Renal 2 Flashcards
Unilateral Renal artery stenosis
when indicated to stent it?
- Short duration of High BP prior to dx renovascular disease (strongest factor)
- intolerance/failure medical therapy
- Flash oedema/heart failure
CaSR apart from parathyroid, where is it found?
Ascending LOH
- blocks NAKatp channel
- secrets Ca/Mg and lowers serum hypercalcemia
In old age, renal cortical or medulla mass is lost?
Cortical part of renal is lost
Medulla is spared
Commonest bone disease in renal dialysis patients?
Adynamic bone disease ( low bone turnover)
2 Inhibitors of vascular calcification in HD?
Fetuin-A = Binds Ca and Phosphate ( low in dialysis patient)
Matrix GLA protein = Inhibits vascular mineralization ( inhibited by warfarin)
Treatment for calciphylaxis?
Sodium thiosulphate - chelates calcium, produce NO - vasodilatation = better perfusion
Nephrogenic systemic fibrosis - pathogenesis? Treatment?
Free Gadolinium dissociated from it’s chelated form
- absorbed into tissue
- phagocytosed by macrophage and express CD34
- Fibrocytes and makan it and transform into fibroblast = fibrosis
Treatment = urgent HD and repeat after 24 hours
Loop diuretics can cause hyponatremia?
Thiazide diuretics can cause hyponatremia?
No, because it blocks NakCI channel, interfering with osmotic gradient - ADH can’t actively absorb water in CD
Yes, blocking of NACI in DCT, upregulates all other channels in the renal tract = Increase NA reabsorption, increase ADH can water reabsorption = DILUTIONAL HYPONATREMIA
When remove catheter in Peritoneal dialysis?
Fungal/mycobacterium peritonitis
Refractory peritonitis ( 4 days ABX - no improvement)
Relapsing peritonitis ( 4 weeks later, same bug)
Peritonitis + intra-abdominal pathology
Peritonitis + Exit site/tunnel infection
PD adequacy has 2 factors - name it?
Small solute clearances
Ultrafiltration - 1L/day
Cardiopulmonary recirculation does what?
Reduces effectiveness of HD ( blood recirculate due to fistula)
It’s 40% of Total cardiac output
For HD - vascular access needs to support what in order to work?
AV fistula - flow rate?
Dialysis flow of 300 ml/minute without recirculation
AV fistula = 500 ml/minute
MCD and FSGS - difference?
FSGS = suPAR protein - increase ab-integrin activity that destroy podocytes so proteinuria
MCD = IL 13 leads to high CD80 expression on podocytes - decreases nephrin protein ( negatively charged)
so proteinuria
Membranous nephropathy a/w what infection, drugs, connective tissue disease most?
Antibodies are?
A/w what demographic?
Infection = Hep B
Connective tissue disease = SLE
Drugs = Penicillamine/NSAIDS/Gold
MALIGNANCY
Antibodies - THSD7A if anti-PLAR2 is negative
most common cause of Nephrotic syndrome in Caucausian
Pathogenesis of Membranous nephropathy?
Immune-antibody complexes ( IgG and anti-PLAR2) at podocytes - triggers complement mediated injury
Podocytes rebuild wall membrane via Type IV collagen
FSGS commonly seen in what population?
African origin - Nephrotic syndrome
APOL1 gene polymorphism to combat trypanosomiasis but somehow kena FSGS
Best FSGS prognosis and worst prognosis?
Tip segmental lesion of glomerular near PCT = GOOD
Collapsing tuft of glomerular = BAD
MPGN has 2 types - name it and difference?
Immune mediated
Hep C/B , SLE , Monoclonal gammopathies (MM)
Treat underlying cause and NO immunosuppression
-Tram-track appearance, subendothelial and mesangial deposits
Complement mediated (antibodies towards C3 convertase) - C3GN or Dense Deposit Disease Treatment - like nephrotic syndrome
Subendothelial and subepithelial deposits
Difference between staph GN and Strep GN?
Staph GN - IgA staining = IgA nephropathy
-rapid onset and poor prognosis, ESRF
Strep GN = C3 staining
-2 weeks post infection , good prognosis
IgA pathogenesis?
Mucosal IgA2 excess production post infection
-translocate to Bone marrow ( which have IgA1) and knock off IgA1 in bone marrow
IgA1 ( defectively glycosylated) run to liver and not cleared
- go to kidneys mesangial and deposited there
IgG antibodies attack IgA1 in kidneys
IgA good prognosis marker according to MEST classification?
IgA poor prognosis marker?
Endocapillary hypercellularity = good response to steroids
Crescents, proteinuria > 1g/day, elevated serum creatinine
Anti GBM antibody targets what in the collagen IV chain?
Alpha 3
GBM syndrome vs GBM disease?
GBM syndrome = Lung hemorrhage + RPGN of ANY CAUSE
GBM disease = Lung hemorrhage + RPGN + Antibodies
Treatment of anti-GBM
PLEX + CYP ( esp. if pulmonary hemorrhage)
RPGN on kidney biopsy shows?
> 50% crescents in bowman space Circumferential crescents (> 805 of glomeruli) respond poorly
PLASMIC score for suspected TTP?
Platelets < 30 Lysis-hemolysis no Active cancer/Stem cell transplant MCV< 90 INR < 1.5 Creatinine < 170
In Australia what causes STEC - HUS?
E. Coli 0111
worldwide is 0157.H7
Commonest cause of drug-induced TMA
Quinine
PAN vasculitis histology shows?
Fibrinoid necrosis arteries + leucocytes and aneurysms
Treatment of GPA and MPA?
IV methylprednisolone then oral prednisolone
Maintenance with Rituximab!
Pulmonary hemorrhage, hemoptysis, anti-GBM antibodies, RPGN = PLEX
Treatment of Churg-Strauss syndrome?
IV Methylprednisolone then oral prednisolone
AZA as maintenance
CYP if have CNS component
