Renal Flashcards
What is the enzyme involved in activation of Vitamin D?
1-alpha hydroxylase
What is the active form of Vit D?
1,25-dihydroxyvitamin D - calcitriol
What are the main hormones that increase phosphate excretion?
FGF 23
PTH
Where is phosphate mostly reabsorbed in kidney?
PCT
What is the effect of Vit D on phosphate?
Increased serum phosphate via increased renal reabsorption
What are the indications for calcitriol in CKD-MBD?
Persistent hypocalcaemia -> if phosphate now normal
Persistent elevated PTH
What is the main cause of adynamic bone disease in CKD-MBD?
Iatrogenic -> over-suppression of PTH
What is the main cause of adynamic bone disease in CKD-MBD?
Iatrogenic -> over-suppression of PTH
Main way to differentiate primary and tertiary hyperparathyroidism?
Phosphate is low in Primary PTH
What is PLA2R ab present in?
Membranous nephropathy
What are the main differences in presentation between contrast-induced nephropathy and cholesterol emboli?
Cholesterol emboli ->
- more delayed presentation
- minimal renal recovery
- transient eosinophilia and hypocomplementaemia
Which GN demonstrates
“subepithelial electron dense deposits” with “spike and dome” appearance on EM?
Membranous GN
What condition is closely associated with collapsing variant FSGS?
HIV
In which GN is “tram tracking” of GBM seen?
Membranoproliferative GN
Kimmelstein Wilson lesions on renal biopsy = ?
Diabetic nephropathy
Most likely GN to recur post transplant?
Type 2 MPGN
Most common type of infection in first 6 months post renal Tx?
Urinary tract infections
What is the treatment for wound healing in calciphylaxis?
Sodium thiosulphate and sevelamer
What are the large vessel vasculitides?
Takayasu arteritis
GCA
Which immune cell is most important in pathogenesis of GCA?
CD4 T cells
In GCA, which layer of the affected arteries are most affected by inflammatory infiltrate?
Media
What is the treatment for GCA with visual involvement?
Pulse methylpred, then de-escalate to high dose oral steroids
What minimum duration of steroids should generally be given for PMR to reduce risk of relapse?
12 months
What is the steroid-sparing agent of choice in PMR if required?
Methotrexate
How long do the histological changes of GCA persist after commencement of therapy?
1 week
Which mab has a role in GCA?
What is its unique AE?
Tocilizumab
IL-6 receptor antagonist
Used in combination with prednisolone
AE: Lower intestinal perforation (contraindicated in hx of diverticulosis)
What are the main medium vessel vasculitides?
Polyarteritis nodosa
Kawasaki Disease
What is the first line treatment for Kawasaki Disease?
What is the main aim of treatment?
IVIG
To prevent formation of coronary artery aneurysms
What are some of the common skin manifestations of PAN? (4)
- cutaneous or subcutaneous nodules
- palpable purpura
- livedo reticularis
- skin infarction
Which virus has a strong association with PAN?
Hep B
What is the common demographic of those affected by PAN?
Middle aged men
Which HLA is associate with GCA?
HLA DR4
What is the difference between demographic of those affected by GCA vs Takayasu?
Takayasu - young, under 40
GCA - over 50
What are the classic symptoms of mesenteric ischaemia?
Sitophobia
Postprandial abdo pain
Weight loss
What is the common neurological manifestation of PAN?
Mononeuritis multiplex
Which type of cryoglobulinaemia has the highest cryocrit?
Type 1 (monoclocal gammopathies)
What type of GN is associated with cryoglobulinaemia?
MPGN
