Renal Flashcards
1
Q
Nephrotic syndrome
A
Proteinuria, hypoalbuminaemia, oedema
2
Q
Nephritic syndrome sx
A
Haematuria
Hypertension
RBC casts
3
Q
Function of juxtaglomerular cells
A
Detects changes in pressure
4
Q
Function of macula densa
A
Detects changes in concentration
5
Q
Cause of nephrotic syndrome
A
Podocyte damage and glomerulonephritis
6
Q
Tx nephrotic syndrome
A
Furosemide and monitor salt/fluid intake
7
Q
What is rhabdomyolysis?
A
Breaking down muscle tissue
8
Q
Cause of rhabdomyolysis
A
Trauma
9
Q
Sx rhabdomyolysis
A
Hyperkalaemia and red/brown urine
10
Q
Treatment for rhabdomyolysis
A
Treat hyperkalaemia (insulin)
IV calcium gluconate
11
Q
Osmotic diuretics
E.g.
Location
MOA
A
Mannitol
Glomerulus
Decrease H2O reabsorption
12
Q
CA inhibitor diuretics
E.g.
Location
MOa
A
Acetazolamide
PCT
No breakdown of carbonic acid means no H+ to be exchanged for Na+ so no H2O reabsorbed
13
Q
Loop diuretics
E.g.
Location
MOA
A
Furosemide
LOH
Inhibits Na+/K+/Cl- transporter
14
Q
Thiazide diuretics
E.g.
Location
MOA
A
Hydrochlorothiazide
DCT
Block Na+/Cl- co-transporter
15
Q
K+ sparing diuretics
E.g.
Location
MOA
A
Triamterene
CD
Aldosterone antagonist
16
Q
Calcium gluconate MOA
A
Stabilises myocardium
17
Q
How does insulin act on potassium?
A
Shifts from ECF to ICF
18
Q
How does calcium resonium act on potassium
A
Removes potassium from body
19
Q
At which level do the kidneys lie?
A
T12 to l3 (right is lower due to liver)
20
Q
Are kidneys retroperitoneal or intraperitoneal
A
Retroperitoneal
21
Q
Kidney layers deep to superficial
A
Renal capsule
Perirenal fat
Renal fascia
Pararenal fat
22
Q
Posterior relations to kidneys (3 muscle)
A
Psoas major, quadrates lumborum and transverus abdominis
23
Q
Blood supply to kidneys
A
Renal arteries (from abdominal aorta)
24
Q
How does the renal artery divide once it reaches the kidney?
A
Renal artery - segmental artery - interlobular artery - arcuate arteries - afferent arterioles
25
Where do kidneys drain?
para-aortic
26
Pelvic kidney
In utero, kidneys ascend from pelvis - this may not happen and one may remain at the level of the common iliac artery
27
Horseshoe kidney
Two developing kidneys fuse together and become stuck under the inferior mesenteric artery
28
Which rib is the upper pole of both kidneys?
11th rib
29
Hilum of left kidney
L1
30
Hilum of right kidney
L1-2
31
Lower border of kidneys
L3
32
Level of adrenals
t12
33
What is an ectopic kidney?
Located below, above or on the opposite side of normal
34
E.g. osmotic diuretics
Mannitol
35
How do osmotic diuretics work?
They are not reabsorbed along the nephron - less water is reabsorbed and more is excreted
36
S/e osmotic diuretics
hyponatraemia and hypokalaemia
37
How do potassium sparing diuretics work?
Inhibit sodium reabsorption from DCT by antagonising aldosterone
38
e.g. potassium sparing diuretic
spironolactone
39
diuretic for heart failure
spironolactone
40
e.g. thiazide diuretics
hydrochlorothiazide
41
thiazide diuretics moa
act on DCT and CD and inhibit sodium/chloride co-transporter
42
loop diuretics e.g.
furosemide
43
loop diuretics moa
act on sodium/potassium/chloride channel on ascending LOH so no chloride reabsorbed
44
Most common type of renal stone
Calcium oxalate
45
Cystine renal stones
Inherited recessive disorder = abnormal reabsorption of cystine from intestine and renal tubes
46
Where is majority of glucose reabsorbed in nephron
PCT
47
What is Goodpasture's disease?
Vasculitis associated with glomerulonephritis
48
Antibodies present in good pasture's syndrome
Anti-GBM
49
HLA association good pasture's
HLA DR2
50
Sx Goodpasture's syndrome
Progressive glomerulonephritis - AKI
Nephritis ->proteinuria and haematuria
51
Type fo hypersensitivity goodpastures
II
52
Where does left testicular/gonadal vein drain?
Left renal vein
53
Where does right testicular/gonadal vein drain to
IVC
54
Most common cause of acute prostatitis
e coli
55
Sx prostatitis
Referred pain, fever, tender, enlarged prostate
56
Tx prostatitis
quinolone
57
What is rhabdomyolysis?
Breakdown of muscle
58
Causes of rhabdomyolysis
Trauma, EBV, alcohol, drugs
59
How to treat rhabdomyolysis
Fluids
60
Sx rhabdomyolysis
Red-brown urine, hyperkalaemia, renal failure
61
What is IgA nephropathy?
IgA immune complexes deposited in mesangium causes glomerular injury
62
Is IgA neuropathy nephritic or nephrotic
Nephritic
63
What kind of hypersensitivity is IgA nephropathy
3
64
Pathophys IgA nephropathy
Abnormal glycosylation of IgA means the compound is galactose deficient
Therefore not identified and broken down by body
Abnormal IgA accumulates
Body releases IgG to target
Immune complex forms in mesangium
Glomerular injury
65
sx iga nephropathy
Haematuria shortly after URTI in young male
66
Sx post-streptococcal glomerulonephritis
headache
haematuria and proteinuria
hypertension
67
What is post-streptococcal glomerulonephritis
1-2 weeks after strep progenies infection, infection spreads to glomerulus where it is deposited
68
Tx post-streptococcal glomerulonephritis
Self-limiting
69
Describe post-streptococcal gloemrulonephritis immunofluorescence appearance
Granular/starry sky
70
Which chemicals are deposited in the glomerulus in post-streptococcal glomerulonephritis?
IgM, IgG and C3
71
What is Henoch-Schonlein purport?
Small cell IgA mediated vasculitis
72
Tx Henoch-Schonlein purpura
Self limiting
73
Sx hence-schonlein purpura
Purpuric rash + oedema
Rash on buttocks and extensor surfaces
Abdo pain
74
Inheritance of Alport's
X-linked dominant
75
What is Alpert's syndrome
Defect in type 4 collagen forms abnormal GBM -> Goodpasture's
76
Mx Alport's
ACEi/ARB
77
Dx Alport's
Splitting of lamina densa = basket weave appearance
78
Why do renal transplants fail?
Anti-GBM antibodies -> Goodpasture's
79
Sx Alport's syndrome
Haematuria
Renal failure
Sensorineural deafness
80
What is Goodpasture' syndrome
Anti-GBM ABs against type 4 collagen
IgG in basement membrane
81
Hypersensitivity type Goodpasture's
2
HLA-DR2 association
82
Tx Goodpasture's
Steroids and cyclophosphamide
83
Sx Goodpasture's syndrome
Glomerulonephritis and pulmonary haemorrhage
84
Where does adrenal artery come from
aorta
85
Contents of hilum from anterior to posterior
Renal vein
Renal artery
Ureter
86
When demyelinated, which nerves cause urinary retention?
Pelvic splanchnic
87
Parasympathetic innervation to bladder
pelvic splanchnic
88
risk factors for bladder cancer
smoking and 2-naphthylamine
89
most common type of bladder cancer
transitional cell carcinoma
90
sx bladder cancer
painless macroscopic haematuria
91
staging and diagnosing bladder cancer
TURBT and pelvic MRI
92
How does alcohol act as a diuretic?
Suppreses ADH from post pituitary
93
Sx hypocalcaemia
tetany (muscle spasm), paraesthesia, long QT, cataracts
trousseau's sign: wrist flexion
Chvostek's sign: tapping parotid makes face twitch
94
Hyperkalaemia causes
metabolic acidosis, AKI, K+ sparing diuretics, ACEi, heparin, Addison's, rhabdomyolysis
95
causes of hypocalcaemia
vit D deficiency, CKD, hypoparathyroidism, rhabdomyolysis
96
management of hypocalcaemia
calcium gluconate
97
Mx hypocalcaemia
calcium gluconate
98
Eosinophilis granulomatosis with polyangiitis
Churg-Strauss
pANCA +ve
Severe asthma, eosinophilia
Tx = steroids
99
Granulomatosis with polyangiitis
Wegener's disease
cANCA +ve
Saddle nose deformity
Tx = steroids
100
first line treatment for CKD
ACEi/ARB
101
Acute tubular necrosis
Necrosis of epithelial cells in tubules caused by toxins (ahminoglycosides, methotrexate etc)
Necrotic cells obstruct lumen
MUDDY BROWN CASTS
102
mussy brown casts
acute tubular necrosis
103
acute interstitial nephritis
inflammation of extra-glomerular tissue
104
causes of intra-renal AKI
acute tubular necrosis and acute interstitial nephritis
105
What is minimal change disease?
Most common cause of nephrotic syndrome in children, normally idiopathic
106
Pathophysiology minimal change disease
Podocytes lose negative charge
- Unable to repel ions
- Ions cross into urine = proteinuria
107
Sx minimal change disease
- Nephrotic syndrome
- Normotension
- Proteinuria
- Hypoalbuminaemia
- Oedema
108
Diagnosis minimal change
electron microscopy
109
Tx minimal change
oral corticosteroids
110
What is rapidly progressive glomerulonephritis/
destruction of glomeruli due to nephritis
111
tx rapidly progressive GN
steroids and cyclophosphamide
112
what is CKD?
kidney dysfunction >3 months characterised by abnormal creatinine and electrolyte levels
113
CKD stages
- **CKD 1:** eGFR >90
- **CKD 2:** eGFR 60-89
- **CKD 3a:** eGFR 45-59
- **CKD 3b:** eGFR 30-44
- **CKD 4:** eGFR 15-29
- **CKD 5:** eGFR <15 (kidney failure)
114
sx CKD
Normally asymptomatic - characterised by abnormal creatinine and electrolytes
Can have pruritus, lethargy, insomnia, HTN
115
what is hepatorenal syndrome?
AKI + liver failure
116
cardiorenal syndrome
congestive HF + renal failure
117
acute interstitial nephritis
'allergic reaction' - inflammation of extra-glomerular tissue
caused by ABx, NSAIDs, diuretics, PPIs, or infections
118
symptoms acute interstitial nephritis
pyuria (oesinophils), crystals
119
tx acute interstitial nephritis
discontinue drugs, add fluids
120
muddy brown casts
acute tubular necrosis
121
what is acute tubular necrosis
necrosis of epithelial cells in tubules
122
causes of acute tubular necrosis
ischaemia, toxins, haemoglobin, proteins (rhabdomyolysis)
123
tx acute tubular necrosis
no treatment - terminal
124
Nephritis 1-2d post URTI
IgA nephropathy
125
nephritis 1-2w post URTI
post-strep GN
126
why do you give steroids in IgA nephropathy?
if renal function starts declining, due to immune reaction - steroids will counteract this
127
cANCA +ve with saddle-nose deformity
Wegener's
128
pANCA +ve granulomatosis
Churg-Strauss (eosinoPhilic)
129
Severe asthma + severe renal failure + high eosinophil count
churg - strauss (eosinophilic granulomatosis with polyangiitis)
130
antibodies against t4 collagen, destroys GBM
Goodpasture's syndrome
131
mutated gene for t4 collagen
alport
132
most common cause of nephrotic syndrome in adults
membranous nephropathy
133
mx membranous nephropathy
ACEi/ARBs
134
most common cause of SIADH
small cell lung cancer
