Renal Flashcards
In renal transplant which HLA antigen is most important to match
DR > B > A
Worldwide most common cause of hepatocellular carcinoma
Chronic Hep Be
Chronic hepatitis C in Europe)
Risk factors for hepatocellular carcinoma
Hep b or c, alcohol, haemochromatosis, primary biliary cirrhosis, male sex, aflatoxin, diabetes/metabolic syndrome,
8 year old child presents with swelling around eyes and limbs, tiredness and weight gain. GP does urine dip. What is most likely underlying diagnosis
Minimal change disease (triad of proteinuria, hypoalbuminemia, and oedema).. most common cause of nephrotic syndrome in children. Mostly idiopathic
Alports syndrome is caused by a defect in….
Type IV collagen
4lports
Alports syndrome is what inheritance
X linked dominant in ,85%. Rarely autosomal recessive
Classic presentation of nephritic syndrome
Hypertension and haematuria with AKI.
e.g. rapidly progressive glomerulonephritis,IgA nephropathy (after URTI), Alports
AKI -distinguish between pre renal uraemia and acute tubular necrosis
Prerenal uraemia - kidneys hold on to sodium to preserve volume… So low urinary sodium (<20)
Fractional sodium excretion <1%
In prerenal, anything related to excretion is low (urine sodium, low fractional sodium and urea excretion,) any real is high (urine: creat , urine plasma osmo)
Features of leptospirosis
Rat urine…Sewage workers, farmers, vets, abattoir,
Fever, renal failure, jaundice, subconjunctival haemorrhage
Treat with high dose benzylpenicillin
Isolated hyperbilirubinaemia with and without bilirubinuria
Gilbert’s if no bilirubinuria
Rotor or dublin-Johnson syndromes if there is bilirubinuria… Because it’s conjugated.
All autosomal recessive
Renal tubular acidosis 1 Vs 2 Vs 3 anion gap
Metabolic acidosis with normal anion gap
… Low bicarb causes hypochloraemia
Complications of RTA 1
Hypokalemia, nephrocalcinosis and renal stones
Complications of RTA2
Hypokalemia, osteomalacia
Complications of RTA4
HYPERkalaemia
(Caused by hypoaldosteronism) so loop diuretics etc
Complications of RTA4
HYPERkalaemia
(Caused by hypoaldosteronism) so loop diuretics etc
What causes increased risk of DVT in CKD
Acquired antithrombin III deficiency… Small protein so easily lost throuhh the nephron
hypertension, kidney injury, proteinuria and haematuria point towards a nephritic picture of kidney insult. In SLE what is most common histological pattern seen?
most common histological pattern seen in lupus nephritis is diffuse proliferative glomerulonephritis
55yr old with persistent proteinuria, BG of multiple myeloma
Renal biopsy shows Congo red stain shows apple-green birefringence under polarised light
Amyloidosis biopsy findings - Congo red stain shows apple-green birefringence under polarised light
Starry sky microscopy renal biopsy
Acute post-streptococcal glomerulonephritis
Also starry sky microscopy in Burkitt’s lymphoma
Nephrotoxicity due to contrast can be prevented by…
IV NaCl 1ml/kg/hr for 12 hr pre and post
Occurs 2-5 days after administration
Food to avoid in CKD because of hyperkalemia
Banana oranges kiwi avocado spinach tomato
🍌 🍊 🥝 🥑 🍅
minimal change glomerulonephritis is made. What is the most appropriate initial treatment to reduce proteinuria?
Prednisolone
majority of cases (80%) are steroid-responsive
Female 55, smoker, poorly controlled hypertension.. develops flash pulmonary oedema. What do you expect renal USS to show?
Asymmetric kidneys -fibromuscular dysplasia
The most common cause for renal vasc disease after renal artery stenosis 2nd atherosclerosis (90%)
Man with hypertension and smoker who develops flash pulmonary oedema after starting on ACEi
Renal artery stenosis (fibromuscular dysplasia is 90% women)
causes of renal papillary necrosis mnemonic
POSTCARDS: Pyelonephritis, Obstruction of the urogenital tract, Sickle cell disease, TB, Cirrhosis of the liver, Analgesia/alcohol abuse, Renal vein thrombosis, Diabetes mellitus, Systemic vasculitis.
what type of renal stones does Proteus mirabilis infection precipitate
struvite kidney stones
When does contrast induced nephropathy occur?
2-5 days after administration
Give 0.9% sodium chlorideat a rate of 1 mL/kg/hour for 12 hours pre- and post-
Most common renal abnormality in Turner’s syndrome
horseshoe kidney
Patient with CKD on haemodialysis..what are they most likely to die from?
Ischaemic heart disease account for 50% of the mortality in patients receiving dialysis
what are the features of autosomal-dominant polycystic kidney disease (ADPKD) ?
Englarged kidneys so well-circ palpable mass in left and right flank
Renal stones, recurrent UTIs, Hypertension
symps may include constant abdominal pain and early satiety
Most common (70%) extra-renal manifestation of hepatic cysts (can cause hepatomegaly)
What is the most common extra-renal manifestation of auto dom polycystic kidney disease ADPKD?
70% have hepatic cysts, which can cause hepatomegaly
Incidence of contrast induced nephropathy without any risk factors Vs renal function impairment
7% generally
25% if impaired
60% Cr>400
100% t2dm and Cr>400
Patient newly taking lithium, protein: creatinine ratio 450, albumin 22 (low). Most likely nephropathy
Minimal changes is most likely lithium-induced nephropathy
Also most common cause of nephrotic syndrome in children
Which nephropathy is associated with malignancy of bronchus or bowel
Membraneous
How long does it take for an AV fistula to be functional
6 to 8 weeks post-surgery to allow full maturation to take place, where the fistula can withstand a dialysis flow rate of 500ml/min
Young boy, 2 days post lrti gets haematuria. Diagnosis and renal biopsy?
IgA nephropathy
histology:mesangial hypercellularity, positive immunofluorescence for IgA & C3
Post strep is 1-2 weeks not days and less likely to have macro haematuria
Young patient, AKI after ACEi starting
Fibromuscular dysplasia
renal angiomyolipomas (haemorrhagic) are strongly linked to…
1/10 have TS
Most patients with TS have it bilat
Patient presents with 4/7 bloody diarrhoea, AKI and platelets 91. No neuro signs Organism?
E coli is the classic cause of HUS
Neuro signs would point towards ttp
Which are nephritic and which are nephrotic
nephRItic - Rapidly progressive, IgA
Proliferative are mixed
The rest are nephrotic
Which glomerulonephritis is most assx with goodpastures
Rapidly progressive (think like pulmonary haemorrhages)
Crescentic histology
Prognosis of Minimal Change disease
Likely full recover but 2/3 have later relapses
Diffuse macpap rash, Sterile pyuria, white cell casts, eosinophilia
Acute interstitial nephritis
Commonly secondary to abx
Glomerulonephritis with Spike and dome appearance on electron microscope and anti phospholipase A2 antibodies
Membraneous glomerulonephritis
anti phospholipase A2 antibodies , facial swelling, proteinuria
Membraneous glomerulonephritis
Which glomerulonephritis is assx with post strep
Diffuse proliferative (same as SLE)
What is thin basement membrane disease
Inherited collagen type 4 defect.
Up to 5% of population
Persistent microscopic haematuria with all other normal results
Sudden deterioration in renal function in patient with nephrotic syndrome
Renal vein thrombosis. Especially occurs in membraneous glom
Predisposed to thrombotic events due to loss of antithrombin iii
eGFR variables
Creatinine
Age
Gender
Ethnicity
May be affected by pregnancy, muscle mass, red meat but they’re not included
Most common cause of peritonitis secondary to peritoneal dialysis
Staph epidermis (coag neg)
Can also be staph A
What are the 4 stages of diabetic nephropathy
1 hyperfiltration
2 silent/latent
3 microalbuminaemia
4 proteinuria
What cancer is someone who is on long-term immunosuppressants for organ transplant at risk of
Skin cancer, particularly Squamous cell carcinoma
