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2 > Renal 2 > Flashcards

Renal 2 Flashcards

1
Q

damage to the podocytes

A

non prolif

proteinuria

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2
Q

damage to the endothelial cells or meningeal cells

A

prolif

haematuria

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3
Q

franc haematuria 1-2 days after URTI

A

Ig A neph

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4
Q

nephrotic syndrome occurring 1-3w after a strep infection

A

post infective GN

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5
Q

haemoptysis with rapidly porgressing GN

A

good pastures

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6
Q

obesity linked to which nephropathy

A

FS

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7
Q

nephrotic syndrome

A

proteinuria, hypoalbuminuria, oedema, increased cholesterol

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8
Q

nephritic syndrome

A

AKI, oliguria, hypertenion, urine has RBCs and RBC and casts

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9
Q 
minimal change neuropathy commones cause for what 
ix
cx
causes
treatment
A

commonest cause ofr nephrotic syndrome in children
children with atopy. follows URTI

EM - podocyte foot fusion

doesn’t cause progressive RF

idiopathic, IL-13, NSAIDs

steroids. relapse cyclophosphamde

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10
Q 
focal segmental commonest cause of what 
causes
ix
cx
rx
A

nephrotic syndrome in adults

idiopathic. HIV

50% go onto end stage renal failure over 10y

steroids, relapse - cyclophosphamide

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11
Q 
membranous nephropathy commonest cause for what
causes
ix
rf
rx
A

second commonest cause of nephrotic syndrome in adults (esp elderly)

thickened BM on silver stain

30% progress tp ESRF in 10y

steroids/alkylating agents/B monoclonal ABs

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12
Q 
IgA nephropathy commonest wha 
symp
causes
ix
cx
rx
A

commonest GN in the world

young men frank haematuria 1-2 days after URTI

idiopathic. HSP

meningeal cells prolif. IGA deposits in mesangium

25% progress to ESRF in 10-30y

BP control ACEI/ARBs

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13
Q

Rapidly progressing GN causes

A

crescents on biopsy

ANCA pos - wegners, microscopic polyangitis
ANCA neg - SLE, HSP, good pastures

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14
Q

TBW male and female

A

male 60% of body weight

females 50%

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15
Q

TBW = what

A

ICF (67%) and ECF (33%)

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16
Q

ECF

A

20% plasma
80% interstitial fluid
lymph and transcellular fluid

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17
Q

ADH and vasopressin type 2 receptor causes what

A

ATP -> cAMP
which increases H2O permeability
which leads to a concentrated urine output

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18
Q

aldosterone

A

sodium reabsorption and potassium secretion

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19
Q

ANP is stored in what
how is it released
what does it lead to

A

atrial cells
cells stretching due to increased plasma volume causes it to be released

leads to increased BP
leads to increased excretion of sodium and diuresis leading to a decrease in plasma volume

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20
Q

renal transplantation HLAs

A

HLA A
HLA B
HLA DR

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21
Q

rejections hyper acute
acute
chronic

A

hyper acute - within mins
acute <6m - B/T cell mediated. treat with immunosuppression
chronic >6m - immunological and vascular - deterioration of transplant

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22
Q

anti rejection therapy cyclosporin and tacrolimus

A

renal dysfunction
tremor
hypertension
DM

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23
Q

anti rejection therapy azathioprine and myelophenate

A

leucopenia, anaemia, GI S/E

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24
Q

anti rejection therapy steroids

A

osteoporosis, weight gain, infection, DM

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25
Q

ADPKD chromosomes
signs and symp
cx

A

type 1 chromosome 16 - develop ESRF faster
type 2 - chromosome 4

hypertension. big kidneys with cysts

intracranial aneurysms

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26
Q

ARPKD chromosome

who

A

6

young children

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27
Q

Alports genetics

symp/signs

A

X linked recessive
sensineural hearing loss - bilateral
proteinuria, haematuria

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28
Q

anderson fabric disease is what
genetics
ix
rx

A

inborn error of glycosphingolipid metabolism. lysosomal storage disease

plasma/leucoyte alpha GAL activity on renal/skin biopsy

fabryz - enzyme replacement

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29
Q

medullary CK
what happens
age

A

medulla and cortex shrink

age 28

30
Q

medullary cystic kidneys

A

looks like a sponge

31
Q

myeloma ix

rx

A

roulex
BJP
lytic lesions

hypercalcaemia, avoid contrast agents, plasma exchange to remove light chains, chemo, dialysis

32
Q

GPA

A

saddle nose
rhinorrhea
sinusitis
otitis media

33
Q

EGPA (charge strauss)

A

eosinophilia

asthma - late onset

34
Q

microscopic polyangitis

A

segmental necrotising GN with crescents

35
Q

DM is the leading cause of what
ix
symp

A

chronic renal failure
kimmelsteil Wilson lesions
NO HEAMTURIA

36
Q

fibromuscular dysplasia

A

renal htn

familial 10% (both kidneys)

37
Q

atherosclerotic renovascular disease

A

Aki after treatment of htn (usually using a ARB/ACEI)

flash pulmonary oedema

38
Q

organisms of UTI commonest
other gram neg
other

A

E coli
klebsiella, enterobacter, proteus
SA

39
Q

proteus and UTIs

A

associated with stones
foul smelling
produces urease which with urea becomes ammonia which decreases the pH leading to stones

40
Q

organisms of UTI and enterococcus

A

feaclis

feacum - harder to treat

41
Q

staphylococcus sap sophoycis UTI organism

A

coag neg staph

women of child bearing age

42
Q

pseudomonas aeruginosa

A

gram neg bacilli
catheter/instrument
only ciprofloxacin works

43
Q

treatment of UTI in female lower uncx
male uncathterised
cx UTI/poly in GP
cx UTI/Poly in hopistal

A

trim or netro PO (3d)
T or N (7d)
co amoxiclav or co tramoxazole for 14d
amox (co tram) and gent IV for 3d

44
Q

BPH cause

treatment

A

hormonal imablance between androgen and oestrogen

alpha blockers. 5 alpha reducatse

45
Q

prostate cancer

A

multifocal adeno

70% in peripheral zone

46
Q

what increases PSA

A 
cancer
BPH
prostitis
UTI
retention 
catheter
47
Q

testicular tumours symp

A

painless testicular enlargement

gynamacamastia

48
Q

seminoma

A

rare before puberty

potato

49
Q

teratoma

A

can be in childhood

trophoblastic

50
Q

AFP
HCG
LDH
PLAP

A

yolk sac components, never increased in seminoma
trophoblastic composants
tumour burden
seminoma

51
Q

nephroblastic (WILMS tumour)

A

children
malignant
abd mass
arises from residual primitive renal tissue

52
Q

renal carcinoma where
what kind
what can it secrete

A 
porximal tubules 
clear cell or papillary 
erythropoietin - polycythaemia
rennin - htn
PTH - hypercalcaemia
53
Q

von hippel lindau

A

ADom

tumours in kidneys, eyes, CNS, gonads, adrenal and pancreas

54
Q

TCC/uroepithelial

types

A

90% transition 9% squamous
transition - most papillary (striped)
non papillary - all malig

55
Q

TCC who gets it

where

A

bilateral and multi centric
rubber, dye, smoker, analgesia
75% occur in the trigone area - obstruction

56
Q

dialysis HD complications

A

fluid overloads, blood leaks, loss of vascular access
hypokalaemia and cardiac arrest
intradialytic hypotension

need arteriovenous fistula

57
Q

peritoneal dialysis

A

continous 4 bags a day

automated - 1 bag in all day - overnight machine

58
Q

PD cx

A

infections either contaminates - staph, strep, diphtheroids
or from gut - EColi, klebsiella
intraperitoneal ABs, bag removed

membrane failure - fluid overload - switch to HD

hernias due to increased pressure - treat hernia and small volumes

59
Q

chronic kidney disease stages

A 
>90 and kidney disease
60-90 and KD
3A 45-60     3B 30-54
15-30
<15 or on RRT
60
Q

what causes faster progression in CKD

A

more proteinuria

61
Q

causes of CKD

A

DM
htn
vascular

62
Q

stop CKD progressing

A

decrease proteinuria and BP:
ACEI/ARBs, stop smoking , control BG

decrease CVD risks - statins, BP, stop smoking

63
Q

complications of CKD

A

anaemia due to decreased erythropoietin - IV iron, then EPO by injection target Hb 10.5-12.5

secondary hyperparathyroid.

64
Q

AKI is what

A

abrupt (48h) reduction in kidney function

65
Q

pre renal causes

treatment

A

hypovalaemic shock - haemorrhage, volume depletion
hypotension - shock
renal hypo perfusion - NSAIDs, ACEI/ARB

fluid rechallange 0.9 NaCL in hypovalaemic shock

66
Q

renal AKI causes

treatment

A

vasculitis. contrast. TB. sarcoid. gentamicin. contrast

ABs if septic. stop nephrotoxins. dialysis if remains anuric and anaemic

67
Q

post renal AKI

A

stones, cancer, strictures, extrinsic pressure

relieve obstruction - catheter

68
Q

complications of AKI

A

severe acidosis <7.15
uraemia pericardial effusion/rub urea >40
fluid overload
hyperkalaemia

69
Q

hyperkalaemia level

treatment

A

> 5.5. bad
6.5 life threatening

10% 10ml over 10 mins calcium gluconate

prevent arryhtmias in myocardium

Actrapid 10 units with 50mls 50% dextrose (30mins)
nebulaised salbutamol over 90 mins

both push K back into cells

calcium resonium in none acute

70
Q

urgent indications for HD

A

acidosis <7.15
hyperkalaemia >7 or >6.5 and not responding to medical therapy
fluid overload
urea >40, uraemia pericardial rub/effusion

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