renal Flashcards
what virus causes Measles mumps and rubella
RNA. paromyoxvrus (measles morbilivirus)
most common viral hepatitis worldwide
route of spread for the viral heps
HEP A
A- FO
B+C - blood
D - always with B
E - Zoo+ FO
child with a high fever and spots on uvula, and as fever settles rash appears ? name and viral cause
roseola
HHV-6
NAGAYAMA spots
what marker is used to distinguish iron overload from haemochromatosis and other causes
transferrin saturations
high in haemochromatosis low in others
lacey rash on kids face - called and virus cause by ?
erythema infectiosum/slapped cheek/ fifths disease
parvovirus B19
what is diagnostic criteria of an AKI
- rise in createnine of 26 within 48 hrs
- an increase of 50% createnine in 7 days
- oligouria (<0.5ml/kg/hr) for > 6 hrs in adults
- 25% fall in eGRF in kids in 7 days
drugs that should be stopped in AKI
ACEI, ARB, NSAID, aminoglyc, diuretic
DIG, met lithium due to toxiciity
what is given in hyperkalaemia to stabalise cardiac memebrane
IV Calcium Gluconate
what size of gallstone can be left to pass psontaneously
<5mm
CKD that causes large not small kidneys
ADPKD
diabetic nephropathy
amyloidosis
HIV assoc nephropathy
most common casue of CKD
diabetic nephropathy
how does scarlet fever casue a rash
GAS releases erythrogenic toxin
what is management of different volvulus
sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed
out of PSC and PBC which is both intra and extr hepatic
PSC is intra and extra
most common complications of measels (2)
otiis media - most common
pneumonia - most common cause of death
where is water reabsorbed from in the kidney
PCT, descending loh and CD
what does ADH do and where does it act
stimulates aquaporin in CD of kidney
in the PCT what is HCO3 resorption driven by
sodium
types of nephrotic syndrome
- minimal change
- membranous GN
- focal segmental glomerulonephritis
- amyloidosis
- diabetic nephropathy
types of nephritic syndrome
- rapidly progressing GN
- IgA nephrpathy
- Alport syndrome
triad of nephrotic syndrome
- proteinuria
- oedema
- hypoalbinaemia
+ hypercholoesterol
what cells does nephrotic syndrome affect
podocytes
how does nephrotic syndrome cause thrombosisi
loss of antithrombin III, protein C and S and associated increase in fibrinogen
what would be seen on renal biopsy in minimal change disease
occasional IgM in mesangium
podocyte foot effacement
causes of minimal change disease
idiopathic
drugs - NSAID
hodgkins
MONO
middle aged itchy woman and treatment
PBC
- first-line: ursodeoxycholic acid
slows disease progression and improves symptoms
- pruritus: cholestyramine
- fat-soluble vitamin supplementation
commonest casue of GN in adults
membranous GN
spikes on renal biopsy
membranous GN
treatment of membranous GN
ACE/ARB
immunisupp
what is the clinical picture of nephritic picture
haematuria
proteinuri <3g
sterile pyuria
HTN
oligouria
what is deposited on the basemenet membraen i nmembranous GN
IgG and C3
IgA nephropathy associated conditions
alcoholic cirrhosis
coeliac. dermatitis herpetiformis
HSP
what anti body is tested for in post streptococcal GN
anti-streptolysin o
what complement protein is low in post strep Gn
C3
starry sky on renal biopsy
post strep Gn
what is seen on renal biopsy in alports syndrome
basket weave - splitting of lamina dense
if someone has renal failure and haemoptysis what shoud you think ?
GPA or goodpasteurs
what chromosome is HLA found on
chromosome 6
different types of renal graft rejection and timeframe
- hyperacute rejection - mins to hrs
- acute graft failure - <6mnths
- chronic graft failure >6mnth
what is the pathogenesis of hyperacute graft failure
due to pre-existing antibodies eg ABO
tx of hyperacute graft rejection
remove transplant
pathogenesis of acute graft failure
mismatched HLA - t cell mediated
what would indicate acute graft failure
increased createnine pyuria and proteinuria
tx of acute graft rejection
steroids and immunosuppresion
how does acute interstital nephritis present and assoc features
HTN and AKI
rash arthralgia, fever, eosinophilia
causes of acute interstitial nephritis
drugs, SLE, sarcoid
what would be seen in urinalysis in acute interstitia nephritis
sterile pyuria white cell casts
what causes acute tubular necrosis
ischaemia or nephrotoxins
features of acute tubular necrosis
features of an AKI - increase createnine, urea and potassium
muddy brown casts
what is the most common casue of an AKI
Acute tubular necrosisi
what is the most common type of renal tubular acidosis and pathophysiology
TYPE 4 - reduction of aldosterone causes a decrease in PT ammonia excretion
what is pathophysiology of type 1 renal tubular acidosis
inability to excrete Hydrogen in DCT
what would the urine pH be in a Type 1 renal tubular acidosis
above 6
is type 1 renal tubualr acidosis hyper or hypokalaemia
hypokalaemia
type 4 renal tubular acidosis- hypo or hyperkalaemia and what is urinary pH
hyperkalaemia and pH is less than 6
what type of acidosis/alkalosis is seen in renal tubular acidosos and what is anion gap
hyperchloraeic metabolic acidosis with a normal anion gap
most common type of renal cell cancer
clear cell
classic triad of renal cancer
loin pain
haematria
abdo mass
what paraneoplastic syndrome can renal cancer give
EPO - polycythaemia
ACTH
PTHrP - hypercalcamia
what testicular pathology can renal cell cancer cause
varicolcele due to compression of pampiniform plexus
what is treatment of a renal cell cancer less htan 7 cm
partial nephrectomy
what is treatment if a patient has transitional cell cancer of the kidney
nephrouretectomy
trasiional cell is bladder cancer
treatment of wilms tumour
nephrectomy and chemo eg vinaristine duxorubicin
what drugs can cause acute urinary retention
TCA’s - amitriptyline
Anticholinergics
opioids
NSAIDS
disopyramide
what is acute urinary retnetion most commonly secondary to
benign prostatic hypertension
how to differetiaite between acute and chronic urinary retention
acute - painful
chronic- painless
what examinations shoud be performed in acute urinary retention
PR, PV and neuro exam
what is diagnostic investigation in urinary retention
USS
what volume of fluid is indicative of urinary retention
> 300cc
if USS ambiguous as to urinary retention hat should be done
cathertise and if over 15 mins <200cc not rentention
if >400 then retention
what is post -op dieuresis
polyuric state after relief of obstruction
due to loss of medullary conc radietn
what differentiates high pressure retention in comparison to low pressure retention
hydronephrosis
treatment of uncomplicated UTI (and durtion )
Nitro/ Trime for 3 days
when should you culture for an uncomplicated UTI
haematuria or >65
management of an asymptomatic UTI in preganant women
nitro for 7 days and test for cure
shoudl you culture for pregannat women with UTI
yes - nitro/amox
treatment for men with UTI
culture and 7 day prescription of nitro or trime
if a child present with recurretn UTIS what shoudl you expect
vesicoureteric reflux
what is a common complication of vesicoureteric reflux
scarring
what is a complication of renal scarring secondary to VUR in kids
hypertension - scar produces renin
commonest renal stones
calcium oxalate
key risk factors for calicum based renal stones
hypercalcaemia and dehydration
how are struvite renal stones made
bacteria hydrolse urea in urine to ammonia creating struvite
what infections predispose struvite renal stones
proteus and Ureaplasma urealyticum - alkali environment
ground glass renal stone
cystine
cystine renal stone are due to what
auto recessive conditiion
risk factors for urate renal stones
GOUT and ILeostomy - loss of bicarb
what drugs are assoc with renal stones
loop diureticsm - cause hypocalcaemia but hypercalcinuria
steroids, and theophylline
what drug prevent renal stones
thiazides
management of renal stones
<5mm pass spontaneously
pain mangement of renal stones
IM diclofenac
causes of renal artery stenosis
atherosclerosis
fbromuscular dysplasia
features of renal artery stenosis
HTn, CKD and flash PO
how and where to LOH diuretics work
work on the ascending loop of henle
they block the NA-CL-K co trasnporter on apical side of membrane
therefore osmosis does not occur and water does not follow Na into interstitium
how and where do thiazides work
the work on the DCT - block NACL co transporter - there fore water and salt remain in lumen
treatment of good pasteurs disease
steroids and cyclophosphamide
common neuro symptoms in ANCA vasculiits
mononeuritis multiplex
qhat type of collagen does Goodpasteurs target
type IV collagen
common causes of acute interstitial nephritis
PPI and Fluclox
why may Acute interstitial nephritis presetn with pain
due to capsular stretch from inflammation
most important post organ trasnplant infection
CMV
is TIBC low or high in anaemia of chronic disease
low/normal in chronic disease
high in iron deficiency
what shoudl be doen for an INR between 5-8 with no bleedign
withhold 1-2 doses of warfarin adn reducce susequent doses
what iron studies are seen in haemochromatosis
tranferrin, ferritin adn TIBC
high transferring, high ferritin and low TIBC
