Renal 3 Flashcards
+ve ANCA - how to confirm it?
Positive Indirect Immunofluorescence (IIF) - sensitive
Use leucocytes
MUST then confirm with ELISA - specific
Use purified antigen
SLE pathogenesis?
Autoantibodies against chromatin/DNA
Defect in self clearance of immune complex, persistence of apoptotic cell debris
Indications for renal biopsy? 4Rs
Rising Proteinuria > 0.5 g/day
Rising serum creatinine ( all other cause excluded)
RBC dysmorphic
Renal ANCA positive
What specific staining specific for SLE in direct immunofluorescence?
C1q staining
Commonest cause of secondary HTN?
Primary aldosteronism
4 types of familial hyperaldosteronism - differences?
Type I - GRA = glucocorticoid remediable
Type II - Familial history but no genetic mutation (largest group)
Type III - KCNJ5 mutation (massive adrenal adenoma)
Type IV = CACNA mutation
What is specific sign for renovascular HTN?
Abdominal bruit lateralize to one side
Commonest cause of Cushing syndrome?
Exogenous steroids
Pituitary gland Cushing disease
Urine anion gap positive in?
Healthy individuals and RTA Type I
Everything else is negative
aldosterone acts where?
Collecting duct
- Absorb NA
- Excrete K
- indirectly excrete H via alpha-intercalated cells
How is ammonia derived in kidney?
Breakdown of GLUTAMINE in PCT
Hyperkalemia decreases glutamine breakdown
Hypokalemia causes what?
Augments alpha-intercalated cells - H-Katpase to secrete for Hydrogen and reabsorb potassium
Why Gitelman has low Mg?
Downregulates Mg absorption Channel - TRMP6 = high urinary Mg loss
Role of Citrate in RTA Type 1?
Citrate binds to Calcium and keeps it soluble
In RTA 1 - Citrate is reabsorbed
So no citrate, calcium + alkaline urine traps calcium = calcium stones
MESNA is use for what?
Prevent hemorrhagic cystitis
MPO P anca has more?
poorer survival - more fibrosis of kidney
Silica exposure
Having positive for both P and C-anca means?
Coccaine use
Levamisole ( anti-helmintic drug)
Thin basement membrane clinical features?
Pathogenesis?
persistent microscopic hematuria only ( has family hx as well)
Everything else negative
Biopsy shows thin basement membrane
Mutation of COL4A3/4
Commonest and prevalent CKD-MBD disease?
Adynamic bone disease (ADB)
Difference between ADB and Osteitis fibrosa cystica?
ADB - reduced osteoblast/clasts + no osteoid accumulation on bone
- Low PTH - resistance to it/suppression
- hypercalcemia
OF - increased bone turnovers then increased bone formation and resorption
Antibody-mediated rejection is due to activation of what complement pathway?
Classical pathway
Treatment for ADB?
Non-calcium-containing phosphate binders
Aim PTH 2x higher than usual baseline
Calcimetic - helps the PTH and Calcium but doesn’t alter BMD/bone turnover
Low calcium in dialysate for dialysis patients
NO Calcitriol or Vitamin D( non-dialysis) - increases PTH and worsens ADB
What drug and condition a/w calciphylaxis?
Warfarin
vitamin K deficiency
