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MRCP 1 > Renal > Flashcards

Renal Flashcards

1
Q

Nephrotic syndrome causes

A

Primary glomerulonepbritis
Systemic disease - DM, SLE, amyloidosis
Drugs - gold, penicillamine
Congenital
Neoplasia
Infection - endocarditis, hepatitis B, malaria

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2
Q

Nephrotic syndrome complications

A

Increased risk of VTE due to loss of antithrombin III and plasminogen in urine

Hyperlipidaemia
CKD
Increased risk of infection
Hypocalcaemia

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3
Q

What is amyloidosis

A

Term to describe the extra cellular deposition of amyloid from precursor proteins
Accumulation of amyloid leads to tissue/organ dysfunction

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4
Q

Diagnosis of amyloidosis

A

Congo red staining : apple green birefringance
Serum amyloid precursor scan
Biopsy of skin- rectal mucosa- abdo fat

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5
Q

ADPKD treatment

A

Tolvaptan - vasopressin receptor 2 antagonist only if -
- ckd 2/3
- rapidly progressive disease
- needs discount from company

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6
Q

Hyperkalaemia management

A

Stabilise cardiac membrane - IV calcium gluconate (doesn’t remove K)

Short term shift - insulin/dextrose infusion & salbutamol Neb

Removal of potassium from body - calcium resonium, loop diuretics, dialysis

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7
Q

What causes focal segmental glomerulosclerosis?

A

Idiopathic
Other renal pathology
HIV
Heroin
Alport’s
Sickle-cell

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8
Q

Investigation of focal segmental glomerulosclerosis

A

Renal biopsy - focal and segmental sclerosis and hyalinosis on light microscopy
Effacement of foot processes on electron microscopy

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9
Q

What’s the management of focal segmental glomerulosclerosis

A

Steroids +/- immunosuppressants

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10
Q

Spironolactone - when to use

A

Ascites- patients with cirrhosis develop secondary hyperaldosteronism
HTN
HF
Nephrotic syndrome
Conn’s

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11
Q

Adverse effects of spironolactone

A

Hyperkalaemia
Gynaecomastia

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12
Q

Features of autosomal dominant PKD

A

HTN
Recurrent UTI’s
Flank pain
Haematuria
Palpable kidneys
Renal impairment
Renal stones

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13
Q

Extra renal manifestations of ADPKD

A

Liver cysts - may cause hepatomegaly
Berry aneurysm
Cardiovascular - mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
Cysts in other organs - pancreas, spleen

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14
Q

Conditions associated with Bergers

A

Alcoholic cirrhosis
Coeliac/dermatitis herpetiformis
Henoch-Schonlein purpura

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15
Q

Pathophysiology of Bergers

A

Deposition of IgA immune complexes
Positive immunofluorescence for IgA & C3

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16
Q

Presentations of Berger’s

A

Young male, recurrent macroscopic haematuria
Recurrent chest infections
Renal failure is unusual

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17
Q

Post-strep glomerulonephritis features

A

Develops 1-2 weeks after URTI
Proteinuria
Low complement

Can have haematuria but not as common

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18
Q

Management of Berger’s

A

Nothing needed unless persistent proteinuria (>500mg) - first line is ACE

Active disease or not responding to ACE - steroids

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19
Q

Investigations for renal stones

A

Urine dip and culture
Serum creat and electrolytes
FBC/CRP - look for infection
Calcium/urate - look for underlying cause
Cultures if Pyrexic
Clotting

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20
Q

Management of renal stones

A

Watch and wait if <5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20mm shockwave or ureteroscopy
>20mm percutaneous nephrolithotomy

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21
Q

Uretic stones management

A

Shockwave lithotripsy +/- alpha blockers

10-20mm ureteroscopy

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22
Q

Prevention of calcium stones

A

High fluid intake
Add lemon juice to water
Avoid carbonated drinks
Limit salt
Potassium citrate
Thiazide diuretics

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23
Q

Prevention of oxalate stones

A

Cholestyramine reduces urinary oxalate secretion
Pyridoxine reduces urinary oxalate secretion

24
Q

Prevention of uric acid stones

A

Allopurinol
Urinary alkalinization (oral bicarbonate)

25
Q

What’s calciphylaxis

A

Rare complication of end-stage renal failure
Deposition of calcium in arterioles causing occlusion and necrosis
Presents as painful necrotic skin lesions

26
Q

Causes of minimal change disease

A

Idiopathic
Drugs - NSAID’s, rifampicin
Hodgkin’s lymphoma, thymoma
Infectious mono

27
Q

Pathophysiology of minimal change disease

A

T-Cell and cytokine-mediated damage to glomerular basement membrane leads to polyanion loss

Reduction in electrostatic charge leads to increased glomerular permeability to serum albumin

28
Q

Features of minimal change disease

A

Nephrotic syndrome
Normotension
Highly selective proteinuria (albumin & transferrin)
Renal biopsy - normal glomeruli on light microscopy, electron microscopy shows fusion of podocytes and effacement of foot processes

29
Q

Management of minimal change disease

A

Oral steroids
Cyclophosphamide

30
Q

Goodpastures features

A

Pulmonary haemorrhage
Rapidly progressive glomerulonephritis

31
Q

Goodpastures investigations

A

Renal biopsy - linear IgG deposits along basement membrane

Raised transfer factor due to pulmonary haemorrhage

32
Q

Management of Goodpastures

A

Plasma exchange - plasmapheresis
Steroids
Cyclophosphamide

33
Q

Causes of anaemia in renal failure

A

Reduced erythropoietin levels
Reduced absorption of iron
Reduced erythropoiesis due to toxic effects of uraemia on bone marrow
Anorexia/nausea due to uraemia
Reduced red cell survival
Blood loss due to capillary fragility
Stress ulceration leading to chronic blood loss

34
Q

Renal transplant post op problems

A

ATN of graft
Vascular thrombosis
Urine leakage
UTI

35
Q

Important HLA antigens when matching for renal transplant

A

DR > B > A

36
Q

How is Alport’s inherited

A

X-linked dominant

37
Q

What is Alport’s due to a defect in?

A

Type IV collagen

38
Q

What is the favourite Alport’s question?

A

Alport patient with failing renal transplant caused by presence of anti-GBM antibodies leading to a Goodpastures type syndrome

39
Q

Alport’s features

A

Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa
Renal biopsy - splitting of lamina densa seen on electron microscopy

40
Q

Diagnosing Alport’s

A

Molecular genetic testing
Renal biopsy - longitudinal splitting of lamina densa of GBM, basket weave appearance

41
Q

Types of testicular cancer

A

95% are germ cell - seminomas & non-seminomas (embryonal, yolk sac, teratoma, choriocarcinoma)

Rest are non-germ cell - Leydig cells and sarcomas

42
Q

Risk factors for testicular cancer

A

Infertility
Cryptorchidism
Family history
Klinefelter’s
Mumps

43
Q

Features of testicular cancer

A

Painless lump
Hydrocele
Gynaecomastia

44
Q

Tumour markers in testicular cancer

A

Seminomas - hcg may be elevated
Non seminomas - AFP
LDH is raised in 40% of germ cell tumours

45
Q

Management of testicular cancer

A

Orchidectomy
Chemo/radio

46
Q

Features of fibromuscuar dysplasia

A

HTN
CKD
Flash pulmonary oedema

47
Q

What is Fanconi syndrome

A

A generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule

48
Q

Features of Fanconi syndrome

A

type 2 (proximal) renal tubular acidosis
Polyuria
Aminoaciduria
Glycosuria
Phosphaturia
Osteomalacia

49
Q

Causes of Fanconi

A

Cystinosis
Sjogren’s
Multiple myeloma
Nephrotic syndrome
Wilson’s

50
Q

Idiopathic membranous glomerulonephritis is due to what?

A

Anti-phospholipase A2 antibodies

51
Q

What triad does haemolytic uraemic syndrome cause

A

AKI
Microangiopathic haemolytic anaemia
Thrombocytopenia

52
Q

Causes of secondary haemolytic uraemic syndrome (typical HUS)

A

Shiga toxin - E Coli
Pneumococcal infection
HIV
Rare - SLE, drugs, cancer

53
Q

Investigation results for primary HUS (atypical)

A

FBC - Hb <80, negative Coombs, thrombocytopenia, fragmented blood film - schistocytes, helmet cells
U&E - AKI
Stool culture -STEC infection, pcr for shiga

54
Q

Causes of normal anion gap

A

GI bicarbonate loss - prolonged diarrhoea, fistula, ureterosigmoidostomy
Renal tubular acidosis
Drugs - acetazolamide
Ammonium chloride injection
Addisons

55
Q

Causes of raised anion gap

A

Lactate - shock, sepsis, hypoxia
Ketones - DKA, alcohol
Urate - renal failure
Acid poisoning - salicylates, methanol

Metformin.

56
Q

Investigations for Bergers

A

Urinalysis - erythrocytes, proteinuria
Urine microscopy & culture - erythrocytes
C3 & C4 levels normal
Renal uss - normal
CT - normal
Biopsy - diffuse mesangial IgA deposition

MRCP 1 (14 decks)

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