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1MRCP Part 1 > Renal > Flashcards

Renal Flashcards

1
Q

Cause of Nephrogenic Diabetes Insipidus
Mechanism

A

Hypercalcaemia
Causes down-regulation of aquaporin 2, reduced water absorption in collecting ducts, more dilute urine
Lithium works the same way

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2
Q

Site affected in Tubular Acidosis
Type 1
Type 2

A

Type 1 = distal tubules
Type 2 = proximal tubules

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3
Q

Associated with Horseshoe Kidney

A

Turner’s Syndrome

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4
Q

Pre renal uraemia =

A

pre renal cause of AKI

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5
Q

Lithium Toxicity
- Grading
- Symptoms

A

Severe = >2.5 lithium level
Sx = coarse tremor, confusion and seizures

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6
Q

Glomerulonephritis associated with low complement

A

Infectious causes
SLE

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7
Q

Drug induced lupus VS lupus

A

Drug induced does NOT usually involve the CNS or renal system

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8
Q

Drug used in PKD
- Mechanism of action

A

Tolvaptan
- vasopressin receptor 2 antagonist, evidence slows renal function decline

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9
Q

Child
Hypokalaemia
Normotension + normal renal function

A

Bartter’s syndrome
Defective chloride absorption in ascending loop of Henle - no co-transport of K+

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10
Q

Causes of hypocalcaemia (4)

A

Acute pancreatitis
Hypoparathyroidism
Pseudohypoparathyroidism
- mutation in PTH channel, unable to respond to PTH = low calcium
Rhabdomyolysis
- myoglobulin causes AKI, messes up absorption, calcium lost

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11
Q

Association with renal cell carcinoma

A

Paraneoplastic hepatic dysfunction syndrome
= raised ALP, abnormal liver enzymes, hepatomegaly

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12
Q

Uraemic polyneuropathy
- Difference between that and GBS

A

Sensory loss
- GBS is predominantly motor loss

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13
Q

Test of choice for renal artery stenosis

A

MR angiography

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14
Q

Medication prophylaxis for calcium stones in hypercalciuria

A

Thiazide diuretics

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15
Q

Medication prophylaxis for oxolate stones (2)

A

Cholestyramine
Pyridoxine

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16
Q

Chromosome associated with ADPKD

A

Chromosome 16
?6 looks like a kidney

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17
Q

What occurs in the first stage of diabetic nephropathy?

A

Increase in the GFR

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18
Q

What is the inheritance of Alport’s syndrome?

A

X-linked dominant

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19
Q

What is the pathophysiology of Bartter’s syndrome?

A

NKCC2 channel mutation in the ascending loop of Henle

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20
Q

How are ACE inhibitors renal protective?

A

= efferent arteriole vasodilation
= decreases the GFR
= decreases the proteinuria

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21
Q

Management of urge incontinence AND old/frail

A

Mirabegron is an option

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22
Q

Pain + likely PKD

A

Haemorrhage into renal cyst

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23
Q

Nephropathy associated with hepatitis B

A

Membranous

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24
Q

HLA matching most important prognostically in renal transplant

A

HLA-DR

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25
Q

Gitelmann’s Syndrome

A

= similar blood results to thiazide diuretic
Acts on Na/Cl co-transporter

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26
Q

Investigation finding in membranous nephropathy
Management of membranous nephropathy

A

ACE-I - steroids not shown to have benefit
Ix: subendothelial deposits

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27
Q

1st line drug class in BPH

A

Alpha-1 antagonist

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28
Q

Association GN with syphillis

A

Rapidly progressive glomerulonephritis

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29
Q

Alport’s syndrome
- inheritance
- association

A

X-linked dominant
Retinitis Pigmentosa

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30
Q

Differentiating between ATN and prerenal uraemia

A

Urinary sodium

ATN = tubules cannot reabsorb sodium, high urine Na+

Prerenal uraemia = reduced perfusion, conserve sodium to increase blood volume, low urine Na+

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31
Q

Findings in diabetic nephropathy (2)

A

Kimmelstiel Wilson nodules
Basement membrane thickening

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32
Q

Sequale of diabetic nephropathy
Management

A

Hyperfiltration (transient rise in GFR) > latent > microalbuminuria
ACEI or ARB

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33
Q

Mechanism of hypocalcaemia in CKD

A

Reduced production of 1-25 dihydroxyD
Results in secondary hyperparathyroidism to try and raise calcium levels

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34
Q

Anaemia in renal disease
- investigations
- management

A

Ferritin (aiming >200)
Use of once weekly epo, aiming Hb 100-120 after 4 months of treatment

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35
Q

Side effects of epo (4)

A

HTN
Seizures
Red cell aplasia
Thrombosis

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36
Q

What is the most important matching in renal transplant?

A

HLA DR
Dr of kidneys will transplant the kidney

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36
Q

What is calciphylaxis?
How does it present?
What can trigger?

A

= calcific uraemic arteriopathy
Px: occlusive, painful purpura
Can be triggered by warfarin

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37
Q

What mediates hyperacute organ rejection?

A

IgG preformed antibodies
= type II hypersensitivity reaction

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38
Q

What mediates acute organ rejection?
What is it defined as?

A

= CD8+ mediated
Within 6 months - usually HLA mismatch or CMV

39
Q

Renal artery thrombosis VS vein thrombosis following renal transplant

A

Artery = sudden complete loss of urinary output
Needs urgent surgical input

Vein = haematuria, pain, reduced urine output and swelling
Poor prognosis

40
Q

Presentation of urinary leak following renal transplant
Investigation finding

A

Reduced urine output, abdominal pain, pyrexia
US: perigraft collection

41
Q

Transplant Management - immunosuppression
- initial
- later/long term management
- when steroids?

A

Initial = monoclonal Ab + calcineurin inhibitor
Later = MMF + calcineurin inhibitor

Add steroids if adverse reaction that is steroid responsive >1 ocassion

42
Q

Calcineurin Inhibitors (2)
Adverse effects (2)

A

Ciclosporin
Tacrolimus
AE: nephrotoxic, hyperglycaemia

43
Q

Mechanism of action of ciclosporin

A

Binds to cyclophillin and inhibits calcineurin

44
Q

Mechanism of action of Tacrolimus

A

Binds to FKBP and inhibits calcineurin

45
Q

Mechanism of action of calcineurin

A

Is a phosphatase that mediates T cells via IL-2

46
Q

What is the mechanism of action of MMF?

A

Inhibits IMPDH which inhibits purine synthesis
= decreases proliferation of B and T cells

47
Q

Genetic association with PKD Type 1

A

Chromosome 16
PKD1 gene
More common

47
Q

Mechanism of action of Sirolimus
Adverse effect

A

Blocks IL-2 receptor therefore inhibiting T cell proliferation
Hyperlipidaemia

47
Q

Adverse effects of MMF (2)

A

Marrow suppression
Diarrhoea

48
Q

Example of monoclonal antibody used in renal transplants

A

Daclizumab

49
Q

Genetic association with PKD Type 2

A

Chromosome 4
PKD2 gene

50
Q

Autosomal recessive PKD
- genetics
- presentation

A

Chromosome 6
Much rarer - renal failure in childhood, liver fibrosis

51
Q

Nephrotic Syndrome =
Mechanism behind thrombosis

A

= oedema, proteinuria, hypoalbuminaemia
Renal loss of anti-thrombin III (protein C and protein S)

52
Q

Causes of nephrotic syndrome (6)

A

Glomerulonephritis
SLE
Amyloid
Gold
Penicillamine
Hepatitis B

53
Q

Minimal change disease
- pathogenesis
- causes (3)
- investigation finding
- management

A

T cell mediated causing GBM damage
Causes:
EBV, idiopathic, Hodgkin’s lymphoma
Ix: podocyte fusion
Mx: steroids (if nil response cyclophosphamide)

54
Q

What glomerulonephritides cause nephrotic syndrome?

A

Minimal change disease
Membranous GN
Focal Segmental GN

55
Q

Which GN is associated with Hodgkin’s lymphoma?

A

Minimal change disease

56
Q

Which GN is the most common?

A

Membranous

57
Q

Membranous GN
- associations (3)
- investigation findings (3)
- management (2)

A

Ax: hepatitis B, malaria, malignancy
Ix: anti-phospholipase A2 antibody positive, thickened basement membrane, IgG/C3 deposits
Mx: initially ACEI, then steroids/cyclophosphamide if no response

58
Q

Which GN is associated with malignancy?

A

Membranous

59
Q

Which GN is associated with malaria?

A

Membranous

60
Q

Focal Segmental GN
- associations (3)
- investigation (2)
- management (2)

A

Ax: HIV, heroin use, Alport’s syndrome
Ix: segmental sclerosis, hyalinosis
Mx: steroids, immunosuppression

61
Q

What GN is associated with HIV?

A

Focal segmental GN

62
Q

What GN is seen in Alport’s Syndrome?

A

Focal Segmental GN

63
Q

Nephritic Syndrome =

A

= HTN, proteinuria, haematuria

64
Q

Causes of nephritic syndrome (5)

A

Glomerulonephritis
SLE
Post-streptococcal
Endocarditis
Hepatitis C

65
Q

IgA nephropathy
- when occurs?
- associations (3)
- investigation findings
- management

A

Usually within 1-2 days of URTI
Ax: HSP, coeliac, dermatitis herpetiformis
Ix: IgA/C3 immunofluoresence
Conservative management

66
Q

What GN is associated with HSP?

A

IgA nephropathy

67
Q

Rapidly progressive GN
- associations (2)
- investigation findings (2)

A

Ax: Goodpasture’s, ANCA vasculitis
Ix: epithelial crescents, red cell casts

68
Q

Which GN is seen in Goodpasture’s?

A

Rapidly progressive

69
Q

Diffuse proliferative =
- investigations (2)
- management (2)

A

= lupus nephritis
Ix: wire loop appearance, immune complex deposition
Mx: HTN management, steroids

70
Q

Which GN have a mixed picture?

A

Diffuse proliferative
Membranoproliferative

71
Q

Membranoproliferative
- types
- presentation
- management

A

Type 1 - cryoglobulinaemia, hepatitis C
Type 2 - partial lipodystrophy
= proteinuria, haematuria, oedema, low C4 levels
Mx: steroids

72
Q

What is Type II membranoproliferative GN associated with?

A

Partial lipodystrophy

73
Q

What is Type I membranoproliferative GN associated with?

A

Cyroglobulinaemia
Hepatitis C

74
Q

Hepatitis and association with GN

A

B - membranous
C - membranoproliferative

75
Q

Distal renal tubular acidosis
- pathogenesis
- biochemical change
- associations (3)

A

= failure to excrete H+
- Hypokalaemia
Ax: RA, SLE, Sjogren’s

75
Q

What RTA is rheumatoid arthritis associated with?

A

Type I (distal)

76
Q

Fanconi’s syndrome associated RTA?

A

Type II (proximal) RTA

77
Q

Proximal renal tubular acidosis
- pathogenesis
- biochemical change
- associations (3)

A

= failure to reabsorb bicarbonate
- Hypokalaemia
Ax: cystinuria, fanconi’s syndrome, Wilson’s

78
Q

What is Type 4 RTA?
- biochemistry
- associations (3)

A

= hypoaldosteronism
Ax: Addison’s, DM, spironolactone

79
Q

Prevention of calcium renal stones
- oxalate stones

A

= thiazide diuretics
- cholestyramine or pyridoxine

80
Q

Issue with struvite or xanthine stones?

A

Radiolucent - need CT KUB non-contrast to be able to see

81
Q

Associations with renal cell carcinoma (3)

A

Von-Hippel Lindau
Tuberous sclerosis
Smoking

82
Q

Genetic association with Wilm’s Tumour
- condition

A

Chromosome 11 - WT1 gene
Beckwith Wiedemann

82
Q

Complications of RCC (4)

A

Polycythaemia
Hypercalcaemia
HTN
Paraneoplastic hepatic dysfunction

83
Q

What is targeted in Goodpasture’s?

A

IgG anti-GBM antibodies target T4 collagen in BM

83
Q

Defect in Alport’s Syndrome
- genetics

A

= defect in T4 collagen
X-linked dominant

84
Q

Investigation finding in Goodpasture’s

A

IgG linear deposits

85
Q

Phenylketonuria
- genetics and inheritance
- investigation
- investigation findings

A

Autosomal recessive
Chromosome 12
Ix: Guthrie test
= high levels of phenylalanine, low tyrosine

86
Q

Investigation for cystinuria
- problem

A

Cyanide nitroprusside
Defective transport of amino acids

87
Q

What is the defect in homocystinuria?

A

Deficiency of cystathionine beta synthase
= increased levels of homocystine

88
Q

Investigation for homocystinuria?
Management?

A

Cyanide Nitroprusside test
Vitamin B6 - pyridoxine

89
Q

Indication for HD in methanol overdose

A

Methanol levels >50

1MRCP Part 1 (20 decks)

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