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Phase 2 - Gen Med > Renal > Flashcards

Renal Flashcards

1
Q

What do patients present with in nephritic syndrome?

A 
Haematuria with RBC casts
Proteinuria
Increased BP
Oliguria
Renal impairment
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2
Q

What is the commonest cause of glomerulonephritis?

A

IgA nephropathy

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3
Q

What is the typical presentation of someone with IgA nephropathy?

A

Young male present with haematuria with an or just following an URTI
- Increased IgA in infection causes IgA deposition in mesangial cells

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4
Q

Give some other causes of nephritis

A 
SLE
Anti-GBM disease/ Goodpastures
Hennoch sconlein purpura
Rapidly progressive GN 
Proliferative GN
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5
Q

What is the treatment for IgA nephropathy?

A

Steroids
ACEi - proteinuria
Can use cyclophosphamide in patients with rapidly deteriorating renal function

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6
Q

What symptoms do you get in nephritic syndrome?

A 
P - proteinuria
H - haematuria 
A - azotemia
R - red cell casts
O - Oliguria 
A - anti-streptolysin-O titres
H - hypertension
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7
Q

What happens in post-streptococcal glomerulonephritis?

A 
Gives an acute response of:
- Haematuria
- Oedema
- Proteinuria
- Hypertension
Following pharyngitis or impetigo due to Group A Beta-haemolytic streptococci
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8
Q

What is the treatment for post-streptococcal glomerulonephritis?

A

Most episodes are subclinical and resolve on their own.

  • Supportive treatment
  • Control BP of admission is needed
  • > 95% regain their renal function
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9
Q

What are the variables which are needed to calculate eGFR?

A

C - creatinine levels
A - age
G - gender
E - ethnicity

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10
Q

What are the points needed to diagnose AKI?

A
  1. loss of 25% of eGFR in 7 days
  2. increase in creatinine to 26mmol/L in 24 hrs
  3. urine output of less than 0.4ml/kg over 6 hours (8 hours in child)
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11
Q

What are the causes of AKI?

A 
Pre-renal (40-70%)
- renal hypoperfusion
- renal artery stenosis
- cirrhosis 
- nephrotoxic drugs
Renal (10-50%)
- ATN due to ischaemia or nephrotoxins
- contrast materials
Post-renal (10%)
- obstruction
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12
Q

What is the management for AKI?

A 
Stop nephrotoxic drugs
Fluids
Treat electrolyte imbalances
RRT if needed - HDU or ITU 
If volume overloaded then give diuretics (loop diuretic)
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13
Q

What changes in nephrotic syndrome predispose to venous thromboembolism formation?

A

Loss of antithrombin III, protein C and protein S in the urine as well as a rise in fibrinogen levels

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14
Q

How is Alports syndrome inherited?

A

X-linked dominant

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15
Q

What does Alport’s syndrome cause?

A

Type IV collagen defect

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16
Q

What is the most common viral infection in a solid organ transplant?

A

Cytomegalovirus

17
Q

What organism is the most likely cause of haemolytic uraemic syndrome?

A

E.coli

18
Q

What is haemolytic uraemic syndrome?

A 
Characterised by:
- Haemolytic anaemia
- AKI
- Thrombocytopaenia 
Generally affects children and is preceded by bloody diarrhoea.
19
Q

How do you treat haemolytic uraemic syndrome?

A

Supportive treatment

  • Fluids
  • Blood transfusions if needed
  • Dialysis if needed
20
Q

What are the features of Hennoch-Schonlein Purpura?

A
  • palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
  • abdominal pain
  • polyarthritis
  • features of IgA nephropathy may occur e.g. haematuria, renal failure
21
Q

What are the features of Alport’s syndrome?

A
  • microscopic haematuria
  • progressive renal failure
  • bilateral sensorineural deafness
  • lenticonus: protrusion of the lens surface into the anterior chamber
  • retinitis pigmentosa
  • renal biopsy: splitting of lamina densa seen on electron microscopy
22
Q

Why do you give calcium gluconate in hyperkalaemia?

A

Protects the myocardium

23
Q

What do you give in hyperkalaemia in order to reduce potassium levels?

A

IV insulin and dextrose

24
Q

When starting an ACEi, what level of a drop in eGFR and rise in serum creatinine is acceptable?

A

25% drop in eGFR

30% rise in creatinine

25
Q

Why do ACEis cause a drop in eGFR?

A

They cause a slight decrease in filtration pressure

26
Q

What is the most common type of SLE associated renal disease?

A

Diffuse proliferative glomerulonephritis

Phase 2 - Gen Med (8 decks)

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