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Finals Revision > Renal > Flashcards

Renal Flashcards

1
Q

Types of glomerulonephritis

A 
Minimal change disease
Focal segmental glomerulosclerosis
Membranous GN
IgA Nephropathy
Goodpasture's syndrome 
Etc
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2
Q

What is nephritic syndrome?

A

Inflammation in the kidneys, causing haematuria, oliguria, proteinuria, fluid retention

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3
Q

Criteria for Nephrotic syndrome

A
  1. Peripheral oedema
  2. Proteinuria
  3. Low serum albumin
  4. Hypercholesterolaemia
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4
Q

What is the most common cause of Primary Glomerulonephritis?

A

IgA Nephropathy

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5
Q

What is the most common cause of Glomerulonephritis overall?

A

Membranous glomerulonephritis

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6
Q

At what age does Membranous glomerulonephritis peak?

A

Bimodal peak- 20s + 60s

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7
Q

What is found on histology in Membranous glomerulonephritis?

A

IgG and complement deposits in basement membrane

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8
Q

What is Polycystic Kidney Disease?

A

Genetic condition where kidneys develop multiple fluid-filled cysts

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9
Q

What is the inheritance pattern of Polycystic Kidney Disease?

A

There is an autosomal dominant and an autosomal recessive type
- AD more common

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10
Q

How is Polycystic Kidney Disease diagnosed?

A

Kidney USS

Genetics

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11
Q

Which chromosome is affected in Autosomal recessive Polycystic Kidney Disease?

A

Chromosome 6

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12
Q

Features of Autosomal recessive Polycystic Kidney Disease

A

Oligohydramnios in pregnancy –> underdevelopment of lungs –> respiratory depression shortly after birth
Dysmorphic features- low set ears, flat nasal bridge
End-stage renal failure before adulthood

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13
Q

Complications of Autosomal dominant Polycystic Kidney Disease

A

Chronic loin pain, hypertension, cardiovascular disease, gross haematuria, renal stones, end-stage renal failure

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14
Q

Features of Autosomal dominant Polycystic Kidney Disease

A

Extra-renal manifestations- cerebral aneurysms, prostatic/ovarian/splenic/pancreatic/hepatic cysts, cardiac valve disease (MR), colonic diverticula, aortic root dilatation

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15
Q

What is the mutated gene in Autosomal dominant Polycystic Kidney Disease?

A

PKD1/2

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16
Q

Management of Polycystic Kidney Disease

A

Tolvaptan- slow progression of cysts and disease
Genetic counselling
Avoid anti-inflammatories + anticoagulation, contact sports
Analgesia for renal colic
Antihypertensives
Dialysis/transplant

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17
Q

What regular monitoring is needed in Polycystic Kidney Disease?

A

USS, renal function, hypertension monitoring

MR angiogram- for intracranial aneurysms

18
Q

General management of Glomerulonephritis

A

Immunosuppression

BP control- ACEi + ARB

19
Q

Presentation of nephrotic syndrome

A 
Oedema
Frothy urine (proteinuria)
20
Q

Complications of nephrotic syndrome

A

Thrombosis
Hypertension
Hyperlipidaemia

21
Q

What is the most common cause of nephrotic syndrome in i) children and ii) adults?

A

Children- Minimal change disease

Adults- Focal segmental glomerulonephritis

22
Q

What is the peak age for IgA nephropathy (Berger’s disease)?

A

20s

23
Q

Histology findings in IgA nephropathy (Berger’s disease)

A

IgA deposits and glomerular mesangial proliferation

24
Q

Causes of Membranous glomerulonephritis

A

Mostly idiopathic

Secondary to malignancy, rheumatoid disorders and drugs (NSAIDs)

25
Q

What is post-streptococcal glomerulonephritis?

A

Presents 1-3 weeks after strep infection eg tonsilitis/impetigo
Nephritic syndrome

26
Q

Aetiology of Goodpasture syndrome

A

Anti-glomerular basement membrane antibodies attack glomerular and pulmonary basement membrane

27
Q

Features of Goodpasture syndrome

A
  1. Glomerulonephritis

2. Pulmonary haemorrhage (haemoptysis)

28
Q

Causes of Chronic Kidney Disease

A

Diabetes, hypertension, age, glomerulonephritis, polycystic kidney disease, meds eg NSAIDs, PPIs, lithium

29
Q

Risk factors for Chronic Kidney Disease

A

Diabetes, hypertension, age, glomerulonephritis, polycystic kidney disease, meds eg NSAIDs, PPIs, lithium
Smoking

30
Q

Presentation of Chronic Kidney Disease

A

Usually asymptomatic

Pruritus, loss of appetite, nausea, oedema, muscle cramps, peripheral neuropathy, pallor, hypertension

31
Q

How is Chronic Kidney Disease diagnosed?

A

eGFR- 2 tests 3 months apart

32
Q

Investigations of Chronic Kidney Disease

A

Urinalysis- proteinuria (urine albumin:creatinine ratio >=3), haematuria
eGFR
Renal USS

33
Q

Classification of Chronic Kidney Disease

A 
By eGFR:
1) >90
2) 60-89
3) 30-59- mild-moderate
4) 15-29- severe
5) <15- kidney failure
By albuminuria:
1) Albumin < 30 - A:Cr <3
2) Albumin 30-300 - A:Cr 3-30
3) Albumin < 300 - A:Cr >30
34
Q

Management of Chronic Kidney Disease

A 
Slow progression: 
- Control diabetes + HTN
- Treat glomerulonephritis
Reduce risk of complications: 
- Exercise, healthy diet, stop smoking
- Reduce water intake
- Atorvastatin
Treat complications:
- Metabolic acidosis- sodium bicarbonate
- Anaemia- iron supplement + erythropoeitin
- Renal bone disease- vitamin D
- Dialysis in end-stage
- Renal transplant
35
Q

Indications for acute renal dialysis

A

AEIOU:

  • Acidosis
  • Electrolyte abnormality
  • Intoxication
  • Oedema
  • Uraemia
36
Q

What is Acute Kidney Injury?

A

Acute drop in kidney function

  • Cr rise >= 25mmol/L in 48hrs
  • Cr rise >50% in 7 days
  • Urine output < 0.5ml/hr/kg for 6 hours
37
Q

Risk factors for Acute Kidney Injury

A

CKD, heart failure, diabetes, liver disease, age > 65, cognitive impairment, nephrotoxic meds (NSAIDs, ACEi), contrast

38
Q

Causes of Acute Kidney Injury

A

Pre-renal: dehydration, hypotension, heart failure
Renal: glomerulonephritis, interstitial nephritis, Acute tubular necrosis
Post-renal: kidney stones, masses in abdomen/pelvis, ureter/urethral strictures, enlarged prostate/prostate cancer

39
Q

Investigations of Acute Kidney Injury

A

Urinalysis, USSKUB

40
Q

Management of Acute Kidney Injury

A

IV Fluid rehydration
Stop nephrotoxic meds
Relieve obstruction eg catheter
Severe- dialysis

41
Q

Complications of Acute Kidney Injury

A

Hyperkalaemia, fluid overload, metabolic acidosis

Uraemia –> encephalopathy/pericarditis

Finals Revision (13 decks)

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