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MRCP > Renal > Flashcards

Renal Flashcards

1
Q

Contrast nephrectomy

A

occurs 2-5 days after administration

RF:

  • Known CKD
  • AGE
  • Dehydration
  • Hfx
  • NEphrotoxicss
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2
Q

ACEI - ?renal A stenosis

A

Fall in eGDR of 25% or rise in Cr of 30%

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3
Q

Gosrelin MOA

A

GnRH Agonist –> neg feedback to ant pituitary

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4
Q

persistent non-visible haematuria def

A

Blood + 2/3 samples taken 2-3 weeks apart

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5
Q

Post tranplant infection

A

CMV - CMV PCR

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6
Q

Testicular Ca - types

A

95% germ cell –> divided into seminoma and non seminomas

Non germ cell = Leydig and sarcomas.

peak incidence for teratoma = 25 yrs

peak incidence for seminoma = 35 yrs

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7
Q

Testicular Ca - RF

A 
Infertility 
cryptorchidism 
Fhx
Klinefelter's
mumps orchitis
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8
Q

Testicula Ca features

A

Painless lump
Hydrocele
gynaecomastia

Seminoma - hCG

AFP/LDH elevated in most

Diagnosis = US

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9
Q

TEsticular Ca Mx

A

Orchidectomy

chemo/RT

Semioma 5yr survivval >teratoma

95%:85%

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10
Q

Site of action of diuretics

A

Loop:

  • Furosemide - TAL - NA-K+-Cl
  • Bumetande

Thiazide:
- Distal tubule - Na-CL

Aldostenerone angtag:

  • Spironolactone
  • Distal tubule/Collectinf duct - Na/K+
  • ANP = anti aldisteribe
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11
Q

Proteinuria

A

microalbuminuria = 30-250 of Alb or UACR >5mg

non renal causes of high protein:

  • Temp
  • Ex
  • Skin dz
  • LUTI

Orthostatic proteinuria:
- Raised protein after standing for long time - disappears afte recumbence - early a.m. = N

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12
Q

Renal angiography complicaion

A

Nephrogenic systemic fibrosis = similar to scleroderma

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13
Q

Renal tubular acidosis

A

Type 1:

  • Distal
  • Poor H+ excretion
  • URinary pH >5.3 - alkaline
  • HYPOKALAEMIA
  • Complication: Nephrocalcinosis/Renal stines
  • Causes: idiopathic/SLE/Sjrogrens/amphoterecin/analgesic neohropathy
Type 2:
- Proximal 
- NaHCO3- rabs fx 
 Urine pH normal
- HYPOKALAEMIA 
- Causes: idiopathic/fanconi syndrome/ Wilsons's dx/cystinosis/tetracycline/carbonic anhydrase inhib

Typ 4:

  • Low aldosterone –> Dont form NH3+
  • HYPERKALAEMIA
  • Causes: Hpoaldosteronism/DB
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14
Q

Fanconi syndrome

A

General reabsorptive disporder of procimal tubule
Rype 2 RTA

glycosuria, Amino-aciduria, polyuria, phsphateuria

Causes:

  • Cystinosis
  • Sjrogrens
  • MM
  • Wilson’s
  • Nephrotic syndrome
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15
Q

Hypokalaemia causes

A

w/HTN

  • Cushings
  • Conns
  • Liddles
  • 11-beta-hydroxyas deficiency

w/o HTN

  • Diuretics
  • GI loss
  • RTA
  • Barters
  • Giltemanns
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16
Q

Liddles/barters/gitelman - what are they

A

Liddle:

  • Xs Na Reabs
  • These NA channels = amiloride sensitice
  • HTN + Hypokalaemia
  • Mx: Na restrict/ K+ replace/ Amiloride

Barters:

  • A.D.
  • Defect in Cl- channel of NA- K - CL transporter
  • low BP/hyper reninuria
  • Tx = K+ replace +/- NSADS

Gitelmans:

  • Similar to BArters
  • A.R.
  • Px later in life:
  • Low K+/ Mg/ H+/ Ca
  • Mx: Mg + K replace
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17
Q

AKI KDIGO Classification

A

Satge 1:

  • Cr - >26 mmol or rise of =/> 1.5-1.9x BL
  • UO - <0.5 ml/kg/6hr

Stage 2:

  • Cr: >2 - 2.9x
  • UO: <0.5 ml/kg/>24hr

Stage 3:

  • Cr: >3x or >354 mmol
  • On RRT
  • UO <0.3/kg/24hr or Anuria for/12 hrs
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18
Q

Drugs to stop in AKI

A

Stop as worsens AKI

  • NSAIDS
  • ACEI/ARBS
  • aminoglycloside
  • Diuretics

Stop as increase toxic:

  • metformin
  • Dig
  • Li
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19
Q

ATN

A

Causes

  • Renal ischaemia
  • Toxins - Aminoglycloside/Myoglobin (Rhabdomyolysis)

Ft

  • High urea/cr/K+
  • MUDDY BROW CASTS

Histopathology

  • Tubular epithelial necrosis
  • these necrotic cells can block tubules
  • thos can cause tubular dilation

Phases

  • Oliguric
  • Polyuric
  • Recovery
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20
Q

ATN Vs Pre-renal uraemia

A

Think about pre-renal ureamia - HOLDING on to Na + urea

Urinary NA:

  • ATN>30
  • PU - <20

Na Secretion:

  • ATN >%
  • PU <1%

Urea excretion:
- ATN >35%
PU <35%

URine:plasma OSm:
- PU >1.5
ATN <1.1

Urine:

  • ATN - muddy brown cast
  • PU - bland sediment
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21
Q

Indications for emergecy dialyss

A
  • Hyperkalia > 6.5
  • URaemia - pericarditis/encephalopathy
  • pH <7.1
  • Resistant fluid overload
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22
Q

Rhadbomyolysis

A

Causes:

  • Seizure
  • Long lie
  • Traumatic –> IVDU
  • Ecstasy
  • Crush injury
  • McArdles
  • Statins - combo with clarithromycin

Mx:

  • IVI
  • URinary alkalinisation
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23
Q

RF for Contrast nephropathy

A

RF:

  • high contrast lad
  • multiple doses
  • Age
  • CKD
  • Hypovolaemia
  • Dehydration
  • Myeloma
  • hyper Ca
  • Hyperuricaemia
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24
Q

CKD

A

Stage 1 - eGF>90
- Req abnoral U+E or proteinuria

Stage 2: 60-90:
req abnormal U+E  or proteinuria
- no anaemia
- no MBD
- may have HTN

Stage 3a = 45-59 and 3b = 30-44

  • Most commonly have HTN]
  • largest group
  • 3b –> anaemia/MBD

Stage 4: 15-30:

  • HTN +++
  • PO4-

Stage 5: <15
- RRT

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25
Q

Anaemia of CKD - causes

A

dmaged kidney produce less EPO

URaemia + Toxin build up –> decrease EPO production

Nausea/anorexia

Decreased Fe absorption

BLood loss - fragile capillaries - GI

Reduced RBC survival

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26
Q

anaemia - CKD MX

A

EPO stimulating agents:

  • EPO/darbopoeitin
  • target = 10 - 12 g/l
  • Ensure Fe Replac
  • only use when deemed likely to benefit from QOL and physical fn

Resistance to EPO:

  • Low Fe
  • Occult GI blood loss
  • Al toxicity
  • hyper PTH
  • sepsis/chronic inflamm
  • pure red cell aplasia

S.e:

  • Accelerated HTN/Encephalopathy
  • Flu-like
  • Bone aches
  • thrombosis
  • Pure red cell aplasia = Ab vs exog/endo EP
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27
Q

CKD HTN

A

ACEI + ARB = 1st line

eGFR <30-45 consider furosemide

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28
Q

CKD - PRoteinuria

A

UACR used :

Early am spot test 3-7 –> rpt –> >3 –> confirms
>70 - doesnt need repeat

Freq monitoring - per yr - SEE NOTES

Referral to nephrologist:

  • UACR >70
  • UACR >30 + persistent haematuria (xcl UTI)
  • UACR >3 + persistent haematuria + 2 other R F(renal fn/CVD)
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29
Q

CKD - MBD - Histological findings at bone biopsy

A

OSteomalacia = low vit D

Hyper PTH bone dx = OSteoperosis + OSteitis fibrosa cystia ( Subperiosrteal eroisons in radial border of phalanges)

OSteoperosis = malnurised + high PTH

Osteosclerosis - RUGGER JERSE SPINE

Adynamic bone dx –> low urnober

Aluminium bone dx - rre now as AL agents not used

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30
Q

CKD - MBD mx:

A

1) low dietary PO4-

2) PO4- Binders
- Sevelamer - Non Ca based –> decreases uric Acid + improves lipids
- Ca based –> S.e. hyper Ca + vascular calc
- Al based - no longer used

3) Vit D replace - alpha -calcidol.calcitriol
4) PTH-ectomy

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31
Q

HD vs PD - When to choose HD

A
  • recent abdo surgery
  • recurrent peritnitis
  • severe recurrent illness
  • resp dx - stenting
  • frail
  • peritoneal mebrane/ ultrafiltration faiure
  • too poor renal fn
  • sev malnutrition –> lots of protein lost in efluent..
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32
Q

PD complications

A

BActerial peritonitis

  • Staph epidermis - most common —> Staph A/G-
  • rpt episodes –> HD

Ultrafiltration fx
Pt = high transporter of glucose

Encapsulating peritoneal scelrosis:
- Recurrent peritonitis or LT PD _-> Peritoneum thickens and encases bowel –> UF/ Bowel obstruct / Malnutritiom

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33
Q

Haemodialysis

A

usually vasc access via elective fistula

can use tunelled catheter in emergencies:

  • Late px w/sev uraemia
  • Fistula complication
  • higher infection risk
  • OBstruction risk
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34
Q

Lt complications

A

IHD

LVH/dilated cardiomyopaty

vacular calcification

calvular dx

pyrophosphate arthropathy –> pseudogout/gout

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35
Q

Contraindications to Renal transplant

A

Recurrent/ malignancy (<2yrs)

Severe comorbidity

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36
Q

Graft rejection

A

Hyperacute:

  • Mins - hrs
  • mottled dusky skin
  • preformed Ab vs Donor HLA class 1
  • Types 2 hypersensitivity
  • mx = remove graft

Acute graft rejection:

  • <6/12
  • T cell mediated
  • mismatch HLA or CMV
  • Mx - Steroid/IS

Chronic graft rejection:

  • > 6/12
  • Ab & Cell mediated –> fibrosis
  • Recurrence of original dx - MCGN>IgA>FSGN
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37
Q

Acute graft dysfn causes

A

ATN of graft

Stenosis:
- Uncontrolled HTN –> angioplasty

thrombosis

  • if arterial –> sudden anuria –> immed surgery
  • Venous –> pain + swelling + oliguria –> graft loss.

urine leakage
- Decreased UP / high Cr/ fever –> US revision

infection/lymphocele –> drain

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38
Q

chronic graft dysfn

A

Chronic renal allograft nephropathy:

  • immunological and non-immune cuases
  • Develop –> proteinuria + graft dysfn
  • Mx - controlled HTN/low proteinuria –> ACEI / ARB

Recurrence of primary dx

polyomavirus infection:

  • BK/JC virus
  • Decrease MMF
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39
Q

Renla transplant I.S - example regimes

A

initial: Ciclosporin/Tacrolimus w/Mab
Maintenance: Ciclosporin/tacrolimus w/ MMF or sirolimus

+ steroid if >1 steroid responsive acute rejection

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40
Q

Renal transplant I.S. - medicaqtions

A

Ciclosporin
- Calcineurin Inhibitor

Tacrolimus

  • Stop B/T cell
  • s.e. - GI/BM supression

Sirolimus:

  • IL-2 inhib –> stop T cell prolif
  • s.e. Hyperlipidsaemia

Mab:
- Il-2 inhibitors

Monitoring:

  • CV dx
  • Renal Fx
  • Malignancy
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41
Q

Nephritic

A
  • Rapidly progressive GN
  • IgA Nephropathy
  • Alports

I= eye = things you can see - H’s:

  • HTN
  • HAematuria
  • HArdly pee - Oliguria
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42
Q

Nephrotic syndromes

nephr-O-tic

A
  • minimal changed - Minimal Age
  • membranous GN - Suck some dick to become a MEMBER of the club
  • FSGS - FSG - HIV
  • Amyloidosis
  • DB nepropathy

-O-:
pr-O-teinuria
hyp-O-albuminaemia
Fat chick with big belly - hyperlipidaemia

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43
Q

Mixed nephrotic/nephritic

A

Triad:

1) Proteinuria - >3g/day
2) Hypoalbuminaemia - <30g/L
3) Oedema

  • Diffuse prolif GN
  • Membranoproliferaive GN - Proliferative = fast
  • post-strep GN
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44
Q

Rapidly progressive GN

  • Rapidly “crescenteric” GN
A

Crescents = look like loops = LUPUS or DIFFLUPUS (Diffuse prolif)

  • Loop wire lesions

Rapid onset –> AKI
HTN

Histology - glomeruli full of crescent cells.

Mx:
- plasma exchange - Steroid/IS

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45
Q

Goodpasteures

  • Goodpasteures = 2 pasteures

The 2s and the Gs

A

Type 2 hypersensitivity
Affects 2 organs - lung + Kidney
Ab vs (type 2 x type 2) = Type 4 collagen

anti-GBM - Vs Collagen type 4 - pulmonary/glomerular BM

Px:

  • Pulmonary haemorrhage - young smoker
  • Biopsy - IgG deposits in linear patterns
  • Increased transfer factor

RF:

  • smoking
  • LRTI
  • pulm oedema
  • inhaled hydrocarbons
  • young male
46
Q

IgA Nephropathy

  • IgA = deposits
A

AKA - Bergers Dx/Mesangioprolif

Most common

Histology:
- Mesangial hypercellularity w/ +ve immunofluroensce IgA/C3

FOLOWS URTI - 1-2/7

Px:
- young male, follows URTI 1-2/7, recurrent macroscopic haematuria.

Good prognosis:
- Frank haematuria

Poor prognosis:

  • Male
  • Smoking
  • HTN
  • proteinuria
  • high lipids
  • ACE
47
Q

Post-streptocoocal GN

PSG = THREE

A

3 weeks post URTI
Low C3
Lump3 - Bump3 - immune complex deposits
Type 3 hypersensitivoty

Immune complex deposition of IgM/IgG/C3

Ft:

  • young child gen unweel
  • LOW C3
  • proteinuria
  • ASO TITRE

Biopsy features:

  • Acute GN - Endothelial prolif w/neutrophils
  • electron microscopy –> subendothelial umps = immune complex deposits
  • immunofluorescence = STARRY SKY = GRANULAR
48
Q

Alports syndrome

Alports = Alfort = Al-4

A

Same as goodpasteures (2 organs) + can’t see or hear (2 more)
- Lungs + Kidney + eyes + Ears

remember dodgy landing X wing video on pixorize.

X - Linked dominant

Collagen type 4 defect

Eyes - cataracts/lenticonus/lens dislocation/retinopathy

  • Ears - sensorineural deafness
  • Kidneys - GN/haematuria

Renal biopsy - S[litting of lamina densa = basket weaves.

49
Q

Minimal change dx

  • THE MINIMALS
A

Affects kids - Minimal age
Foot = minimal body part = foot process effacement

Nepjrotic syndrome

affects CHILDREN

Causes:

  • idiopathic
  • Drugs - NSAID/Rifampicin
  • Hodgkins lymphoma.thymoma
  • infectious mononucleosis

Pathophysiology:
- T cell mediated damage to BM –> Anion loss –> electrostatic charge –> more permeable to Albumin

Ft:

  • Nephrotic syndrome
  • Normotension
  • Selective protein loss

Inc:

  • Light microscopy no change
  • e- microscopy - effacement of foot processes + fusion ofpodocytes.

Mx: STEROIDS –> fx –> Cyclophoisphamade

Prognosis:
- 1/3 recover
1/3 infreq episodes
1/3 freq episodes –> stop b4 adulthood

50
Q

FSGS

FSG = HIV

A

Px - Young adults w/ nephrotic syndrome

Causes:

  • idiopathic
  • secondary to IgAA/Reflux nephropathy
  • HIV
  • Heroin
  • Alports
  • SCD
  • recureence risk in transplant

Biopsy finding:

  • Light microscopy - focal + segmental sclerosis
  • e- microscopy - foot effacement process.

Mx:
- Steroid + IS

51
Q

Membranoproliferative GN

Proliferative = Fast

A 
Prolif = fast = TRAM TRACK 
Px = Mixed ]

Type 1:

  • majority
  • causes = cryoglobulinameia/hep C
  • Renal biopsy - TRAM TRACK

Type 2:

  • dense deposit dx
  • Causes = lipodystrophy/factor H deficiency
  • Ft = low complement - C3
  • Biopsy = DENSE DEPOSITS - immune complex
52
Q

DB Nepropathy

A

Pathophysiology:
- Raised glomerualar capillary pressure –> non-enzymatic glycosylation of BM

Histology:

  • BM thickening
  • Capillary obliteration
  • Mesangial thickening
  • KW nodules

Stages:

1) Hyperfiltration - raised eGFR
2) Silent phase - no microalbuminuria
3) Incipient nephropathy microalbumin - 30 -300
4) Over nephropathy: - alb excretion >300/HTN/ KW nodules
5) ESRF

53
Q

APKD

A

Most common inherited kidney dx.

ADPKD - Chromosome 16

APKD type 1

  • 85%
  • Polycystin 1
  • Px earlier

APKD type 2

  • 15%
  • polycystin 2

Px:

  • Abdo pain
  • HTN
  • UTI
  • Aneurysmal dx

+FHx –> SCREEN

Mx: Tolvaptan - vasopressin 2

US diagnostic criteria:

  • 2 cysts unilat - <30 yrs
  • 2 cysts B/l - 30-60yrs
  • 4 cysts B/L - >60yrs

NB: These adults tend not to be EPO Defficient –> Inflamm or mlaignancy –> suddem fall in Hb in prev stable pt as –> increase inhibition of recombinant EPO

54
Q

Thin BM disease

A

Inherited - type 4 collagen

3 of:

  • persistent haematuria
  • No renal fx
    • FHx - haematuria w/o renal fx.
55
Q

Acute interstitial nephritis.

A

accounts for 25% of drug induced AKI

Causes:

  • Penicillin
  • Rifampicin
  • NSAIDS
  • Allopurinol
  • Furosemide
  • systems - sjrogrens/SLE/Sarcoid
    infectious: - Hanta virus/staph

Ft:

  • Temp/Rash/Arthralgia
  • ESR
  • mild renal impairment
  • HTN

Inx:

  • Sterile pyuria
  • white casts

Histology:
- increased oedema + infiltrate of CT between renal tubule

Mx:
- Cesation +/- Steroids

56
Q

Chronic interstitial nephritis.

A

Many causes - systemic and local

Px:
CKD/ ESRF/RTA. DB1/ Salt wasting

57
Q

Renal papillary necrosis

A

Coagulative necrosis of renal papillae

Causes:

  • severe acute pyelonephritis
  • DB Nephropathy
  • Obstructive nehropathy
  • Analgesic nephropathy - Phenacetin/NSAIDS
  • Sickle cell anaemia

Ft:

  • Visable haematuria
  • loin pain
  • proteinuria

Q STEM - pt with chronic pain px with loin pain + CKD = Haematuria.

58
Q

Reflux nephropathy

A

most common cause of ESKD in children
Scarring in 1st 5 years of life

Strong GENETIC component - therefore if siblings affected –> Screen

Grade 1 - 4 with increasing reflux

All children UTI - investigate - VUR

Inx - micturition cystography

Px:

  • UTI in child
  • Renal scar –> HTN
  • Proteinuria

Mx:
GRade 1-3 self resolve
Grade >4 - surgery

Prophylactic abx if >grade 2

59
Q

UTI in pregnancy

A

symptomatic:

  • 7/7 abx - avoid Nitro if near term
  • urine culture

Asx + bacteruria:

  • 7/7
  • urine culture
  • 2nd urine culture after completeion.
60
Q

Renal Stones Types

A

Ca Oxalate

Cystine

  • Metabollic
  • semi opaque

Uric Acid - Assoc with GOUT

CaPO4-

Struvite - Recurrent UTI - P.mirabilis

61
Q

Diffuse proliferative GN

A

Post strep - in child

  • Nephritix syndrome and AKI
  • SLE
62
Q

Goodpasteures - REMEMBER THE G

A

IgG

anti-GBM

63
Q

AV fistula - ?time taken to develop

A

6-8 weeks

64
Q

Cystinuria

A

A.R. - Chromsome 2 - defect in transport of cysteine, orthinine lysine arginine (COLA)

Recurrent renal stones = yellow + crystalline = semiopaque

Inx - cyanide - nitroprusside test

Mx:

  • Hydralazine
  • penicillamine
  • urina alkalinisation
65
Q

Membranous GN

  • Need to suck some dick to become a MEMBER
A

Dome = street for sucking dick = Spike + Dome apperance

Who sucks dick int he street - IVDU looking to score = HEPATITIS

Most common type of GN in adults:

e- microscopy –> spike and dome appearance = thick BM + electron dense deposits

Causes:

  • Idiopathic - anti-phospholipase A2
  • Infection - Hep B, malaria and symphillis
  • malignance - lung Ca, lymphoma, leukaemia
  • Drugs - Gold, penicillamine, NSAIDs
  • AI - SLE, thyroiditis, RA

Mx

  • ACEI + ARB
  • I.S.
  • if high risk 0—> anticoah

Prognossi s= rule of 1/3

  • 1/3 recover
  • 1/3 persistent proteimuria
  • 1/3 ESRF
66
Q

HIV + renal involvement

A 
Large kidneys 
FSGS 
Proteinuria/nephrotic syndrome  
Elevated urea + creatinine
normotesnion
67
Q

retroperitoneal fibrosis

A 
Reidels thyroiditis 
inflamm AAA
Sarcoidosis 
RT 
Drugs - methysergide
68
Q

eGFR variables

A

CAGE

Cr
Age
Gendor
Ethnicity

69
Q

Renal stones types

A

Ca Oxalate:

  • pH 6
  • Radio-opaque
  • High calcium
  • low oxalate in ureine

Cystine stones:

  • Cystinuria / metabolic
  • SEMI-OPAQUE

URate stones:

  • Produc of pirine synthesis
  • pH low
  • GOUT / ileostomy
  • Can be caused by malignancy
  • Radio-opazue

CaPO4-:

  • RTA
  • pH>5.5
  • RTA - type 1 + Type 2
  • Radio-LUCENT
Struvite:
pH<7.2
-Staghorn calculi 
- stones of Mg, NH3, Po4 
- assoc w/ CHRONIC INFECTION
70
Q

RF for stones

A 
ehydration
hyper Ca/PO4 
high oxalate
RTA
Medullary sponge kidney 
Cadmium.berillyium

RF for urate stones:

  • gout
  • ileostomy
Drugs:
- Loop diuretics
steroids 
acetazolamide 
theophylline
71
Q

Mx of renal stones general

A

NSAID - diclofenac for renal colic

Non contrast CT KUB

<5 mm - pass by itself

> 5 mm:

  • SWL - CI Pregnancy - <2cm+ not preg
  • Ureteroscopy - <2cm + preg
  • Percut - complex staghorn

Obstruction + infection –> SURGICAL EMERGENCY

72
Q

Mx of renal stones specific

A

Calcium:

  • low protein + salt diet
  • Fluid
  • Thiazides

Oxalate:

  • cholecystyramine
  • Pyrodixine

Uric Acid:

  • Allopurinol
  • Urinary alkalinisation
73
Q

Acute urinary retention

A

Pain

Px –> anuria/AKI

Inx - US

Mx: If bladder outflow obstruct –> catheter

if vesico-ureteric and above –> stent or drainage - percut

post mx – > massive diurese = temporary nephrogenic DI

74
Q

Chronic urinary retention

A

Painless

px –> CKD/ESRF

Common complication - Na wasting/metabolic acidosis

Inx: - US –> retrograde pyelography if no obstruction identified ( VUR/post obstruct atrophy)

Causes:
Luminal = calc/clot/tumour/papillary necrosis.
Wall = neuromuscular - neuropathic bladder
External compression = multiple cause

75
Q

Neuropathic bladder

A

Childhood most common cause:

Px:

  • Upper tract dilatation –> US - no obstruction
  • incontinence/reflux/infection
  • assoc bowel dysfn.

Mx:
- anticholinergic
intermittent self cath
ileal conduit

76
Q

Post urethral valces

A

Px:

  • male infants
  • px in 1st year of life w/ - poor stream/bladder dysfunction/failure to thrve.

Inx –> ANC US

Tx - self cath

77
Q

Renal Cell Ca

A

Most common cell type = Clx cell

Assox:

  • middle aged male
  • smoking
  • VHL
  • Tuberous Sclerosis

Ft - Triad of:

1) Loin pain
2) Haematuria
3) Abdo mass

Other ft

  • Left varicocele
  • Enocrine - high PTH/high EPO. Renin/ ACTH
  • 25% metastatic
  • Stauffer syndrome = paraneoplastic hepatic dysfn

Mx:

  • Confined - SURGERY
  • High size/METS - TKI (Sonafenib)/INF-alpha/ IL-2
78
Q

Wilm’s Tumour

A

Childhood Px - <5yrs

Ft:

  • Abdo mass
  • Flank pain
  • Haematuria

95% = Unilat 20% Mets = lung

Assoc.

  • Beckswith wiedenaan –> overgrowth syndrome - big tongue + open abdo
  • WAGR - Wilms/Aniridia/ G-U/ Retardation

Mx: Nephrectomy/cryo/RT

Good prognosis - 80% cure rate

79
Q

Uroethelial tumours

A

majority = transitional cell Ca
others - Squamous cell

RF:
- Smoking
- Alanine
- Analgesic nephropathy
 -Rubber
-Schistomiasis 
- renal cystiv dx
- Renal stones (VHL)
-
80
Q

Bladder Ca RF

A

Transitional:

  • Smoking
  • ALANINE
  • Rubber
  • Cyclophosphamide

Sq Cell Ca:

  • Smoking
  • Schistomiasis
81
Q

Amyloidosis of renal tract - Inx

A

Inx

  • CONGO RED STAINING - APPLE GREEN BIFRINGENCE
  • SAP Scan - serum amyloid precursor
  • Rectal tissue biopsy
82
Q

Amyloidosis of renal tract types

A

AL:

  • Most common
  • Light chain - Ig
  • Ft - nephrotic syndrome/cardiac/neuro
  • Mx = Mephalan –> BM transplant
AA:
- Amyloid A precursor = acute phase ractant 
- seen in CHRONIC INFECTION
- High renal dx
= Tx = txunderlying

Beta-2 microglobulin

  • Part og MHC
  • assoc w/ pt on renal dialysis
83
Q

Renal A stenosis

A

cokmmon causes:
Old = athersclorosis

Young female = Fibromyscylar dysplace

  • US = Assymetric kidneys
  • Angiography =string of beads

Px:

  • HTN
  • CKD/AKI
  • Flash pulm oedema
  • Above exac by ACEI/ARB
84
Q

SLE and the Kidney

A

SLE –> Lupus nephritis –> Therefore req REGULAR SCREENING

WHO CLassification:
- Class 1 = Normal
Class 2 = Mesangial GN
Type 3 = FSGN
Class 4 = Diffuse prolif GN
Type 5 = Diffuse membranous GN
Type 6 = Sclerosing GN

Inx = Renal Biopsu

  • WIRE LOOPING = endothelial/Mesangial expansio
  • E- micro - Subendothelial immune deposits
  • IF –> GRanular appearance

MX:

  • ACEI/ARB
  • Active dx –> Steroids/IS
85
Q

H.U.S

A

see in young child - Triad of:

  • AKI
  • Miicroangiopathic anaemia
  • Thrombocytopaenia

Causative agent - E.COLI
other causes:
- Pneumococcal
- HIV- SLE/Drugs/Ca

Inx:

  • FBC
  • U+E
  • Stool culture

tx = supportive
- V.Sev ecoli infec –> Plasma exchnge

86
Q

TTP

A

Abnormally large sticky multimers of vWF –> clumo

Ft:

  • Triad as for HUS
  • these patients have FLUCTUATING neuro signs = microemboli.
CauseS:
- infection
-preg 
- Drugs - ciclosporin/OCP/pemmocollin/Clopi 
- Tumours 
SLE
- HIV

Mx:

  • PLASMA EXCHANGE
  • Steroid/IS
87
Q

Multiple Myeloma

Mnemonics:

Ecidence of end organ damage - CRAB

M.Y.E.L.O.M.A

A

NEoplasm of BM

CRAB:
- Ca >11/ RFx / Anaemia / Bone dx (lytic lesion/rain drop skull)

M.Y.E.L.O.M.A

  • M spike
  • You better check Ca + lYtic lesion
  • ESR
  • Light chain/bence jones
  • Ouch my bones
  • myeloma nephrosis/ marrow plasmocytosis >10%
  • Anaemia

Inx:

  • BM biopsy –> >10% plasma cells
  • IgA + IgG + Bence jones
  • Skull XRAY - Raindrop skull
  • MRI - radiculopathy

Diagnostic criteria 1 maj + 1 minor or 3 minor:

MAjor:

  • Plasmocytoma
  • > 30% plasma celss
  • v.high M protein

Minor:

  • 10-30% plasma cells
  • minor M protein
  • Osteolytic lesions
  • minor level Ab
88
Q

VAsculitis in Renal

A

Small vesse vasculitis - NO HTN :

  • WG - cANCA - Saddle nose
  • Churg strauss - pANCA - Astham/nasal polyp/eosinophillia
  • MPA - pANCA
  • Histology for all above = Necrotising GN = CRESCENT OR FOCAL PROLIF

Poly arteritis Nodosa - HTN:

  • med vassel
  • ANCA neg

HSP - IgA cross over

Kawasaki Dx - Child - CRASH & BURN

  • Conjunctivitis - non purulent
  • Rash
  • adenopathy
  • Strawberry togue
  • HAnds + feet - erythema
  • Burn = temp
Takaysau:
- Lrg vessel vasculitis 
- claudication
RAS 
- arotid bruit

GCS

89
Q

Renal sarcoid

A

Px as AKI due to AIN –> HYPER CA AND HEPATO-SPLENOMEGALU

Px as CKD - due to HyperCa or CIN

Mx - steroids
- monitor serum ACE

90
Q

Nephrotoxic drugs

A

Decrease BF:

  • NSAID
  • ACEI
  • ARB
  • Tacrolimus
  • Ciclosporin

Direct toxic

  • Aminoglycloside
  • Amphotericin
  • Cisplatin

GN:

  • gold
  • penicillamine

Li –> interstitial fibrosis

91
Q

Most common infectign organism of PD?

A

Staph epididermis !!!!!

Followed by:

  • stah A
  • enterococcus
92
Q

Rapidly progressive haematuria

HAemoptysis

URTI signs - what is it

A

Granulamotosis with polyangitis

93
Q

Plasma exchange wjhat electrolyte is low

A

Hypocalcaemia

Plasma exchange is used to remove and filter a patients blood.

Citrate is used as an anticoagulant, which can bind to calcium –> hypocalcaemia

94
Q

bph MX - medical

A

1) - alpha-1 antag
- Tamsulosin
- causes postural hypotension, dry mouth, depression
- decreas SM tone dizziness

2) 5-alpha reductase inhibitor - Finasteride
- stops T –> DHT
- reduces volume of prostate –> slow progression
- take sup to 6/12 to work
- E.D./decreased libido/ejac problems.

95
Q

Drug induced AIN

A

Commonky allopurinol and NSAIDs

Allopurinol -, eosinophika

Note NSAIDs no eosinophiks

Mx:
A
Withdrasl of drug
(no proof for steroids, may be use din very severe)

96
Q

Following Transplant immunosupression what is a common side effet

A

Increase in DB

Steroids heavily used in I.S.

97
Q

Renal involvement in Myeloma

A

Cast nephropathy:

  • severe renal insufficiency
  • ABSENT ALBUMIN (or bery small amounts)
  • Bence jones

AL. Amyloidosis:

  • nephrotic syndrome
  • mild. Renal. Insufficiency
  • LAMBDA LIGHT CHAIN

Cryoglobunaemic glomerulonephritis:

  • mild. To. Severe nephrotic sybdroe
  • HAEMATURIA

Light chain deposition diseass:

  • MILD disease
  • KAPPA ligt chain
98
Q

Amyloidosis

A

seen on MYELOMA AND MGUS

Other csuses:

Familal Mediterranean fever
Secondary (RA)

Apple green bifringence on congonred staining

Renal. Amyloidosis recurrs after. Transplant

Affects liver kidneys and heart

Cardiac involcemenr is the most common causs of sudden. Death

99
Q

AA vs AL amyloid question features

A

Both are apple. Green bifringencd

AA

  • related to RHEUMATOID
  • chronic inflamm diseass

AL
- severe disease

100
Q

Acute vs chrinic graft rejection

A

Acute <2 weeks:

  • acute rejextion
  • ATN
  • CNI Toxicity
  • thrombosis
  • surgicla comlkciatuon

Chronic reject - >2 weekz

  • chronic rejection
  • chronic CNI toxicity
  • obstruxt
  • R. A. S
  • Bk/JC virus
  • recurrenc of primary dx
101
Q

Acute vs chrinic graft rejection

A

Acute <2 weeks:

  • acute rejextion
  • ATN
  • CNI Toxicity
  • thrombosis
  • surgicla comlkciatuon

Chronic reject - >2 weekz

  • chronic rejection
  • chronic CNI toxicity
  • obstruxt
  • R. A. S
  • Bk/JC virus
  • recurrenc of primary dx
102
Q

HyperPTH vs familial hypocalciuric hypercalcaemia

A

Both have high serum Ca

FHH has LOW URINARY CA

103
Q

Which glomerulonephritis is assoc with cance

A

Membranous neohritid - lung cancer

104
Q

Wegners

we-C-ners

A

cANCA

C on stick man - effects nasopharync + lungs + kidneys

Biopsy:
- Segmental -C-rescentic necrotising GN

Poor prognosis - Renal dx

105
Q

most common side effect of LT dialysis

A

Carpal tunnel syndrome

106
Q

medullary sponge kdiney

A

increase risk of renal stones in pregnancy

107
Q

Oain in drinking alcohol and renal. Dx

A

Minimal change disease

108
Q

Hb aim. In CKD

A

110-120 g/DL

109
Q

Nephritic Syndromes: PIG ARM

A

Post strep GN
IgA Nephropathy
Goodpastuers

Alports
RPGN
Membrano-prolif

110
Q

Partial lipodystrophy - renal involvement

A

mesangiocapillary with C3 nephritic factor

therefore get low C3 and normal C4

111
Q

Normal Anion Gap

A

12-18

112
Q

Which vasculitis is assoc with wegners

A

R PGN

MRCP (20 decks)

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