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BPT Sadness 😔 > Renal > Flashcards

Renal Flashcards

1
Q

What is the most common type of RTA?

A

Type IV

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2
Q

Most common type of kidney stone?

A

Calcium oxalate

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3
Q

Where does phosphate absorption occur in the nephron?

A

Proximal tubule (P for Phosphate)

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4
Q

What is rate of spontaneous remission in membranous nephropathy?

A

30% of patients

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5
Q

In E. coli, Pseudomonas, Klebsiella UTIs, is urine pH likely to be higher or lower?

A

Usually high/alkaline
- Urease-splitting organisms

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6
Q

Why is nephrotic syndrome a hypercoagulable state?
• DVT, PE, renal vein thrombosis

A

Excretion of
• LMW anticoagulants - AT III, protein S
• Fibrinolytics - plasminogen

Overproduction of proteins (intrinsic response to hypoalbuminuria)
• Hyperlipidaemia
• Procoagulants - factor V, factor VIII, fibrinogen

Membranous nephropathy highest risk

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7
Q

In Goodpasture syndrome, what do anti-GBM Ab target?

A

Alpha-3 chain of type IV collagen

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8
Q

Which type of vasculitis-associated ANCA has higher rates of relapse?

A

c-ANCA/anti-PR3
• Think “chronic ANCA”

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9
Q

Which complement pathway do immune complex-mediated GN activate, and what are their C3 and C4 levels?

What is the exception?

A

Classical complement pathway
- Usually LOW C3 + C4

Exception - IgA nephropathy due to chronic and gradual nature

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10
Q

Alternative loop diuretic if allergies to sulfonamides (i.e. frusemide)?

A

Etacrynic acid

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11
Q

Potent diuretic in setting of refractory congestion?

A

Metolazone

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12
Q

What is the main benefit of EPO in CKD?

A

Improved exercise tolerance

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13
Q

Normotension, hypokalaemia + hypocalciuria makes you think?

A

Gitelman’s syndrome
- Little man’s syndrome/everything is small

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14
Q

Most common glomerular disease?

A

IgA nephropathy
- 8x more likely to have clots

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15
Q

Nephrotic syndrome protein cut off?

A

Proteinurua >3.5g/24 hours

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16
Q

Most common hereditary nephritis?

A

Alport syndrome
- Mutation in genes encoding alpha 3, 4, 5 chains of type IV collagen

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17
Q

How do diuretics work?

A

Inhibition of tubular Na reabsorption

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18
Q

African, HIV and Parvovirus B19 makes you think of which renal disease?

A

FSGS

Collapsing - HIV

Primary is 80% - responds to steroids

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19
Q

Membranous nephropathy

A

DOM
- Spikes and Domes
- Caucasian male

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20
Q

MCGN associated with which infections?

A

Hep C > B, autoimmune (SLE, RA), monoclonal gammopathy (MGUS, MM)

Tram track

Complement or immunoglobulins

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21
Q

What percentage of protein loss needs to be albumin to be considered nephrotic?

A

> 60% albumin loss

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22
Q

GN classification

A
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23
Q

ANCA positive vasculitidies

A

GPA
- Pulmonary, renal, ENT = PR3

Microscopic polyangitis
- MPO

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24
Q

Infectious GN

A

Staph GN
- GN with infection
- Half develop CKD/ESKD

Post-Strep GN
- Up to 2 weeks after
- Follows throat
- Kids

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25
Q

IgA nephropathy

A

Synpharyngitis GN
- IgA made by bone marrow (IgA1) and mucosal surface (IgA2)
- Haematuria within 24-48 hours of URTI
- Episodic gross haematuria
- Coke-coloured urine due to haemosiderin

IgA1 is seen on renal Bx

Associated with
- Coeliac disease
- Rheumatic disease
- Cirrhosis
- Sarcoidosis
- HIV

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26
Q

Anti-GBM

A

Type IV collage, alpha 3 chain

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27
Q

Plasma exchange in Goodpasture’s

A

Double positive ANCA + anti-GBM

or

pulmonary haemorrhage

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28
Q

Alport syndrome

A

Type IV collagen, alpha chains 3, 4, 5

X linked - worse prognosis

Treatment:
- ACE/ARB for proteinuria
- Transplant

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29
Q

RPGN

A
  • Crescent cells
  • Causes: ANCA vasculitis (50%), anti-GBM (20%), immune-complex e.g. SLE, IgA, infectious, or MCGN

Treatment:
- IV methypred > oral pred
- IV cyclophosphomide OR rituximab
- Plasmaphoresis if pulmonary haemorrhage and/or double positive ANCA + anti-GBM
- Treat underlying disease

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30
Q

Adrenal causes of HTN

A
  1. Primary hyperaldosteronism - suspect if K low
  2. Cushing syndrome
  3. Phaeo
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31
Q

What drugs don’t affect PRA/PAC

A

Prazocin
Hydralazine
Moxonidine
Verapamil or diltiazem

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32
Q

What condition is like being on frusemide?

A

Barter syndrome
- Problem with NK2Cl
- Associated with growth and mental retardation

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33
Q

Which condition is like being on thiazide diuretic?

A

Gitelmann syndrome
- Problem with NaCl cotransported
- Hypomagnesaemia

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34
Q

What is like being on amelioride?

A

Liddle syndrome
- Problem with ENaC

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35
Q

What is the MOA and role of tolvaptan?

A

Selective vasopressin V2 receptor antagonist
- Delays the increase in kidney volume
- Slows the decline in renal function

36
Q

Causes of NAGMA? (AG 4-12)

A

USED PART
- Urinary diversion
- Small bowel fistula
- Extra chloride
- Diarrhoea
- Pancreatic fistula
- Addison’s, acetazolamide
- RTA
- Tenofovir, topiramate

37
Q

Antibodies in membranous nephropathy?

A

PLA2R (70-80%)
THSD7A
- PLA2R can be used as marker of disease activity

38
Q

What is soluable urokinase-type plasminogen activator receptor (suPAR) associated with?

A

FSGS

39
Q

Most common type of GN?

A

IgA nephropathy

Primary (most common)
- URTI or GI Sx
- Synpharyngitic

Secondary
- EtOH liver
- Coeliac
- IBD
- AnkSpond
- Dermatitis herpatiformis
- Mycosis fungoides

40
Q

Nephrotic range proteinuria?

A

> 3.5 grams/24 hours
- Spot ACR >30mg/g
- Spot PCR >150mg/g

41
Q

Manifestiation of hungry bone disease?

A

Profound hypocalcaemia post parathyroidectomy
- Assoc. low PTH and Mg

42
Q

High mortality in dialysis patient factors

A

High PO4
Low Ca
High PTH
High FGF23
Hypoalbuminaemia

43
Q

Treatment if acute rejection renal transplant?

A
  1. Methylpred 500mg-1 gram OD for 3/7
  2. Rescue dose MMF
  3. Modify CNI - change cyclosporine to tacrolimus
  4. ATG
  5. Ritux/PlEx, IVIg if Ab-mediated
44
Q

BK virus

A

Diagnose on biopsy

Inclusion bodies and inflammatory cells can be found on Bx

Viruria (decoy cells) > viraemia
- Can develop nephropathy
- Treatment: if levels increasing, reduce immunosuppression; can also switch Rx (i.e. from mycophenolate to lefluonamide)

45
Q

Treatment of CMV in renal transplant?

A

Valganciclovir

46
Q

Diseases most likely to recur post renal transplant?

A

FSGS
HUS
Membranoproliferative GN

47
Q

Post renal transplant lymphoproliferative disorder associated with which pathogen?

A

EBV

48
Q

Most common cancer in renal transplant?

A

SCC/non-melanoma skin Ca

49
Q

Kimmelstiel-Wilson nodules are found in what type of kidney disease?

A

Diabetic kidney disease

50
Q

Most common cause of death in renal transplant patients?

A

0-1 year post Tx = infection
>1 year post Tx = CVD

51
Q

Which Rx are used to work on signal 3 (proliferation)?

A
  1. mTOR inhibitors (evrolimus, sirolimus)
  2. anti-proliferatives (azathioprine, mycophenolate)
52
Q

Which immunosuppressive Rx causes diarrhoea the most?

A

Mycophenolate
- How to treat: change to Myfortic (longer-acting) or change to azathioprine

53
Q

Which immunosuppressive medications cause non-union of skin healing?

A

mTOR i.e. everolimus, sirolimus

54
Q

Which medications reduce IL2 production?

A

Calcineurin inhibitors
- Tacrolimus (targets FKBP)
- Cyclosporine (targets cyclophillin)

(VERSUS - IL2 blocker/anti-CD25 = basiliximab)

55
Q

Major complication post-transplant esp. if patient is hypotensive and as early as 48 hours post Tx?

A

Renal transplant vein thrombosis
- Graft loss in most cases

56
Q

In renal transplant patient, what is highest risk of BK nephropathy and how to treat?

A

BK viraemia
- Tx reduction in immunosuppression +/- IVIg

SV40 staining on Bx

Replication > viraemia > nephropathy
- If >10K copies - at risk of BK nephropathy
- Intervene at viraemia stage

57
Q

Biopsy features of acute CNI toxicity?

A

Isometric vacuolisation of tubules and vascular smooth muscle
- Isometric very specific

58
Q

Features of chronic CNI toxicity?

A

Striped fibrosis
- Contributes to chronic allograft nephropathy

59
Q

2 causes of TMA in renal transplant?

A
  1. Drugs - mTOR, CNI (most common)
  2. Ab-mediated rejection (blood vessel inflammation)
60
Q

Which statin is avoided in renal transplant (esp. if on ciclosporin)?

A

Simvastatin
- Rosuvastatin, pravastatin OK

Cyclosporin increases simvastatin > LFT derangement, rhabdo

61
Q

When does maintenance immunosuppression start after renal transplant?

A

6 months
- This is where most prophylaxis ceases

62
Q

Infection timeline post renal transplant?

A

Hospital-related > opportunistic infection (1 month-1 year) > CAP (after 1 year)

63
Q

Common SE of valganciclovir and what does it treat?

A

Myelosuppression
- Tx HSV, CMV, VZV, HH6

64
Q

Which vaccines CAN’T be used in immunosuppression?

A

Live vaccines include:

BCG (bacille Calmette–Guérin) vaccine
Some Japanese encephalitis virus vaccines
MMR (measles-mumps-rubella) vaccine
rotavirus vaccine
oral typhoid vaccine
varicella vaccine EXCEPT Shinrix
yellow fever vaccine
zoster vaccine (Zostavax)

65
Q

Which factors stimulate renin production?

A

Decreased BP
Decreased Na to macula densa
Increased sympathetic tone

66
Q

Medications which do NOT affect aldosterone-renin ratio?

A

Veramapil SR
Moxonidine
Prazosin
Hydralazine

67
Q

What is another name for thin basement membrane disease?

A

Benign familial haematuria
- AD mutation in the type IV collagen alpha-4 gene
- Treat with ACEI/ARB

68
Q

How to differentiate between Barter’s and Gitelmans?

A

Hypocalcaemia in Bartter’s syndrome

69
Q

Mechanism of increased thrombosis in nephrotic syndrome?

A

Decreased protein S and AT III
- Protein C is normal

Nephrotic SAT

70
Q

ADPCKD facts

A

• PKD1 more severe than PKD2
• PKD1 is more common 85%
• PKD1 chromosome 16, PKD2 chromosome 4
• 95% genetic
• 100% penetrance
• Extrarenal manifestations: hepatic cysts (80%), pancreatic cysts, aortic root dilation and aneurysm, mitral prolapse and regurgitation, abdominal wall hernias, intracranial aneurysms (10%)

71
Q

BK virus prevalence in community?

A

60-80%

72
Q

Mechanism of amyloidosis in ESKD on haemodyalisis

A

Deposition of B2 microglobulin
- Found on MHC 1

73
Q

What is another name for familial hypokalaemia-hypomagnesaemia?

A

Gitelman syndrome
- Like a thiazide diuretic
- Low K and Mg, HIGH calcium (due to hypocalcuria)
- Autosomal recessive in SLC12A3 gene

74
Q

What is this indicative of when seen under polarised light?

A

Nephrotic syndrome
- Maltese cross with oval fat bodies

75
Q

What is this pathognomonic of in AKI?

A

Acute tubular necrosis
- Muddy brown casts

76
Q

Ferritin aim in CKD

A

Ferritin >300 microgL and/or transferrin saturation >25%

77
Q

Normal kidney size

A

Normal kidney size >10 cm

78
Q

Hepatorenal syndrome type 1 vs. type 2

A

Type 1
- Acute onset <2 weeks
- Poorer prognosis
- May reverse renal failure if reversible cause found

Type 2
- Refractory ascites; diuretic-resistant
- More mild than type 1

Terlipressin can help both type 1 and type 2

No parenchymal disease, no haematuria, no proteinuria

79
Q

Timeline for acute rejection and what is the leading cause of death in this period

A

Less than 3 months
- Leading cause of death: CVD and infection

80
Q

Key cause of early graft failure in kidney transplant

A

Vascular occlusion

81
Q

Most effective intervention to delay CKD progression?

A

BP control

82
Q

Greatest risk factor for stage V CKD is?

A

EGFR <30ml/min

83
Q

Which part of nephron is most vulnerable to ATN?

A

Outer medulla
- Proximal tubule and loop of Henle

84
Q

What is the cause of secondary hyperparathyroidism in renal disease?

A

PO4 retention

85
Q

What substance determines dialysate strength?

A

Glucose

86
Q

Frusemide mechanism of action?

A

Acts on apical membrane thick ascending loop of Henle
- Works on Na K Cl channel

87
Q

Which immunosuppresive agent can delay wound healing?

A

Everolimus can affect wound healing
- Can consider temporary change to tacrolimus

BPT Sadness 😔 (20 decks)

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