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MRCP part 2 > Renal > Flashcards

Renal Flashcards

1
Q

Granulomatosis with polyangiitis features

A
  • pulmonary haemaorrhage / epistaxis
  • sinusitis, nasal crusting
  • dyspnoea
  • saddle nose deformity
  • vasculitic rash
  • mononeuritis multiplex
  • renal failure

cANCA +ve

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2
Q

Granulomatosis with polyangiitis mx

A
  • steroids + cyclophosphamide

- PLEX

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3
Q

Post streptococcal glomerulonephritis ix

A
  • ASOT positive
  • low C3
  • immune complex deposition

Renal biopsy

  • Diffuse proliferative glomerulonephritis
  • starry sky appearance EM
  • subepithelial humps
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4
Q

Post streptococcal glomerulonephritis mx

A
  • supportive, good prognosis
    Oedema & hypertension?
    1) loop diuretics
    2) ACEi / CCBs
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5
Q

Liddle’s

A 
AD inheritance
High ENaC (mimics hyperaldosteronism)
BUT low renin and aldosterone
HypoK, metabolic alkalosis
HTN

Mx: amiloride

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6
Q

GPA vs anti-GBM differentiation

A
  • p-ANCA vs anti-GBM

- raised ESR in GPA, normal in anti-GBM

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7
Q

Bartter syndrome features and mx

A

NaK2Cl co-transporter mutation (AR) - analogous to loop diuretics

  • hypokalaemia
  • metabolic alkalosis
  • hypomagnesaemia
  • normal blood pressure
  • INCREASED urinary calcium
  • high renin, hyperaldosteronism

Mx: K / Mg supplementation, NSAIDs, ACEi

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8
Q

Gitelman syndrome features and mx

A

NaCl transporter mutation DCT - analogous to thiazide use

  • hypokalaemia
  • metabolic alkalosis
  • normotension
  • high renin, hyperaldosteronism
  • DECREASED urinary calcium
  • presents later vs Bartter’s

Mx: K / Mg supplementation, NSAIDs, ACEi

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9
Q

Liddle’s syndrome

A

AD condition -> high ENaC - mimics hyperaldosteronism

  • hypokalaemia
  • metabolic alkalosis
  • hypertension
  • low renin and aldosterone

Mx: amiloride

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10
Q

Type 1 (distal) renal tubular acidosis causes

A
  • idiopathic
  • rheumatological conditions
  • amphotericin B
  • analgesic nephropathy
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11
Q

Type 2 (proximal) renal tubular acidosis causes

A
  • idiopathic
  • Fanconi sydrome (losing all electrolytes?)
  • Wilson’s
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12
Q

Type 4 renal tubular acidosis causes

A
  • most common
  • aldosterone deficiency is usually cause
  • hypoaldosteronism
  • ACEi / ARB / spiro
  • NSAIDs
  • diabetes
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13
Q

Cast nephropathy

A

Myeloma with renal involvement as cause
Mx: chemotherapy
- mephalan + corticosteroids
- OR bortezomib + thalidomide + steroids if younger patient

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14
Q

Time-frame for EPO-induced epilepsy

A

90 days

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15
Q

Isograft

A

From genetically identical source (identical twin)

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16
Q

Allograft

A

Genetically different source but same species

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17
Q

Autograft

A

Same individual is donor and recipient

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18
Q

Heterotopic graft

A

Graft into different anatomical locations

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19
Q

Orthotopic graft

A

Graft into same anatomical location

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20
Q

Xenograft

A

Graft from different species

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21
Q

Fibromuscular dysplasia affecting renal artery

A

Angio: string of beads appearance
Mx: angioplasty > medical therapy. NB: no role for renal artery re-implantation

22
Q

Renal artery stenosis

A
  • raised renin and aldosterone (mech to preserve blood flow to kidney)
    Mx: medical management of hypertension is as effective as angioplasty. ACE / ARB + diuretic usually used
    NB: ACE/ARB NOT contraindicated as long as U&Es closely monitored
23
Q

Minimal change disease features features, causes, management, prognosis

A
  • nephrotic syndrome
  • EM: fusion of podocytes

Causes

  • mostly idiopathic
  • drugs: NSAIDs, rifampicin
  • Hodgkin’s lymphoma, thymoma
  • infectious mononucleosis

Mx:

1) 80% steroid responsive
2) cyclophosphamide

Prognosis
1/3 one episode
1/3 infrequent relapses
1/3 frequent relapses which stop just before adulthood

24
Q

Membranous GN features, causes, management, prognosis

A
  • nephrotic syndrome
  • EM: thickened BM, subepithelial deposits - spike and dome

Causes

  • idiopathic
  • hep B, malaria, syphilis
  • cancers
  • drugs e.g. NSAIDs
  • AI disease e.g. SLE, RA

Mx

  • ACEi
  • corticosteroid + cylophosphamide
  • generally poorly steroid responsive as monotherapy
  • consider anticoag

Prognosis
1/3 spontaneous remission
1/3 remain proteinuric
1/3 ESRF

25
Q

ADPCKD screening

A
  • renal USS after age 20

- cerebral angio only if +ve FHx cerebral bleed, previous rupture, warning symptoms

26
Q

Haemolytic uraemic syndrome

A
  • usually young children
  • bloody diarrhoea & abdo pain
  • acute renal failure
  • microvascular autoimmune haemolytic anaemia (schistocytes)
  • thrombocytopenia
  • NO RASH

Causes:

  • O157 e coli
  • cancers
  • pregnancy
  • COCP
  • SLE
  • HIV

Mx: supportive
- ?PLEX if no diarrhoea

27
Q

TTP

A
  • fever
  • microangiopathic haemolytic anaemia (schistocytes)
  • thrombocytopenia
  • renal failure
  • fluctuating neuro signs

Ix: ADAMTS13 low

Mx
- post-infection e.g. urinary, gastrointestinal
pregnancy
- drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel, aciclovir
- tumours
- SLE
- HIV

Mx

1) PLEX
2) Steroids
3) Rituximab

28
Q

Mx calcium stones

A
  • increase fluid intake
  • low salt diet
  • low animal protein diet
  • thiazide diuretics e.g. indapamide
29
Q

Oxalate stones mx

A
  • hydration
  • cholestyramine
  • pyridoxine
  • thiamine
30
Q

Uric acid stones mx

A
  • allopurinol

- bicarbonate

31
Q

Type 1 RTA features

A
  • acidosis
  • low bicarb
  • hypokalaemia
  • alkaline urine
  • hypercalciuria
  • nephrocalcinosis
32
Q

Type 2 RTA features

A
  • acidosis
  • hypokalaemia
  • acidic urine
  • high bicarb in urine
  • hyperchloraemia
33
Q

Type 4 RTA

A
  • low renin, low aldosterone

- hyperK

34
Q

AA amyloidosis

A

Secondary amyloidosis e.g. rhuematological conditions

35
Q

AL amyloidosis

A

Primary amyloidosis e.g. myeloma

36
Q

Beta 2 microglobulin amyloidosis

A
  • accumulation as unable to be filtered by cellulose dialysis machines
  • CTS, tenosynovitis, arthropathy, bony cysts, pathological fractures
    Mx: other newer dialysis machines (high flux) OR transplant
37
Q

HIV associated nephropathy

A
  • nephrotic range proteinuria
  • normotensive
  • normal / increased kidney size
  • focal segmental glomerulosclerosis
  • Mx: ACEi and ART
38
Q

Von Hippel Lindau

A
  • AD VHL tumour suppressor gene mutation
  • cerebellar haemangiomas
  • retinal haemangiomas
  • premalignant renal cysts (may -> high hb)
  • phaeo
  • other cysts
39
Q

Acute interstitial nephritis

A

Causes:

  • drugs e.g. penicillins, NSAIDs, furosemide
  • rheumatological disease
  • infections e.g. staph

Features

  • fever
  • rash
  • arthralgia
  • hypertension
  • mild renal impairment

Ix

  • eosinophilia
  • sterile pyuria, white cell casts

Mx

  • remove cause
  • supportive
  • steroids if no improvement

NB: if uveitis also present -> GIVE STEROIDS

40
Q

Alport’s syndrome, features, inheritance

A
  • X-linked dominant OR autosomal recessive

Features

  • microscopic haematuria
  • prog renal failure
  • b/l sensorineural deafness
  • retinitis pigmentosa
  • anti-GBM disease in 5% after renal transplant -> RPGN

Mx: renal transplant

41
Q

Pseudohyponatraemia causes

A

Hyperlipidaemia

Very high protein

42
Q

Primary hyperoxaluria

A
  • recurrent calcium oxalate stones
  • raised urinary oxalate, calcium, urate
  • may progress to kidney failure
  • Mx: urinary acidification with citrate; may need combined liver / kidney transplant
43
Q

Causes and effects of ciclosporin toxicity

A

Causes:
- drugs that inhibit cytochrome p450 system e.g. erythromycin and clarithyromycin

Effects

  • nephrotoxicity
  • hepatotoxicity
  • hypertension
  • gingival hyperplasia
  • hypertrichosis
  • tremor
  • hyperlipidaemia
  • impaired glucose tolerance
44
Q

Hyperacute graft rejection

A
  • minutes-hours
  • pre-existent IgG vs HLA antigens
  • now rare because of HLA matching
45
Q

Acute graft rejection

A
  • <6 months
  • cytotoxic T-cell mediated vs HLA
  • Mx: steroids, immunosuppressants
46
Q

Chronic graft rejection

A

> 6 months

- fibrosis

47
Q

CMV in renal transplantation

A
  • disease usually 1-4 months after transplant or stopping CMV prophylaxis
  • prophylaxis with valganciclovir given to all patients unless both donor and recipient are CMV -ve

Features

  • fever, myalgia, arthralgia
  • leukopenia
  • mild transaminitis
  • complications: acute graft failure, hepatitis, pancreatitis, colitis, pneumonitis

Mx: IV ganciclovir

48
Q

Post transplant lymphoproliferative disorder

A
  • often EBV -> B cell proliferation / lymphoma
  • 1st year after transplant
  • fever, weight loss, fatigue, organ dysfunction
  • Ix: monoclonal Ig/paraprotein
  • Mx: reduce immunosuppression + rituximab
49
Q

Features of ADPCKD

A
  • progressive renal failure
  • hypertension
  • associated with mitral valve prolapse
  • 20% will have berry aneurysms
  • liver cysts may be present
50
Q

HIV drugs and AKI

A

Protease inhibitors can cause intratubular crystal obstruction
Mx: IV fluids

51
Q

Urge incontinence mx

A

1) bladder training (6 weeks minimum)
2) anticholinergics
- solifenacin / tolterodine > oxybutynin as fewer SEs including cognitive impairment in elderly
3) mirabegron - another alternative with fewer SEs

52
Q

Stress incontinence

A

1) pelvic floor training (3 months minimum)
2) surgical procedures
3) duloxetine

MRCP part 2 (11 decks)

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