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MRCP PART 1 > Renal > Flashcards

Renal Flashcards

1
Q

In rhabdo the myoglobin is directly nephrotoxic and causes an AKI in what way? Electrolytes in rhabdo? Same as?

A

Acute tubular necrosis

HyperK, HyperPO4
HypoCa (due to hyperPO4 which causes calcium deposition)

[Same as tumour lysis]

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2
Q

Why DIC in rhabdo

A

thromboplastin release during muscle damage

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3
Q

3 things that stimulate renin release

A

HypoNa (in distal convolute tubule by macula densa cells)
HypoVolaemia (detected by afferent arteriole)
Sympathetic stimulation of B1 receptors

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4
Q

RAAS system

A

Renin converts angiotensin (produced in liver) to angiotensin I.

ACE (produced in lung vasculature) converts Angiotensin I -> Angiotensin II

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5
Q

Effects of angiotensin II on
Vasculature?
Kidney?
Pit?
Nervous system?
Hypothalamus?

A

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

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6
Q

Where in adrenal cortex is aldosterone released? what does it do?

A

Zona glomerulosa

Acts on Distal convoluted tubule [Last part of RAAS acts distal]
- Increases Na reabsorption and potassium excretion
-> Increases osmolarity

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7
Q

Glomerular nephritis includes nephrotic (protein loss predominant) and nephritic syndrome (blood predominant). Most common in Kids? Adults? Black adults?

A

Kids - minimal change disease

Adults - IgA nephropathy (Bergers) disease

Black - FSGN (nephrotic)

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8
Q

Urine protein excretion and albumin levels in nephrotic. Key complications?

A

Urine >3.5g protein excretion / day
Albumin <25

Thrombosis
hyperlipidaemia
Infection

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9
Q

Kid with minimal change on steroids? Rx of hypertension first line? Steroid sparing agent first line? Bar steroids what other Rx is needed?

A

ACEi
Cyclophosphamide

Anticoag - Eg enox / warfarin

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10
Q

Bone disease in diabetic patients (especially if on dialysis) ?

A

Adynamic bone disease

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11
Q

PTH, Ca, PO4 in osteoporosis

A

NORMAL

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12
Q

Who gets osteitis fibrosis cystica

A

HyperPTH

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13
Q

Who gets osteitis fibrosis cystica

A

HyperPTH

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14
Q

What stimulates PTH.
Effects?

A

Low Ca

Increase Ca from bone.
Less Ca exerted in urine
Stimulates vit D -> Increased Ca absorption from intestines

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15
Q

Vit D in CKD ? Why?

A

Low - part of hydroxylation process occurs in kidney

Also high PO4 levels suppress

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16
Q

CKD and PTH

A

Get secondary HyperPTH (low ca)

Or eventually tertiary [high pth high Ca]

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17
Q

1st line phosphate binder (may be used in CKD)

A

Calcium acetate

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18
Q

CKD statins?

A

All CKD 3 or over should be on atorvostatin

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19
Q

HTN on thiazide. What are key biochem side effects causing nephropathy? Rx?

A

Hypercalcaemia, hyperUric acid -> deposition

Change to alternative - eg amlodipine

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20
Q

Why urine dipstick positive for nitrites in UTI?

A

Bacteria -Eg E coli
Break down nitrates into nitrites in urine

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21
Q

What is pollakiuria?

A

Increased urinary frequency
Eg in antipsychotic meds

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22
Q

Most common histological type of RCCs

A

Clear cell adenocarcinoma

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23
Q

Renal tumours, retinal haemangiomas, pancreatic islet cells tunours

A

Von-hippel lindau

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24
Q

Epithelium from urological Cancer

A

transitional

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25
Q

Wilms tumours from?

A

embryonic epithelium (which should have regressed at birth)

-> poorly differentiated epithelium and grow fast / mets fast

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26
Q

Thickened glomerular basement membrane with IgG and C3 deposits + nephrotic syndrome = ? What are 10% assoc with? Rx?

A

Membranous glomerulonephritis -> nephrotic syndrome

Carcinoma: usually SCC bronchial or adenocarcinoma of GI

Prophylactic anticoagulation, Dietary Na restriction, diuretics
Alternating cycles of pred and cyclophosphamide

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27
Q

Most common cause of bilateral ureteric obstruction with anaemia

A

Retroperitoneal fibrosis

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28
Q

Hypertension, hypokalaemic metabolic alkalosis with dominant inheritance

A

Liddle syndrome

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29
Q

Hypokalaemic metabolic alkalosis, HypoCa, HypoMg

A

Gitelman syndrome

Everythings low G [K/Ca/Mg/H+]

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30
Q

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

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

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31
Q

How do ciclosporin and tacrolimus work? Which inflammatory cytokine do they inhibit?

A

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

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32
Q

What class of drug is mycophenolate mofetil

A

Antiproliferative

[selectively impairs B and T cell production]

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33
Q

Cause of HTN in turners

A

coarctation

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34
Q

Why are CKD anaemic

A

Mainly reduced EPO

Decreased dietary iron
Decreased iron absorption
GI blood loss due to capillary fragility + platelet dysfunction
RBC survival reduced Eg haemodialysis

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35
Q

Limited cutaneous sclerosis signs and symptoms

A

CREST
Calcinosis on skin usually fingertips
Raynauds
Esophageal dysmotility
Telangectasia

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36
Q

tight shiny skin on fingers. AKI and Hypertensive crisis? Pathogenic hallmark?

A

Scleroderma renal crisis
mucoid intimal thickening of vascular endothelium

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37
Q

Systemic sclerosis with dry cough and SOB progression =

A

Pulmonary fibrosis as complication of systemic sclerosis
[Also get pulm HTN]

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38
Q

Antibodies in scleroderma? Which is marker of severe disease?

A

ANA
Anti-centromere - in limited cutaneous

Anti-SCL 70 in severe diffuse disease (SCLerodema)

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39
Q

Differentiate primary raynauds and secondary caused by systemic sclerosis

A

Visulaise with nailfold capiliaroscopy

Systemic sclerosis will have abnormal capillaries, avascular areas and capillary haemorrhage

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40
Q

Drug for Rx of severe digital ischemia

A

iloprost

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41
Q

How does VU reflex present?
Key Ix

A

UTIs as kid
May have had hydronephrosis on fetal US

Micturating cysturethrogram
US scan
DMSA scan

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42
Q

Pharma Rx of VU reflux

A

Prophylactic Abx if recurrent UTI to prevent scarring

May use anticolinergics Eg Oxybutynin to increase bladder capacity / reduce contractions

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43
Q

When is an AKI ATN?

A

Usually quick onset - it is ischemia + necrosis
Shock/sepsis/dehydration
NSAIDs /Gent /contrast dye

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44
Q

Muddy brown casts on urinanysis

A

ATN - pathagnomonic

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45
Q

Acute interstitial nephritis usually due to ? Presents?

A

Drugs Eg NSAIDs / Abx

Features of hypersensitivity - rash/fever/eosinophilia

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46
Q

Pt from easten europe
Yellow palms and soles
AKI/CKD

A

balkan nephropathy

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47
Q

Asymptomatic UTI in preg

A

Nitrofurantoin 7 days
Or amox if has sensitivities

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48
Q

Who gets a urine dipstick with sx of UTI

A

Women under 65

Men and women >65 need C&S

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49
Q

Amyloid histology stain? Shows?

A

Congo red positive stain

Green birefringence under polarised light

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50
Q

Formal amyloid Dx requires biopsy + histology. What less invasive tests are there? Which test for prognosis?

A

Serum immunofixation
Urine immunofixation
Immunuglobin free light chain assay - sensitive

Beta-2-microglobin for prognosis

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51
Q

Rx of amyloid? How to monitor repsponse to Rx?

A

Chemo / marrow Tx

Monitor levels of free light chains in blood

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52
Q

AL is main (primary amlyloid) AmyLoid
Which type seen in chronic conditions?

A

AA
->Rx is controlling other condition Eg IBD/Rheum/Malignancy

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53
Q

Amyloid affects many organs. Some key things to raise suspicion in question

A

Inflam disease Eg Rhem / IBD (if AA amyloid)

Nephrotic syndrome
Cardiac failure
Neuropathy

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54
Q

Most common inflam condition with AA amyloid

A

Rhem arthritis

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55
Q

Lipodystophy and nephrotic syndrome? Key Ix for diagnosis?

A

Mesangiocapilliary nephritis

Complement studies
[Will show low C3 with normal C4]

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56
Q

Post partum may develop a thrombotic microangiopathy. How would you differentiate HUS and HELLP syndrome? What needs to be considered in HUS post partum?

A

Normal clotting indicies in HUS

Need to consider retained products of conception

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57
Q

CIs to lithotripsy

A

Bleedy
Pregnant
Urosepsis
Obstruction distal

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58
Q

Which two things in blood stop stone formation

A

Magnesium
Citrate

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59
Q

Most common type of urinary stone

A

mixed calcium oxylate and phosphate

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60
Q

Ureteric colic choice of analgesia. Whar else should everyone get if stone < 10mm

A

Rectal diclofenac if normal renal function

Tamsulosin (alpha blocker)

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61
Q

Calcium oxylate stones. Recurrence prevention drugs

A

Potassium citrate

Thiazide directics - increase calcium resorption

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62
Q

Hep B Nephrotic syndrome pathophysiology

A

membranous nephropathy

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63
Q

Mesangiocapiliary glomerulonephritis. With Pan Hypocomplimentaemia. Nephritc/nephrotic syndrome is what infection

A

Hep C

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64
Q

What causes stag horn calculi ? Pathogenesis and type of stone

A

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]

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65
Q

Differentiate high red cell counnt from polycythemia and from RCC

A

Erythropoetin levels

-High in RCC or if hypoxic cause
-low in polycythemia vera

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66
Q

CT demonstrates ring shaddows in medulae and pelvis filling defects =? Common cause?

A

Papilliary necrosis
Often caused by high dose NSAID + hypotension

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67
Q

Define AKI

A

Oliguria <0.5ml/kg for >6hrs
Raise in Cr by >50%
Raise in Cr by 26 in 48 hrs

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68
Q

Cystine stones caused by

A

cystinuria (familial)

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69
Q

Hyperoxaluria is a rare primary cause of stones. What usually causes it?

A

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]

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70
Q

Proximal tubular dysfunction
->glycosuria, proteinuria, amioaciduria, citraturea
Bone pain =?

[If proline and arginine in normal levels in urine =?

A

Fanconi syndrome

[Hartnup syndrome]

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71
Q

Frank haematuria + URTI / Gastroenteritis =?
[usually have a fever + inflam response]

Seen on urine microscopy?

Rx?

A

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

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72
Q

SLE + acute glomerulonephritis. Seen on microscopy of biosy?

A

Capillary wire looping
(diffuse subendothelial glomerular deposits)

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73
Q

Rapidly progressive glomerulonephritis. Characteristic findings on biopsy?

A

Crescents of fibrin and plasma protein

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74
Q

Minimal change disease. Seen on biopsy

A

effacement of food processes

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75
Q

Differentiate post-strep glomerulonephritis and IgA nephritis

A

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]

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76
Q

Solute removal in haemodialysis ? Water removal ?

A

Solute - diffusion

Water - ultrafiltration

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77
Q

Key severe complication with IV urography

A

Contrast nephrotoxity

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78
Q

Urine osmolality / Na level urinalysis of ATN

A

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]

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79
Q

Pathagnomic of alports? Other key features
Seen on echo?
What is alports a disorder of?

A

Anterior lenticonus

Progressive CKD and bilat sensorineural deafness

Left ventricular hypertrophy on echo

Disorder of collagen IV (Genes COL4A-)

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80
Q

Which antihypertensives have no effect on RAAS system? Eg can be continued during aldosterone studies for resistant hypertension

A

A blockers - Eg doxazosin

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81
Q

Pulm haemorrhage and rapid progressive glomerulonephritis. ANCA Negative =? Gene? Biopsy of lung / renal? Rx?

A

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]

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82
Q

Cancer + nephrotic syndrome = ? Seen on biopsy?

A

Membranous glomerulonephropathy

Subepitheial deposition of IgG and c3

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83
Q

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?

A

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

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84
Q

Recurrent UTI with same bug usually means?

A

Failure to eradicate pathogen secondary to:
-stones
-scarring
-PKD
-Proctatitis

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85
Q

Why prothrombotic in nephrotic syndrome

A

Loss of protein S and antithrombin in urine

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86
Q

Diabetes with Cr of > 200, glucose 7.8. Multiple episodes of pulm oedema. Different kidney sizes and hypertension. Cause od kidney disease

A

Renal artery stenosis
[HTN, Different sizes, pulm oedema recurrent]

NOT diabetic nephropathy

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87
Q

PKD inheritance

A

dominant

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88
Q

What mechanism does gent cause renal damage?

A

Proximal tubular dysfunction

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89
Q

Lung cancer + nephrotic syndrome likely is? Seen on histology? Which 2 cancers mostly assoc?

A

Membranous glomerulonephritis

Thickened glomerular basement membrane with IgG and C3 deposits + nephrotic syndrome

Lung SCC / bowel adenocarcinoma

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90
Q

Bartters
Gitetleman
Liddle
Where in kidney? Similar to? Which transporters?

A

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

91
Q

Rx Liddles why

A

Amiloride or triamterene block ENaC

[In liddles constantly activated]

92
Q

Bartter, gitelman and liddle all cause?

BP?

Which causes hypercalcuria/hypocalcuria?

Inheritance?

Aldosterone levels?

A

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.

93
Q

Why NSAIDS in barters

A

NSAIDs reduce polyuria and salt wasting in Bartter’s syndrome
-due to increased renal PGE2 production.

94
Q

What are striruvate stones made of

A

Magnesium ammonium phosphate

95
Q

Pulm odema in context of significant HTN and renal impairment =

A

Renal artery stenosis

96
Q

Usual cause of Renal artery stenosis? First line and gold standard Ix?
RX?

A

Atherosclerosis 90%

US
MRA

Lifestyle / chronic control
If high grade -> angioplasty +/- stents

97
Q

Why HTN in Renal artery stenosis

A

Reduced blood flow to kidneys -> produce renin

98
Q

Reflux nephrophathy usually presents as a child with recurrent infections. Usual presentation in adult

A

Mild proteinuria/ HTN / renal impairment

99
Q

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

A

X-linked [type IV collagen -COL4 genes]

Non-visible haemarturia
[-> frank haematuria with chest infections]

100
Q

Alports common Rx

A

ACEi or ARBs

101
Q

Taking allopurinol for gout -> significant kidney impairment. What has happened?
Key blood urine test?
How would this differ if drug was NSAID?

A

Acute interstitial nephritis

Eosinophilia / urinary eosinophils

No eosinophilia with NSAIDs

102
Q

Raised urinary eosinophils found in?

A

AIN
Cholesterol emboli
UTIs

103
Q

Usual cause of AIN? Rx?

A

Drug hypersensitivity

Removal of drug

104
Q

osmolality in DI

A

high plasma osmolality (≥300 mOsm/Kg)

normal or low urine osmolality (≤280 mOsm/Kg)

105
Q

What do you expect urinary sodium to be if pre-renal disease? ATN?

A

Pre renal urinary Na <20

ATN >40

106
Q

Rapidly progressive glomerulonephritis with:

Linear deposit of IgG?
Hypocomplimentaemia?

A

Linear deposit of IgG - Anti-GBM

Hypocomplimentaemia - SLE /cryoglobulinaemia / mesangiocapilliary GN

107
Q

Which PKD if end stage kidney disease in childhood? Chromosome? Most common chromosome for ADPKD

A

Recessive (Chrom 6)

Chrom 16 (80%)

108
Q

Which drug can be used in PKD to limit cyst formation>

A

Tolvaptan (ADH receptor antagonist)

109
Q

Bar kidney - most common cyst location in PKD

A

Liver 70%
berry 5%

110
Q

Acute ATN -> dialysis what % need permanent dialysis? %with long standing mild impairment?

A

5% dialysis dependent

50% mild impairment

111
Q

Full bladder and bilat hydronephrosis most likely? Seen in?

A

Neurogenic bladder

Advanced Diabetes, parkinsons, MS, cerebral vasuclar disease

spinal injuries

112
Q

Usual Rx of neurogenic bladder

A

Antimuscarinics

Get Botox injections in MS / spinal cord injuries

113
Q

Myeloma gold standard Ix

A

marrow biopsy

114
Q

1 line on 4 Types of RTA? Which has ++acidosis? Which has hyperkalaemia?
Which gets stones and why?

A

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

115
Q

Neurological decline, mononeuritis, livedo reticularis, p-anca and glomerulonephritis = ? Key Ix? Rx?
Why CNS features?

A

Microscopic polyangitis

p-ANCA
Renal biopsy

Steroids / cyclophosphamide

Likely recurrent cerebral ischemia

116
Q

What is livedo reticularis

A

mottling
due to reduced blood flow

117
Q

pANCA targets? C ANCA?

A

P = MPO (myeloperoxidase)

c - PR3 (Proteinase 3)

118
Q

Key drug class and Eg for symptoms of BPH?

What other class involved ?

A

A blocker
-Tamsulosin / doxasosin

5-alpha reductase inhibitors
-Finasteride - reduces testosterone

119
Q

SLC12A3 gene seen in ?

A

Gitleman

120
Q

What things cause acute renal tubular damage?
Acute glomerular damage?

A

Renal artery stenosis
AIN
ATN
Sarcoid
Myeloma

Glomerular is
Immune complex / causes of glomerulonephritis

121
Q

IgA, IgG and C3 deposits in

A

mesangioproliferative glomerulonephritis

122
Q

Who gets minimal change as an adult?

A

Hodgkins

123
Q

Diabetes / CKD what are the LDL, Triglycerides and HDL doing

A

Raised triglycerides and LDL

Low HDL

124
Q

Kidney transplant rejection Ig if second transplant rejection?
Hyperacute?

A

IgG

[IgM if first and acute]

IgG in hyperacute

125
Q

Glomerulonephritis + pulm disease + Upper respiratory =

A

Granulomatosis with polyangitis

[GBM wouldn’t have upper respiratory]

126
Q

Gingival hypertrophy by which class of immunosuppressant?

A

Calcineruin inhibitors
Eg ciclosporin

127
Q

Key side effect of azathioprine

A

Marrow suppression

128
Q

Diabetes + HTN need to prescribe

A

ACEi/ARB - eg losartan for renal protection

DONT need amlodipine even if black

129
Q

Following HSP what are chances of getting it again? How many have long term renal failure?

A

33%

1% failure long term

130
Q

HSP platelet count? and what is deposited?

A

NORMAL
Purpura with normal platelets

IgA

131
Q

Most common cause of infection 1-4 months after renal transplant

A

Cytomegalovirus
-> Diffuse interstitial pneumonia

132
Q

Malignant lymphoproliferative disease post renal transplant due to

A

EBV - usually occurs within 1 year

133
Q

Who commonly gets type 1 RTA ? Why renal stones?

A

Autoimmune

Urinary alkalosis
Also high urinary Ca and low urinary citrate

134
Q

Key factor which can make GFR unreliable

A

Muscle mass (creatinine directly proportional)

135
Q

On metformin and acetazolamide which causing asymptomatic acidosis if
Na 137, k+ 3.5, Cl 115, hco3 15? Pathogenesis>

A

NAGMA
= Acetalzolamide

Inhibits carbonic anhydrase in proximal tubule

->chronic asymptomatic metabolic acidosis

136
Q

Recurrent UTI, palpable mass in flank, neutrophillia and biopsy showing lipid laden macrophages, urine ++ bacteria? What is Ix of choice?

A

Xanthogranulomatossis pyelonephritis

[often mimics renal Ca]

CT - Replacement of renal parenchyma by low density and ring enhancemennt

137
Q

Differentiate Xanthogranulomatosis pyelonephritis and renal abscess

A

Mass palpable in Xantho

138
Q

Where do each class of diuretics work?
Carbonic anhydride inhibitors
Osmotic
Loop
Thiazide
Potassium sparing

A

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

139
Q

Which class of diuretics cause worst lithium toxicity

A

Thiazide

[Cause reduced Na -> increased lithium absorption]

140
Q

HepB, now protein/haematuria and HTN. Low C3 Levels. What is this? Seen on biopsy ?

A

Membranoproliferative glomerulonephritis

Thickening of GBM

141
Q

BPH with recurrent UTI first line ix? Rx if abnormal?

A

Post void bladder volume

Finasteride / intermittent catheterisation / TURP

142
Q

Usual dipstick of ATN

A

Nothing

[muddy brown casts on microscopy]

143
Q

MS with urge incontinence 1st line Rx ? if fails?

A

Oxybutinin

Intravesicular Botox

144
Q

Recurrent Calcium stones. Rx?

A

Thiazide diuretics
+potassium citrate

145
Q

Anti-gbm directed at

A

Alpha-3 chain of type IV collagen

146
Q

Nephrotic syndrome and levels of:
thyroxine
Fibrinogen
Antithrombin

A

Low thyroxine levels as nephrotic loss of thyroxine binding globulin

High fibrinogen as loss of clotting proteins

Low antithrombin, protein S [C less affected]

147
Q

Collapse of nasa bridge in vasculitis =

A

Granulomatosis with polyangitis
c-anca MPO

148
Q

nephrotic syndrome protein electrophoresis. What is a1 and a2 globulins? Albumin ?

A

Increased a1/a2 globulins

Decreased albumin

149
Q

AIN secondary to drugs eg diclofenac. What is seen on biopsy

A

interstitial infiltrate of lymphocytes and eosinophils

150
Q

Key fidning to differentiate CKD and AKI on imaging

A

Small kidney size in CKD
(usually 10-12cm and eg 7cm in CKD)

151
Q

Most common cause of death in dialysis patients

A

CV disease
-think often longstanding atherosclerotic disease, on EPO etc…

152
Q

Untreated uti in diabetics leads to?
[Suprapubic pain which -> flank pain]
What is complication?

A

Renal papillary necrosis

as parts slough off -> ureteric obstruction

153
Q

New drug now significant AKI and eosinophilia?

A

AIN

154
Q

In 2 words what causes renal impairment in haptorenal syndrome?

[Pathology]

A

Renal vasoconstriction

[Portal HTN -> Nitric oxide production

->Spanchnic and systemic vasodilation

->arterial under-filling and reduced systemic vascular resistance

-> reduced SVR -> renal vessel constriction

155
Q

Biopsy of lupus nephritis

A

Diffuse proliferative glomerulonephritis with IgG, IgM and c3 deposits

156
Q

Long term dialysis -> pain in shoulders and carpal tunnel? why?

A

Dialysis related amyloidosis due to accumulation of beta-2-microglobin

157
Q

how many in nephrotic syndrome get renal vein thrombosis

A

40%

158
Q

AntiGBM can have which ANCA

A

p

159
Q

IgA nephropathy - what is most strongly associated with poor long term outcomes

A

Hypertension

160
Q

What causes the damage in rhabdo

A

myoglobin

161
Q

What is the mechanism that ACEi both protect kidneys but may reduce gfr

A

Reduction in the intraglomerular pressure

[if renal artery insufficiency +ACEi
-> unable to keep pressure up to point that maintains GFR]

162
Q

TB renal imaging Ix of choice

A

CT urogram (with contrast)

Also need multiple sets of early morning urine cultures

163
Q

name 2 common urine abx which are CI in preg

A

cipro
Trimethoprim

164
Q

Incidence of contrast nephropathy in normal pop? CKD? when is it 60%

A

5%

25%

60% if Cr >400

165
Q

Persistent [usually familal] long-term haematuria but nothing else and not progressive Biopsy?

A

Normal light microscopy and thin basement membranes

166
Q

Differentiate conn and liddle

A

Aldosterone levels are high in hyperaldosteronism, whereas they are low to normal in Liddle syndrome.

167
Q

Sick. EG pancreatitis and now AKI what has with is the pathology of renal damage

A

ATN - Likely ischemic due to hypotension while septic etc…

168
Q

Brocnhial Ca + nephrotic syndrome =

A

Membranous glomerulonephritis

169
Q

Membranous vs membranoproliferative (mesangiocapiliary).
Nephritic vs nephrotic
Where are complexes deposited

A

Membranous
Nephrotic
Subepithelial immune complexes

Membranoproliferative
Nephritis (+sometime nephrotic)
-As -itis has inflammatory cells
Subendothelial

170
Q

Mesangialcapillary glomerulonephritis
3 types
Which is most common?
Associated with HepB/C, measles?
On microscopy which has characteristic finding?

A

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

171
Q

Which cholesterol is raised in nephrotic syndrome

A

LDL

[HDL is normal]

172
Q

Hx of recurrent UTI
Multiple small calculi in papillary zones on imaging =? Key ix?
Assoc?
What happens in preg?

A

Medullary sponge kidney

Excretion urography

HyperCa, skeletal hemihypertrophy, RTA

Get more colic/UTI

173
Q

Which RTA can have urinary pH lowered by increasing acid load?

Which has hyperK

A

Type 2
[disorder of bicarb absorbtion not h+ secretion]

Type 4

174
Q

5 types of lupus nephritis

A
  1. Minimal mesangial glomerulonephritis.
  2. Mesangial proliferative glomerulonephritis
  3. Focal glomerulonephritis.
  4. Diffuse proliferative nephritis.
  5. Membranous glomerulonephritis.
175
Q

What protein: creatinine ratio for nephrotic

A

> 300mg/mmol

[and 3g/day]

176
Q

Old woman with dysuria / frequency of UTI but no UTI. What is it? Rx?

A

Urethral syndrome
Topical oestrogen

177
Q

Where does most sodium reabsorbtion occur

A

Proximal convoluted tubule

178
Q

Why do people get diabetes post transplant

A

Ciclosporin and steroids increase glucose

179
Q

Where is epo produced

A

Interstitial fibroblasts

180
Q

Aortic aneurysm
Now recked kidneys - but not had a big rupture. Whats happened?

A

Retroperitoneal fibrosis
->ureteric obstruction

[thought to be due to micro leaks]

181
Q

What is key prognostic indicator for GPA?

A

the extent of renal involvement at presentation

[Proportion of sclerosed glomeruli
Poor response to treatment after 2 weeks
Alveolar haemorrhage]

182
Q

Which cells in graft rejection most

A

T-cells

183
Q

Sterile pyuria, haematuria and renal tract calcification, weight loss?

A

TB

184
Q

Which RTA often caused by long term NSAIDS

A

Type 4
[impaires renin / aldosterone secretion]

185
Q

Antihypertensive good for incontinence issues in men

A

Doxazosin

186
Q

Why carpal tunnel in dialysis

A

beta-2-microglobin depoitision

187
Q

PKD has absence of

A

Polycystin

188
Q

Persistent haematuria with a mild rise in cr in old person and normal US renal. Ix?

A

Cystoscopy and CTU

189
Q

Which amyloid in dialysis? Myeloma? Inflam? Downs/Alzheimers?

A

Dialysis - b-2microglobin
Myeloma - Light chains / AL (lambda)
Inflam - AA
Downs/Alzheimers - AbPP

190
Q

Sore hands
Proliferative glomerulonephritis with IgA, IgM,IgG, C3 and C4 (and some crescents)

A

Lupus nephritis type 4

[‘Full house’ on immunoflurourescence = diffuse proliferative]

191
Q

30s. Hepatosplenomegally with HyperCa and mild proteinurea=?

A

Sarcoid

192
Q

Adult with nephrotic syndrome Normal light microscopy but fused podocyte foot processes on electron microscopy

A

Still minimal change - don’t get thrown by age - can occur in adults

193
Q

Severe amyloid - what are kidneys

A

Big - unlike most other causes of CKD

194
Q

17-year-old girl with recurrent UTI whats the first line Rx

A

Lifestyle measures Eg post-coital voiding and adequate fluid intake.

Then Ix Eg micturating cytogram

195
Q

What is HIV associated nephropathy on biopsy

A

Microcystic tubular dilation and collapsing FSGN

196
Q

IgA nephrophathy under microscope

A

Diffuse mesangial proliferation and extraellular matrix exapnsion
Deposits of IgA (and sometimes IgG / c3)

197
Q

Old person gets first UTI. what do you need to do after Abx?

A

Re test urine with cytological examination - could be bladder Ca if persistent haematuira

198
Q

Addison’s get which RTA? Who else gets it?

A

Type 4
[its due to a deficiency of mineral corticoids ]
Strangely acidosis is actually uncommon in Type 4 RTA

Sickle cell, diabetes

199
Q

Who gets RTA type 1

A

Liver disease, SLE/sjorgrens
NSAIDs
Amportectin B

200
Q

secondary Syphilis can lead to which renal issue

A

Rapidly progressive glomerulonephritis

201
Q

Can IgA nephropathy present with nephrotic syndrome?

A

Yes 5% of the time (likely will have non visible haematuira

202
Q

Where are deposits in SLE nephritis

A

Subendothelial

203
Q

Bar kidney where is most common cyst location in PKD? Bonus marks for common chromosome in PKD

A

Hepatic

16

204
Q

CKD with gubbed kidneys presents with pericarditis what is the cause ? Rx?

A

Uraemic pericarditis
Dialyss

205
Q

Anti-GMB what HLA

A

HLA DRB1, DR15, DR2

206
Q

HLA Cw6

A

Psoriasis

207
Q

Pulm oedema, AKI, HTN with Blood + protein on urine dip =

A

Glomerulonephritis

[RAS would not have blood and protein on dip]

208
Q

Which Abx cause AIN most

A

Penicillins, Rifampicin, cephalosporins

209
Q

What is the most common complication of patient on dialysis

A

Protein-calorie malnutrition

210
Q

Most common presenting Sx of retroperitoneal fibrosis

A

Lower back pain

211
Q

Finasteride key side effects

A

Sexual dysfunction
Gynaecomastia

212
Q

Most common cause of death in someone with ATN

A

Secondary infectio

213
Q

Hepatitis and green brown discolouration of cornea? What form of RTA is this assoc with? Electrolytes?

A

Wilsons
RTA Type 2
-HypoK, HypoPO4

214
Q

Biopsy of GPA

A

Necrotising granulomas WITHOUT complement of immune complex deposition

215
Q

Intermittent flank pain and haematuria with dysmorphic red cells on urinalysis

A

Loin pain haematuria syndrome

216
Q

Pre renal failure what would urine osmolality / sodium be?

A

Raised osmolality
Low Na

217
Q

Cockily flank pain with renal angle tenderness. Heritability. Normal XR? What on urine analysis? Test for Dx?

A

Cystinuria
[cystine stone dont show up on XR]

Hexagon shaped crystals

Sodium nitroprusside test

218
Q

When CMV post transplant? Ix?

A

Within 6 weeks
CMV PCR
[Serology tests for IgM/IgG and may not have adequate immune response]

219
Q

Extensive surgical resection for crohns - now extensive renal stones - what are they made from? Rx?

A

Calcium oxalate

Calcium supplementation

220
Q

1st session of dialysis -> headache, blurred vision =? What may happen?

A

Dialysis disequilibrium syndrome

Seizure coma death

221
Q

Tamsulosin vs finasteride - which has quicker effect on Sx of BPH

A

A blockers - much faster

5a reductase inhibitors take about 6 months

222
Q

Most common issue in kidneys if diabetic?

A

Glomerulosclerosis

223
Q

If there is haematuria, what structure MUST be affected

A

Glomeruli

[Tubles would not cause haematuria]

MRCP PART 1 (22 decks)

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