progressive renal disease

A

Familial renal amyloidosis

126
Q

What cause of seizure is seen within 90 days of starting erythropoietin

A

Erythropoietin-induced epilepsy

127
Q

What is the target Hb of patients on Epo

MRCP (16 decks)

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