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Renal Flashcards

1
Q

What blood result is most suggestive of the diagnosis of rhabdomyolysis?

A

Raised CK

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2
Q

What characterises rhabdomyolysis?

A

Muscle damage and lysis of muscle cells

Cellular content degradation –> release of K, myoglobin, CK, phosphate

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3
Q

Why does rhabdomyolysis cause renal impairment

A

Excessive myoglobin release - filtered by kidney –> renal tubular damage + cast formation.
Prostaglandins etc –> renal arteriole constriction –> decreased perfusion.

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4
Q

Causes of rhabdomyolysis

A 
Trauma
Compartment syndrome
Crush injury
Ischaemia
Severe electrolyte disturbance 
Bacterial / viral infection
Inherited metabolic disorders 
Drugs
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5
Q

Criteria of nephrotic syndrome

A

Albumin < 35g/L
Urine protein > 3 - 3.5 g/24 hrs
Marked pitting oedema

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6
Q

Causes of nephrotic syndrome

A 
Glomerulonephritis - e.g. Minimal change disease, membranous glomerulonephritis  
Focal segmental glomerulosclerosis
Diabetic nephropathy 
Amyloid 
Connective tissue disorder - SLE
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7
Q

Main function of kidneys

A

Excretion of nitrogenous waste - from protein catabolism

= urea

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8
Q

What is renal tubular acidosis?

A

Failure of the kidney to excrete acids into the urine –> acidaemia

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9
Q

What is type 1 renal tubular acidosis

A

Distal RTA

Failure of acid secretion

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10
Q

Define nephrotic syndrome

A

> 3G Proteinuria
Low albumin
Oedema

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11
Q

Causes of nephrotic syndrome

A 
minimal change glomerulonephritis 
Membranous nephropathy
Mesangiocapillary glomerulonephritis 
Focal segmental glomerulonephritis 
Thin basement membrane nephropathy
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12
Q

Define nephritic syndrome

A

Haematuria
(Proteinuria <3g)
Hypertension
Uraemia

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13
Q

Causes of nephritic syndrome

A

Post-streptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
IgA nephropathy
SLE

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14
Q

Pre-renal causes of AKI

A 
Hypoperfusion (haemorrhagic shock, sepsis, severe dehydration, burns, CHF) 
RAS
Renal vein thrombosis  
Drugs (NASIDS / ACEi) 
Pancreatitis,Cirrhosis --> ascites
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15
Q

Renal causes of AKI

A

ATN
Acute glomerulonephritis (immune)
Acute interstitial nephritis (drugs, bacteria)
Septic renal failure
Endogenous renal toxins (Hb, urate, myoglobin)
Hepatorenal syndrome

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16
Q

Post-renal causes of AKI

A

Bladder outlet obstruction (stones, tumour, clot, prostate)

Bilateral ureteric obstruction (retroperitoneal fibrosis,

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17
Q

What is IgA nephropathy

A

Autoimmune

Increased IgA forms immune complexes which deposit in mesangial cells

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18
Q

What is goodpastures syndrome

A

Anti-glomerular basement membrane disease
Autoantibodies to type 4 collagen in kidney and lung
–> macroscopic haematuria, haemoptysis

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19
Q

What is analgesic nephropathy

A

Prolonged heavy ingestion of compound analgesics (esp containing caffeine)

  • -> interstitial nephritis + papillary necrosis
  • -> slow progressive CRF
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20
Q

What is glomerulonephritis

A

Immunologically mediated inflammation of renal glomeruli

  • -> haematuria
  • -> subcutaneous oedema
  • -> polyuria or oliguria
  • -> proteinuria
  • -> hx of recent infection
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21
Q

Inheritance of polycystic kidney disease

A 
Autosomal dominant (usually)
Autosomal recessive (less common)
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22
Q

Anatomical features of PKD

A

Multiple renal cysts
Gradually expanding
Replace normal kidney structure

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23
Q

What predisposes to UTI

A 
Female
Renal calculi
Catheter
Post-GA
Double ureter
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24
Q

Presentation of PKD

A 
30-40yo
Pain in flanks due to cyst expansion, stones, blood clots, infection
Haematuria
Hypertension
SAH from burst berry aneurysm
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25
Causes of RAS
Older pts - atherosclerosis Younger pts - fibromuscular dysplasia Causes hypertension
26
Types of renal calculi
``` 65% calcium oxalate 15% calcium phosphate 10% magnesium ammonium phosphate 5% uric acid 1% cystine ```
27
Risk factors for renal calculi
``` Dehydration Change in urine PH UTI Hypercalciuria Hypercalcaemia Oxalates Hyperuricaemia Cyst injuries Horseshoe kidney ```
28
Presentation of renal calculi
``` Loin to groin pain Dysuria Frequency Strangury Penis tip pain Urine retention Haematuria ```
29
What is Alports syndrome
Inherited mutation of gene coding collagen IV | --> haematuric nephritis + sensorineural deafness
30
What is Medullary sponge kidney
Dilation of terminal collecting ducts in medulla | Causes cysts and calcium phosphate stones
31
Tumour markers of testicular cancer
Alpha-fetoprotein | Beta-HCG
32
Antibodies in Wegeners granulomatosis
cANCA
33
Antibodies in goodpastures disease
Anti-glomerular basement membrane antibodies
34
Treatment for goodpastures disease
Steroids | Avoid smoking
35
Main cause of nephrotic syndrome in children?
Minimal change glomerulo-nephritis
36
Treatment of minimal change disease
``` Steroids Fluid restriction Low-salt diet Penicillin prophylaxis ACE inhibitors Statins for hyperlipidaemia ```
37
Most common cause of nephrotic syndrome in adults
Membranous glomerulonephritis
38
What happens in Membranous glomerulonephritis
Immune complexes form when circulating antibodies bind to basement membrane antigens, or antigens deposited in the glomerulus by the circulation. --> immunological response Damage glomerular basement membrane --> permeability
39
Causes of Membranous glomerulonephritis
``` 90% idiopathic SLE Hepatitis B Systemic infection Drugs ```
40
Treatment of Goodpastures syndrome
Plasmapheresis Corticosteroids Immunosuppression
41
What happens in IgA nephropathy
IgA antibodies deposited in the mesangium and trigger an immune response.
42
Presentation of an IgA nephropathy
Urine dip - microscopic haematuria + proteinuria Or Frank haematuria (usually 2 days after URTI)
43
Diagnosis of IgA nephropathy
Renal biopsy - mesangium proliferation + expansion of extracellular matrix Immunofluorescence shows IgA deposition Raised serum IgA in 50 %
44
What is post-streptococcal glomerulonephritis
Glomerulonephritis seen 1-2 weeks post beta-haemolytic streptococcus infection E.g. Tonsillitis / cellulitis
45
Features suggesting post-streptococcal glomerulonephritis
``` Recent Tonsillitis / skin infection Dark urine (tea / cola) Oedema Hypertension Haematuria Oliguria ```
46
Investigations for post-streptococcal glomerulonephritis
Raised Streptolysin-o Reduced complement Urine protein and haematuria
47
Management of post-streptococcal glomerulonephritis
Fluid restriction Anti hypertensives Low salt diet Prognosis is usually good
48
Symptoms of renal colic
Severe loin pain Radiates to groin Patient writhes around in agony +/- vomiting, pallor, sweating, pyrexia, haematuria
49
Investigation of renal colic
``` Urine dipstick FBC U+E KUB xray (IV urogram, CT urogram, renal tract USS) ```
50
What % of renal calculi are radio-opaque
90%
51
Management of renal calculi
Initial tx = supportive + analgesics - diclofenac If stone will not pass spontaneous seek surgical opinion - extracorporeal shock wave lithotripsy, cystoscopy, uretoscopy, percutaneous nephrolithotomy
52
Investigation of deteriorating function in a transplanted kidney
Renal biopsy
53
Causes of deteriorating function in a transplanted kidney
Organ rejection Vessel thrombosis Infection Recurrence of existing disease
54
Presentation of UTI in young children
Poor feeding Vomiting Lethargy Abdominal pain
55
Important causes of UTI in children
``` Vescicouretric reflux Urinary tract obstruction Duplex ureters Constipation Sexual abuse ```
56
Features of renal TB
``` Sterile pyuria (leucocytes + negative culture) Lethargy Dysuria Urinary frequency Weight loss Night sweats ```
57
Features of adult polycystic kidney disease
Multiple, large cysts in the kidneys Also in liver, pancreas and spleen. --> renal failure and hypertension Berry aneurysms in circle of willis --> rupture --> SAH
58
Management of low calcium in chronic renal failure
Prescribe alfacalcidol (vitamin D supplement)
59
What causes encephalopathy in renal failure?
Serum urea crosses the blood brain barrier
60
Features of uraemic encephalopathy
Fluctuating confusion, cognitive impairment, myoclonic jerk, seizures
61
Treatment of uraemic encephalopathy
Dialysis | Haemofiltration in an emergency
62
What is Henoch-schonlein purpura
IgA mediated Autoimmune vasculitis of childhood. | Often preceded by a viral respiratory illness
63
Commonest renal cancer
Renal cell adenocarcinoma
64
Presentation of renal cell carcinoma
Haematuria Flank pain Palpable mass New left sided varicocele may occur in M Hypertension. Polycythaemia Hypercalcaemia
65
What congenital conditions may be associated with renal cell carcinoma
Von Hippel-Lindau | Tuberous sclerosis
66
What is Waterhouse-friedrichsen syndrome
Bilateral haemorrhage into the adrenal glands caused by meningococcal sepicaemia
67
What is renal osteodystrophy
``` Skeletal disorder seen in patients with renal failure. combination of: - secondary hyperparathyroidism - osteomalacia - vitamin D deficiency ```
68
What is secondary hyperparathyroidism
Chronic renal failure - hyperphosphataemia + reduced vit D --> chronic hypocalcaemia Parathyroid produces more PTH in response Promotes bone resorption --> renal osteodystrophy
69
Symptoms of Renal osteodystrophy
Chronic renal failure Bone pain Pathological fractures (Osteomalacia)
70
In what 2 ways can NSAIDS cause renal problems
Haemodynamic acute renal failure | Acute interstitial nephritis with Nephrotic syndrome
71
Best investigation for suspected renal injury after trauma
CT

General Medicine (25 decks)

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