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MRCP Part II > Renal > Flashcards

Renal Flashcards

1
Q

Features of Alport’s syndrome

A

Microscopic haematuria

Sensorineural deafness

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2
Q

Radio-opaque renal stones

A

Calcium oxalate
Calcium phosphate
Mixed calcium oxate/phosphate
Struvite (triple phosphate)

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3
Q

Radio-lucent renal stones

A

Urate

Xanthine

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4
Q

Semi-opaque renal stones

A

Cystine

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5
Q

AKI stage I - by creatinine

A

1.5-1.9X baseline
or
Increase >26.5

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6
Q

AKI stage I - by urine output

A

<0.5ml/kg/hr for 6-12 hrs

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7
Q

AKI stage II - by creatinine

A

2.0-2.9X baseline

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8
Q

AKI stage II - by urine output

A

<0.5ml/kg/hr for =>12 hrs

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9
Q

AKI stage III - by creatinine

A 
3.0X baseline
or
Increase => 353.6
or
started renal replacement
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10
Q

AKI stage III - by urine output

A

anuria =>12 hrs

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11
Q

Drugs associated with retroperitoneal fibrosis

A

Bromocriptine
Beta-blockers
Methysergide

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12
Q

Drugs which exacerbate calciphylaxis

A

Warfarin

Calcium containing compounds

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13
Q

IgA nephropathy (Berger’s disease) presentation

A

1 -2 DAYS after URTI
Macroscopic haematuria
Young people

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14
Q

Patient with CKD - when start investigating for anaemia

A

Hb falls below 110 OR if symptomatic

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15
Q

AKI with ‘allergic’ features (fever, rash, IgE, eosinophils)

A

Acute interstitial nephritis (AIN)

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16
Q

Commonest causes of nephrotic syndrome

A

MMF:
Minimal change disease
Membranous nephropathy
Focal segmental glomerulosclerosis

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17
Q

Urine sodium in pre-renal AKI

A

Low <20 mmol/L

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18
Q

24 hr protein excretion in nephrotic syndrome

A

> 3g/24hr

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19
Q

Urine microscopy findings in acute tubular necrosis (ATN)

A

Granular casts + renal epithelial cells

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20
Q

Renal biopsy findings in focal segmental glomeruloscerosis

A

Scarring ‘sclerosis’ and effacement of foot processes

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21
Q

Indications for plasma exchange in ANCA-associated vasculitis

A

Rapidly progressive renal failure
Pulmonary haemorrhage
anti-GBM disease

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22
Q

Management of IgA nephropathy (Berger’s disease)

A

Observation

Consider ACEi if significant HTN or high creatinine

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23
Q

Definition of microalbuminuria

A

Albumin:creatinine ratio >2.5

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24
Q

Medication to reduce recurrence of calcium stones

A

Thiazides

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25
Q

Infectious causes of membranous glomerulonephritis

A

Hep B
Malaria
Syphilis

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26
Q

Causes of membranous glomerulonehritis

A 
Idiopathic 
Infections
Malignancy
NSAIDs
SLE, thyroiditis, RA
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27
Q

Antibodies present in idiopathic membranous glomerulonephritis

A

anti-phospholipase A2

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28
Q

Alport patient with failing renal transplant

A

Think Goodpastures

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29
Q

Granular casts (brown/muddy, acellular casts) are found in which type of AKI?

A

ATN - Acute Tubular Necrosis

Also in dehydration + exercise

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30
Q

Which type of nephrotic syndrome shows rapid response to steroid therapy (rapid improvement in proteinuria)

A

Minimal Change Disease

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31
Q

CKD stage 1 defined as

A

eGFR >90 + sign of kidney damage on another test

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32
Q

CKD stage 2

A

eGFR 60-90 + some sign of kidney damage

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33
Q

CKD stage 3a

A

eGFR 45-59

34
Q

CKD stage 3b

A

eGFR 30-44

35
Q

CKD stage 4

A

eGFR 15-29

36
Q

CKD stage 5

A

eGFR <15 ml/min

37
Q

Cause of AKI in septic shock

A

Acute tubular necrosis

or rarely: cortical necrosis

38
Q

Causes of acute tubular necrosis (ATN)

A

Sepsis/shock

Contrast media
Myoglobin (rhabomyolysis)
Aminogloycosides

39
Q

Causes of acute interstitial nephritis/tubulointerstitial nephritis (AIN)

A

NSAIDs, penicillin, rifampicin, furosemide, allopurinol

SLE, sarcoid, Sjogren

Staphylococcus

40
Q

1st-line management of hypertension in CKD 4/5

A

ACEi

41
Q

2nd-line management of hypertension in CKD 4/5

A

Furosemide

42
Q

Haematuria in sickle cell anaemia, think:

A

Papillary necrosis

43
Q

Management of 15-39yo with ADPKD and eGFR>90

A

ACEi with target BP < 110 / 75 mmHg

44
Q

Alports appearance under light microscopy

A

Normal

45
Q

Alports appearance under electron microscopy

A

‘Basket weave’ appearance of basement membrane

46
Q

Management of nephrogenic diabetes insipidus

A

Thiazide

47
Q

Young women with AKI, visual disturbance, weight loss, think:

A

Tubulointerstitial nephritis with uveitis (TINU)

48
Q

USS kidney shows ‘clubbed calyces’ in which condition

A

Papillary necrosis

49
Q

Target ferritin level in CKD stage 4/5 (not undergoing haemodialysis)

A

> 100 ng/ml

50
Q

Target transferrin saturation in CKD stage 4/5

A

> 20%

51
Q

Target Hb in CKD stage 4/5

A

100 - 120

52
Q

Target ferritin level in CKD stage 4/5 (undergoing haemodialysis)

A

> 200 ng/ml

53
Q

Biopsy findings in membranous glomerulonephritis

A

Diffuse thickening of BM

‘Spike & dome’: Subepithelial deposits of IgG AND complement

54
Q

Biopsy findings in Goodpastures

A

Linear deposition of IgG in BM

55
Q

Hepatitis C is most commonly associated with which type of glomerulonephritis

A

MesangioCapillary GN

56
Q

Renal complication of Indinavir

A

Renal stones (needle-shaped crystals)

57
Q

Renal complication of Tenofovir

A

Acute Tubular Necrosis

Fanconi syndrome

58
Q

Pattern of glomerulonephritis seen in HIV-associated nephropathy

A

FSGS with capillary collapse

59
Q

Renal conditions that reoccur after renal transplant

A

Membranoproliferative GN
IgA nephropathy
FSGS
Membranous GN

60
Q

Indications for dialysis in CKD stage 5

A

Symptomatic from fluid overload or uraemia (lethargy, itch, confusion, nausea)

or

Asymptomatic with eGFR 5 - 7

61
Q

Presentation of post-streptococcal glomerulonephritis

A

1 - 2 WEEKS post strep infection
Haematuria (“cola urine”)
Proteinuria, oedema
Low complement

62
Q

Pattern of GN seen in post-streptococcal glomerulonephritis

A

Diffuse proliferative glomerulonephritis

63
Q

Measurement of anion gap

A

(Na + K) - (HCO3 - Cl)

64
Q

Normal anion gap

A

10 - 18

65
Q

Causes of metabolic acidosis with normal anion gap (hyperchloremic metabolic acidosis/bicarb loss)

A

Gastrointestinal bicarb loss
RTA
Addisons
Acetazolamide

66
Q

Causes of metabolic acidosis with raised anion gap

A 
Lactate (shock, hypoxia)
Ketones
Urate (renal failure)
Methanol, Ethanol glycol
Salicylates
5-oxoproline (paracetamol)
67
Q

Management of membranous lupus nephritis (class V lupus nephritis)

A

ACEi for HTN

IV methylprednisolone (severe)

Immunosuppressant
(cyclophosphamide/MMF)

68
Q

ADPKD with CKD 2/3 and rapidly progressing disease, consider

A

Tolvaptan (vasopressin R2 antagonist)

69
Q

AA amyloidosis associated with which diseases

A

(Poorly controlled) chronic inflammation eg RA, Ankylosing Spondylitis

70
Q

Management of patient with visible haematuria coinciding with intercurrent URTI (and clinically well)

A

Routine referral to renal

to establish diagnosis and risk of future renal impairment

71
Q

Where to biopsy for suspected AA amyloidosis

A

Skin, rectal mucosa or abdominal fat (less invasive than renal)

72
Q

Membranous glomerulonephritis - all patients should receive..

A

ACEi/ARB

Consider anti-coagulant

73
Q

Membranous glomerulonephritis - management of severe/progressive disease

A

ACEi/ARB

Corticosteroid + Immunosuppressant (eg cyclophosphamide/MMF/chlorambucil/ciclosporin)

74
Q

1st line investigation of testicular mass

A

USS testes

then tumour markers if suspicious for malignancy

75
Q

Management of Goodpastures

A

Plasmapheresis + steroids + cyclophosphamide

76
Q

Features of fibromuscular dysplasia (FMD)

A

Young
Renal vascular disease/cerebrovascular disease
‘String of beads’ appearance

77
Q

Indications for urgent dialysis

A

Symptomatic uraemia

Pulmonary oedema, despite full medical management

K >6.5 despite, full medical management

Metabolic acidoses pH < 7.1

Remove toxins eg lithium

78
Q

Presentation of CMV infection post-renal transplant

A

1-4 months after transplant/after stopping prophylaxis

Fever, myalgia
AKI

79
Q

Which renal transplant recipients do not receive CMV prophylaxis (valganciclovir)

A

If recipient and donor both test negative for CMV

80
Q

Anti-hypertensive used in systemic sclerosis renal crisis (and other renal vasculitis)

A

ACEi

81
Q

1st line management of minimal change disease

A

Steroids

+/- ACEi if HTN/AKI

82
Q

2nd line management of minimal change disease

A

Immunosuppressant (eg Cyclophosphamide)

MRCP Part II (15 decks)

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