Renal Flashcards
What do urine dipstics struggle to pick up?
Non-albuminic proteinuria
AIN - 5P’s
Pee - diuretic (part sulfur)
PPI
Pain - NSAIDs
Penicillins and cephalasporins
RifamPin
3 criteria for brain death testing
GCS 3
No brainstem reflexes
APnoea test
Causes of high omsolar gap
Methanol, ethanol, sorbitol (alcohols)
Mechanism of frusemide resistance
Increased Na absorption other sites in nephron –> called ‘braking’
Poor predictors in IgA nephropathy
- predict ESKD
Proteinuria > 1g/day
HTN
Cr
Moa of insulin in hyperkalaemia
Enhances Na/K pump in skeletal muscle
Bartter’s site?
Thick Asc LoH - loop diuretic
Gittelman’s site
DCT - thiazide
Bartter’s vs Gittelman’s differences
Bartter’s - nephrocalcinosis
Gittelman’s - hypercalcaemia, hypomagnesiaemia
Liddle syndrome
- features
- defect
Increased Na channel activity at distal collecting duct
Present’s as Conn’s but low aldosterone
Treatment of Liddle
Traimterone or amiloride (distal Na channel blockers)
Tacrolimus benefits A/E over cyclosporin
Less acute rejection and graft loss
Tacro A/E compared with cyclosporin
More diabetes
More hypomagnesiaemia
More HTN/PRES
Cyclosporin A/E more than tacro
Gum hypertrophy
Hirsutism
Dyslipidaemia
Calciphylaxis management
Correction of CaPO4 product
Sodium thiosulfate
Linear IgG
Anti-GBM
IgA and IgG, but IgA greater
IgA nephropathy or HSP
IgG and C3 seen only - suggestive of?
Causes?
Immune complex
External to GBM = post-strep
Internal/mesangium = MPGN
- Autoimmune/cryo
- M protein/amyloid
Full house - C1q, IgM, IgA, C3, IgG
Lupus
No IgG or C3
Pauci immune
RPGN - ANCA vasculitis
Benefits of MMF over AZA
No drug interaction with xanthine oxidase
No TPMT testing
A/E of MMF compared to AZA
More diarrhoea
Teratogenic
A/E of mTOR over CNI
Wound infection
Teratogenic
Benefits of mTOR over CNI
Less SCC/BCC
Less CMV infection (often used if high risk of reactivation)
Triple phosphate
Struvite
Alkaline urine and stones
Struvite
Coffin lid shaped
Struvite
Which stones to treat with urinary alkalinisation
Uric - 6.5-7
Cysteine - > 7
Type 1 RTA associated with which stones?
Ca oxalate
Envelope shaped
Ca oxalate
Rhomboid shaped calculi
Uric acid
Good to make make Ca and Oxalate soluble in urine
Citrate
LM shows C3 but no IGG
- 2 options?
Dense deposit disease - have sausage waxy shaped
C3 glomerulopathy
Monocytes/t cells in Bowman’s space on Light micrsocopy
Crescents –> RPGN
PLA2R positive and proteinuria - when to biopsy?
Renal impairment
Any other doubt re diagnosis - other risk factors (diabetes, Hep etc)
PLA2R negative but proteinuria
Needs kidney biopsy
Can have negative serum PLA2R in end stage disease
Management of PLA2R Mem GN
< 3.5g proteinuria - monitor PCR and PLA2R
> 3.5g - initiate immunosuppressive therapy with ritux, CNI, or steroids and Cyclo
All patients should also be investigated for? when diagnosed with memb GN
Age related malignancy
Antibody which associated with progression to CKD
2/3 FSGS have elevated levels
SuPAR
FSGS
- congenital and acquired
-primary
Congenital - supportive, no response to steroid
Primary - steroids
Initial treatment of IgA
ACE/ARB
BP control - aim < 140
Salt and water restriction
Who gets glucocorticoids in IgA
Those > 1g proteinuria per day
AFTER 6 months supportive therapy
Oral C5a inhibitor
Avacopan
- Useful in ANCA vasculitis as adjunct
Factors which restrain C3/complement activation
Deficiencies in this make patients susceptible to C3 glomerula disease
Factor H and I
Granular casts
ATN
Muddy brown casts
ATN
Maltese crosses
Oval/lipid bodies - nephrotic syndrome
SGLT-2 perioperative
Stop 3 days before surgery
Start when eating and drinking - for small cases after they return home
Biggest predictor of progression of CKD
Proteinuria
Effects of FGF-23 on
- Kidney
- GIT
- Parathyroids
Kidney - binds klotho co-receptor, reduces PO4 reasborption.
Reduces calcitriol production, so reduces intestinal PO4 absorption
Binds klotho receptor on parathyroids –> suppressed PTH
Deficiency of klotho
Causes
- Reduce renal phosphate excretion
- No suppression of PTH
1,25 hydroxyvitamin D - other name
Calcitriol
Cholecalciferol other name
Vit D3
Where is 25 hydroxyvitamin D made
Liver - from Vit D3 from skin/UV light and diet
Target Hb level on dialysis and EPO
110-115
Factor most predictive of effective haemodialysis
Time on haemodialysis
Risk factors for ischaemic ATN post transplant
DCD - warm isch time higher
Higher ischaemic time
HDx
Age of donor
Post renal Tx, 6 weeks with stent removal and subsequent Cr rise
Likely distal ureteric stenosis
Decoy cells
BK virus
UL97 mutation prevention activation of ganciclovir - what to do for CMV
Use foscarnet
Most commo immunosuppression related malignancy
Skin
Low Mg post Tx, cause?
2nd to tacrolimus
WHere is urine acidified and alkalanised?
Collecting ducts - have highest proportion of a and b intercalated cellsq=
Urine pH cutoff in RTA
5.5`
Most common cause nephrotic syndrome adults
Membranous
Biggest predictor renal failure in PCKD
Measured total kidney volume
Collapsing glomerulosclerosis
HIV
Most specific for GN in urine?
Red cell casts
Dysmorphic red cells can be seen by examining morphology, but not as specific
Best negative predictive value for PCKD
U/S (or imaging) excluding cysts
Which type of AIN usually doesn’t respond to steroids
NSAID induced
Most common GN
IgA
Causes of NAGMA
ABCD
Addison’s
Bicarb loss - GI (diarrhoea) or renal (RTA)
Chloride excess
Diuretic - acezatolamide
Most severe histopath finding of T cell mediate rejection
Transmural arteritis
Aminoglcyoside renal complication faetures
D5-7 rise in Cr
Urine output preserved
ATN rare
Strep skin infections - which AB positive
Anti-DNA ase-B
(can have negative ASOT)
Rhabdomyolysis vs acute AKI from sepsis - electrolyte differences
RHabdo - will have elevated phosphate and reduce Ca due to muscle breakdown
AKI - will have normal phosphate, FGF23 can increase to compensate and reduce phosphate levels (unless already have CKD)
Pathophys of aminoglycoside ATN - which site of nephron?
Proximal tubule
