Renal Flashcards
62M BG of HTN
Cr 280
Urine Blood ++ Protein 1.8g
US kidneys L 8.5cm R 8.9cm (b/l small)
Ix?
renal biopsy
for ? glomerulonephritis
NB if no blood or urine then angiogram for ?renovascular disease
Aspirin OD
Salicylate 1100
Rx?
Haemodialysis (FASTER than haemofiltration)
do dialysis when salicylate >700 or severe metabolic acidosis
Thiazide diuretics act on?
proximal convoluted tubule
Loop diuretics acts on
ascending Loop of Henle
Spironolactone acts on
DCT
14M
dark urine 2 weeks after sore throat
what do you see on renal biopsy?
Humps in the subepitheilal space on electron microscopy
post-streptococcal glomerulonephritis (GN)
Cystinuria, cystinosis, urate uropathy and hyperoxaluria
inheritance
AR
Idiopathic hypercalciuria (causes stones) inheritance
AD
Headaches
Hypertensive retinopathy associated with visual disturbances
Seizures
Heart failure and pulmonary oedema.
malignant HTN
Scleroderma renal crisis Rx
ACEi
16F ankle swelling 4 days post sore throat
Cr 90
Albumin 25
24hr urine protein 9
Dx?
Rx?
IgA nephropathy
Give Prenisolone (as nephrotic range proteinura >3g/day)
if <3g/day = ACEi
if just haematuria = conservative Mx
IgA nephropathy
nephrotic or nephritic?
BOTH
% IgA nephropathy with ESRF in 10 years
25%
Ig resposible for acute kidney rejection associated with anti-HLA Abs
IgG
16F
Father had ADPCKD
What Ix for her?
Why?
geneticist
US better at picking up in >20s
Cirrhosis +SBP
What will prevent hepatorenal syndrome?
IV Albumin
+ABx
Commonest type renal calculi
calcium oxalate
Stones that are radiolucent on XR
uric acid
HIV med causing acute renal impairment
Tenofovir
untreated granulomatosis with polyangiitis
Ab?
cANCA = antiproteinase 3
ANCA associated with which gastro condition
UC
sinusitis/epistaxis
glomerulonephritis
small vessel vasculitis
Dx?
Ab?
Granulomatosis with polyangiitis
cANCA/ antiproteinase 3
Rx for SIADH
Demeclocycline
ADH blocker
On LT doxycycline for acne
polydipsia, polyuria and nocturia
Dx?
nephrogenic diabetes insipidus
from doxycyline
cinacalcet moa
calcimimetic
used in 2 hyperparathyroidism in CKD
low Ca, high PTH
stops more PTH release
Imaging to identify renal scarring after childhood UTIs
Renal DMSA scan
Kimmelstiel-Wilson stain for
Diabetic nephropathy
shows nodular glomerulosclerosis
patient on dialysis for 5 years
carpal tunnel
bilateral shoulder pain
Cause?
B2 microglobulin amyloidosis
worsening renal function haemoptysis
purpuric rash on lower limbs
MPO ANCA positive
Microscopic polyangiitis
most common and severe form of lupus nephritis
Diffuse proliferative glomerulonephritis
Started on amoxicillin
rapid AKI
rash
eosinophilia
Cause?
interstitial nephritis
Drugs causing interstitial nephritis
amoxicillin
NSAIDs
antiproteinase 3/cANCA
AKI
pulmonary haemorrhage
epistaxis/sinusitis
Granulomatosis with polyangiitis
how to distinguish prerenal cause and ATN
Urine sodium concentration is typically above 30 mmol/L
fractional excretion of sodium distinguishes ATN from pre-renal diseases as a cause of AKI
pANCA present in
UC and CD
Start diuretic
develop hearing loss, tinnitus and vertigo
which diuretic?
furosemide
thiazide diuretics can -> OTOTOXICITY
Focal segmental glomerulosclerosis Rx
Steroids
if dont respond then steroids
IgA nephropathy Rx if:
haematuria only
> 3g/day proteinuria
<3g/day proteinuria
to control BP
haematuria - conservative Rx
> 3g/day proteinuria - steorids
<3g/day proteinuria - ACEi
to control BP- ACEi
Nephrotic syndrome
membranous nephropathy (adult)
Rx?
Methylpred + cyclophosphamide
64M
12h pleuritic CP
no murmurs, JVP normal
bibasal creps
ECG ST elevation all leads
Urea 44 Cr 746 K 5.2
Rx?
Haemodialysis
ECG - pericarditis ?2 to uraemia
new HTN
after 20 wks gestation
no proteinuria
gestational HTN
new HTN
sig proteinuria
AFTER 20 wk gestation
Pre-eclampsia
HTN present before 20 wks gestation or pt on anti HTN
no proteinuria
chronic HTN
chronic HTN
significant proteinuria
16 wks gestation (BEFORE 20 wks gestation)
secondary HTN
?2 to renal disease
NB if occurs at >20 wks then = preeclampsia
Erythropoeitin SE
HTN
can lead to seizures
First line Rx systemic sclerosis hypertensive crisis
ACEi
Sx malignant HTN
Headaches
Hypertensive retinopathy associated with visual disturbances
Seizures
Heart failure and pulmonary oedema.
electrolyte abnormality in rhabdomyolysis
why?
low Ca
as Ca bound to damaged muscle (lost)
nephrotic syndrome
ADULTS
membranous nephropathy
Rx
oedema - low salt + diuretic
HTN + stop proteinuria - ACEi
Sx of nephrotic syndrome (oedema) = PREDNISOLONE + CYCLOPHOSPHAMIDE
PCKD assocaited with what heart abnormality
Mitral valve prolapse
Cirrhosis
what can you give to prevent hepatorenal syndrome?
IV albumin
gastroenteritis
then
acute renal failure
microangiopathic haemolytic anaemia
thrombocytopenia with normal clotting
Dx?
Ix?
HUS
BLOOD FILM (MAHA)
HUS vs TTP
TTP get HUS triad + neuro problems + fever
70F
painless haematuria
started on IM authoramine + ibuprofen
First line Ix?
cystoscopy (rule out bladder Ca first)
could then also stop NSAID (cause of interstitial nephritis -> haematuria)
