RENAL

Question 1

RTA Type 2
- Mechanism
- Associations

Answer 1

PCT

Mechanism
- no reabsorption of bicarb/uric acid/glucose

Associations
- MM
- Drugs: Tenofovir!!!!!!!!!!!!!!!!!!!
- Fanconi

Question 2

RTA Type 1
- Mechanism
- Associations

Answer 2

DCT

Mechanism
- Hypokalemia, hypercalciuria

Associations
- Sjogrens
- RA
- Urine stones
- Glue sniffing

Question 3

RTA Type 4
- Mechanism
- Associations

Answer 3

CD

Mechanism
- Hyperkelamia
acidosis

Associations
- Addisons
- Sjogrens
- Drugs: Angiotensin II inhibitors, NSAIDs, trimeth, heparin

Question 4

Features of nephrotic syndrome?

Answer 4

Proteinuria > 3.5 g / day
Hypoalbuminema
Hyperlipidemia + lipiduria
Edema
Frothy urine
Hypercoagulable state (loss of antithrombin, Protein C + S)

Question 5

Features of nephritis syndrome?

Answer 5

Haematuria
Hypertension (salter + water retention -> filtered proteins stimulate reabsoption of Na + H2O)
RBC casts in urine
Incr BUN + Creatinine (Azotemia)
Oliguria
Proteinuria < 3.5 g / day

Question 6

Causes for RPGN? What do you see on LM?

Answer 6

GBM
Immune complex
Pauci immune

LM: crescents

Question 7

What are the causes of immune complex GN? Which ones are complement mediated and which ones are antibody mediated?

Answer 7

COMPLEMENT is LOW
SLE
Cryglobulinemia
Infection assoc
MGUS

ANTIBODY
IgA
HSP

Question 8

Which causes of GN cause mesangial deposition?

Answer 8

IgA
MPGN
Diabetes
Lupus

Question 9

Types of GN lupus?

Answer 9

I: minimal mesangial
II: proliferative mesangial

III: focal proliferative < 50%
IV: diffuse proliferative > 50%

V: diffuse membranous –> NEPHROTIC
VI: adv sclerosing

Question 10

When are PLA2R antibodies seen? Primary or secondary?

Answer 10

Membranous Nephropathy - primary AND secondary

Question 11

Treatment for IgA nephropathy? What is this dependent on?

Answer 11

Proteinuria < 3.5g + normal eGFR: supportive
Proteinuria > 3.5g + normal eGFR: Ritux/calcineurin/ cyclophosphamide
Proteinuria > 3.5g + eGFR < 60: Add steroids to above
Life threatening proteinuria / rapidly reducing kidney function: Steroids + cycle

Question 12

Treatment for MCD/FSGS?

Answer 12

MCD: steroids resistance, supportive

FSGS: not as responsive to steroids, yclo/tac

Question 13

Treatment for MCD/FSGS?

Answer 13

MCD: steroids resistance, supportive

FSGS: not as responsive to steroids, yclo/tac

Question 14

Treatment for RPGN?

Answer 14

Cyclo
Steroids
Plasmapheresis if GBM

Question 15

Pathophys of IGA nephropathy?

Answer 15

IgA lacks galactose in hinge region –> body does not recognise as self and produces IgG antibodies against IgA1

Question 16

Causes of nephritic syndrome with low complement?

Answer 16

Lupus III/IV
Infection
Cryoglobulinemia
MPGN
Endocarditis

Question 17

Treatment for IgA nephropathy?

Answer 17

Supportive
- steroids if required
ACEI/ARB

Question 18

Anti-GBM GN is against what?

Answer 18

Type IV collagen

Question 19

Px of IgA vasculitis (HSP)?

Answer 19

Arthralgia
Abdominal pain
Rash
GN

Question 20

Tx Iga vasculitis?

Answer 20

Steroids
Immunosupressive

Question 21

What does each type of lupus nephritis correlate to?

Answer 21

• I: minimal mesangial
  - II: mesangial proliferative
  - III: focal proliferative < 50% involved
  - IV: diffuse proliferative GN ? 50% involved
  - V: diffuse membranous
  - VI: adv sclerosing >90% gloms involved

Question 22

When to treat lupus nephritis?

Answer 22

I II: RAAS blockafe
II, IV, V: steroids, cyclo

Question 23

Causes of cryoglobulinemia types?

Answer 23

I: MM, haematological malignancy
II: hepatitis
III: AI

Question 24

Causes of cryoglobulinemia types?

Answer 24

I: MM, haematological malignancy
II: hepatitis
III: AI

Question 25

How do you decide when to treat Membraneous Nephropathy? Treatment options?

Answer 25

Based on proteinuria and eGFR Options - Cyclo - Ritux - Calcineurin - Steroids

Question 26

How to differentiate primary vs secondary FSGS?

Answer 26

Primary: proteinuria and hypoalbuminemia Secondary: slowly progressing proteinuria, no hypoalbuminema

Question 27

When do you treat FSGS? What do you use?

Answer 27

Proteinuria Not as responsive to steroids; may need immunosupression

Question 28

Post transplant lymphproliferative disorder: causes, manifestation and treatment?

Answer 28

Cause - EBV - Uncontrolled B cell proliferation Clin - Splenomgaly - Lymphadenopathy - Extranodal Treatment - Reduce immunosuppression - mTOR - Ritux

Question 29

Poor prognostic factors of post transplant lymphoproliferative disorder?

Answer 29

Older age Poor response ritux CNS involvement

Question 30

Use of Finerenone in CKD?

Answer 30

Reduces progression of CKD, albuminuria in eGFR as low as 25

Question 31

Which causes of nephrotic/nephritic syndrome demonstrate mesangial hypercellularity on biopsy?

Answer 31

IgA Diabet SLE MPGN

Question 32

How does ACEI/ NSAIDs/ SLGT2I cause an AKI?

Answer 32

SLGT2: impaired aff vasodilation NSAIDs: impaired aff vasodilation ACEI: impaired eff vasoconstriction

Question 33

How to tell if an AKI is pre renal?

Answer 33

Ur Na low Ur osm high Ur:Cr > 20

Question 34

How to tell if an AKI is due to ATN?

Answer 34

Muddy brown casts Ur Na high and Ur Osm low because the kidney is not concentrating urine

Question 35

HTN treatments?

Answer 35

ACEI/ARB Thiazide CCB Spiro BB

Question 36

Renal artery stenosis investigations and treatment

Answer 36

Renal duplex doppler ultrasonography CT angiography MRI angiography Nuclei ACEI scintigraphy Medical therapy just as good as stenting - Those with more rapidly decling renal function pre angioplasty had better outcomes after

Question 37

RAAS: decribe

Answer 37

Check notes

Question 38

Ca stones: risk factors and treatment

Answer 38

Causes - Increased Ca intake - RTA - Reduced Ca reabsorption - loop diuretics, steroids, acetazolamide, theophylline Risk factors - Hypercalciuria - Hypercalcemia - Fat malabsorption ○ Gastric bypass ○ Crohns ○ Fat not absorbed and binds to Ca - Low citrate Tx - thiazides

Question 39

Struvite stones: risk factors and treatment

Answer 39

- Infection stones: can present with UTI as often caused by urease positive bugs - Klebsiella/ proteus/ staph saprophyticus has urease which breaks down urea to NH3, which can precipitate stones

Question 40

Uric acid stones: risk factors and treatment

Answer 40

Risk factors - Hyperuricemia - Dehydration - Leukaemia: incr tissue breakdown + more uric acid Tx - Alkalinisation of urine Allopurinol

Question 41

Cysteine stones: risk factors and treatment

Answer 41

Risk factors - Cystinuria: autosomal recessive - Defect in cystine reabsorping PCT transporter Treatment - Low Na diet - Alkalinisation of urine - Chelating agents