Renal Flashcards
Predictors for rapid renal disease progression in ADPKD - name 6
Which is the strongest predictor
Low water intake Large kidney volume (strongest predictor) Haematuria Early onset of HTN Early decrease in gfr PKD1 mutation
Others - smoking, caffeine, high protein intake, proteinuria
- A 72-year-old man presents with acute kidney injury, haematuria and proteinuria. A renal biopsy shows membranoproliferative glomerulonephritis, with strong C3 staining on immunofluorescence. Staining for immune complexes was negative.
Which of the following is most likely to be an associated underlying disorder?
A. Diabetes mellitus
B. Monoclonal gammopathy
C. Malignant hypertension
D. Hepatitis B
B. Monoclonal gammopathy
Membrnaoprolofierative GN with C3 staining can be seen with HBV but would stain positive for immune complexes
Most common cause of death of people over 75 years of age on haemodialysis?
Withdrawal from dialysis
CVD in <75yo
Which drugs can be cleared by haemodialysis?
Barbiturate Lithium Alcohol (methanol,ethylene glycol) Salicylates Theophyllines
What is most likely to improve after adrenalectomy in unilateral adrenal hyperplasia?
Hypokalemia - improves in 100% of cases
Name 4 drugs which increase lithium blood levels and 1 drug that decreases lithium blood levels
Diuretics acting at DCT increase levels: hydrochlorothiazide, spironolactone, triamterene
also frusemide increases levels
Diuretics acting at proximal tubule (site of lithium absorption) decrease lithium levels: acetazolamide
Electrolyte abnormalities in Gittlemans syndrome + genetic mutation
Mimics THIAZIDES (Tim is a GIT MAN)
2 Ms, pee out C
Metabolic alkalosis
HypoMagnesemia
Hypercalcemia with hypocalcuria
Hypokalemia
Genetic mutation - NKCC1 loss of function mutation (gene coding for Na and Cl co transporter of DCT)
Site of action of frusemide
Ascending loop of Henle
Blocks NKCC2 transporter
Ferritin/transferrin targets in end stage renal failure patients
Ferritin >200
Transferrin saturation > 20%.
Target hb range in CKD patients
> 110g/dL
Role of principal cells in the nephron
Reabsorb sodium, secrete potassium
Role of intercalated cells in the nephron
Type A (alpha): secrete Acid, reabsorb base (bicarb)
Type B (beta): secrete Bicarb (base), reabsorb acid
Role of peritubular cells in the nephron
Synthesize EPO
Electrolyte abnormalities in Barters syndrome
Hormone elevated in the urine?
Mimics actions of frusemide (defect in NKCC2)
Metabolic alkalosis, hypocalcemia, hypokalemia
Urine prostaglanin E elevated
Name 3 causes of sterile pyuria
interstitial nephritis
renal tuberculosis
nephrolithiasis
Recurrent haematuria after resp infections + family history renal failure
Alport syndrome
Metabolic abnormalities in excess vomiting
metabolic alkalosis
Metabolic abnormalities in diarrhea
NAGMA due to loss of bicarbonate
Also seen in ureterosigmoidostomyjejunal loop (not really done anymore - for this reason)
Which RTA is associated with hypercalcuria?
Urine Ph in this RTA?
T2 RTA (distal) Urine ph >5.5
Mechanism of action of mycophenylate
Reversible inhibitor of Inositol Monophosphate Dehydrogenase(IMPDH) –> inhibits purine biosynthesis –> inhibits T + B cell proliferation
Investigation of choice for light chain amyloidosis
Abdominal fat pad aspirate
Most common histologic feature seen in chronic allograft nephropathy
Chronic interstitial fibrosis
Which of the following is least useful in acute renal Tx rejection? A. Tacrolimus B. Sirolimus C. MMF D. Cyclosporine E. Methylpred
D - Cyclosporin
Name 4 advantages of cyclosporine over tacrolimus
Name 4 disadvantages
Cyclosporine advantages
- less diabetogenic
- less nephrotoxicity
- less neurotoxicity
- doesn’t cause hair loss
Cyclosporin disadvantages
- more hyperlipidemia and HTN
- causes gingival hyperplasia
- less potent
- more nephrotoxic
Which of the following can be used in pregnancy?
A. MMF
B. MTOR inhibitoirs
C. CNI
C - CNI (cyclosporin>tacro)
Drugs associated with FSGS
Heroin
bisphosphonates
interferon alpha
anabolic steroids
less clear link - sirolmus, lithium, CNI, anthracyclines
Most common manifesation of lupus nephritis
proteinuria
Therapies for acute antibody mediated rejection
cell mediated?
glucocorticoids, plasmapheresis, and intravenous immune
globulin
Cell mediated - steroids + antithymocyte globulin (high grade)
Which GN is most likely to recur with transplant?
Which rercurs most rapidly
IgA nephropathy
FSGS most rapidly
GN with greatest risk of VTE
Membranous
A 37 year old male with a family history of Autosomal Dominant Polycystic Kidney Disease is inquiring about kidney donation to his affected sister with end stage kidney disease. Which family member should undergo genetic testing to guide transplant decisions?
She should - need to identify the gene.
Major vascular bed controlling blood pressure at the renal level
afferent arteriole
Afferent or efferent constriction or dilatation:
- NSAID
- ACE-I
- SGLT2
NSAID: afferent arteriole constriction (prevent PGE2 production–> inhibit vasodilation)
ACE-I: efferent arteriole vasodilation
SGLT2: afferent arteriole constriction
