Renal Flashcards
In rhabdo the myoglobin is directly nephrotoxic and causes an AKI in what way? Electrolytes in rhabdo? Same as?
Acute tubular necrosis
HyperK, HyperPO4
HypoCa (due to hyperPO4 which causes calcium deposition)
[Same as tumour lysis]
Why DIC in rhabdo
thromboplastin release during muscle damage
3 things that stimulate renin release
HypoNa (in distal convolute tubule by macula densa cells)
HypoVolaemia (detected by afferent arteriole)
Sympathetic stimulation of B1 receptors
RAAS system
Renin converts angiotensin (produced in liver) to angiotensin I.
ACE (produced in lung vasculature) converts Angiotensin I -> Angiotensin II
Effects of angiotensin II on
Vasculature?
Kidney?
Pit?
Nervous system?
Hypothalamus?
Vasculature - binds to g coupled protein -> vasoconstriction,
Kidney - Increases Na reabsorption in proximal convoluted tubule
-Stimulates aldosterone release from the adrenal cortex
-Contstrics efferent arteriole
Pit - Stimulates release of ADH
Nervous system - Release of noradrenaline
Hypothalamus - increases thirst
Where in adrenal cortex is aldosterone released? what does it do?
Zona glomerulosa
Acts on Distal convoluted tubule [Last part of RAAS acts distal]
- Increases Na reabsorption and potassium excretion
-> Increases osmolarity
Glomerular nephritis includes nephrotic (protein loss predominant) and nephritic syndrome (blood predominant). Most common in Kids? Adults? Black adults?
Kids - minimal change disease
Adults - IgA nephropathy (Bergers) disease
Black - FSGN (nephrotic)
Urine protein excretion and albumin levels in nephrotic. Key complications?
Urine >3.5g protein excretion / day
Albumin <25
Thrombosis
hyperlipidaemia
Infection
Kid with minimal change on steroids? Rx of hypertension first line? Steroid sparing agent first line? Bar steroids what other Rx is needed?
ACEi
Cyclophosphamide
Anticoag - Eg enox / warfarin
Bone disease in diabetic patients (especially if on dialysis) ?
Adynamic bone disease
PTH, Ca, PO4 in osteoporosis
NORMAL
Who gets osteitis fibrosis cystica
HyperPTH
Who gets osteitis fibrosis cystica
HyperPTH
What stimulates PTH.
Effects?
Low Ca
Increase Ca from bone.
Less Ca exerted in urine
Stimulates vit D -> Increased Ca absorption from intestines
Vit D in CKD ? Why?
Low - part of hydroxylation process occurs in kidney
Also high PO4 levels suppress
CKD and PTH
Get secondary HyperPTH (low ca)
Or eventually tertiary [high pth high Ca]
1st line phosphate binder (may be used in CKD)
Calcium acetate
CKD statins?
All CKD 3 or over should be on atorvostatin
HTN on thiazide. What are key biochem side effects causing nephropathy? Rx?
Hypercalcaemia, hyperUric acid -> deposition
Change to alternative - eg amlodipine
Why urine dipstick positive for nitrites in UTI?
Bacteria -Eg E coli
Break down nitrates into nitrites in urine
What is pollakiuria?
Increased urinary frequency
Eg in antipsychotic meds
Most common histological type of RCCs
Clear cell adenocarcinoma
Renal tumours, retinal haemangiomas, pancreatic islet cells tunours
Von-hippel lindau
Epithelium from urological Cancer
transitional
Wilms tumours from?
embryonic epithelium (which should have regressed at birth)
-> poorly differentiated epithelium and grow fast / mets fast
Thickened glomerular basement membrane with IgG and C3 deposits + nephrotic syndrome = ? What are 10% assoc with? Rx?
Membranous glomerulonephritis -> nephrotic syndrome
Carcinoma: usually SCC bronchial or adenocarcinoma of GI
Prophylactic anticoagulation, Dietary Na restriction, diuretics
Alternating cycles of pred and cyclophosphamide
Most common cause of bilateral ureteric obstruction with anaemia
Retroperitoneal fibrosis
Hypertension, hypokalaemic metabolic alkalosis with dominant inheritance
Liddle syndrome
Hypokalaemic metabolic alkalosis, HypoCa, HypoMg
Gitelman syndrome
Everythings low G [K/Ca/Mg/H+]
Types of transplant kidney rejection + RX:
A) Occurs in minutes after revascularization -> swollen and discoloured kidney
B) Over first few weeks (up to 6months) 2 causes and how to differentiate
A) Hyperacute (due to antibodies against kidney) -> transplant nephrectomy
B) Acute either cell-mediated or antibody-mediated
-Cell - mononuclear cell infiltration Rx high dose steroids
-Antibody - Biopsy shows positive staining for CD4 or donor-specific antibody
How do ciclosporin and tacrolimus work? Which inflammatory cytokine do they inhibit?
BOTH are calcineurin inhibitors
Ciclosporin
- inhibits IL-2 and TNFa by binding to cyclophilin and inhibiting calcineurin
Tacrolimus (binder of calcineurin)
Inhibits IL-2 by binding to calcineurin
What class of drug is mycophenolate mofetil
Antiproliferative
[selectively impairs B and T cell production]
Cause of HTN in turners
coarctation
Why are CKD anaemic
Mainly reduced EPO
Decreased dietary iron
Decreased iron absorption
GI blood loss due to capillary fragility + platelet dysfunction
RBC survival reduced Eg haemodialysis
Limited cutaneous sclerosis signs and symptoms
CREST
Calcinosis on skin usually fingertips
Raynauds
Esophageal dysmotility
Telangectasia
tight shiny skin on fingers. AKI and Hypertensive crisis? Pathogenic hallmark?
Scleroderma renal crisis
mucoid intimal thickening of vascular endothelium
Systemic sclerosis with dry cough and SOB progression =
Pulmonary fibrosis as complication of systemic sclerosis
[Also get pulm HTN]
Antibodies in scleroderma? Which is marker of severe disease?
ANA
Anti-centromere - in limited cutaneous
Anti-SCL 70 in severe diffuse disease (SCLerodema)
Differentiate primary raynauds and secondary caused by systemic sclerosis
Visulaise with nailfold capiliaroscopy
Systemic sclerosis will have abnormal capillaries, avascular areas and capillary haemorrhage
Drug for Rx of severe digital ischemia
iloprost
How does VU reflex present?
Key Ix
UTIs as kid
May have had hydronephrosis on fetal US
Micturating cysturethrogram
US scan
DMSA scan
Pharma Rx of VU reflux
Prophylactic Abx if recurrent UTI to prevent scarring
May use anticolinergics Eg Oxybutynin to increase bladder capacity / reduce contractions
When is an AKI ATN?
Usually quick onset - it is ischemia + necrosis
Shock/sepsis/dehydration
NSAIDs /Gent /contrast dye
Muddy brown casts on urinanysis
ATN - pathagnomonic
Acute interstitial nephritis usually due to ? Presents?
Drugs Eg NSAIDs / Abx
Features of hypersensitivity - rash/fever/eosinophilia
Pt from easten europe
Yellow palms and soles
AKI/CKD
balkan nephropathy
Asymptomatic UTI in preg
Nitrofurantoin 7 days
Or amox if has sensitivities
Who gets a urine dipstick with sx of UTI
Women under 65
Men and women >65 need C&S
Amyloid histology stain? Shows?
Congo red positive stain
Green birefringence under polarised light
Formal amyloid Dx requires biopsy + histology. What less invasive tests are there? Which test for prognosis?
Serum immunofixation
Urine immunofixation
Immunuglobin free light chain assay - sensitive
Beta-2-microglobin for prognosis
Rx of amyloid? How to monitor repsponse to Rx?
Chemo / marrow Tx
Monitor levels of free light chains in blood
AL is main (primary amlyloid) AmyLoid
Which type seen in chronic conditions?
AA
->Rx is controlling other condition Eg IBD/Rheum/Malignancy
Amyloid affects many organs. Some key things to raise suspicion in question
Inflam disease Eg Rhem / IBD (if AA amyloid)
Nephrotic syndrome
Cardiac failure
Neuropathy
Most common inflam condition with AA amyloid
Rhem arthritis
Lipodystophy and nephrotic syndrome? Key Ix for diagnosis?
Mesangiocapilliary nephritis
Complement studies
[Will show low C3 with normal C4]
Post partum may develop a thrombotic microangiopathy. How would you differentiate HUS and HELLP syndrome? What needs to be considered in HUS post partum?
Normal clotting indicies in HUS
Need to consider retained products of conception
CIs to lithotripsy
Bleedy
Pregnant
Urosepsis
Obstruction distal
Which two things in blood stop stone formation
Magnesium
Citrate
Most common type of urinary stone
mixed calcium oxylate and phosphate
Ureteric colic choice of analgesia. Whar else should everyone get if stone < 10mm
Rectal diclofenac if normal renal function
Tamsulosin (alpha blocker)
Calcium oxylate stones. Recurrence prevention drugs
Potassium citrate
Thiazide directics - increase calcium resorption
Hep B Nephrotic syndrome pathophysiology
membranous nephropathy
Mesangiocapiliary glomerulonephritis. With Pan Hypocomplimentaemia. Nephritc/nephrotic syndrome is what infection
Hep C
What causes stag horn calculi ? Pathogenesis and type of stone
Infection (Proteus, klebsiellla, serratia)
-> These bugs can cause splitting of ammonia into ammonium and hydroxyl ions
-> Increases urinary pH and struvite stone formation
[also called ammonium magnesium phosphate]
Differentiate high red cell counnt from polycythemia and from RCC
Erythropoetin levels
-High in RCC or if hypoxic cause
-low in polycythemia vera
CT demonstrates ring shaddows in medulae and pelvis filling defects =? Common cause?
Papilliary necrosis
Often caused by high dose NSAID + hypotension
Define AKI
Oliguria <0.5ml/kg for >6hrs
Raise in Cr by >50%
Raise in Cr by 26 in 48 hrs
Cystine stones caused by
cystinuria (familial)
Hyperoxaluria is a rare primary cause of stones. What usually causes it?
Small bowel malabsorption. eg resection / crohns
-> Increased bowel exposure to bile salts
->increased oxalate absorption
[Usually needs quite a significant small bowel resection / short gut syndrome]
Proximal tubular dysfunction
->glycosuria, proteinuria, amioaciduria, citraturea
Bone pain =?
[If proline and arginine in normal levels in urine =?
Fanconi syndrome
[Hartnup syndrome]
Frank haematuria + URTI / Gastroenteritis =?
[usually have a fever + inflam response]
Seen on urine microscopy?
Rx?
IgA nephropathy (Burgers disease)
-get diffuse IgA mesangial deposition
Blood, Red cell casts and dysmorphic features
Supportive
May require ACE (if HTN or significant proteinuria)
May require steroids
SLE + acute glomerulonephritis. Seen on microscopy of biosy?
Capillary wire looping
(diffuse subendothelial glomerular deposits)
Rapidly progressive glomerulonephritis. Characteristic findings on biopsy?
Crescents of fibrin and plasma protein
Minimal change disease. Seen on biopsy
effacement of food processes
Differentiate post-strep glomerulonephritis and IgA nephritis
PSGN - Infection usually 10-30 days prior and in kids. IgA similar time for sore throat and renal issues
PSGN - deposits of IgG, IgM, C3 on biopsy
[IgA in IgA]
Solute removal in haemodialysis ? Water removal ?
Solute - diffusion
Water - ultrafiltration
Key severe complication with IV urography
Contrast nephrotoxity
Urine osmolality / Na level urinalysis of ATN
Low osmolality. eg 300mosmol/kg
[if pre renal cause this would be high]
Raised sodium >40mm/L due to failure to resorb Na
[cannot concentrate the urine or conserve sodium]
Pathagnomic of alports? Other key features
Seen on echo?
What is alports a disorder of?
Anterior lenticonus
Progressive CKD and bilat sensorineural deafness
Left ventricular hypertrophy on echo
Disorder of collagen IV (Genes COL4A-)
Which antihypertensives have no effect on RAAS system? Eg can be continued during aldosterone studies for resistant hypertension
A blockers - Eg doxazosin
Pulm haemorrhage and rapid progressive glomerulonephritis. ANCA Negative =? Gene? Biopsy of lung / renal? Rx?
Anti-GBM
HLA-DR2 [or DR15 / DRB1] in 80%
Renal - Crescentric glomerulonephritis + IgG/C3 deposition
Lung - Pulm haemorrhage and haemosiderin-laden macrophages
Pred, cyclophosphamide and plasma exchange (14 days or until Anti-GBM undetectable)
[+/- dialysis]
Cancer + nephrotic syndrome = ? Seen on biopsy?
Membranous glomerulonephropathy
Subepitheial deposition of IgG and c3
Heart block
Red papules
protein urea
Microscopic lipid deposits in the cornea = ? inheritance
What is this a disorder of?
Key complaint / presenting feature?
Seen on opthalmoscopy?
Echo?
Fabry disease - X-linked disorder
fat metabolism
Due to a deficiency of the lysosomal enzyme, α-galactosidase A (α-Gal A).
excruciating pain in the hands and feet which occur with exercise, fevers, stress
star-burst pattern of the cornea
left ventricular hypertrophy (LVH) and then hypertrophic cardiomyopathy (HCM
Recurrent UTI with same bug usually means?
Failure to eradicate pathogen secondary to:
-stones
-scarring
-PKD
-Proctatitis
Why prothrombotic in nephrotic syndrome
Loss of protein S and antithrombin in urine
Diabetes with Cr of > 200, glucose 7.8. Multiple episodes of pulm oedema. Different kidney sizes and hypertension. Cause od kidney disease
Renal artery stenosis
[HTN, Different sizes, pulm oedema recurrent]
NOT diabetic nephropathy
PKD inheritance
dominant
What mechanism does gent cause renal damage?
Proximal tubular dysfunction
Lung cancer + nephrotic syndrome likely is? Seen on histology? Which 2 cancers mostly assoc?
Membranous glomerulonephritis
Thickened glomerular basement membrane with IgG and C3 deposits + nephrotic syndrome
Lung SCC / bowel adenocarcinoma
Bartters
Gitetleman
Liddle
Where in kidney? Similar to? Which transporters?
Bartters: Hypercalciuric Furosemide like
-Thick ascending Loop of Henle (LOH)
–Defect in Na-2K-Cl transporter
Gitelman: Hypocalciuric Thiazides Hypomagnesemia. Presents with cramping and spasms.
-Distal tubule
–Defect in Na-Cl co-transporter
Liddles: Think of Conns but low aldosterone
[low renin]
-Collecting duct
–Continuous activation of ENaC in collecting duct leading to increased Na absorption
Rx Liddles why
Amiloride or triamterene block ENaC
[In liddles constantly activated]
Bartter, gitelman and liddle all cause?
BP?
Which causes hypercalcuria/hypocalcuria?
Inheritance?
Aldosterone levels?
All of these cause hypokalemia and metabolic alkalosis.
Bartter and Gitelmann causes normotension or hypotension while Liddle causes hypertension.
Bartter’s syndrome causes hypercalciuria while Gitelmann’s syndrome causes hypocalciuria.
Gitelmann’s syndrome causes hpomagnesemia.
Bartter’s and Gitelmann’s are autosomal recessive (AR) while Liddle’s is autosomal dominant (AD).
In Bartter’s and Gitelmann’s there is secondary hyperaldosteronism and in Liddle’s, there is hypoaldosteronism.
Why NSAIDS in barters
NSAIDs reduce polyuria and salt wasting in Bartter’s syndrome
-due to increased renal PGE2 production.
What are striruvate stones made of
Magnesium ammonium phosphate
Pulm odema in context of significant HTN and renal impairment =
Renal artery stenosis
Usual cause of Renal artery stenosis? First line and gold standard Ix?
RX?
Atherosclerosis 90%
US
MRA
Lifestyle / chronic control
If high grade -> angioplasty +/- stents
Why HTN in Renal artery stenosis
Reduced blood flow to kidneys -> produce renin
Reflux nephrophathy usually presents as a child with recurrent infections. Usual presentation in adult
Mild proteinuria/ HTN / renal impairment
Alports has multiple patterns of inheritance, but what form if progresses to renal failure?
Sensory neural deafness is key. But what feature always in first decade
X-linked [type IV collagen -COL4 genes]
Non-visible haemarturia
[-> frank haematuria with chest infections]
Alports common Rx
ACEi or ARBs
Taking allopurinol for gout -> significant kidney impairment. What has happened?
Key blood urine test?
How would this differ if drug was NSAID?
Acute interstitial nephritis
Eosinophilia / urinary eosinophils
No eosinophilia with NSAIDs
Raised urinary eosinophils found in?
AIN
Cholesterol emboli
UTIs
Usual cause of AIN? Rx?
Drug hypersensitivity
Removal of drug
osmolality in DI
high plasma osmolality (≥300 mOsm/Kg)
normal or low urine osmolality (≤280 mOsm/Kg)
What do you expect urinary sodium to be if pre-renal disease? ATN?
Pre renal urinary Na <20
ATN >40
Rapidly progressive glomerulonephritis with:
Linear deposit of IgG?
Hypocomplimentaemia?
Linear deposit of IgG - Anti-GBM
Hypocomplimentaemia - SLE /cryoglobulinaemia / mesangiocapilliary GN
Which PKD if end stage kidney disease in childhood? Chromosome? Most common chromosome for ADPKD
Recessive (Chrom 6)
Chrom 16 (80%)
Which drug can be used in PKD to limit cyst formation>
Tolvaptan (ADH receptor antagonist)
Bar kidney - most common cyst location in PKD
Liver 70%
berry 5%
Acute ATN -> dialysis what % need permanent dialysis? %with long standing mild impairment?
5% dialysis dependent
50% mild impairment
Full bladder and bilat hydronephrosis most likely? Seen in?
Neurogenic bladder
Advanced Diabetes, parkinsons, MS, cerebral vasuclar disease
spinal injuries
Usual Rx of neurogenic bladder
Antimuscarinics
Get Botox injections in MS / spinal cord injuries
Myeloma gold standard Ix
marrow biopsy
1 line on 4 Types of RTA? Which has ++acidosis? Which has hyperkalaemia?
Which gets stones and why?
1 - Distal collecting tubules/collecting duct fail to secrete H+ and absorb K+
->SEVERE acidosis and Hypokalaemia
-Get stones as Ca insoluble in urinary alkalosis (No H+ excretion)
2 - Proximal - fail to resorb bicarbonate
3 - Mix of above
4 - Kidney resistant to aldosterone / low aldosterone levels
-> Hyper K
Neurological decline, mononeuritis, livedo reticularis, p-anca and glomerulonephritis = ? Key Ix? Rx?
Why CNS features?
Microscopic polyangitis
p-ANCA
Renal biopsy
Steroids / cyclophosphamide
Likely recurrent cerebral ischemia
What is livedo reticularis
mottling
due to reduced blood flow
pANCA targets? C ANCA?
P = MPO (myeloperoxidase)
c - PR3 (Proteinase 3)
Key drug class and Eg for symptoms of BPH?
What other class involved ?
A blocker
-Tamsulosin / doxasosin
5-alpha reductase inhibitors
-Finasteride - reduces testosterone
SLC12A3 gene seen in ?
Gitleman
What things cause acute renal tubular damage?
Acute glomerular damage?
Renal artery stenosis
AIN
ATN
Sarcoid
Myeloma
Glomerular is
Immune complex / causes of glomerulonephritis
IgA, IgG and C3 deposits in
mesangioproliferative glomerulonephritis
Who gets minimal change as an adult?
Hodgkins
Diabetes / CKD what are the LDL, Triglycerides and HDL doing
Raised triglycerides and LDL
Low HDL
Kidney transplant rejection Ig if second transplant rejection?
Hyperacute?
IgG
[IgM if first and acute]
IgG in hyperacute
Glomerulonephritis + pulm disease + Upper respiratory =
Granulomatosis with polyangitis
[GBM wouldn’t have upper respiratory]
Gingival hypertrophy by which class of immunosuppressant?
Calcineruin inhibitors
Eg ciclosporin
Key side effect of azathioprine
Marrow suppression
Diabetes + HTN need to prescribe
ACEi/ARB - eg losartan for renal protection
DONT need amlodipine even if black
Following HSP what are chances of getting it again? How many have long term renal failure?
33%
1% failure long term
HSP platelet count? and what is deposited?
NORMAL
Purpura with normal platelets
IgA
Most common cause of infection 1-4 months after renal transplant
Cytomegalovirus
-> Diffuse interstitial pneumonia
Malignant lymphoproliferative disease post renal transplant due to
EBV - usually occurs within 1 year
Who commonly gets type 1 RTA ? Why renal stones?
Autoimmune
Urinary alkalosis
Also high urinary Ca and low urinary citrate
Key factor which can make GFR unreliable
Muscle mass (creatinine directly proportional)
On metformin and acetazolamide which causing asymptomatic acidosis if
Na 137, k+ 3.5, Cl 115, hco3 15? Pathogenesis>
NAGMA
= Acetalzolamide
Inhibits carbonic anhydrase in proximal tubule
->chronic asymptomatic metabolic acidosis
Recurrent UTI, palpable mass in flank, neutrophillia and biopsy showing lipid laden macrophages, urine ++ bacteria? What is Ix of choice?
Xanthogranulomatossis pyelonephritis
[often mimics renal Ca]
CT - Replacement of renal parenchyma by low density and ring enhancemennt
Differentiate Xanthogranulomatosis pyelonephritis and renal abscess
Mass palpable in Xantho
Where do each class of diuretics work?
Carbonic anhydride inhibitors
Osmotic
Loop
Thiazide
Potassium sparing
Sequential site of action along the nephron
COLT Pee
Carbonic anhydrase inhibitors (at the proximal tubule)
Osmotic diuretics (at the Loop of Henle)
Loop diuretics (at the ascending loop)
Thiazides (at the distal tubule)
Potassium-sparing diuretics (at the collecting tubules
Which class of diuretics cause worst lithium toxicity
Thiazide
[Cause reduced Na -> increased lithium absorption]
HepB, now protein/haematuria and HTN. Low C3 Levels. What is this? Seen on biopsy ?
Membranoproliferative glomerulonephritis
Thickening of GBM
BPH with recurrent UTI first line ix? Rx if abnormal?
Post void bladder volume
Finasteride / intermittent catheterisation / TURP
Usual dipstick of ATN
Nothing
[muddy brown casts on microscopy]
MS with urge incontinence 1st line Rx ? if fails?
Oxybutinin
Intravesicular Botox
Recurrent Calcium stones. Rx?
Thiazide diuretics
+potassium citrate
Anti-gbm directed at
Alpha-3 chain of type IV collagen
Nephrotic syndrome and levels of:
thyroxine
Fibrinogen
Antithrombin
Low thyroxine levels as nephrotic loss of thyroxine binding globulin
High fibrinogen as loss of clotting proteins
Low antithrombin, protein S [C less affected]
Collapse of nasa bridge in vasculitis =
Granulomatosis with polyangitis
c-anca MPO
nephrotic syndrome protein electrophoresis. What is a1 and a2 globulins? Albumin ?
Increased a1/a2 globulins
Decreased albumin
AIN secondary to drugs eg diclofenac. What is seen on biopsy
interstitial infiltrate of lymphocytes and eosinophils
Key fidning to differentiate CKD and AKI on imaging
Small kidney size in CKD
(usually 10-12cm and eg 7cm in CKD)
Most common cause of death in dialysis patients
CV disease
-think often longstanding atherosclerotic disease, on EPO etc…
Untreated uti in diabetics leads to?
[Suprapubic pain which -> flank pain]
What is complication?
Renal papillary necrosis
as parts slough off -> ureteric obstruction
New drug now significant AKI and eosinophilia?
AIN
In 2 words what causes renal impairment in haptorenal syndrome?
[Pathology]
Renal vasoconstriction
[Portal HTN -> Nitric oxide production
->Spanchnic and systemic vasodilation
->arterial under-filling and reduced systemic vascular resistance
-> reduced SVR -> renal vessel constriction
Biopsy of lupus nephritis
Diffuse proliferative glomerulonephritis with IgG, IgM and c3 deposits
Long term dialysis -> pain in shoulders and carpal tunnel? why?
Dialysis related amyloidosis due to accumulation of beta-2-microglobin
how many in nephrotic syndrome get renal vein thrombosis
40%
AntiGBM can have which ANCA
p
IgA nephropathy - what is most strongly associated with poor long term outcomes
Hypertension
What causes the damage in rhabdo
myoglobin
What is the mechanism that ACEi both protect kidneys but may reduce gfr
Reduction in the intraglomerular pressure
[if renal artery insufficiency +ACEi
-> unable to keep pressure up to point that maintains GFR]
TB renal imaging Ix of choice
CT urogram (with contrast)
Also need multiple sets of early morning urine cultures
name 2 common urine abx which are CI in preg
cipro
Trimethoprim
Incidence of contrast nephropathy in normal pop? CKD? when is it 60%
5%
25%
60% if Cr >400
Persistent [usually familal] long-term haematuria but nothing else and not progressive Biopsy?
Normal light microscopy and thin basement membranes
Differentiate conn and liddle
Aldosterone levels are high in hyperaldosteronism, whereas they are low to normal in Liddle syndrome.
Sick. EG pancreatitis and now AKI what has with is the pathology of renal damage
ATN - Likely ischemic due to hypotension while septic etc…
Brocnhial Ca + nephrotic syndrome =
Membranous glomerulonephritis
Membranous vs membranoproliferative (mesangiocapiliary).
Nephritic vs nephrotic
Where are complexes deposited
Membranous
Nephrotic
Subepithelial immune complexes
Membranoproliferative
Nephritis (+sometime nephrotic)
-As -itis has inflammatory cells
Subendothelial
Mesangialcapillary glomerulonephritis
3 types
Which is most common?
Associated with HepB/C, measles?
On microscopy which has characteristic finding?
Type 1 - most common
Chronic infection eg Hep B/C
Circulating immune complexes which get deposited + activate the complement pathway
-Tram track on microscopy
[will have low circulating C3]
Type 2
Only Complement deposits
Assoc with Measles
Due to nephritic factor (IgG which activates c3convertase -> more activation of complement)
[will have low circulating C3]
Type 3
Has both subendothelial and sub-epithelial space deposits
Which cholesterol is raised in nephrotic syndrome
LDL
[HDL is normal]
Hx of recurrent UTI
Multiple small calculi in papillary zones on imaging =? Key ix?
Assoc?
What happens in preg?
Medullary sponge kidney
Excretion urography
HyperCa, skeletal hemihypertrophy, RTA
Get more colic/UTI
Which RTA can have urinary pH lowered by increasing acid load?
Which has hyperK
Type 2
[disorder of bicarb absorbtion not h+ secretion]
Type 4
5 types of lupus nephritis
- Minimal mesangial glomerulonephritis.
- Mesangial proliferative glomerulonephritis
- Focal glomerulonephritis.
- Diffuse proliferative nephritis.
- Membranous glomerulonephritis.
What protein: creatinine ratio for nephrotic
> 300mg/mmol
[and 3g/day]
Old woman with dysuria / frequency of UTI but no UTI. What is it? Rx?
Urethral syndrome
Topical oestrogen
Where does most sodium reabsorbtion occur
Proximal convoluted tubule
Why do people get diabetes post transplant
Ciclosporin and steroids increase glucose
Where is epo produced
Interstitial fibroblasts
Aortic aneurysm
Now recked kidneys - but not had a big rupture. Whats happened?
Retroperitoneal fibrosis
->ureteric obstruction
[thought to be due to micro leaks]
What is key prognostic indicator for GPA?
the extent of renal involvement at presentation
[Proportion of sclerosed glomeruli
Poor response to treatment after 2 weeks
Alveolar haemorrhage]
Which cells in graft rejection most
T-cells
Sterile pyuria, haematuria and renal tract calcification, weight loss?
TB
Which RTA often caused by long term NSAIDS
Type 4
[impaires renin / aldosterone secretion]
Antihypertensive good for incontinence issues in men
Doxazosin
Why carpal tunnel in dialysis
beta-2-microglobin depoitision
PKD has absence of
Polycystin
Persistent haematuria with a mild rise in cr in old person and normal US renal. Ix?
Cystoscopy and CTU
Which amyloid in dialysis? Myeloma? Inflam? Downs/Alzheimers?
Dialysis - b-2microglobin
Myeloma - Light chains / AL (lambda)
Inflam - AA
Downs/Alzheimers - AbPP
Sore hands
Proliferative glomerulonephritis with IgA, IgM,IgG, C3 and C4 (and some crescents)
Lupus nephritis type 4
[‘Full house’ on immunoflurourescence = diffuse proliferative]
30s. Hepatosplenomegally with HyperCa and mild proteinurea=?
Sarcoid
Adult with nephrotic syndrome Normal light microscopy but fused podocyte foot processes on electron microscopy
Still minimal change - don’t get thrown by age - can occur in adults
Severe amyloid - what are kidneys
Big - unlike most other causes of CKD
17-year-old girl with recurrent UTI whats the first line Rx
Lifestyle measures Eg post-coital voiding and adequate fluid intake.
Then Ix Eg micturating cytogram
What is HIV associated nephropathy on biopsy
Microcystic tubular dilation and collapsing FSGN
IgA nephrophathy under microscope
Diffuse mesangial proliferation and extraellular matrix exapnsion
Deposits of IgA (and sometimes IgG / c3)
Old person gets first UTI. what do you need to do after Abx?
Re test urine with cytological examination - could be bladder Ca if persistent haematuira
Addison’s get which RTA? Who else gets it?
Type 4
[its due to a deficiency of mineral corticoids ]
Strangely acidosis is actually uncommon in Type 4 RTA
Sickle cell, diabetes
Who gets RTA type 1
Liver disease, SLE/sjorgrens
NSAIDs
Amportectin B
secondary Syphilis can lead to which renal issue
Rapidly progressive glomerulonephritis
Can IgA nephropathy present with nephrotic syndrome?
Yes 5% of the time (likely will have non visible haematuira
Where are deposits in SLE nephritis
Subendothelial
Bar kidney where is most common cyst location in PKD? Bonus marks for common chromosome in PKD
Hepatic
16
CKD with gubbed kidneys presents with pericarditis what is the cause ? Rx?
Uraemic pericarditis
Dialyss
Anti-GMB what HLA
HLA DRB1, DR15, DR2
HLA Cw6
Psoriasis
Pulm oedema, AKI, HTN with Blood + protein on urine dip =
Glomerulonephritis
[RAS would not have blood and protein on dip]
Which Abx cause AIN most
Penicillins, Rifampicin, cephalosporins
What is the most common complication of patient on dialysis
Protein-calorie malnutrition
Most common presenting Sx of retroperitoneal fibrosis
Lower back pain
Finasteride key side effects
Sexual dysfunction
Gynaecomastia
Most common cause of death in someone with ATN
Secondary infectio
Hepatitis and green brown discolouration of cornea? What form of RTA is this assoc with? Electrolytes?
Wilsons
RTA Type 2
-HypoK, HypoPO4
Biopsy of GPA
Necrotising granulomas WITHOUT complement of immune complex deposition
Intermittent flank pain and haematuria with dysmorphic red cells on urinalysis
Loin pain haematuria syndrome
Pre renal failure what would urine osmolality / sodium be?
Raised osmolality
Low Na
Cockily flank pain with renal angle tenderness. Heritability. Normal XR? What on urine analysis? Test for Dx?
Cystinuria
[cystine stone dont show up on XR]
Hexagon shaped crystals
Sodium nitroprusside test
When CMV post transplant? Ix?
Within 6 weeks
CMV PCR
[Serology tests for IgM/IgG and may not have adequate immune response]
Extensive surgical resection for crohns - now extensive renal stones - what are they made from? Rx?
Calcium oxalate
Calcium supplementation
1st session of dialysis -> headache, blurred vision =? What may happen?
Dialysis disequilibrium syndrome
Seizure coma death
Tamsulosin vs finasteride - which has quicker effect on Sx of BPH
A blockers - much faster
5a reductase inhibitors take about 6 months
Most common issue in kidneys if diabetic?
Glomerulosclerosis
If there is haematuria, what structure MUST be affected
Glomeruli
[Tubles would not cause haematuria]
