Renal Flashcards
Differential for acute renal failure days after transplant (2)
Acute graft failure
Post transplant lymphoproliferative disorder
PTLD
- pathology
- management
Clonal T/B cell population
Lymphoid cells
Can be EBV positive
Mx: reduce immunosuppression +- chemo
Management of acute graft rejection
IV steroids
Focal Segmental Glomerulosclerosis
- classification
- pathology
- management
1y = nil obvious cause found
2y = HIV, heroin use
Scarring seen sparingly, only in a few parts of the glomerulus
Mx: steroids
Absolute contra-indications to being a living kidney donor (6)
Uncontrolled BP (defined as not controlled on >3 agents)
Active malignancy
Chronic infection
Proteinuria
Bilateral renal artery atherosclerosis
Sickle cell disease
Post-streptococcal GN
- alternative name
- pathology
Acute diffuse proliferative GN
See sub-epithelial humps, may have a starry sky appearance
Young
Abdominal pain worse after eating and haematuria
Lack of collateral supplies on angiogram
Polyarteritis Nodosa
Linear deposition IgG along glomerular capillaries
Anti-GBM disease
- can be post-transplant in patients with Alport’s syndrome
Deciding on epo delivery
Give SC if pre-dialysis
Give IV if on dialysis
1st line management over active bladder/mixed incontinence
Tolteradine
IgA vs streptococcal GN
Days vs Weeks
Large muscle mass
- what can you use to estimate eGFR?
Cystatin-C
Management of Goodpasture’s Syndrome
Steroids
Cyclophosphamide
Plasmophoresis
Gitelmann’s VS Bartter’s Syndrome
Normotension, hypokalaemia
G = hypocalciuria (thiazide channel affected, distal convoluted tubule)
B = hypercalciuria (ascending loop)
Focal segmental sclerosis
Effacement of foot process
FSGS
Hypokalaemia
HTN
Low renin
Low/normal aldosterone
- management
Liddle’s Syndrome
Mx: amiloride
What GN has the highest rate of recurrence?
Membranoproliferative GN
Which RTA is associated with calcium stones?
T1 RTA (distal)
Urine result in acute tubular necrosis
High urine Na+ (unable to retain sodium)
Is hyalinosis present in focal segmental sclerosis?
- causes
Yes
HIV/heroin use
Liddle’s
Gitelman’s
Bartter’s
Liddle = LOW K+, renin, aldosterone
Gitelman’s = GET down low - K+/Mg2+/hypocalciuria
Bartter’s = BE low K+ BE high hypercalciuria
Renal biopsy in MPA
Focal necrosis
Crescent formation
No immunoglobulin deposits
Focal necrosis
Crescent formation
No immunoglobulin deposits
pANCA and cANCA positive
Microscopic polyangiitis
Sjogren’s syndrome is associated with what RTA?
Distal (type 1)
What subclass of lupus nephritis has the worst prognosis?
Diffuse
Acute limb pain in ESRD
Fistula
Fistula stenosis - bruit audible
Contra-indications to renal biopsy (3)
Hydronephrosis
Polycystic kidneys
Obstruction
BP target in ADPKD
Use ACEI for BP <110/75
Recurrent renal stones
High cystine urine
Cystinuria
- manage with pencillamine
Threshold for reducing iron supplementation in CKD
Want to avoid ferritin >500 - if so reduce treatment
Investigation of renal artery stenosis
Renal MRA
Hyperkalaemia
Low HCO3-
Metabolic acidosis
Type 4 RTA
Clubbed calyces
Ring sign
Papillary necrosis
- diagnosis?
Analgesic nephropathy
Low K+
Leg weakness following strenuous exercise
- diagnosis
- management
Hypokalaemic periodic paralysis
Mx: oral potassium and gentle exercise
Hypokalaemia
Glycosuria
Proteinuria
- diagnosis
- cause
Type 2 (proximal) renal tubular acidosis
Fanconi’s syndrome, drugs e.g. topiramate
Fanconi’s syndrome features
Hypokalaemia
Glycosuria
Proteinuria
