Renal Flashcards
4 subtypes of Rapidly progressive glomerulonephritis
- Diffuse proliferative
- Goodpastures (anti-GBM)
- Microscopic polyangitis
- Granulomatosis with polyangitis
Nephrotic syndrome with hepatosplenomegaly most likely what?
Amyloidosis
Acanthocytes are found in nephritic or nephrotic syndrome?
Nephritic
Most common viral infection after organ transplant?
CMV
Tetrad of symptoms in IgA vasculitis (nephropathy) (HSP)? (1 sign on bloods as well)
- Non-thrombocytopenic palpable purpura,
- Arthritis or arthralgia
- Abdominal pain
- Renal disease
All patients with CKD should be started on this drug?
Atorvastatin
A GFR of between 60 - 90 with no clinical signs/symptoms is what?
Normal kidney function (NOT CKD 1 or 2)
Causes of transient or spurious non-visible haematuria (4)
- UTI
- Menstruation
- Vigorous exercise (this normally settles after around 3 days)
- Sex
AKI definition (creatinine, urine output) (3)
- Rise in serum creatinine of 26 micromol/litre or greater within 48 hours
- > = 50% rise in serum creatinine in past week
- Fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults
Name the 1st and 2nd line drug for proteinuric CKD (> 30 mg/mmol)
- ACEi or ARB
- SGLT2i
Drugs which may cause AIN
- Penicillin
- Rifampicin
- NSAIDs
- Allopurinol
- Furosemide
AIN histology findings
Marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules
What disease will have sterile pyuria,
white cell casts an allergic feel (fever, rash, arthralgia, eosinophilia) and HTN?
AIN
Non-drug causes of AIN
- Systemic disease: SLE, sarcoidosis, and Sjögren’s syndrome
- Infection: Hanta virus , staphylococci
What drugs cause Hyaline casts in urine?
Loop diuretics (Furosemide) (can be normal)
Acute tubular necrosis, what is seen in urine?
Brown granular casts
What is seen in urine of Prerenal uraemia
‘bland’ urinary sediment
Red cell casts seen in what condition (or group of conditions)?
Nephritic
Management of high phosphate in CKD
- what is the 1st line MEDICAL management?
- Reduced dietary intake of phosphate (1st line)
- Phosphate binders: Sevelamer (non-calcium based phosphate binder)
- Aluminium and calcium-based binders (less commonly used)
How to prevent contrast-induced nephropathy
IV 0.9% NaCl at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure
All mostly nephritic syndromes (4 or 7)
- PSGS
- IgA nephropathy (HSP)
- Alport Syndrome (collagen IV)
Rapidly progressive GN
- Goodpastures
- Diffuse proliferative
- Granulomatosis w. polyangitis
- Microscopic polyangitis)
All nephrotic syndromes (5)
- FSGS
- Minimal change
- Membranous nephropathy
- Diabetic glomerulonephropathy
- Amyloidosis
Nephritic syndrome with hearing loss
Alports
Hemoptysis + Nephritic syndrome
Goodpastures (anti-GBM)
(type of rapidly progressive GN)
Nephrotic syndrome associated with spike and dome and Malignancy
Membranous nephropathy
Neprhritic syndrome + Crescent formation in Bowmans space and fibrin or macrophage based crescentric expansion
Rapidly progressive GN
(Goodpastures, Microscopic polyangitis, granulomatosis w. polyangitis, diffuse proliferative GN)
ADH receptor antagonist used in ADPKD and ?SIADH?
Tolvaptan
Bacteria associated with bloody diarrhoea and renal impairment
E. coli 157:H7 (HUS syndrome)
SIADH causes Hyo or Hypernatremia?
Hyponatremia, high Na+ in urine
Nephrogenic DI management
- Thiazides
- Low salt/protein diet
How is nephrogenic DI inherited?
X linked recessive (usually)
Clinically relevant level of ACR (albumin:creatinine) ratio
3 mg/mmol
1st line testing of ADPKD
Abdo US
Carbamezapine can cause what disease
SIADH
How is Henoch-Schonlein purpura usually treated?
(Berger’s disease), (IgA mediated small vessel vasculitis)
Supportive
Chromosome responsible of ADPKD (type 1 and 2)
- Type 1: chr 16
- Type 2: chr 4
Anti-phospholipase A2 antibodies cause the idiopathic disease of what?
Membranous nephropathy
CKD usually causes small kidneys (AKI, large) - what conditions are an exception to this rule?
- ADPKD
- Diabetic nephropathy (early stages)
- amyloidosis
- HIV-associated nephropathy
What nephrotic syndrome is usually seen in kids but has an association with Hodgkins lymphoma/
Minimal change
The rapidly progressive GN disease (4 of them) have different features on immunofluorescence, what are they?
- Granulomatosis with polyangitis: Negative or pauci immune
- Microscopic polyangitis: Negative or pauci immune
- Goodpastures: Linear
- Diffuse proliferative: Granular
What nephritic syndrome has thickening of glomerular capillaries (e.g. wire loops) and an association with SLE?
Diffuse proliferative GN
Management of SIADH (4)
- Correction must be done slowly to avoid precipitating central pontine myelinolysis
- Fluid restriction
- Demeclocycline: reduces the responsiveness of the collecting tubule cells to ADH
- ADH (vasopressin) receptor antagonists (Tolvaptan)
Stage 1, 2 and 3 AKI according to creatinine levels
- Stage 1: 1.5-1.9 times baseline (or increase in creatinine by ≥26.5 µmol/L)
- Stage 2: 2.0 to 2.9 times baseline
- Stage 3 ≥ 3.0 times baseline
Stage 1, 2 and 3 AKI according to urine output
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours
What is the other criteria beyond urine output and creatinine that can define stage 3 AKI? (2)
- Initiation of kidney replacement therapy
- In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2
