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Renal Flashcards

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1
Q

What is the classic triad of symptoms for renal cell carcinoma?

A

Haematuria
Flank pain
Palpable mass

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2
Q

What are risk factors for renal cell carcinoma?

A

Smoking, obesity, age
End-stage renal disease
Tuberous sclerosis, von Hippel Lindau syndrome

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3
Q

What is the most common histology of renal cell carcinoma?

A

Clear cell carcinoma

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4
Q

What are paraneoplastic syndromes associated with renal cell carcinoma?

A

Hypercalcaemia
Polycythaemia
Hypertension
Varicocele in men

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5
Q

What is the classic radiological feature of renal cell carcinoma metastasis?

A

Cannonball mets in the lungs

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6
Q

What is the gold standard test for renal cell carcinoma?

A

Contrast-enhanced CT

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7
Q

What are the complications of renal transplant?

A 
Rejection
Failure of transplant
Electrolyte imbalance
Recurrence of disease
Ureter blockage/leakage of anastomosis
Infection + effect of immunosuppressant medication
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8
Q

What are the complications of immunosuppressant therapy post-transplant?

A 
Infection
IHD
T2DM
Non-Hodgkin Lymphoma
Skin cancer
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9
Q

What are pre-renal causes of AKI?

A

Hypovolemia - blood loss / dehydration
Hypotension - heart failure, shock
Sepsis
Renal artery obstruction / stenosis

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10
Q

What are renal causes of AKI?

A

Nephrotoxic medication
Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis

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11
Q

What are post-renal causes of AKI?

A 
Renal/ ureteric calculi
Ureteric stricture / blockage
Tumour compression / internal tumours
Enlarged prostate
VUJ dysfunction
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12
Q

How would you approach a patient with suspected AKI?

A

A-E assessment
Full set of obs
Prescription review
Bloods: FBC, U&E, CRP, LFT, Cultures if septic
Urinalysis: dip for blood, protein, infection
MSU -> MC+S to look for casts, cells and organisms
USS urinary tract -> CTKUB

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13
Q

What are the complications of AKI?

A 
Hyperkalaemia
Hyper-uraemia -> encephalopathy, pericarditis
Fluid overload -> pulmonary oedema
Metabolic acidosis
Interstitial damage
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14
Q

What are the causes of CKD?

A 
Diabetes
Hypertension
Long term use of nephrotoxic medication
PKD, Glomerulonephritis
Childhood renal disease

Medication: NSAIDs and lithium most commonly

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15
Q

What are the symptoms of CKD?

A 
Often asymptomatic
Fluid overload + oedema
Nausea, Pruritus, loss of appetite
Pallor
Hypertension
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16
Q

What investigations can be done for CKD?

A
  1. A-E + full set of obs
  2. Bloods: FBC, U&E, CRP, bone profile, LFT, HbA1c
  3. Urine: albumin: creatinine ratio, blood (A:Cr >3 = significant)
  4. Renal USS

For diagnosis, need eGFR <60 or proteinuria

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17
Q

How is CKD managed?

A
  1. Fluid restriction
  2. Sodium restriction
  3. Glycaemic control
    SGLT2 inhibitor eg. dapagliflozin should be given
  4. BP control: ACE-I -> diltiazem
  5. Atorvastatin
  6. RRT
  7. Dialysis

Treat complications

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18
Q

What are the complications of CKD?

A
  1. Renal anaemia
  2. Secondary hyperparathyroidism
  3. Metabolic acidosis
  4. Hyperkalaemia
  5. CVD
  6. Pulmonary Oedema
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19
Q

What is the treatment for renal anaemia?

A
  1. Treat any iron deficiency
  2. If Hb very low, transfuse (but avoid regular transfusion due to risk of sensitisation)
  3. Erythropoietin
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20
Q

What are the features of renal bone disease?

A

Osteomalacia, osteoporosis, osteosclerosis

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21
Q

What is the pathophysiology of secondary hyperparathyroidism?

A

Reduced phosphate excretion, increased serum levels
Reduced activation of vitamin D by the kidneys -> reduced calcium absorption from gut
In response to low calcium and high phosphate, increased PTH release
PTH stimulates osteoclast activity to resorb bone

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22
Q

What is the management for secondary hyperparathyroidism?

A 
Low phosphate diet
Activated vitamin D supplementation: alfacalcidol, calcitriol
Bisphosphonates for bone protection
Calcium carbonate
Phosphate binder e.g. calcium acetate
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23
Q

What are the indications for dialysis?

A

AEIOU

A: Acidosis- severe, refractory metabolic acidosis
E: Electrolyte abnormality: Severe, refractory hyprekalaemia
I: Intoxication- ingestion of certain toxins
O: Oedema - severe, treatment resistant pulmonary oedema
U: Uraemia- High urea causing encephalopathy or pericarditis

End stage renal failure with anuria

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24
Q

What are the two most common types of AV fistula?

A

Radiocephalic

Brachiocephalic

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25
How long before an AV fistula is mature and ready to use?
4w-4m
26
What are the complications of AV fistulae?
``` Infection Aneurysm formation Thrombosis Stenosis STEAL syndrome: ischaemia to distal limb ```
27
What is nephrotic syndrome?
Group of symptoms characterised by: significant proteinuria, oedema and low serum albumin You also get high cholesterol production to compensate for the loss in albumin
28
What are important complications of nephrotic syndrome?
High cholesterol Loss of antithrombin III - increased risk of clotting Loss of immunoglobulins- increased risk of infection Hypertension Fluid overload -> heart strain
29
What is nephritic syndrome?
Characterised by group of symptoms: haematuria, low grade proteinuria, oliguria Hypertension and oedema also occur as a result of fluid retention
30
What are common causes of nephrotic syndrome?
``` Minimal change disease FSGS Membranous nephropathy Diabetic nephropathy Severe membranoproliferazive GN ```
31
What are common causes of nephritic syndrome?
``` IgA nephropathy Post-streptococcal GN Membranoproliferative GN Goodpasture syndrome Alport syndrome Small vessel vasculitis: GPA, EGPA, MPA, HSP RPGN ```
32
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
33
What is the diagnostic test for minimal change disease?
Renal biopsy and electron microscopy - loss of podocyte foot processes
34
How is minimal change disease managed?
Tapering course of prednisolone over 4-16w
35
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
36
What is seen on biopsy in FSGS?
Focal areas of glomerular scarring
37
How is FSGS managed?
ACE-I / ARB + other BP control Steroids Plasma exchange in recurrent disease
38
What is seen on biopsy in membranous nephropathy?
IgG and complement deposits in the glomerular basement membrane
39
How is membranous nephropathy managed?
ACE-I / ARB and BP control | Immunosuppressants in severe disease
40
What are the general symptoms of nephrotic syndrome?
Oedema, breathlessness, frothy urine, increased clotting, fatigue
41
What investigations should be done in suspected nephrotic syndrome?
Bloods: FBC, U+E, LFT (low albumin), clotting, lipids Urine dip: proteinuria MSU: A:Cr ratio Renal USS and biopsy -> microscopy
42
What is the general management in nephrotic syndrome?
Fluid and salt restriction, daily weights Loop diuretics + thiazide if insufficient response ACE-I/ARB and BP control Glycaemic control Statin VTE prophylaxis Steroids/immunosuppressants in more severe disease
43
What are the classic symptoms of IgA nephropathy?
Microscopic haematuria with episode of macroscopic following: respiratory/GI infection, strenuous exercise Discernable from post-strep as occurs DURING/days after infection rather than weeks
44
How is IgA nephropathy diagnosed?
Elevated serum IgA Low serum C3 Mesangial proliferation IgA deposits in the mesangium
45
Which vasculitis has identical findings on renal biopsy to IgA nephropathy?
HSP | - discernible by systemic symptoms in HSP
46
How is IgA nephropathy treated?
ACE-I / ARB | Steroids if persisting >6m
47
What is the characteristic presentation of post-strep GN?
Macroscopic haematuria presenting weeks post strep infection - most commonly throat or skin infection -> 1-2 w post pharyngitis/tonsilitis -> 3-4w post skin infection Caused by group A B-haemolytic strep Also present with oedema, HTN
48
What is the hypersensitivity type of post-strep GN?
Type 3
49
What is found on investigation in post-strep GN?
1. Low serum C3 2. Anti-strep antibodies 3. Complement and IgG deposits in GBM and mesangium
50
How is post-strep GN managed?
Supportive treatment- fluid restrict, diuretics, ACE-I | Antibiotics if any remaining infection
51
What is goodpasture's syndrome?
Anti-GBM syndrome- antibodies against type 4 collagen | Causes haemoptysis and nephritic syndrome
52
How is goodpasture's syndrome diagnosed?
Symptoms of haemoptysis + haematuria Presence of anti-GBM/type 4 collagen antibodies in circulation and in the mesangium on renal biopsy Pulmonary infiltrates on CXR Iron deficiency anaemia Usually presents with RPGN
53
How is goodpasture's syndrome managed?
1. Plasma exchange 2. Steroids + cyclophosphamide + other nephritic syndrome managements
54
What is Alport's syndrome?
X-linked condition: most commonly dominant but can be recessive Mutation in gene encoding type 4 collagen Leads to sensorineural hearing loss, loss of vision, haematuria and oedema Often leads to end-stage renal disease No specific treatment
55
Which small vessel vasculitis most commonly cause nephritic syndrome?
GPA and EGPA GPA: nasal crusting/nasopharyngeal involvement + haemoptysis + haematuria + Purpura C-ANCA EGPA: brittle asthma/eosinophilia + haematuria + purpura P-ANCA
56
What is rapidly progressing GN?
Rapid decline in renal function due to any form of nephritic syndrome Can case ESRD within a matter of weeks-months Characterised by cresents on renal biopsy Usually requires plasma exchange and immunosuppression
57
How does nephritic syndrome most commonly present?
Haematuria, proteinuria, hypertension, oedema and oliguria Proteinuria is far less prominent than in nephrotic syndrome
58
How would you investigate somebody presenting with nephritic syndrome?
``` Bloods: FBC, U&E, LFT, CRP Immunoglobulins, complement, ANCA + antibody screen Urine dip: haematuria, protein MSU: A:CR ratio, granular casts in some Renal USS + biopsy ```
59
What is the generic management of nephritic syndrome?
ACE-I and BP control Low sodium diet and fluid restriction Diuretics if severe oedema Sometimes immunosuppression/plasma exchange
60
In what condition would you expect waxy urinary casts?
Advanced CKD
61
In what condition would you expect RBC casts in the urine?
Nephritic syndrome / glomerulonephritis
62
In which conditions would you expect epithelial cell casts in the urine?
Glomerulonephritis | Nephrotic syndrome
63
In which condition would you expect WBC casts in the urine?
Pyelonephritis
64
In which condition would you expect granular/muddy brown casts in the urine?
Acute tubular necrosis
65
In which condition would you expect fatty casts in the urine?
Nephrotic syndrome

Finals Revision (23 decks)

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