Renal Flashcards

Question

Which type of histological classification of FSGS has the worst prognosis?

Answer 1

Collapsing FSGS secondary to HIV

Answer 2

Prednisolone achieves 40-60% partial to complete remission inprimary Calcineurin inhibitor

Answer 3

characterised by increased mesangial and endocapillary cellularity (proliferative lesions) with thickened GBM leading to a double contour appearance of glomerular capillary walls

Answer 4

``` Hepatitis C (70-90% of all patients), cryoglob HBV, HIV, IE, malaria, SLE, Myeloma ```

Answer 5

Associated with C3nef Inherited mutation of Factor H Monoclonal gammopathies

Answer 6

chronic antigenemia and classical pathway subendothelial and mesangial immune deposit glomerular deposition of immune complexes in the sub-endothelial and mesangial region leading to activation of the classical pathway and low C3 and C4 levels

Answer 7

Persistent activation of the alternative pathway C mediated MPGN ie either dense deposit disease (DDD) or C4GN may result from antibodies to C3 convertase by preventing its degradation by factor H, or by genetic mutation in factor H Excessive activation of the alternate complement pathway: continuous overactivation so low C3 but normal C2 and 4

Answer 8

microscopic haematuria with non-nephortic proteinuria (35%) nephrotic syndrome with minimall depressed GFR (34%) chronic progressive GN (20%) rapidly progressive GN (10%)

Answer 9

supportive therapy: ACEi, statin, anticoag, low Na diet identify and treat precipitant e.g. HIV idiopathic cases treated with prednisolone and cyclophosphamide Complement mediated MCGN - C3Nef disease: PLEX, rituximab, eculizumab - For Factor H deficiency: FFP

Answer 10

``` Renovascular HTN Primary aldosteronism Cushings disease Pheochromocytoma Drugs: OCP, NSAIDs, Glucocorticoids, Decongestants, Cyclosporine, Tacrolimus, Erythropoeitin, Primary renal disease Coarctation of Aorta Polyarteritis Nodosa Liddle Syndrome Chronic liquorice ingestion Apparent mineralocorticoid excess Glucocorticoid remediable hypertension ```

Answer 11

Elevation in serum creatine by >30% within 1 week of starting ACEi/ARB Sever hypertension with an unexplained atrophic kidney or asymmetry >1.5cm Onset of severe HTN 180/120 after age 55 A systolic-diastolic abdominal bruit that literalists to one side Flash pulmonary oedema

Answer 12

Hypokalaemia and metabolic alkalosis (potassium normal in 50% cases) May be as high as 10% in HTN population Bilateral idiopathic hyperplasia (60%) Unilateral aldosterone producing adenoma or Conns syndrome (30-40%)

Answer 13

aldosterone/renin activity ratio >20 strongly predictive confirm with oral sodium or IV saline infusion test - 2 litres/8hours In normal people urinary and plasma aldosterone should fall Adrenal Ct scan Adrenal vein sampling to differentiate adenoma from hyperplasia

Answer 14

Cushing disease (pituitary source of increased ACTH) 68% Ectopic ACTH 12% Adrenal adenoma 10% Adrenal carcinoma 8%

Answer 15

mid night salivary cortisol 24-hour urinary cortisol low-dose dexamethasone suppression test if 2/3 positive -> serum ACTH low ACTH: CT scan adrenal gland high ACTH: high dose dex suppression, pituitary MRI, petrosal vein sampling

Answer 16

Catecholamine secreting tumours that arise from chromatin cells of the adrenal medulla and the sympathetic ganglia 10% extra-adrenal, multiple, malignant Tria of presenting Sx: episodic headache, sweating, tachycardia Urinary fractionated metanephrines and catecholamines has highest sensitivity and specificity at 98%

Answer 17

Von Hippel Lindau Multiple endocrine neoplasia type 2 Neurofibromatosis type 1

Answer 18

Vasculitis that typically affects medium-sized muscular arteries with new onset HTN seen in 35% Kidneys, skin, joints, muscles, nerves, and GO tract most commonly affected 20% of patients are positive for Hep B Necrosis of arterial wall with disruption of the elastic lamina leads to characteristic development of aneurysmal dilatations and constrictions

Answer 19

systemic features 80% neuropathy 75% Arthralgias 60% Skin: lived reticularis, purpura, ulcers 50% Renal failure but no GN 50% GI 40% New onset HTN 35% Orchitis 20% Hep B 20%

Answer 20

Autosomal dominant condition with mutation in ENAC channel in collecting duct (under control of aldosterone) rendering it resistant to normal degradation Persistent sodium reabsorption and resultant hypertension Presentation at young age and may develop hypokalaemia with metabolic alkalosis

Answer 21

Cortisol avidly binds aldosterone receptor. In kidney 11-beta-hydroxysteroid dehydrogenase enzyme type 2 converts cortisol to cortisone. Deficiency in this 11-beta-HSD2 leads to elevated levels of cortisol in the kidneys which stimulates hyperaldosteronism plasma renin and aldo will be low urinary cortisol will be high chronic liquorice ingestion also causes this picture