Renal Flashcards
How can you prevent calcium stones?
This is caused by hypercalcuria hence you can:
- High fluid intake
- Add lemon juice to water
- Avoid carbonated drinks
- Limit salt intake
- K citrate may be useful
- Thiazide diuretics - increases distal tubular ca resorption ***
How can you prevent oxalate stones?
cholestyramine reduces urinary oxalate secretion
pyridoxine reduces urinary oxalate secretion
How can you reduce uric acid stones?
allopurinol
urinary alkalinization e.g. oral bicarbonate
podocyte fusion and effacement of the podocyte foot processes on renal biopsy
What diagnosis?
Mx?
Minimal change disease
mx- oral corticosteroids (80% of cases) -> cyclophosphamide in steroid resistant cases
What does focal segmental glomerulosclerosis cause?
cause of nephrotic syndrome and chronic kidney disease
typically presents in younger adults
What are some causes of focal segmental glomerulosclerosis?
idiopathic
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport’s syndrome
sickle-cell
Also high recurrence rate in renal transplants
What are the main extra-renal manifestations of ADPKD?
Liver cysts - 70% most common feature
Berry aneurysms - can rupture -> SAH
CVS - MV prolapse, M / T valve incompetence, aortic root dilatation, aortic dissection
Cysts in other organs - pancreas, spleen
Rarely - thyroid, oesophagus and ovary
In children presenting suspectingly for minimal change disease what is mx?
1st line oral pred
If steroid non-responsive, high suspicion of alternative diagnosis or declining renal func (on calcuerin inhibitor) -> renal biopsy
Which immunosuppression can cause tremor?
Tacrolimus
Which renal stones are radio-opaque?
Calcium oxalate
Mixed calcium oxalate / phosphate
Triple phosphate
Calcium phosphate
Which renal stones are radio-lucent?
Urate stones
Xanthine stones
Which renal stones are semi-opaque? what do they look like?
Cystine stones - ground glass appearance
Why do you get mineral bone disease in ckd?
Basic problems in chronic kidney disease (CKD):
> 1-alpha hydroxylation normally occurs in the kidneys → CKD leads to low vitamin D
> the kidneys normally excrete phosphate → CKD leads to high phosphate
This, in turn, causes other problems:
> the high phosphate level ‘drags’ calcium from the bones, resulting in osteomalacia
> low calcium: due to lack of vitamin D, high phosphate
> secondary hyperparathyroidism: due to low calcium, high phosphate and low vitamin D
How is mineral bone disease risk reduced in CKD?
The aim is to reduce PO4 and PTH levels.
reduced dietary intake of phosphate is the first-line management
phosphate binders
vitamin D: alfacalcidol, calcitriol
parathyroidectomy may be needed in some cases
MoA of Spironolactone?
Aldosterone antagonist: acts on the cortical collecting ducts as a diuretic via inhibition of mineralocorticoid receptor
What is the most common type of glomerulonephritis in adults? how does this present / biopsy
Membranous glomerulonephritis - third most common cause of ESRF
Nephrotic syndrome / proteinuria
What are the causes of membranous glomerulonephritis?
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
Young female, hypertension and asymmetric kidneys → what diagnosis?
Fibromuscular dysplasia
HTN is secondary to renal artery stenosis (this is the 2nd most common cause after renal vascular disease)
Why does lithium cause DI?
Causes nephrogenic DI - densitises kidneys ability to respond to ADH in collecting ducts
Features of Goodpasture syndrome?
Goodpastures syndrome = Anti-GBM disease - small vessel vasculitis associated with:
pulmonary haemorrhage
rapidly progressive glomerulonephritis
this typically results in a rapid onset acute kidney injury
nephritis → proteinuria + haematuria
Ix findings in Goodpastures syndrome?
renal biopsy: linear IgG deposits along the basement membrane
raised transfer factor secondary to pulmonary haemorrhages
Anti-GBM antibodies
Main mx for rhabdomyolysis?
IV fluids
Urinary alkalinization used sometiems
Which drugs to stop in AKI?
DAMN
D diuretics
A ace/ arbs + aminoglycosides (eg gent)
M metformin
N nsaids except aspirin at low dose 75mg
What are some adverse effects associated with aldosterone antagonists? how can you reduce this risk?
Hyperkalaemia
Gynaecomastia - less common with eplerenone (more selective with less afinity for androgen receptors)