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Renal Flashcards

1
Q

Nephrotic syndrome what is it and path

A

proteinuria
= low serum albumin
= which provokes Oedema
& hyperlipidemia

cause = podocyte effacement = more permeable to protein

thefor no renal impairment bc diseases of only filtration barrier (podocytes) (bc nephrin bridges between the podocyte feet are lost which usually filter proteins

normal renal fxn normal Cr

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2
Q

Minimal change disease (MCD), what is it

pt
ix
tx

A

non immune depositing nephrotic syndrome

pt: children post viral infection w nephrotic syndrome (oedema)

Ix: only finding is podocyte effacement on electron microscopy (but normal glomeruli)

tx: corticosteriods resolution and complete recovery & no recurrence is norm. if dont respond = progress to FSGS

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3
Q

ATN types and area

A

TOXIC ATN (PCT)
rhabdo (myoglobin), amphoterecin, contrast dye

ISCHAEMIC/hypoperf ATN (PCT, TA, DCT)

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4
Q

ATN phases

A

PRODROMAL
Apoptosis of epithelial cells and sloughing
= Inc Cr

OLIGURIC
Filtration impaired (cast obstructing)
hyperkalaemia (ions not filtered)
volume overload (water not filtered)
Increased urea and Cr (ratio<10)
- haemodialysis

POLYURIC
Resorption impaired (cast washed away but epithelium still dont work)
volume depleted
reduced urea and CR
tx - iv fluids n ion replace

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5
Q

types of AIN

A

pyelonepthritis
allergic nephritis
NSAID caused

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6
Q

Pyelonephritis fx

A

urgency freq and dysuria + fever and loin tenderness

WBC casts (macrophages n neutrophils)

Urine micro: gram -ve ie klebsiella Uti ones

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7
Q

allergic nephritis fx

A

Eosinophilia + fever + rash post starting new sulf med:

either duiretics or abx eg PCN, cephalo, trimeth

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8
Q

NSAID nephropathy

A

reduced prostaglandins = arteriole constriction = hypoperf –> pupillary necrosis

= haematuria
and fibrosis (may lead to urothelial ca of renal pelvis)

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9
Q

hypocalcaemia tx

A

prolonged QT = urgent iv calcium gluconate

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10
Q

SGLT2 inhibitor example and adverse effects

A

dapagliflozin

Urinary genital infection (bc glycosuria)
Fourniers gangrene
normoglycaemic ketoacidosis
inc risk of lower limb amputation: closely moniter feet

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11
Q

fourneiers gangrene

A

necrotizing faciatis of the genetalia or perineum

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12
Q

prenal AKI

A

hypovolaemia ie diarohea vomiting
renal artery stenosis

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13
Q

renal AKI cause

A

glomerulonephritis
ATN
AIN
rhabdomyolysis
tumor lysis

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14
Q

post renal aki

A

stone
bph
external compression

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15
Q

unknown cause of aki ix

A

renal tract USS in 24 hrs

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16
Q

hypercalaemia features

A

bones stones groans and psychic moans
corneal calcification
shortened QT on ecg
hypertension

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17
Q

young pt started on acei for htn and then has deterioation in renal function

A

undiagnosed bilateral renal artery stenosis

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18
Q

causes of CKD

A

htn
diabetic nephropathy
chronic pyelonephritis
chronic glomeruloneph
adult polycyctic kidney disease

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19
Q

renal USS in CKD why

A

exclude obstruction
renal size (small in ckd)

exclude polycystic kidneys

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20
Q

drugs in CKD to slow disease

A

ACEi

SGLT2 - dapafloglzin

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21
Q

signs of CKD on examination

A

oedema, pallor, uremic tinge, purpura, bruising, evidence of scratching
pericardial rub
pleaural effusion

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22
Q

how does haemodialysis work

A

Blood and dialysis fluid flow either side o f a semi permeable
membrane, molecules diffuse down their concentration gradients,
plasma biochemistry changes to become more like the dialysis fluid

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23
Q

peritoneal dialysis complications

A

Bacterial peritonitis, local infection at catheter site, constipation, failure, sclerosing peritonitis.

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24
Q

organ transplant rejection types

A

hyperacute - abo incompatible

acute - in 6 mths - T cell mediated

chronic = after 6 mths vascular changes

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25
membranous glomerulonephritis histology
basement membrane thickening on light microscopy subepithelial spikes on sliver stain positive immunohistochemistry for PLA2
26
causes of membranous glomeruloneph
idiopathic: due to anti-phospholipase A2 antibodies infections: hepatitis B, malaria, syphilis malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia drugs: gold, penicillamine, NSAIDs autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
27
why does nephrotic predispose to vte
loss of antithrombin 3
28
iga nephro vs post strep glomer
iga = 2 days post illness post strep = 1-2weeks
29
FSGS causes LM IF EM
idiopathic congenital HIV Sickle cell heroin Lm = some glomeruli some sclerosis IF = -ve (maybe igm) EM = effacement
30
membrano prolif path lm em if
preformed ag-ab complexes mesnagial prolif into BM lm = basement mem splitting/thickening em = subendothe if = granular igg +c3
31
membranous nepthro LM EM IF
lm = diffuse capillary thickening em = subepithelial deposits IF = granular igg +c3
32
acute urinary retention causes
BPH UTI dx - Anti cholinergic, opiods, TCAs urethral structures constipation calculi
33
acute vs chronic urinary retention
chronic typically painless may present with overflow incontinence larger volume of urine in bladder ie 1.5l+
34
acute urine retention ix
urinalysis and culure (catheterise) FBC U&E Cr CRP Bladder USS
35
acute urinary retention complication
post obstructive duireses check hourly urine output and replace any loss with fluids
36
hyperkalaemia mx
10% IV ca gluconate Dextrose 50% 50ml + 15 units insulin oral or enema calcium resonium (remove from body)
37
bph tx
tamulosin (relax smooth muscle alpha 1 recep) Finesteride (stops converstion test -->dihydrotest which is more potent to androgen tissue)
38
macrscopic haem causes
renal tract trauma or tumor UTI nephritic syndrome renal calculi shistosomiasis
39
bladder causes risks
smoking male paint or dye worker (aromatics) shistosomiasis (SCC) cyclophosphomide
40
bladder ca ix
cystoscopy bipsy TURBT
41
bladder ca tx
TURBT intravesical chemo radical cystectomy or ileal conduit or radical radiotherapy
42
bladder ca spread
local - uterus, rectum, pelvic side wall lymphatic: iliac, paraortic lymph nodes haem - liver, lungs, bone
43
Lower urinary tract storage sx
urgency / frequency / nocturia / urinary incontinence / feeling the need to urinate again immediately after
44
lower urinary tract voiding sx
hesitancy / weak or intermittent urinary stream / splitting / spraying / straining / incomplete emptying / terminal dribbling
45
screening tool for lower urinary tract sx
international prostate symptoms score
46
causes for increased PSA
prostate ca bph urinary retention DRE UTI anal sex catheterisation vigorous excersise
47
zone most affected in prostate cancer
peripheral zone
48
prostate ca mc place and type
adenocarcinoma peripheral zone
49
score used for prstate cancer how does it work
gleason grading system sum of individual scores for two most dominant ca type
50
1st line ix prostate ca
multiparametric MRI
51
ADPKD (polycystic kidney) mc common presenting sx
haematuria loin pain hypertension
52
types ADPKD
1 =more svere PKD1 on chromosome 16 2 = less severe PKD2 chromosome 4
53
ADPKD mx
refer nephrologist htn mc pain mx tx uti tx kidney stones tolvaptan for some to reduce growth rate of cysts ESRD = transplant
54
signs of ADPKD on examination
Palpable kidneys/abdominal mass Hepatomegaly due to hepatic cysts Abdominal wall hernias These are more common in ADPKD, affecting 45% of patients Cardiac murmur This is due to an increased incidence of mitral valve prolapse, mitral regurgitation, aortic regurgitation and dilated aortic root in patients with ADPKD.
55
mc cause ckd uk
t2dm
56
na resabsorption where and how
Main factor determining extracellular volume drop BP and drop NaCI @ macula densa (DCT) = renin release -> aldosterone release -› more Na/K pumps.
57
water reabsorption
At PCT and thin loop Determines ECF osmolality inc osmolality or drop in BP = ADH release
58
loop diuretic eg work and effect use
furosemide bumetanide inhibit na/k/2cl transporter in thick ascending limb = massive nacl ca and k excretion oedema - ccf, nephrotic, hypercalcaemia
59
thiazide diuretic eg work and effect use SE
bendroflumethiazide inhibit Nacl cotransport in DCT = massive nacl excretion, inc Ca resabsortion Htn, decrenal stones, mild oedema
60
SE loop duiretic
hypokalaemia met alkalosis ototoxic hypovolameia
61
thiazdie se
hypokal hyperglycaemia inc urate (CI in gout)
62
casts causes: RBC WBC Tubular
glomerular haematuria interstioal nephritis or pyelonephritis ATN
63
interpreting urea and Cr
isolated urea rise = dec flow ie hypoperf/dehydration urea and cr raised = dec filtration ie renal failure
64
causes of post renal disease
SNIPPIN Stone Neoplasm Inflammation: stricture Prostatic hypertrophy Posterior urethral valves Infection: TB, schisto Neuro: post-op, neuropathy diseases of renal papillae, pelvis, ureter, bladder or urethra
65
hyperkalaemia ecg
Peaked T waves Flattened P waves 1 PR interval Widened QRS Sine-wave pattern -» VE
66
causes of sterile pyuria
ie wbc in urine but no bacteria TB treated uti appendicitis calculi TIN PCK
67
thin basement disease
autosomal dom mc cause asx haematuria persistant asx microscopic haemturia small risk of esrf
68
alport syndrome gene fx
mostly x linkes haematuria , portenuria ---> progressive renal failure Sensorineural deafness Lens dislocation and cataracts Retinal "flecks" Females: haematuria only
69
nephritic syndrome/ acute GN fx causes
Haematuria (macro / micro) + red cell casts Proteinuria oedema (esp. periorbital) Hypertension Oliguria and progressive renal impairment 1 . Proliferative / post-streptococcal 2. Crescentic / RPGN
70
complications of nephrotic syndrome
Infection: reduced lg, reduced complement activity VTE: up to 40% Hyperlipidaemia: 1 cholesterol and triglycerides
71
hyperkal tx
10ml 10% calcium gluconate 100ml 20% glucose + 10u insulin (Actrapid) Salbutamol 5mg nebulizer Calcium resonium 15g PO or 30g PR Haemofiltration (usually needed if anuric)
72
indications for acute dialysis
1. Persistent hyperkalaemia (>7mM) 2. Refractory pulmonary oedema 3. Symptomatic uraemia: encephalopathy, pericarditis 4. Severe metabolic acidosis (pH <7.2) 5. Poisoning (e.g. aspirin)
73
AIN/TIN what is it and causes
Immune-mediated hypersensitivity c either drugs or other Ag acting as haptans Drug hypersensitivity in 70% NSAIDs Abx: Cephs, penicillins, rifampicin, sulphonamide Diuretics: frusemide, thiazides Allopurinol Cimetidine Infections in 15% - Staphs, streps Immune disorders - SLE, Sjogren's
74
AIN/TIN IX AND Results
1gE, eosinophilia Dip: haematuria, proteinuria, sterile pyuria
75
acute urate cyrystal nephropathy what and why tx
AKI due to urate precipitation Usually after chemo-induced cell lysis Rx: hydration, urinary alkalinisation
76
rhabdo path
Pathogenesis Skeletal muscle breakdown release of: K*, PO4, urate Myoglobin, CK inc K and AKI
77
causes of rhabdo
ischaemic ie embolsim/surgery trauma toxins - statins, fibrates, escstacy, neuroleptics
78
rhabdo ix and results
Dipstick: +ve Hb, -ve RBCs Blood: increased CK, K, P04, urate
79
complications of CKD
CRF HEALS Cardiovascular disease Renal osteodystrophy Fluid (oedema) HTN Electrolyte disturbances: K, H Anaemia Leg restlessness Sensory neuropathy
80
how does srcoidosis affect kidneys
inc ca TIN
81
renal vascular disease ie bilat renal artery stenosis ix 1st and gold
US + doppler: small kidney red flow CT/MR angio Renal angiography: gold standard
82
what is TTP
Genetic or acquired deficiency of ADAMTS13 -> giant vWF multimers
83
features of TTP pentad
Adult females Pentad: Fever CNS signs: confusion, seizures MAHA Thrombocytopenia Renal failure
84
tx ttp
plasmapharesis immunosupression splenectomy
85
dom PCK mx
general: inc water intake, dec Na, deccaffeine (may dec cyst formation) Monitor U+E and BP Genetic counselling MRA screen for Berry aneurysms med tx HTn aggressively ie ACEi surg maybe helped by laprosc cyst rmova or nephrectomy dialysis or transplant in those w ESRF (70%by 70yo)
86
renal englargement differentials
PHONOS Polycystic kidneys: ADPKD, ARPKD, TS Hypertrophy 2° to contralateral renal agenesis Obstruction (hydronephrosis) Neoplasia: RCC, myeloma, amyloidosis Occlusion (renal vein thrombosis) Systemic: early DM, amyloid
87

finals (28 decks)

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