Renal Flashcards
Cause of Nephrogenic Diabetes Insipidus
Mechanism
Hypercalcaemia
Causes down-regulation of aquaporin 2, reduced water absorption in collecting ducts, more dilute urine
Lithium works the same way
Site affected in Tubular Acidosis
Type 1
Type 2
Type 1 = distal tubules
Type 2 = proximal tubules
Associated with Horseshoe Kidney
Turner’s Syndrome
Pre renal uraemia =
pre renal cause of AKI
Lithium Toxicity
- Grading
- Symptoms
Severe = >2.5 lithium level
Sx = coarse tremor, confusion and seizures
Glomerulonephritis associated with low complement
Infectious causes
SLE
Drug induced lupus VS lupus
Drug induced does NOT usually involve the CNS or renal system
Drug used in PKD
- Mechanism of action
Tolvaptan
- vasopressin receptor 2 antagonist, evidence slows renal function decline
Child
Hypokalaemia
Normotension + normal renal function
Bartter’s syndrome
Defective chloride absorption in ascending loop of Henle - no co-transport of K+
Causes of hypocalcaemia (4)
Acute pancreatitis
Hypoparathyroidism
Pseudohypoparathyroidism
- mutation in PTH channel, unable to respond to PTH = low calcium
Rhabdomyolysis
- myoglobulin causes AKI, messes up absorption, calcium lost
Association with renal cell carcinoma
Paraneoplastic hepatic dysfunction syndrome
= raised ALP, abnormal liver enzymes, hepatomegaly
Uraemic polyneuropathy
- Difference between that and GBS
Sensory loss
- GBS is predominantly motor loss
Test of choice for renal artery stenosis
MR angiography
Medication prophylaxis for calcium stones in hypercalciuria
Thiazide diuretics
Medication prophylaxis for oxolate stones (2)
Cholestyramine
Pyridoxine
Chromosome associated with ADPKD
Chromosome 16
?6 looks like a kidney
What occurs in the first stage of diabetic nephropathy?
Increase in the GFR
What is the inheritance of Alport’s syndrome?
X-linked dominant
What is the pathophysiology of Bartter’s syndrome?
NKCC2 channel mutation in the ascending loop of Henle
How are ACE inhibitors renal protective?
= efferent arteriole vasodilation
= decreases the GFR
= decreases the proteinuria
Management of urge incontinence AND old/frail
Mirabegron is an option
Pain + likely PKD
Haemorrhage into renal cyst
Nephropathy associated with hepatitis B
Membranous
HLA matching most important prognostically in renal transplant
HLA-DR
Gitelmann’s Syndrome
= similar blood results to thiazide diuretic
Acts on Na/Cl co-transporter
Investigation finding in membranous nephropathy
Management of membranous nephropathy
ACE-I - steroids not shown to have benefit
Ix: subendothelial deposits
1st line drug class in BPH
Alpha-1 antagonist
Association GN with syphillis
Rapidly progressive glomerulonephritis
Alport’s syndrome
- inheritance
- association
X-linked dominant
Retinitis Pigmentosa
Differentiating between ATN and prerenal uraemia
Urinary sodium
ATN = tubules cannot reabsorb sodium, high urine Na+
Prerenal uraemia = reduced perfusion, conserve sodium to increase blood volume, low urine Na+
Findings in diabetic nephropathy (2)
Kimmelstiel Wilson nodules
Basement membrane thickening
Sequale of diabetic nephropathy
Management
Hyperfiltration (transient rise in GFR) > latent > microalbuminuria
ACEI or ARB
Mechanism of hypocalcaemia in CKD
Reduced production of 1-25 dihydroxyD
Results in secondary hyperparathyroidism to try and raise calcium levels
Anaemia in renal disease
- investigations
- management
Ferritin (aiming >200)
Use of once weekly epo, aiming Hb 100-120 after 4 months of treatment
Side effects of epo (4)
HTN
Seizures
Red cell aplasia
Thrombosis
What is the most important matching in renal transplant?
HLA DR
Dr of kidneys will transplant the kidney
What is calciphylaxis?
How does it present?
What can trigger?
= calcific uraemic arteriopathy
Px: occlusive, painful purpura
Can be triggered by warfarin
What mediates hyperacute organ rejection?
IgG preformed antibodies
= type II hypersensitivity reaction
What mediates acute organ rejection?
What is it defined as?
= CD8+ mediated
Within 6 months - usually HLA mismatch or CMV
Renal artery thrombosis VS vein thrombosis following renal transplant
Artery = sudden complete loss of urinary output
Needs urgent surgical input
Vein = haematuria, pain, reduced urine output and swelling
Poor prognosis
Presentation of urinary leak following renal transplant
Investigation finding
Reduced urine output, abdominal pain, pyrexia
US: perigraft collection
Transplant Management - immunosuppression
- initial
- later/long term management
- when steroids?
Initial = monoclonal Ab + calcineurin inhibitor
Later = MMF + calcineurin inhibitor
Add steroids if adverse reaction that is steroid responsive >1 ocassion
Calcineurin Inhibitors (2)
Adverse effects (2)
Ciclosporin
Tacrolimus
AE: nephrotoxic, hyperglycaemia
Mechanism of action of ciclosporin
Binds to cyclophillin and inhibits calcineurin
Mechanism of action of Tacrolimus
Binds to FKBP and inhibits calcineurin
Mechanism of action of calcineurin
Is a phosphatase that mediates T cells via IL-2
What is the mechanism of action of MMF?
Inhibits IMPDH which inhibits purine synthesis
= decreases proliferation of B and T cells
Genetic association with PKD Type 1
Chromosome 16
PKD1 gene
More common
Mechanism of action of Sirolimus
Adverse effect
Blocks IL-2 receptor therefore inhibiting T cell proliferation
Hyperlipidaemia
Adverse effects of MMF (2)
Marrow suppression
Diarrhoea
Example of monoclonal antibody used in renal transplants
Daclizumab
Genetic association with PKD Type 2
Chromosome 4
PKD2 gene
Autosomal recessive PKD
- genetics
- presentation
Chromosome 6
Much rarer - renal failure in childhood, liver fibrosis
Nephrotic Syndrome =
Mechanism behind thrombosis
= oedema, proteinuria, hypoalbuminaemia
Renal loss of anti-thrombin III (protein C and protein S)
Causes of nephrotic syndrome (6)
Glomerulonephritis
SLE
Amyloid
Gold
Penicillamine
Hepatitis B
Minimal change disease
- pathogenesis
- causes (3)
- investigation finding
- management
T cell mediated causing GBM damage
Causes:
EBV, idiopathic, Hodgkin’s lymphoma
Ix: podocyte fusion
Mx: steroids (if nil response cyclophosphamide)
What glomerulonephritides cause nephrotic syndrome?
Minimal change disease
Membranous GN
Focal Segmental GN
Which GN is associated with Hodgkin’s lymphoma?
Minimal change disease
Which GN is the most common?
Membranous
Membranous GN
- associations (3)
- investigation findings (3)
- management (2)
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
Which GN is associated with malignancy?
Membranous
Which GN is associated with malaria?
Membranous
Focal Segmental GN
- associations (3)
- investigation (2)
- management (2)
Ax: HIV, heroin use, Alport’s syndrome
Ix: segmental sclerosis, hyalinosis
Mx: steroids, immunosuppression
What GN is associated with HIV?
Focal segmental GN
What GN is seen in Alport’s Syndrome?
Focal Segmental GN
Nephritic Syndrome =
= HTN, proteinuria, haematuria
Causes of nephritic syndrome (5)
Glomerulonephritis
SLE
Post-streptococcal
Endocarditis
Hepatitis C
IgA nephropathy
- when occurs?
- associations (3)
- investigation findings
- management
Usually within 1-2 days of URTI
Ax: HSP, coeliac, dermatitis herpetiformis
Ix: IgA/C3 immunofluoresence
Conservative management
What GN is associated with HSP?
IgA nephropathy
Rapidly progressive GN
- associations (2)
- investigation findings (2)
Ax: Goodpasture’s, ANCA vasculitis
Ix: epithelial crescents, red cell casts
Which GN is seen in Goodpasture’s?
Rapidly progressive
Diffuse proliferative =
- investigations (2)
- management (2)
= lupus nephritis
Ix: wire loop appearance, immune complex deposition
Mx: HTN management, steroids
Which GN have a mixed picture?
Diffuse proliferative
Membranoproliferative
Membranoproliferative
- types
- presentation
- management
Type 1 - cryoglobulinaemia, hepatitis C
Type 2 - partial lipodystrophy
= proteinuria, haematuria, oedema, low C4 levels
Mx: steroids
What is Type II membranoproliferative GN associated with?
Partial lipodystrophy
What is Type I membranoproliferative GN associated with?
Cyroglobulinaemia
Hepatitis C
Hepatitis and association with GN
B - membranous
C - membranoproliferative
Distal renal tubular acidosis
- pathogenesis
- biochemical change
- associations (3)
= failure to excrete H+
- Hypokalaemia
Ax: RA, SLE, Sjogren’s
What RTA is rheumatoid arthritis associated with?
Type I (distal)
Fanconi’s syndrome associated RTA?
Type II (proximal) RTA
Proximal renal tubular acidosis
- pathogenesis
- biochemical change
- associations (3)
= failure to reabsorb bicarbonate
- Hypokalaemia
Ax: cystinuria, fanconi’s syndrome, Wilson’s
What is Type 4 RTA?
- biochemistry
- associations (3)
= hypoaldosteronism
Ax: Addison’s, DM, spironolactone
Prevention of calcium renal stones
- oxalate stones
= thiazide diuretics
- cholestyramine or pyridoxine
Issue with struvite or xanthine stones?
Radiolucent - need CT KUB non-contrast to be able to see
Associations with renal cell carcinoma (3)
Von-Hippel Lindau
Tuberous sclerosis
Smoking
Genetic association with Wilm’s Tumour
- condition
Chromosome 11 - WT1 gene
Beckwith Wiedemann
Complications of RCC (4)
Polycythaemia
Hypercalcaemia
HTN
Paraneoplastic hepatic dysfunction
What is targeted in Goodpasture’s?
IgG anti-GBM antibodies target T4 collagen in BM
Defect in Alport’s Syndrome
- genetics
= defect in T4 collagen
X-linked dominant
Investigation finding in Goodpasture’s
IgG linear deposits
Phenylketonuria
- genetics and inheritance
- investigation
- investigation findings
Autosomal recessive
Chromosome 12
Ix: Guthrie test
= high levels of phenylalanine, low tyrosine
Investigation for cystinuria
- problem
Cyanide nitroprusside
Defective transport of amino acids
What is the defect in homocystinuria?
Deficiency of cystathionine beta synthase
= increased levels of homocystine
Investigation for homocystinuria?
Management?
Cyanide Nitroprusside test
Vitamin B6 - pyridoxine
Indication for HD in methanol overdose
Methanol levels >50
