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STEPH BPT 2021 > RENAL > Flashcards

RENAL Flashcards

1
Q

Angiotensin effect on arteriolar resistance

A

Constricts efferent >afferent arteriole (AT1 receptor)

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2
Q

Afferent arteriole dilators

A

Prostaglandin
NO
Dopamine (low dose)

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3
Q

Afferent arteriole constrictors

A

Adenosine
Noradrenaline (SNS)
Vasopressin
Endothelin

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4
Q

AT2 receptor action

A

Vasodilatation

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5
Q

Renal autoregulatin response

A

Via changes in afferent arteriole tone
> Prostaglandin and NO causing dilation
> Adenosine causing constriction

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6
Q

Angiotensin II action

A 
Increases SNS 
Increases aldosterone secretion from adrenals 
Arteriole vasoconstrictor 
ADH production 
Increases tubular Na/Cl reabsoorption
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7
Q

Tubule segment that is not permeable to water

A

Ascending thin and thick loops

distal convoluted tubule

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8
Q

Tubule segment that is not permeable to sodium

A

descending thin loop of henle

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9
Q

ADH receptor

A

G coupled receptor on basolateral membrane. Leads to aquaporin-2 insertion on apical membrane and aquaporin-3 on basolataeral

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10
Q

Tubule segment associated with complete resorption of glucose, amino acids, majority of bicarbonate and phosphate

A

Proximal tubule

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11
Q

Sodium transporter in the loop of henle (Thick ascending limb)

A

NKCCT (Na x1 K x1 Cl x2)

Blocked by frusemide

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12
Q

Sodium transporter in the distal tubule

A

Na-chloride cotransporter on apical membrae, Na-K-ATPase in basolateral membrane
Na-Cl CTP blocked by Thiazide diuretics

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13
Q

Electrolyte effects thiazide

A

Hypokalaemia
Hyponatraemia
Metabolic Alkalosis
Hypercalcaemia

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14
Q

Sodium transporters in the proximal tubule

A

Organic molecules co transporter (eg Na-glucose, Na-amino acids)
Na/H exchanger

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15
Q

Sodium transporter in the collecting duct

A

Na/K-ATPase in basolateral membrane of principal cells

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16
Q

Aldosterone action

A

Acts on receptors on basolateral membrane
in distal tubule, increases mRNA synthesis in the nucleus leading to increases Na-K ATPase
Results in Na reabsorption and K excretion
Due to effect of increased K in duct, results in Hydrogen excretion

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17
Q

The action of Type A intercalated cell

A

Excretion of H+

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18
Q

Action of Type B intercalcated call

A

Excretion of HCO3-

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19
Q

Amiloride action

A

Blocks apical Na channels (ENac) in principal cells

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20
Q

Site of hypoosmotic tubular contents

A

Thick ascending loop (impermeable to water)

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21
Q

Tubular site of PTH for calcium reabsorption

A

Thick ascending limb and distal tubules

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22
Q

Role of FGF-23

A

Decrease serum PO4
Acts on FGF receptor and coreceptor klotho in proximal tubule, decreasing PO4 reabsorption
Decreases calcitriol, in turn reducing phosphate GI absorption

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23
Q

High FGF-23 levels

A

Early marker of CKD-MBD

Increase CVD mortality risk, causes LVH

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24
Q

Barter syndrome

A

Defect in NaCl resorption in ascending thick limb
Hypokalaemia
Metabolic alkalosis
Hypercalcaemia

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25
Q

Barter syndrome Type 3

A

Affects basolateral Cl channel CIC-Kb impacting on NKCCT

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26
Q

Barter syndrome Type 5

A 
Affects Calcium sensing receptor 
Hypocalcaemia 
Hypokalaemia
Metabolic alkalosis
Hypomagnesaemia
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27
Q

Drug class leading to barter type 5 effect

A

Aminoglycosides

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28
Q

Gitelman syndrome

A

Hypokalaemia
Metabolic alkalsosis
Hypomagnesaemia
Hypocalcaemia

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29
Q

Liddle’s

A 
EnaC function increased
Hypokalaemia
Hypertension 
Metabolic alkalosis
Treated with amilioride
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30
Q

Minimal obligatory urinary loss volume

A

430ml

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31
Q

Insensible daily losses

A

500ml

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32
Q

Site of K reabsoroption

A

proximal tubule

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33
Q

Drug that inhibits ADH

A

Alcohol

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34
Q

NAGMA

A

Chloride excess
Addissons
GI
Extra - RTA

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35
Q

HAGMA

A 
Ketoacidosis 
Lactic acidosis 
Ethalene/methanol
salicyclic acid
Uraemia 
Metformin 
CO
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36
Q

Type 1 RTA (Distal tubule)

A

H+ secretion is defective
NAGMA
Alkalotic urine (>5.5)
Hypercalcaemia

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37
Q

Type 2 RTA (proximal tubule)

A

HCO3 reabsorption defect
NAGMA
Amino-aciduria, glycosuria, phosphaturia
Fanconi syndrome

38
Q

Type 4 RTA

A

NAGMA

Hyperkalaemia

39
Q

Causes of Type 4 RTA

A 
Hyperkalaemia leads to impaired ammonia production 
Diabetes
Hypoaldosteronism 
ACEi
Spironolactone
40
Q

Metabolic alkalosis

A 
Vomiting
Diuretics
Corticosteroid excess
Barter's syndrome 
Gitleman's syndrome
41
Q

Active vitamin D

A

1, 25 dihydroxycholecalciferol

=Calcitriol

42
Q

Secondary Hyperparathyroidism parameters

A

High phosphate
Low calcium
High PTH

43
Q

Treatment of Secondary Hyperparathyroidism

A

Low phosphate diet
Phosphate binders
Calcitriol to suppress PTH

44
Q

Treatment of tertiary Hyperparathyroidism

A

Parathyroidectomy

45
Q

EPO targets

A

Hb 100 - 110

46
Q

CMV prophylaxis

A

Valganciclovir

47
Q

CMV treatment

A

Ganciclovir

48
Q

CMV resistant treatment

A

Forscarenet

Cidofovir

49
Q

Cancer risk in kidney tx

A

SCC

Lymphoma

50
Q

Elevated levels of soluble urokinase plasminogen activator receptor (suPAR) is associated with which condition?

A

FSGS
suPAR has been shown to bind and activate podocyte β3 integrin, which leads to podocyte foot process effacement that is characteristic of proteinuric renal diseases

51
Q

Fanconi’s syndrome

A 
RTA
phosphaturia
renal glucosuria (with a normal plasma glucose concentration)
aminoaciduria
 tubular proteinuria.
52
Q

Primary membranous nephropathy antibody

A

PLA-2R

Spike and dome on silver stain

53
Q

Wire loops

A

Lupus nephritis

54
Q

Full house

A

IGM IGG IGA C3 C1 seen in lupus

55
Q

MPGN findings

A

Double basement membrane/ tram tracking

56
Q

Membranous nephropathy histology findings

A

Spike and dome

57
Q

Diffuse linear IgG staining Woth crescents

58
Q

Onion skin hypertrophy on histology

A

Scleroderma renal crisis

59
Q

Diagnostic criteria for AD PCKD

A

2 or more cysts in one kidney and at least one in the contra lateral kidney by age 30

Or

4 or more in each kindey of over 60 Yo

60
Q

Age to screen for PCKD

61
Q

When to screen for cerebral aneurysm in PCKD

A

Patients with previous aneurysm
Family Hx
Persistent headache

Rescreen if size <5mm

62
Q

Indication for revascularistion of renal artery stenosis?

A 
Short duration of BP elevation
Failure of medical therapy to control BP 
Intolerance to medical therapy 
Recurrent flash oedema
Refractory heart failure
63
Q

Diagnostic approach to Renal artery stenosis

A

> 75% stenosis on CT angiography

Peak velocity above 200cm/second

64
Q

Sirolimus action

A

mTOR inhibitor

mTOR inhibits IL-2 transduction resulting in arrest in G1-S phase arrest

65
Q

Side effect of sirolimus

A

Hyperlipidaemia due to inhibitor of lipoprotein lipase

66
Q

Treatment of acute renal transplant rejection

A

IV methylpred
ATG lymphocyte depleting Ab
Indefinite steroids

Plex/IVIG/Rituximab if antibody mediated
Rescue: Tacro or MMF

67
Q

IgAnephropathy findings

A

Mesangial hypercellularity

Positive immunofluorescence for IgA and C3

68
Q

Markers of good prognosis for IgA nephropathy

A

Frank Haematuria

69
Q

Stage I Lupus nephritis

A

Minimal mesangial lupus nephritis

70
Q

Stage II lupus nephritis

A

Mesangial proliferation LN

71
Q

Stage III lupus nephritis

A

Focal LN < 50% gloms involved

72
Q

Stage IV LN

A

Diffuse LN > 50% gloms involved

73
Q

Stage V LN

A

Pure membranous LN

74
Q

Stage VI LN

A

Advanced sclerosising LN > 90% gloms involved

75
Q

Lupus nephritis histology

A 
Subendothelial immune deposits/wire loops
Hypercellularity 
Leulocyte infiltration 
Fibrinoid necrosis 
Hyaline thrombi 
Crescents in severe LN
76
Q

Protective effect of ACE/arb in diabetics with normal urine albumin and normal BP

A

Protects against retinopathy

Does not protect against renal disease

77
Q

Target of anti-G antibodies

A

Type 4 collagen

78
Q

Drugs cleared by HD

A 
BLAST
barbiturates 
Lithium
Alcohols 
Salicylates 
Theophyllines
79
Q

Causes of primary hyperaldosteronism

A 
Bilateral adrenal hyperplasia (most common)
Adrenal adenoma 
Familial hyperaldosteronism 
Adrenal carcinoma (lesion>4cm)
Ectopic
80
Q

When to perform adrenal vein sampling

A

Primary hyperaldosteronism +

Normal CT or
Bilateral abnormalities or
Unilateral abnormality and patient over 35

81
Q

Conns syndrome

A

Primary hyperaldosteronism

82
Q

Target for iron in ESRF

A

Ferritin >200
Transferritin sat >20%

Treat with IV iron

83
Q

Cause of Type 1 (Distal) RTA

84
Q

Causes of acute renal transplant rejection

A 
T Cell vs B cell acute rejection 
Differential diagnoses:
– Volume depletion
– ATN
– Interstitial nephritis
– Drugs: Calcineurin toxicity, Bactrim.
– Obstruction
– HUS
– Infection with CMV, BK virus (beyond 4 weeks)
85
Q

Gold standard for diagnosing fibromuscular dysplasia

A

intra-arterial digital subtraction angiography

String of beads appearance

86
Q

Patient with resistant HTN with normal renal function, first test for evaluating renovascular HTN

A

ACEI renography or Doppler US

87
Q

histological feature of chronic allograft nephropathy

A

Chronic interstitial fibrosis

88
Q

Immunosuppressants safe for pregnancy

A

Cyclosporin and Azathioprine

89
Q

Cyclosporin side effects

A

**Nephrotoxicity

Hyperlipidemia
Hypertension

Hirsutism

HUS-mostly dose related

Hepatotoxicity

Fluid retention

Hyperkalemia

Hypertrichosis

Gum hyperplasia

Diabetes

Tremor

Neurotoxicity

90
Q

Foods containing high amounts of oxylate

A

spinach, rhubarb, nuts, and wheat bran

91
Q

Target iron measures CKD

A

Target ferritin >100/TSat >20% pre-dialysis

STEPH BPT 2021 (17 decks)

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