Renal Flashcards
1
Q
What formula is used to calculate eGFR?
A
Modification of Diet in Renal disease
2
Q
Which variables are used to calculate eGFR?
A
Serum creatinine
Age
Gender
Ethnicity
3
Q
Factors that may affect result of eGFR
A
Pregnancy
Muscle mass - amputees, body builders
Eating red meat 12 hours prior to sample being taken
4
Q
CKD Stage 1 eGFR
A
> 90
5
Q
CKD Stage 2 eGFR
A
60-90
6
Q
CKD Stage 3a eGFR
A
45-59
7
Q
CKD Stage 3b eGFR
A
30-44
8
Q
CKD Stage 4
A
15-29
9
Q
CKD Stage 5
A
<15
10
Q
What increase in creatinine is acceptable following introduction of an ACE inhibitor?
A
30%
11
Q
What decrease in eGFR is acceptable following introduction of an ACE inhibitor?
A
up to 25%
12
Q
First line medication for HTN in CKD
A
ACE-I
13
Q
Collecting an ACR sample
A
First pass morning urine
14
Q
What qualifies as haematuria in the context of CKD?
A
1+ of blood on 2 out of 3 dipsticks
15
Q
Causes of transient microscopic haematuria
A
UTI
menstruation
vigorous exercise
sexual intercourse
16
Q
Causes of persistent microscopic haematuria
A
Cancer - bladder, renal, prostate
Stones
BPH
prostatitis
urethritis
IgA nephropathy
Thin basement membrane disease
17
Q
Causes of red/orange urine which is not blood
A
Beetroot
Rhubarb
Rifamicin
Doxorubicin
18
Q
Criteria for urgent referral for haematuria
A
Age ≥45 AND unexplained visible haematuria without UTI or that persists/recurs after treating UTI
Age ≥60 AND unexplained microscopic haemuatira + either dysuria or WCC
19
Q
Criteria for non-urgent referral for haematuria
A
Age ≥60 with recurrent or persistent unexplained UTI
20
Q
Features of nephrotic syndrome
A
Proteinuria >3g/day
Hypoalbuminaemia
Oedema
21
Q
Causes of nephrotic syndrome
A
Primary glomerulonephritis
Diabetes
SLE
Amyloidosis
Gold
Penicillamine
Congenital
22
Q
Which glomerulonephropathies cause nephrotic syndrome?
A
Minimal change
Membranous
Focal segmental
Membranoproliferative
23
Q
Features of nephritic syndrome
A
Haematuria and red cell casts
Oedema
Mild hypertension
Oliguria <300ml/day
24
Q
Causes of nephritic syndrome
A
Post streptococcal GN IgA nephropathy Rapidly progressive GN Membranoproliferative GN Henoch-Schonlein purpura
25
What type of drug is spironolactone?
Aldosterone antagonist
26
Indications for spironolactone
```
Ascites
Hypertension
Heart failure
Nephrotic syndrome
Conn's syndrome
```
27
Side effects of spironolactone
Hyperkalaemia
| Gynaecomastia
28
When to refer for suspected renal artery stenosis?
Refractory HTN on 3 antihypertensives
Recurrent pulmonary oedema with normal LVSF
Rise of >20% in creat or >15% in eGFR over 12 months, or first 2 months after starting ACEI/ARB
29
Causes of renal artery stenosis
Atherosclerosis
| Renal fibromuscular dysplasia
30
What is Bartter's syndrome?
Inherited cause of severe hypokalaemia
Normotensive
31
What is Gitelman's syndrome?
Inherited hypokalaemia with hypocalcinuria
Normotensive
32
What eGFR values should prompt nephrology referral?
- <30
- Decrease of 25% or more within 12 months
- Change in eGFR category within 12 months
- Decrease of 15 within 12 months
33
What ACR should prompt referral to nephrology?
>70
| >30 + persistent haematuria
34
BP target in patients with CKD and a ACR of >70
<130/80
35
BP targets in patient with CKD and ACR <70
<140/90
36
In CKD what urine ACR is classed as A1?
ACR <3
37
In CKD what urine ACR is classed as A2?
ACR 3-70
38
In CKD what urine ACR is classed as A3?
>70
39
Renal cell carcinoma - features
Haematuria
Loin pain
Abdominal mass
Left sided varicocele
40
Renal cell carcinoma - management
Partial/total nephrectomy
| Alpha interferon and IL2 reduce tumour size
41
Renal cell carcinoma - associations
Middle aged men
Smoking
von Hippel-Lindau syndrome
Tuberous sclerosis
42
What is granulomatosis with polyangiitis also known as?
Wegner's granulomatosis
43
What is granulomatosis with polyangiitis?
Autoimmune condition
causing necrotising granulomatous vasculitis
affecting upper respiratory tract, lower respiratory tract and kidneys
44
Granulomatosis with polyangiitis - features
```
Epistaxis
Dyspnoea
Haemoptysis
Rapidly progressive glomerulonephropathy
Saddle shaped nose
Vasculitis
```
45
What is Henoch-Schonlein Purpura?
IgA mediated small vessel vasculitis
46
Who is normally affected by Henoch-Schonlein Purpura?
Children after infection
47
Henoch-Schonlein Purpura - features
Palpable purpuric rash over buttocks and extensor surfaces of arms and legs
Abdo pain
Polyarthritis
Features of IgA nephropathy = haematuria, renal failure
48
Henoch-Schonlein Purpura - investigations
Clinical diagnosis
Raised ESR and raised serum IgA
Check renal function
Urine dipstick for haematuria and proteinuria
Renal biopsy if persistent nephrotic syndrome
49
Henoch-Schonlein Purpura - management
Analgesia for arthralgia
| Supportive treatment for nephropathy
50
Henoch-Schlonlein Purpura - prognosis
Generally excellent
| 1/3rd will relapse
51
What is Goodpasture's syndrome?
Autoimmune disease caused by anti-glomerular basement membrane antibodies to type IV collagen
52
Goodpasture's syndrome - features
Nephritic syndrome
Pulmonary haemorrhage
Rapidly progressive glomerulonephritis
53
CKD causes
```
Diabetic nephropathy
Chronic glomerulonephritis
Chronic pyleonephritis
HTN
Adult polycystic kidney disease
```
54
CKD diagnostic criteria
Reduction in renal function to eGFR <60 or proteinuria with ACR >3, for ≥3 months
55
CKD - management of proteinuria
ACEI/ARB if ACR>70
56
CKD - which proteinuria should prompt nephrology referal?
ACR >70
ACR >30 + haematuria
ACR 3-29 + haematuria + other risk factors
57
CKD - who should get a statin?
Everyone with CKD 3, 4 or 5
58
CKD - findings on bone profile
Low vit D
Low calcium
High phosphate
59
CKD - protecting against bone mineral disease
Non-calcium phosphate binders = sevelamer
60
CKD - first line HTN treatment
ACEI
61
CKD - Hb target
10-12
62
CKD - main cause of anaemia
Reduced epo causing normocytic normochromic anaemia
63
CKD - management
Iron replacement
| Erythropoiesis stimulating agents = Erythropoeitin, darbepoeitin
64
Causes of cranial diabetes insipidus
Idiopathic
Head injury
Pituitary surgery
Craniopharyngiomas
65
Causes of nephrogenic diabetes insipidus
Genetic
Hypercalcaemia
Hypokalaemia
Lithium
Demeclocycline
Sickle cell
Pyelonephritis
66
What is cranial diabetes insipidus?
What is nephrogenic diabetes insipidus?
Cranial DI = decreased production ADH from pituitary
Nephrogenic DI = insensitivity to ADH
67
Investigations for diabetes insipidius
High plasma osmolality
Low urine osmolality
Water deprivation test
68
What urine osmolality excludes diabetes insipidus?
>700
69
Management of cranial diabetes insipidus
Desmopressin
70
Management of nephrogenic diabetes insipidus
Thiazides
| Low salt and low protein diet
71
Features of diabetes insipidus
Polyuria
| Polydipsia
72
What is Alport's syndrome?
Defect in type IV collagen causing abnormal glomerular basement membrane
73
Alport's syndrome - inheritance
X linked dominant in 85%
74
Alport's syndrome - features
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa
75
What is lenticonus?
Protrusion of lens surface into the anterior chamber
76
Alport's syndrome - diagnosis
Genetic testing
| Renal biopsy = splitting of lamina propria causing 'basket weave' appearance
77
Alport's syndrome - management
Control HTN
ACE-I
Dialysis
Transplant
78
Why does renal transplant fail in Alport's syndrome?
Anti-GBM antibodies leading to a goodpasture's syndrome like picture
79
Autosomal dominant polycystic kidney disease - renal features
HTN
recurrent UTI
abdo pain
renal stones
haematuria
CKD
80
Autosomal dominant polycystic kidney disease - extra renal manifestations
```
Liver cysts
Berry aneuryms
MV prolapse
Aortic root dilation, aortic dissection
Cysts in other organs
```
81
Autosomal dominant polycystic kidney disease - screening test for family members
Abdominal ultrasound
82
Autosomal dominant polycystic kidney disease - diagnostic criteria
In patients with positive family history:
- 2 cysts, unilateral or bilateral, if <30y
- 2 cysts in both kidneys if 30-59y
- 4 cysts in both kidneys if >60y
83
Autosomal dominant polycystic kidney disease - management
Tolvaptan (vasopressin receptor 2 antagonist) IF
- CKD 2 or 3
- rapidly progressing disease
- drug company agree discount cost
84
Renal papillary necrosis - features
Visible haematuria
Loin pain
Proteinuria
85
What is Berger's disease also called?
IgA nephropathy
86
What is IgA nephropathy also called?
Berger's disease
87
IgA nephropathy - presentation
Young male with recurrent macroscopic haematuria
Recent respiratory tract infection
88
IgA nephropathy - investigations
Urine dipstick - protein, blood
Increased plasma IgA
24h urine - proteinuria
Renal biopsy
89
IgA nephropathy - management if isolated haematuria with no/minimal haematuria and normal egfr
No treatment
| monitor renal function
90
IgA nephropathy - management if persistent proteinuria with normal or slightly reduced egfr
ACE-I
91
IgA nephropathy - management if active disease with falling eGFR or not responding to ACE-I
Corticosteroids
92
IgA nephropathy - associations
Alcoholic cirrhosis
Coeliac disease
Dermatitis herpetiformis
Henoch-Schlonlein purpura
93
IgA nephropathy - prognosis
25% develop ESR
94
IgA nephropathy - markers of good prognosis
Frank haematuria
95
IgA nephropathy - markers of poor prognosis
Male
Proteinuria
HTN
Hyperlipidaemia
AE genotype DD
96
Post-streptococcal glomerulonephritis - when does it occur?
In young children
7-14 days after strep infection
97
Post-streptococcal glomerulonephritis - what is the most common cause?
strep pyogenes
98
Post-streptococcal glomerulonephritis - features
nephritic syndrome
visible haematuria
proteinuria - may cause oedema
oligouria
99
Post-streptococcal glomerulonephritis - investigations
low C3
increased ASO titre
Urine red cell casts
Renal biopsy
100
Post-streptococcal glomerulonephritis - management
supportive
may need dialysis
95% recover renal function
101
Minimal change disease - features
Nephrotic syndrome - oedema
| Normotension
102
Minimal change disease - investigations
Proteinuria
| Renal biopsy - normal on LM, fusion of podocytes on EM
103
Minimal change disease - management
80% cases steroid responsive
| Cyclophosphamide if not
104
Minimal change disease - causes
Idiopathic
NSAIDS
rifampicin
Hodgkin's lymphoma
Thyoma
Infectious mononucleosis
105
Minimal change disease - prognosis
1/3 have one episode
1/3 have infrequent episodes
1/3 have frequent relapses which stop before adulthood
