Renal Flashcards

1
Q

Predictors for rapid renal disease progression in ADPKD - name 6

Which is the strongest predictor

A

Low water intake
Large kidney volume (strongest predictor)
Haematuria
Early onset of HTN
Early decrease in gfr
PKD1 mutation

Others - smoking, caffeine, high protein intake, proteinuria

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2
Q
  1. A 72-year-old man presents with acute kidney injury, haematuria and proteinuria. A renal biopsy shows membranoproliferative glomerulonephritis, with strong C3 staining on immunofluorescence. Staining for immune complexes was negative.
    Which of the following is most likely to be an associated underlying disorder?

A. Diabetes mellitus
B. Monoclonal gammopathy
C. Malignant hypertension
D. Hepatitis B

A

B. Monoclonal gammopathy

Membrnaoprolofierative GN with C3 staining can be seen with HBV but would stain positive for immune complexes

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3
Q

Most common cause of death of people over 75 years of age on haemodialysis?

A

Withdrawal from dialysis

CVD in <75yo

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4
Q

Which drugs can be cleared by haemodialysis?

A

Barbiturate
Lithium
Alcohol (methanol,ethylene glycol)
Salicylates
Theophyllines

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5
Q

What is most likely to improve after adrenalectomy in unilateral adrenal hyperplasia?

A

Hypokalemia - improves in 100% of cases

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6
Q

Name 4 drugs which increase lithium blood levels and 1 drug that decreases lithium blood levels

A

Diuretics acting at DCT increase levels: hydrochlorothiazide, spironolactone, triamterene

also frusemide increases levels

Diuretics acting at proximal tubule (site of lithium absorption) decrease lithium levels: acetazolamide

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7
Q

Electrolyte abnormalities in Gittlemans syndrome + genetic mutation

A

Mimics THIAZIDES (Tim is a GIT MAN)

2 Ms, pee out C

Metabolic alkalosis
HypoMagnesemia
Hypercalcemia with hypocalcuria
Hypokalemia

Genetic mutation - NKCC1 loss of function mutation (gene coding for Na and Cl co transporter of DCT)

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8
Q

Site of action of frusemide

A

Ascending loop of Henle
Blocks NKCC2 transporter

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9
Q

Ferritin/transferrin targets in end stage renal failure patients

A

Ferritin >200
Transferrin saturation > 20%.

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10
Q

Target hb range in CKD patients

A

> 110g/dL

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11
Q

Role of principal cells in the nephron

A

Reabsorb sodium, secrete potassium

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12
Q

Role of intercalated cells in the nephron

A

Type A (alpha): secrete Acid, reabsorb base (bicarb)

Type B (beta): secrete Bicarb (base), reabsorb acid

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13
Q

Role of peritubular cells in the nephron

A

Synthesize EPO

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14
Q

Electrolyte abnormalities in Barters syndrome

Hormone elevated in the urine?

A

Mimics actions of frusemide (defect in NKCC2)

Metabolic alkalosis, hypocalcemia, hypokalemia

Urine prostaglanin E elevated

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15
Q

Name 3 causes of sterile pyuria

A

interstitial nephritis
renal tuberculosis
nephrolithiasis

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16
Q

Recurrent haematuria after resp infections + family history renal failure

A

Alport syndrome

17
Q

Metabolic abnormalities in excess vomiting

A

metabolic alkalosis

18
Q

Metabolic abnormalities in diarrhea

A

NAGMA due to loss of bicarbonate

Also seen in ureterosigmoidostomyjejunal loop (not really done anymore - for this reason)

19
Q

Which RTA is associated with hypercalcuria?
Urine Ph in this RTA?

A

T2 RTA (distal)
Urine ph >5.5

20
Q

Mechanism of action of mycophenylate

A

Reversible inhibitor of Inositol Monophosphate Dehydrogenase(IMPDH) –> inhibits purine biosynthesis –> inhibits T + B cell proliferation

21
Q

Investigation of choice for light chain amyloidosis

A

Abdominal fat pad aspirate

22
Q

Most common histologic feature seen in chronic allograft nephropathy

A

Chronic interstitial fibrosis

23
Q

Which of the following is least useful in acute renal Tx rejection?
A. Tacrolimus
B. Sirolimus
C. MMF
D. Cyclosporine
E. Methylpred

A

D - Cyclosporin

24
Q

Name 4 advantages of cyclosporine over tacrolimus
Name 4 disadvantages

A

Cyclosporine advantages
- less diabetogenic
- less nephrotoxicity
- less neurotoxicity
- doesn’t cause hair loss

Cyclosporin disadvantages
- more hyperlipidemia and HTN
- causes gingival hyperplasia
- less potent
- more nephrotoxic

25
Q

Which of the following can be used in pregnancy?
A. MMF
B. MTOR inhibitoirs
C. CNI

A

C - CNI (cyclosporin>tacro)

26
Q

Drugs associated with FSGS

A

Heroin
bisphosphonates
interferon alpha
anabolic steroids

less clear link - sirolmus, lithium, CNI, anthracyclines

27
Q

Most common manifesation of lupus nephritis

A

proteinuria

28
Q

Therapies for acute antibody mediated rejection

cell mediated?

A

glucocorticoids, plasmapheresis, and intravenous immune
globulin

Cell mediated - steroids + antithymocyte globulin (high grade)

29
Q

Which GN is most likely to recur with transplant?
Which rercurs most rapidly

A

IgA nephropathy
FSGS most rapidly

30
Q

GN with greatest risk of VTE

A

Membranous

31
Q

A 37 year old male with a family history of Autosomal Dominant Polycystic Kidney Disease is inquiring about kidney donation to his affected sister with end stage kidney disease. Which family member should undergo genetic testing to guide transplant decisions?

A

She should - need to identify the gene.

32
Q

Major vascular bed controlling blood pressure at the renal level

A

afferent arteriole

33
Q

Afferent or efferent constriction or dilatation:
- NSAID
- ACE-I
- SGLT2

A

NSAID: afferent arteriole constriction (prevent PGE2 production–> inhibit vasodilation)

ACE-I: efferent arteriole vasodilation

SGLT2: afferent arteriole constriction