Renal Flashcards

1
Q

how do you tell the difference between acute tubular necrosis and prerenal uraemia?

A

in prerenal uraemia the kidneys hold on to sodium to try and preserve volume. Therefore test urinary sodium
Prerenal uraemia responds to fluid challenges (ATN doesn’t)

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2
Q

what is a significant albumin:creatinine ratio?

A

non-diabetics >30 is clinically significant

in diabetics ACR >2.5 in men and 3.5 in women is significant

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3
Q

what is nephrotic syndrome?

A

proteinuria
hypoalbuminaemia
peripheral oedema

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4
Q

pathology of MGN?

causes of membranous glomerulonephritis?

A

immune complex formation in the glomerulus -> inflammation and nephrotic syn

idiopathic
infection - malaria, hep B
malignancy - lung ca, lymphoma, leukaemia
drugs - gold, penacillamine, NSAIDS
SLE
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5
Q

management of membranous glomerulonephritis

A

immunosuppression - corticosteroids + other (eg chlorambucil)
antihypertensives (ACEi for proteinuria)
?anticoagulant

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6
Q

PCKD type 1 inheritance

A

auto dominant chromosome 16

0.1% of caucasians

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7
Q

what’s the pathology in Alport’s syndrome?

what’s the inheritance?

A

defect in gene for type 4 collagen, leading to defective glomerular basement membranes
X-linked dominant

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8
Q

features of Alport’s syndrome

A
presents in childhood
sensorineural deafness
microscopic haematuria
progressive renal failure and episodic frank haematurea
ocular pathology
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9
Q

features of Goodpasture’s syndrome

A

pulmonary haemorrhage

rapidly progressive glomerulonephritis (IgG)

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10
Q

what is Goodpasture’s syndrome

HLA association

A
autoimmune antibodies to type 4 collagen in BM (anti GBM antibodies)
(type 2 hypersensitivity)
HLA DR2 (narcolepsy and goodpastures)
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11
Q

Ix and Mx of goodpasture’s syndrome

A

renal biopsy - linear IgG deposits
transfer factor - raised due to pulmonary haemorrhage

plasma exchange, steroids, cyclophosphamide

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12
Q

how do you calculate the anion gap?

what is normal?

A

(Na + K) - (Cl + HCO3) (cations(+) - anions(-))

normal 10-18

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13
Q

causes of a metabolic acidosis with normal anion gap

A

GI bicarb loss: diarrhoea, fistula etc
renal tubular acidosis
Addison’s disease (no aldosterone)
drugs eg acetazolamide

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14
Q

causes of a metabolic acidosis with raised anion gap

A

lactate: shock, hypoxia, metformin
ketones: DKA, alcohol,
urate: renal failure
acid poisoning; salicylate, methanol

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15
Q

variables in eGFR calculation

A
CAGE
creatinine
age
gender
ethnicity
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16
Q

what are the eGFR boundaries for CKD staging?

A

1: >90
2: 90 - 60
3a: 59 - 45
3b: 44 - 30
4: 29 - 15
5: <15

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17
Q

action of Spironolactone and eplerenone

where does it act?

A
aldosterone antagonist (eplerenone more selective)
acts on the distal convoluted tubule
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18
Q

What is Henoch-Schonlein Purpura?

features?

A

IgA mediated vasculitis
usually in children post infection
palpable purpuric rash on buttocks and extensor surfaces, IgA nephropathy (haematuria, RF - resolves), abdo pain, poly arthritis

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19
Q

What is the composition of a staghorn calculus?

risk factors?

A

Struvite (triple phosphate)
form in alkaline urine so proteus and ureaplasma urealyticum infections (which produces ammonia) predispose to their formation.

20
Q

Features of haemolytic uraemic syndrome

Mx

A

triad:
acute renal failure
thrombocytopenia
microangiopathic haemolytic anemia

generally seen in young children after E.coli 157:H7
Supportative, plasma exchange if severe with no diarrhoea

21
Q
Type 1 renal tubular acidosis
pathology?
causes?
features?
Mx
A

unable to make acidic urine in distal CT (pH >5.5)
idiopathic, SLE, Sjogren’s syn
metabolic acidosis, hypokalaemia, renal stones
Mx: correct K then give bicarbonate 1-3mmol/kg/day

22
Q

Type 2 renal tubular acidosis
pathology?
causes?
features?

A

Inability to reabsorb HCO3 in PCT
Fanconi syn, Wilsons, cystinosis, idiopathic
hypokalamia, osteomalacia

23
Q

Type 4 renal tubular acidosis
pathology?
causes?
features?

A

decreased aldosterone -> decreased NH3 excretion
hypoaldosteronism, diabetes
hyperkalaemia

24
Q

Where do renal cell carcinomas originate from?

25
RCC associations/RFs
smoking Von-Hippel-Lindau disease tuberous sclerosis
26
RCC features
``` loin pain, haematuria, abdo mass left varicocele (left testicular vein occlusion) endo: may secrete PTH, erythropoetin, renin, ACTH ```
27
Mx of RCC | 5 yr survival?
nephrectomy even if mets as these may regress - C/I if bilateral tumours or poor renal function small molecule kinase inhibitors interferon alpha and IL-2 no benefit in radio/chemotherapy 5yr survival - 60-70% without mets, 5% with mets
28
features of minimal change glomerulonephritis | pathology
T-cell and cytokine BM damage leads to loss in electrostatic charge, increased permeability to albumin Sx: nephrotic syn, normotensive renal biopsy - fusion of podocytes
29
Mx of minimal change glomerulonephritis | prognosis
oral prednisolone 1/3rd have single episode 1/3rd have infrequent recurrences 1/3rd have frequent relapses, which stop before adulthood
30
features of IgA nephropathy
deposits of IgA immune complexes positive immunoflorescence for IgA and C3 typically in young males, following an URTI as seen in Henoch Schoelein Purpura
31
most common organism infecting peritoneal dialysis
staph epidermis
32
Mx of renal stones
``` diclofenac/naproxen analgesia alpha blockers (tamsulosin) to aid stone passage stones <5mm will pass spontaneously ```
33
imaging of choice for renal stones
non contrast CT (99% reliability) | xray KUB shows 60% of stones
34
Membranous glomerulonephritis: presentation prognosis
proteinurea/nephrotic syn, CKD | 1/3rd resolve, 1/3rd respond to cytotoxics, 1/3rd develop CKD
35
Diffuse proliferative glomerulonephritis presentation disease association
classical post-strep nephritis in children presents as nephritic syn (haematuria, proteinurea, HTN, uraemia) or AKI most common renal disease in SLE
36
Minimal change disease presentation causes Mx
child with nephrotic syn (80%) causes: Hodgkin's, NSAIDs, good response to steroids
37
Focal segmental glomerulonephritis presentation causes
proteinurea / nephrotic syn / CKD | may be idiopathic or 2ndary to HIV, heroin
38
Rapidly progressive glomerulonephritis presentation causes
rapid onset AKI causes: Goodpastures, ANCA positive vasculitis both can be managed by plasma exchange
39
Mesangiocapillary glomerulonephritis | associations
type 1: cryoglobinaemia, Hep C | type 2: partial lipodystrophy.
40
most common type of renal stone
``` calcium oxalate (40%) - radio-opaque note urate and xanthine stones are radiolucent (can't be seen on xray) ```
41
causes of nephrogenic diabetes insipidus
genetic hypercalcaemia, hypokalaemia demeclocycline (reduces response to ADH), lithium sickle cell disease, obstruction, pyelonephritis
42
Indications for emergency renal replacement therapy
hyperkalaemia refractory to medical management refractory volume overload severe metabolic acidosis uraemic pericarditis
43
how do you treat hyperphosphataemia?
sevelamer - a phosphate binder
44
Indications for spironolactone
``` ascites (cirrohsis -> 2ndary hyperaldosteronism therefore high doses 100-200mg needed) HF (NYHA stage 3-4) nephrotic syn (proteinurea, hypoalbuminaemia, oedema) Conns syn. (too much aldosterone) ```
45
What is the usual precipitating factor for mesangioproliferative (IgA) nephropathy?
upper respiratory tract infection 2-3 days prior
46
What are the microscopic findings in chronic glomerulonephritis?
glomeruli filled with hyaline (homogenous pink substance) with dilation of the remaining tubules.
47
What age group are affected by renal artery stenosis? | how should it be managed?
hypertension in young adults (30s) | AVOID ACEis