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MRCP > Renal > Flashcards

Renal Flashcards

1
Q

Causes of pre-renal AKI

A

hypovolaemia - D&V
Renal artery stenosis

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2
Q

Causes of intrinsic AKI

A

Glomerulonephritis
Acute tubular necrosis
Rhabdomyolysis
Tumour lysis syndrome

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3
Q

Causes of post-renal AKI

A

Kidney stone
BPH
External ureter compression

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4
Q

Diagnosis of AKI

A

rise in creatinine >= 26 in 48hrs
rise in creatinine >=50% in 7 days
fall in urine OP <= 0.5mls/kg/hr
US KUB if ?cause

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5
Q

Common causes CKD

A

diabetic nephropathy
chronic glomerulonephritis
chronic pyelonephritis
HTN
APCKD

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6
Q

GFR equating to CKD

A

1 > 90
2 60-90
3a 45-59
3b 30-44
4 15-29
5 <15

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7
Q

Use of ACR

A

detects proteinuria
first pass morning sample
>3 = clinically signifcant

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8
Q

management of proteinuria in CKD

A

ACE inhibs (increase Cr 30% and decrease GFR 25% acceptable)
ARBs
SGLT2s

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9
Q

Causes of anaemia in CKD

A

low erythropoietin
low iron
Anorexia/nausea due to uraemia

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10
Q

Management of anaemia in CKD

A

erythropoiesis stimulating agents
PO iron (IV if not improved in 3 months)

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11
Q

What causes bone disease in CKD

A

Low vit D and high phosphate cause low Ca
Above causes secondary hyperparathyroidism

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12
Q

Clinical manifestations of bone disease in CKD

A

Osteitis fibrosa cystica
osteomalacia
osteoporosis

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13
Q

Management of bone disease in CKD

A

reduce dietary phosphate
Phosphate binders (Sevelamer)
Vit D
parathyroidectomy

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14
Q

Complications of AV fistulas

A

Infection
Thrombosis
Stenosis
Steal syndrome

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15
Q

Time for AV fistula to develop

A

6-8 weeks

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16
Q

Symptoms of BPH

A

Voiding: weak flow, straining, hesitancy, terminal dribbling, incomplete emptying

Storage: urgency, frequency, nocturia

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16
Q

Scoring for BPH

A

International Prostate Symptom Score
<7 : mild
8-10: mod
>20: severe

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17
Q

Management of BPH

A

alpha 1 antagonists e.g. tamsulosin, alfuzosin

5 Alpha reductase inhibitors e.g finasteride

TURP

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17
Q

MOA alpha 1 antagonists

A

tamsulosin, alfuzosin
decrease smooth muscle tone in prostate and bladder

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18
Q

SE alpha 1 antagonists

A

dizziness, postural hypotension, dry mouth

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19
Q

MOA 5 alpha reductase inhibs

A

finasteride
block conversion of testosterone to DHT which induces BPH
reduces size of prostate, can take 6 months to see effects

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20
Q

SE 5 alpha reductase inhibs

A

erectile dysfunction, decreased libido, ejaculation issues, gynaecomastia

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21
Q

Pathophysiology of PKD

A

cysts form, reduce function + compress other nephrons
initial compensation but when disease progresses GFR drops

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22
Q

Types of PKD

A

Autosomal dominant
PKD 1: polycystin 1 Ch 16
PKD 2: polycystin 2 Ch 4

Autosomal recessive
PKHD1: fibrocystin Ch 6

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23
Q

Presentation of PKD

A

HTN
haematuria, polyuria
abdo/flank pain
UTIs
renal stones

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24
Q

Extra renal manifestations of PKD

A

liver cysts
Berry aneurysm
mitral valve prolapse

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25
Q

Diagnosis of PKD

A

US abdo
<30 yo 2 cysts
30-59 yo 2 cysts bilaterally
>60 yo 4 cysts bilaterally

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26
Q

Management of PKD

A

Vasopressin receptor 2 antagonist (tolvaptan)
ACE/ARB
statin
RRT

27
Q

Pathophysiology amyloidosis

A

proteins which fold incorrectly then stick together forming Beta sheet which deposits in tissues causing damage

28
Q

Types of amyloidosis

A

AL
- plasma cell disorder, increased light chain production, leak into blood, fold incorrectly

AA
- chronic inflam causes increased serum amyloid A in blood, fold incorrectly

29
Q

Examples of systemic amyloidosis

A

Nephrotic syndrome
Restrictive Cardiomyopathy

30
Q

Investigations for amyloid

A

Biopsy
Congo red staining: pink
Polarised light: apple green

31
Q

What is nephrotic syndrome

A
  • proteinuria >3.5g/day
  • hypoalbuminaemia <30
  • hyperlipidaemia
  • oedema
32
Q

How does nephrotic syndrome present

A
  • oedema: legs, face, SOB
  • hyperlipidaemia: xanthelasma
  • recurrent infections: immunoglobulins lost in urine
  • frothy urine
  • hypercoagubility: antithrombin III lost in urine, increased risk of DVT/PE
    -hypocalcaemia: vit D and binding protein lost in urine
33
Q

Causes of nephrotic syndrome

A

Minimal change
focal segmental glomerulosclerosis
membrane nephropathy
diabetic nephropath
amyloidosis

34
Q

diagnosis of nephrotic syndrome

A

PCR >300mg/mmol
hypoalbuminaema

35
Q

Management of nephrotic syndrome

A

steroids - pred
10/20% steroid resistant (50% more likely to go to end stage renal failure)
immunosuppressants
- diuretics
statins
prophylactic LMWH

36
Q

Bladder cancer type

A

transitional cell

37
Q

What is Calciphylaxis and how does it present

A

deposition of calcium within arterioles causing microvascular occlusion and necrosis of the supplied tissue. It most commonly affects the skin and presents with painful necrotic skin lesions.

38
Q

Treatment of Calciphylaxis

A

reducing calcium and phosphate levels, controlling hyperparathyroidism and avoiding contributing drugs such as warfarin and calcium containing compounds.

39
Q

What causes chronic pyelonephritis

A

recurrent infections lead to scarring of renal parenchyma and impaired function

40
Q

Predisopising factors of chronic pyelo

A

obstruction (Stones)
vesicourethral reflux in kids

41
Q

exam features of chronic pyelo

A

blunted calyx
corticomedullary scarring with atrophy of tubules
eosinophilic casts in tubules

42
Q

What is diabetes insipidus

A

either decrease in secretion of ADH (cranial) or insensitivity to ADH (nephrogenic)

43
Q

Causes of cranial DI

A

idiopathic
head injury
pituitary surgery
craniopharyngiomas
infiltrative (sarcoid)

44
Q

causes of nephrogenic DI

A

genetic
hypercalcaemia
hypokalaemia
lithium
tubulo-interstitial disease: obstruction, sickle cell, pyelo

45
Q

symtoms of DI

A

polyuria
polydypsia

46
Q

investigations of DI

A

increased plasma osm and decreased urine osmo (if urine >700 cannot be DI)
water deprivation test

47
Q

Management of DI

A

Cranial: desmopressin
Nephrogenic: thiazides, low salt low protein diet

48
Q

Causes of epididymo-orchitis

A

genital: chlamydia, gonorrhoea
bladder: e.coli

49
Q

Features of epididymo-orchitis

A

unilateral tesicular pain/swelling

*in torsion, <20yo, severe acute pain

50
Q

Ix for epididymo-orchitis

A

STI check
MSU

51
Q

Mx epididymo-orchitis

A

if STI: sexual health check
?organism ceftriaxone 500mg IM once + doxy 100mg BD 10-14/7
if enteric: PO quinolone (ofloxacin) 2/52

52
Q

pathophysiology of minimal change disease

A

T cells release cytokines that flatten podocytes (effacement) so the negative charge barrier is reduced allowing albumin through
Larger proteins cannot get through = selective proteinuria

53
Q

Features of minimal change disease

A
  • nephrotic syndrome
  • selective proteinuria
  • renal biopsy: podocyte fusion and effacement of foot processes, normal glomeruli
54
Q

Management of minimal change disease

A

PO cortiocosteroids -> cyclophosphamides

55
Q

prognosis of minimal change disease

A

1/3 single episode
1/3 infrequent relapse
1/3 frequent relapse

56
Q

causes of minimal change disease

A

mostly idiopathic
NSAIDS
Hodgkins
infective mono

57
Q

causes of focal segmental glomerulosclerosis

A

idiopathic
secondary to renal pathology - IgA nephropathy
HIV
heroin
SSD

58
Q

Pathophysiology of FSGS

A

damaged podocytes -> proteins through
trapped proteins/lipids in glomerulous -> hyalinosis -> sclerosis

59
Q

Ix FSGS

A

renal biopsy -> focal and segmental sclerosis and hyalinosis
effacement of foot processes

60
Q

Mx FSGS

A

steroids +/- immunosuppressants

61
Q

causes of membranous glomerulonephritis

A

idiopathic
hep B, malaria, syphilis
malig: prostate, lung, lymphoma, leukaemia
SLE, rheumatoid, thyroiditis

62
Q

Membranous glomerulonephritis diagnosis

A

nephrotic symptoms
renal biopsy: spike and dome appearance of basement membrane

63
Q

Management of membranous glomerulonephritis

A

ACEI/ARB
cortiocosteroids= + cyclophosphamide
anticoag if high risk

64
Q

Prognosis of membranous glomerulonephritis

A

1/3 spontaneous recovery
1/3 persistent proteinuria
1/3 ESRF

Good prognostic factors: female, young, asymptomatic

65
Q

What type of tumour is Wilms

A

nephroblastoma

66
Q

management of wilms

A

nephrectomy
chemo
radio

MRCP (19 decks)

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