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Renal Flashcards

1
Q

Autosomal dominant kidney disease type 1 is associated with gene mutations on which chromosome?

A

Chromosome 16

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2
Q

Autosomal dominant kidney disease type 2 is associated with gene mutations on which chromosome?

A

Chromosome 4

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3
Q

Classify the drug tolvaptan

A

Vasopressin receptor II antagonist

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4
Q

Recall the 3 hallmark symptoms of nephrotic syndrome

A
  1. Proteinuria
  2. Hypoalbunemia
  3. Hyperlipidemia
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5
Q

Familial amyloid cardiomyopathy is associated with misfolding of which protein?

A

Transthyretin

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6
Q

Name a cardiac pathology associated with ATTR amyloidosis

A

Restrictive cardiomyopathy

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7
Q

What is the normal mode of inheritance of Alport’s syndrome?

A

X - linked dominant

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8
Q

Briefly describe the pathophysiology of Alport’s syndrome

A

Defect in a gene coding for type IV collagen that results in an abnormal glomerular basement membrane

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9
Q

Define Fanconi syndrome

A

Generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule

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10
Q

Suggest 5 potential causes of Fanconi syndrome

A
  1. Cystinosis
  2. Sjorgen’s syndrome
  3. Multiple myeloma
  4. Nephrotic syndrome
  5. Wilson’s disease
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11
Q

What are the 2 cardinal features of Goodpasture’s syndrome?

A
  1. Pulmonary haemorrhage

2. Followed by rapidly progressive glomerulonephritis

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12
Q

What will a renal biopsy show from a patient with Goodpasture’s syndrome?

A

Linear IgG deposits along the basement membrane

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13
Q

What is the most common causative organism of Post-steptococcoal glomerulonephritis?

A

Streptococcus Pyogenes

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14
Q

What form of acid-base disturbance would be caused by alcohol poisoning?

A

Raised anion gap metabolic acidosis

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15
Q

What is the normal anion gap expected range?

A

10-18 mmol/L

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16
Q

Sickle cell anemia may be associated with what form of kidney degeneration?

A

Renal papillary necrosis

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17
Q

A normal urea:serum creatine ratio is associated with what type of AKI?

A

Acute tubular necrosis

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18
Q

What is the most common prerenal cause of AKI?

A

Hypovolemia e.g. dehydration

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19
Q

What is the pathological consequence of poor renal perfusion?

A

Acute tubular necrosis

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20
Q

Name the classic tetrad of ‘drugs’ that may cause AKI

A
  1. NSAIDS
  2. ACE inhibitors
  3. Gentamicin
  4. CT contrast dye
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21
Q

Give 6 key components of assessment for a fluid status exam

A
  1. Skin turgour/ mucous mebranes
  2. JVP
  3. Postural blood pressure
  4. Heart rate
  5. Urine output
  6. Peripheral/ pulmonary oedema
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22
Q

Name 2 causes of palpable kidneys

A
  1. Polycystic kidney disease

2. Pyelonephritis

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23
Q

Give 4 clinical manifestations of uraemia

A
  1. Pericarditis
  2. Twitching
  3. Hiccups
  4. Uraemic frost
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24
Q

Suggest 6 potential causes of prerenal AKI

A
  1. Diarrhoea and vomiting (GI fluid loss)
  2. Haemorrhage
  3. Decreased cardiac output e.g. heart failure
  4. Hepatorenal syndrome
  5. Burns
  6. Dehydration
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25
What are the 2 main causes of post renal AKI
1. Obstruction | 2. Urinary retention
26
The presence of red cell casts on microscopy is pathognomonic of what form of renal injury?
Glomerulonephritis
27
Broadly, how can urine biochemistry be used to differentiate between a prerenal AKI and acute tubular necrosis?
In prerenal AKI there is significant sodium and water retention leading to a low urinary sodium (<20mmol/L) and high urinary osmolality (>500mmol/L) compared to acute tubular necrosis
28
What are the 4 questions to ask yourself when evaluation a patient with AKI?
1. Are there any life-threatening complications 2. Is this renal impairment acute or chronic 3. If acute, is this prerenal, renal or post renal AKI 4. If intrinsic renal failure, what is the cause
29
Name the 4 life-threatening complications of AKI
1. Hyperkalemia 2. Pulmonary oedema 3. Acidosis 4. Symptomatic uraemia
30
Hyperkalemia is consider life-threatening at what level?
>6.5 mmol/L
31
Outline the 4 conventional therapies for the treatment of pulmonary oedema
1. High-flow oxygen 2. High dose duiretics 3. Nitrates 4. Opiates ( only low doses due to renal excretion)
32
What eGFR level defines severe renal failure?
< 30mL/min
33
Give the 2 most common medical causes of end-stage renal failure
1. Diabetes mellitus | 2. Hypertension
34
Name the 2 most common inherited disorders to cause end stage renal failure
1. Autosomal dominant polycystic kidney disease | 2. Alport's disease
35
What is the classical clinical feature associated with Alpert's syndrome?
Sensorineural deafness
36
What is the most significant complication of chronic kidney disease?
Premature cardiovascular disease
37
Name the 2 pathological mechanisms that contribute to renal osteodystrophy
1. Disturbed vitamin D deficiency | 2. Secondary hyperparathyroidism
38
What type of anemia is seen in renal failure?
Normocytic normochromic anemia
39
Give 7 indications for dialysis in patients with end stage renal failure
1. Symptomatic uraemia 2. Hyperkalemia 3. Metabolic acidosis 4. Peripheral neuropathy 5. Pericarditis 6. CNS disorders 7. Poor control with more conservative treatments
40
What are the 4 main challenges faced by dialysing a patient?
1. Loss of vascular access 2. Infection 3. Hypotension 4. Maintenance of fluid and electrolyte balance
41
Give 11 systemic disorders which may involve the glomerulus
1. Diabetes 2. Amyloidosis 3. SLE 4. Rheumatoid arthritis 5. Ankylosing spondylitis 6. Neoplasia 7. Myeloma 8. Vasculitic syndromes 9. Liver disease 10. Sarcodosis 11. Partial lipodystrophy
42
What are the 3 components of nephritic syndrome?
1. Proteinuria 2. Haematuria 3. Renal failure
43
Recall the triad of symptoms associated with nephrotic syndrome
1. Significant proteinuria (>3g/day) 2. Hypoalbuminaemia ( < 20g/L) 3. Peripheral oedema
44
What is the most likely cause of nephrotic syndrome?
Primary glomerulonephritis
45
Recall the secondary causes of nephrotic syndrome (DAVID)
``` D - Diabetes mellitus A - Amyloidosis V - Vasculitis I - Infections D - Drugs ```
46
Name 2 types of glomerular disease in which ANCA antibodies may be present
1. Microscopic polyangitis | 2. Wegener's Granunlomatosis
47
Name 2 antibodies associated with SLE
1. Anti dsDNA | 2. Antinuclear antibodies
48
Which antibodies are used for the diagnoses of Goodpastures syndrome
Anti-glomerular basement membrane antibodies
49
Classify the diuretic metolazone
Thiazide-like diuretic
50
What is the treatment of choice for rapidly progressive glomerulonephritis?
Immunosuppression with high dose hydrocortisone
51
Define pyuria
Presence of pus in the urine - usually secondary to bacterial infection
52
What are the 5 potential causes of sterile pyuria?
1. Tuberculosis of the urinary tract 2. Analgesic nephropathy 3. Partially treated UTI 4. Neoplasia 5. Intra-abdominal inflammation
53
Name 3 tumour types that may present with polycythaemia
1. Renal cell carcinoma 2. Hepatoma 3. Cerebellar haemangioblastoma
54
Suggest 4 symptoms of prostatism
1. Hesitancy 2. Frequency 3. Nocturia 4. Post micturition dribbling
55
What is the most common position for a Berry aneurysm related to autosomal dominant polycystic kidney disease?
Anterior communicating artery of the circle of Willis
56
What are the 2 main types of thrombotic microangiopathies?
1. Haemolytic uraemic syndrome | 2. Thrombotic thrombocytopenia purpura
57
What is the risk of correcting sodium levels too quickly?
Central pontine myelinolysis may occur
58
Suggest 5 potential causes of parenchymal AKI
1. Malignant hypertension 2. Bilateral cortical necrosis 3. Pyelonephritis 4. Amyloidosis 5. Nephrotoxins
59
Recall the 7 absolute indications for the imitation of RRT in patients with AKI
1. Anuria 2. Severe oliguria 3. Hyperkalemia 4. Severe metabolic acidosis 5. Volume overload 6. Pronounced azotemia 7. Clinical complications of uraemia
60
Suggest 3 clinical complications associated with uraemia
1. Encephalopathy 2. Pericarditis 3. Neuropathy
61
Define Oliguria
A urine output <400mls/day
62
What is the most common cause of AKI in the hospital setting?
Sepsis
63
Briefly outline the 3 subcategories of intra-renal disease
1. Acute tubular necrosis (ATN) - Toxicity or ischaemia leading to a reduced GFR 2. Nephrotoxcity e.g. aminoglycosides or contrast nephropathy 3. Renal parenchymal disease -as a result of ATN
64
When investigating AKI, what are the two main features to look for on urine microscopy?
1. Red cells | 2. Red cell casts
65
Suggest 4 potential options for renal replacement therapy
1. Haemodialysis 2. Peritoneal dialysis 3. Haemofiltration 4. Renal transplantation
66
Suggest 8 indications for renal replacement therapy
1. Fluid overload 2. Hyperkalemia 3. Hypocalcaemia 4. Metabolic acidosis 5. Pericarditis 6. Uraemic Symptoms 7. GFR < 15ml/min1.73m2
67
What is the main initial investigation for suspected obstruction?
USS of the kidneys
68
What are the 4 main causes of pre-renal AKI?
1. Hypovolaemia 2. Hypotension 3. Decreased cardiac output 4. Vascular disease
69
Suggest 6 clinical signs of pre-renal uraemia
1. History of blood/ fluid loss 2. Sepsis - leading to vasodilation 3. Cardiac disease 4. Postural hypotension 5. Weak rapid pulse 6. Low JVP
70
Name the 3 mechanisms by which ischaemia results in a reduction in GFR
1. Glomerular contraction 2. Back-leak of filtration 3. Obstruction of the tubule
71
Outline the 6 main biochemical features associated with AKI
1. Hyperkalaemia 2. Metabolic acidosis 3. Hyponatraemia 4. Pulmonary oedema 5. Hypocalcaemia and hyperphosphataemai 6. General symptoms of uraemia
72
Suggest 6 possible symptoms of uraemia
1. Anorexia 2. Vomiting 3. Nausea 4. Fits 5. Coma 6. Haemorrhagic episodes
73
Name 4 aminoglycosides
1. Vancomycin 2. Gentamycin 3. Kanamycin 4. Streptomycin
74
5 signs of hypovolaemia
1. JVP 2. Low BP 3. Low urine output 4. Poor tissue turgor 5. Fast, weak pulse
75
Metformin should be stopped at what creatine level?
Creatine >150mmol/L
76
What is the risk of administering bicarbonate too quickly?
Inducing hypocalcaemia which may result in tetany
77
Name the 4 main causative categories of anemia of chronic disease
1. Chronic infection 2. Chronic inflammation 3. Neoplasia 4. Chronic kidney disease
78
Why does CKD lead to anemia of chronic disease?
Reduced renal synthesis of EPO
79
What is the vascular supply to the bladder and urethra?
Internal iliac artery
80
Recall 7 common extra-renal manifestations of ADPKD?
1. Hepatic cysts 2. Pancreatic and intestinal cysts 3. Abdominal wall hernias 4. Valvular heart disorders 5. Aortic regurgitation 6. Coronary artery aneurysm 7. Cerebral aneurysm
81
What are the 3 principle physiological roles of calcium?
1. Contraction of skeletal, cardiac and smooth muscle 2. Blood clotting 3. Control of nerve impulses
82
What are the 2 main functions of PTH in regards to calcium homeostasis?
1. Increase osteoclast activity | 2. Decrease excretion of calcium by the kidneys
83
Suggest 5 causes of hypocalcaemia
1. Renal failure 2. PTH deficiency i.e. hypoparathyroidism 3. Insufficient vitamin D 4. Insufficient dietary calcium 5. Excessive dietary magnesium
84
Which ethnic group has a predisposition to the development of ESRF as a result of hypertensive nephropathy?
Black populations
85
What are the 2 main causes of CKD in African populations?
1. Malaria | 2. Schistosomiasis
86
Give 6 risk factors for the development of CKD
1. CV disease 2. Diabetes 3. Smoking 4. Hypertension 5. AKI 6. Chronic use of NSAIDS
87
Give 4 congenital causes of CKD
1. Polycystic kidney disease 2. Alports syndrome 3. Medullary cystic disease 4. Tuberous sclerosis
88
Name 6 glomerular diseases that may lead to CKD
1. IgA nephropathy 2. Wegeners granulomatosis 3. Amyloidosis 4. Diabetic glomerulosclerosis 5. TTP 6. Sickle cell anemia
89
Suggest 8 potential clinical signs associated with CKD
1. Increased skin pigmentation 2. Excoriation 3. Pallor 4. Hypertension 5. Postural hypotension 6. Peripheral oedema 7. Pleural effusion 8. Peripheral neuropathy
90
What are the 2 diagnostic criteria that can be used to diagnose CKD?
1. eGFR <60 on 2 separate occasions more than 2 weeks apart | 2. Albuminuria (ACR>30) on 2 occasions within 3 months
91
What are the 3 core components of preventative heath measures for patients with CKD?
1. BP management 2. Prevention of CV disease 3. Lifestyle factors
92
Outline the 4 components of CV disease prevention in patients with CKD
1. Statins 2. B12 and folate supplementation 3. Aspirin 4. Oral anticoagulants
93
What are the 3 primary functions of angiotensin-II
1. Massive vasoconstriction 2. Release of ADH and aldosterone 3. Kidney activation in the setting of low BP
94
Describe the action of ADH
Acts on distal convoluted tubule to up-regulate synthesis of water channels, thereby increasing water reabsorption.
95
What is the most common indication for the use of an osmotic diuretic?
Prevention/ treatment of cerebral oedema
96
Define Goodpasture's syndrome
Rare genetic autoimmune condition characterised by a combination of glomerulonephritis with alveolar haemorrhage in the presence of circulating anti - GBM antibodies
97
Give 6 predisposing factors to Goodpasture's syndrome
1. Association with HLA-DR2 2. Exposure to organic solvents or hydrocarbons 3. Smoking 4. Infections e.g. Influenza A2 5. Cocaine inhalation 6. Exposure to metal dusts
98
Define hepatorenal syndrome
Renal failure secondary to liver disease - most commonly seen as a complication of alcoholic hepatitis
99
Recall the triad of symptoms associated with nephrotic syndrome
1. Proteinuria >3g/24hrs 2. Hypoalbuminaemia <30g/L 3. Oedema
100
What is the main difference between nephrotic and nephritic syndrome?
Haematuria is present in nephritic syndrome
101
Name the 2 'standard features' of nephritic syndrome
1. Hypertension | 2. Red cell casts
102
Suggest 8 potential causes of postural hypotension
1. Dehydration 2. Pregnancy 3. Drugs 4. Tricyclic antidepressants 5. Age 6. Addison's disease 7. Diabetes - due to autonomic neuropathy 8. Parkinson's disease
103
Name 5 drug categories that may cause postural hypotension in patients
1. ACE inhibitors 2. Diuretics 3. Calcium channel blockers 4. Beta blockers 5. Vasodilators
104
How is postural hypotension diagnosed?
Lying and standing BP measured after the patient has been lying down for at least 15 minutes. A drop of >20mmHg alongside symptoms is diagnostic of postural hypotension
105
Name 4 things that will shift K+ into the cells
1. Insulin 2. Aldosterone 3. Beta agonists 4. Alkalosis
106
Name 4 things that will shift K+ outside of cells
1. Addison's disease 2. Beta blockade 3. Acidosis 4. Cell lysis
107
What are the ECG changes associated with hypokalaemia?
1. T wave depression 2. ST sagging 3. U wave prominence 4. P-R prolongation
108
Outline the 6 potential causes of hyperkalaemia
1. Renal e.g. oliguric renal failure or potassium sparing diuretics 2. Metabolic acidosis 3. Adrenal insufficiency 4. Drugs e.g. ACE inhibitors, beta blockers, NSAIDS 5. Rhabdomyolysis 6. Artefact as a result of haemolysis
109
What are the ECG changes associated with hyperkalaemia?
1. Tall tented T waves 2. Small P waves 3. Wide QRS complex 4. Ventricular fibrillation
110
What are the 5 components of management of severe hyperkalaemia
1. Calcium gluconate 10 mms of 10% IV over 2 minutes (repeat as necessary) 2. IV Insulin and glucose 3. Nebulised salbutamol 4. Calcium resonium 5. Dialysis
111
Briefly define a renal cell carcinoma
A form of adenocarcinoma that arises from the proximal tubular epithelium
112
Give 6 risk factors for the development of renal cell carcinoma
1. Irradiation 2. Exposure to oestrogens 3. Hypertension 4. Smoking 5. Exposure to cadmium 6. Urban/ industrial populations
113
Congenital renal cell carcinoma is associated with what genetic defect?
Defect on chromosome 3p
114
Name an inherited condition that has a strong association with renal cell carcinoma
von Hippel-Lindau disease
115
What are the 4 main types of renal replacement therapy?
1. Haemodialysis 2. Peritoenal dialysis 3. Haemoflitration 4. Renal transplant
116
What are the 3 modes of access that can be used for renal replacement therapy?
1. Cannulation 2. Arterovenous fistula 3. Synthetic graft
117
What degree of blood flow is required for adequate access for renal replacement therapy?
Blood flow of at least 200mls/min
118
What is the most common form of AV fistula?
Radiocephalic fistula in the patient's non dominant arm
119
Suggest 7 possible drug reactions which may lead to rhabdomyolysis
1. Statins 2. Fibrates 3. Alcohol 4. Ecstasy 5. Heroin 6. Carbon monoxide 7. Neuroleptic malignant syndrome
120
Name 2 genetic muscular disorders that carry a risk of rhabdomyolysis
1. McArdle's disease | 2. Duchenne's muscular dystrophy
121
Name 3 infections which may cause rhabdomyolysis
1. EBV 2. Coxackie virus 3. Infleunza
122
Give 4 products that are released into the blood as a result of muscle breakdown
1. Myoglobin 2. Potassium - resulting in hyperkalaemia 3. Creatine kinase 4. Phosphate urate
123
Suggest 4 complications associated with rhabdomyolysis
1. Hyperkalaemia 2. Acute renal failure 3. Increased coagulability 4. Compartment syndrome
124
Recall the categories of the RIFLE criteria for assessment of AKI
``` R - Risk I - Injury F - Failure L - Loss E - End stage kidney disease ```
125
Suggest 4 causes of hypovolaemic hyponatraemia
1. Diuretics 2. Mineralocorticoid insufficiency (Addison's disease) 3. Osmotic diuresis (low glucose, urea) 4. Nephropathy
126
Give 5 medical causes of hypovolaemic hyponatraemia
1. Diarrhoea and vomiting 2. Burns 3. Rhabdomyolysis 4. Pancreatitis 5. Peritonitis
127
Outline the 4 potentially causes of hypervolaemic hyponatraemia
1. Heart failure 2. Renal failure 3. Liver failure 4. Hyperglycaemia
128
Outline the action of thiazide diuretics
Act on distal convoluted tubule and collecting duct and inhibit the sodium/chloride cotransporter
129
What are the 3 main causes of renal failure
1. Hypertension 2. Diabetes 3. Pyelonephritis/ Glomerulonephritis
130
Give 2 electrolyte imbalances commonly associated with AKI
1. Hyperkalaemia | 2. Hyperphosphataemia
131
What is the most common cause of AKI among hospital inpatients?
Sepsis

Clinical Medicine (8 decks)

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