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Finals Revision > Renal > Flashcards

Renal Flashcards

1
Q

What is glomerulonephritis?

A

Immune mediated disease of the kidneys affecting the glomeruli with secondary tubo-interstitial damage

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2
Q

What mediates glomerulonephritis?

A

Antibody mediated - T cells, inflammatory cells, mediators, complement

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3
Q

What is the commonest cause of end stage kidney disease?

A

Diabetes

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4
Q

How does nephrotic syndrome present?

A

Proteinuria, oedema, hypoalbulinaemia, lipiduria

NON-PROLIFERATIVE

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5
Q

How does nephritic syndrome present?

A

Haematuria, hypertension, oedema, renal failure

PROLIFERATIVE

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6
Q

How is glomerulonephritis diagnosed?

A

Clinical presentation
Bloods
Urinalysis, microscopy, urine protein
Kidney biopsy

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7
Q

What are some causes of nephrotic syndrome?

A

Minimal change nephropathy
Focal segmental glomerulonephritis
Membranous glomerulonephritis

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8
Q

Whats the commonest cause of nephrotic syndrome in kids?

A

Minimal change nephropathy

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9
Q

What is the commonest cause of nephrotic syndrome in adults?

A

Focal segmental glomerulonephritis

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10
Q

‘Foot process fusion on EM’

A

Minimal change nephropathy

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11
Q

How do you treat minimal change nephropathy?

A

Steroids - should go into complete remission

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12
Q

Does minimal change nephropathy progress to renal failure?

A

No

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13
Q

What can cause focal segmental glomerulonephritis in adults?

A

Can be primary or secondary to HIV, heroin use and obesity

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14
Q

Does focal segmental glomerulonephritis progress to renal failure?

A

Yes - 50% have end stage kidney disease in 10 years

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15
Q

‘Focal segmental glomerulonephritis on LM’

A

Focal segmental glomerulonephritis

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16
Q

How is focal segmental glomerulonephritis treated?

A

Steroids

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17
Q

What causes membranous glomerulonephritis?

A

Can be primary or secondary to SLE, infection, malignancy, rheumatoid drugs (gold/penicillamine)

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18
Q

Can membranous glomerulonephritis progress to renal failure?

A

Yes

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19
Q

‘Thickened basement membrane on silver stain’

A

Membranous glomerulonephritis

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20
Q

How is membranous glomerulonephritis treated?

A

Steroids, alkylysing agents, monoclonal antibodies

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21
Q

What are causes of nephritic syndrome?

A

IgA nephropathy

Rapidly progressive glomerulonephritis

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22
Q

What is the commonest glomerulonephritis worldwide?

A

IgA nephropathy

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23
Q

‘Macroscopic haematuria 1-2 days following infection’

A

IgA nephropathy

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24
Q

‘Mesangial IgA proliferation’

A

IgA nephropathy

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25
Q

What condition does IgA nephropathy have some overlap with?

A

Henoch-Schonlein Purpura

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26
Q

How is IgA nephropathy treated?

A

Blood pressure control if needed

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27
Q

What is rapidly progressive glomerulonephritis?

A

A treatable cause of acute kidney failure that rapidly progresses over days to weeks

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28
Q

What are some ANCA +ve causes of rapidly progressive glomerulonephritis?

A

Vasculitis, Wegners, Churg-Strauss

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29
Q

What are some ANCA -ve causes of rapidly progressive glomerulonephritis?

A

Goodpastures, Henoch-Schonlein Purpura, SLE

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30
Q

What other organ does Goodpastures disease affect?

A

Lungs - haemoptysis, cough, SOB

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31
Q

What antibody is seen in Goodpastures?

A

Anti-GBM

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32
Q

‘Glomerular cresents seen’

A

Rapidly progressive glomerulonephritis

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33
Q

How is rapidly progressive glomerulonephritis treated?

A

Strong immunosuppressants +/- dialysis

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34
Q

What glomerulonephritis’ will give a mixed nephrotic and nephritic picture?

A

Membranoproliferative

Post-infective

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35
Q

What causes membranoproliferative GN?

A

Cryoglobulinaemia, HepC

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36
Q

‘Subendothelial IgG deposits’

A

Membranoproliferative GN

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37
Q

‘Tram track appearance of basement membrane’

A

Membranoproliferative GN

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38
Q

How is membranoproliferative GN treated?

A

Steroids

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39
Q

‘A child has a sore throat. 7-14 days later he has haematuria’

A

Post infective/Diffuse Proliferative GN

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40
Q

‘Coca cola urine’

A

Post infective/diffuse proliferative GN

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41
Q

‘Proliferation of mesangial cells, neutrophils and monocytes’

A

Post infective/diffuse proliferative GN

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42
Q

What is the criteria for AKI?

A

Rise of serum creatinine to >26 in 48hrs OR
Rise of serum creatinine to >50% of last 7 days OR
Fall in urine output to <0.5ml/kg/hr for more than 6hrs

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43
Q

What are pre-renal causes of AKI?

A

Lack of blood supply to kidneys - hypovolaemia, hypotension, drugs (NSAIDs, COX-2, ACEis, ARBs)

44
Q

What are renal causes of AKI?

A

Vasculitis, IV contrast, toxins, glomerulonephritis, acute intersitital nephritis, rhabdomyolysis

45
Q

What are post-renal causes of AKI?

A

Obstruction of urine outflow causing backpressure (e.g. stones, BPH, strictures, tumours)

46
Q

What are risk factors for developing AKI?

A

CKD, Age over 65, diabetes, heart failure, liver failure, history of AKI, nephrotoxins

47
Q

How do you prevent AKI?

A

Minimise risk factors

48
Q

What are some signs and symptoms of AKI?

A

Can be asymptomatic

Reduced urine output, pulmonary and peripheral oedema, arrythmias, uraemic features (pericarditis, encephalopathy)

49
Q

What investigations are important in AKI?

A

Bloods - FBC, U&Es, Clotting
Urinalysis - check for haemoproteinuria
Renal USS - within 24hrs to check for cause

50
Q

What management is important in pre-renal AKI?

A

Fluids - 0.9% sodium chloride bolus then infusion

51
Q

How should fluid status be assessed?

A

JVP, HR, BP, cap refil, urine output

52
Q

What is a complication of untreated pre-renal AKI?

A

Acute tubular necrosis

53
Q

What is acute tubular necrosis?

A

Death of renal tubular epithelial cells

54
Q

‘Muddy brown casts’

A

Acute tubular necrosis

55
Q

What is an important investigation to carry out in intrinsic AKI?

A

Renal biopsy - assess for glomerulonephritis

56
Q

What is the specific management of post-renal AKI?

A

Catheter/nephrostomy/stent

57
Q

What medications should be stopped in AKI?

A

NSAIDs, aminoglycosides, ACEis, ARBs, diuretics

58
Q

What metabolic complication may occur in AKI?

A

Hyperkalaemia

59
Q

What ECG changes does hyperkalaemia cause?

A

Tall tented T waves

60
Q

How is hyperkalaemia treated?

A

Calcium gluconate 10mls of 10% IV
Nebulised salbutamol
Insulin/Dextrose continuous infusion
Calcium resonium/dialysis

61
Q

What may be considered in AKI if medical management does not get an adequate response?

A

Haemodialysis

62
Q

What are complications of AKI?

A

Increased length of hospital stay
Increased mortality and morbidity
Increased risk of CKD

63
Q

What is CKD?

A

Reduced eGFR and/or evidence of kidney damage that is chronic

64
Q

What equation is used to work out eGFR?

65
Q

What variables does the MDRD4 counteract?

A

Creatinine, race, sex, age

66
Q

What is classified as stage I CKD?

A

eGFR >90ml/min AND evidence of kidney damage

67
Q

What is classified as stage II CKD?

A

eGFR 60-90ml/min AND evidence of kidney damage

68
Q

What is classified as stage IIIA CKD?

A

eGFR 45-59ml/min

69
Q

What is classified as stage IIIB CKD?

A

eGFR 30-44ml/min

70
Q

What is classified as stage IV CKD?

A

eGFR 15-29 ml/min

71
Q

What is classified as stage V CKD?

A

eGFR <15ml/min

72
Q

What are causes of CKD?

A

Diabetes, hypertension, vascular disease, glomerulonephritis, PCKD, unknown

73
Q

What are symptoms of CKD?

A

Usually non-specific - tiredness, poor appetite, itch, sleep disturbance

74
Q

Which patients are more likely to progress in CKD?

A

Patients with proteinuria, younger patients

75
Q

How is cardiovascular risk reduced in patients with CKD?

A

Stop smoking, lose weight, healthy diet

Statin and Aspirin

76
Q

What management can slow the progression of CKD?

A

By decreasing proteinuria by controlling BP

Use ACEis and ARBs

77
Q

What is the target blood pressure in CKD?

A

140/90 or 130/80 in diabetics

78
Q

What kind of anaemia do patients with CKD get?

A

Normocytic normochromic anaemia

79
Q

Why do patients with CKD become anaemia?

A

Decrease in erythropoetin

80
Q

How is anaemia treated in CKD?

A

Correct any deficiencies

Give erythropoeitin injections

81
Q

How should bones be protected in CKD?

A

Phosphate binders, calcium and vitamin D

82
Q

How should oedema be treated in CKD?

A

Loop diuretics

83
Q

When is dialysis considered in CKD?

A

End stage kidney disease - when eGFR <20

84
Q

What must be formed in order to carry out haemodialysis?

A

Arteriovenous fistula

85
Q

Why is an arteriovenous fistula needed?

A

Means there is not continuous cannulation of small veins that may eventually collapse
Allows for faster blood flow

86
Q

How long after formation of an AV fistula will it be functional?

87
Q

What is dialysed out of a patient?

A

Urea, creatinine, potassium, toxins

88
Q

What is dialysed into a patient?

A

Water, sodium, potassium, bicarbonate, glucose

89
Q

What is the minimum amount of time dialysis should be done?

A

At least 4 hours 3 times a week

90
Q

What restrictions are put on a patient on haemodialysis?

A

1L fluid per day, low salt diet, low potassium diet, low phosphate diet

91
Q

How does peritoneal dialysis work?

A

Solute removed by diffusion across the peritoneal membrane

92
Q

What are some complications of peritoneal dialysis?

A

Infection, membrane failure, hernias

93
Q

When can a patient with CKD be put on the transplant list?

A

When they are within 6 months of starting dialysis

94
Q

What can cause an increase in urea?

A

Dehydration, GI bleed, increased protein breakdown (infection, malignancy), drugs, high protein diet

95
Q

What may cause a low urea?

A

Malnutrition, liver disease, pregnancy

96
Q

What does a rise in both urea and creatinine suggest?

A

Renal dysfunction

97
Q

What is the likely cause of haematuria in a patient just back from a holiday to India/Malawi?

A

Schistosomiasis

98
Q

What are some renal features of autosomal dominant kidney disease?

A

Hypertension, recurrent UTI, abdominal pain, renal stones, haematuria, renal stones

99
Q

What are some extra renal features of ADPKD?

A

Liver cysts, berry aneurysms

100
Q

What is Alports Syndrome?

A

Genetic syndrome caused by a defect in type IV collagen

101
Q

How is Alports syndrome inherited?

A

X-linked dominant

102
Q

What symptoms and signs do you get in Alports syndrome?

A 
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafnes
Lenticonus - anterior lens dislocation
Retinitis Pigmentosa
103
Q

What are ‘eosinophilic casts’ in the urine found in?

A

Chronic pyelonephritis

104
Q

In pre-renal AKI, what is the urinary osmolality and urinary sodium like?

A

Urinary osmolality HIGH

Urinary sodium LOW

105
Q

In renal AKI, what is the urinary osmolality and urinary sodium like?

A

Urinary osmolality LOW

Urinary sodium HIGH

106
Q

What is the best investigation for hydronephrosis?

A

Ultrasound

Finals Revision (22 decks)

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