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MRCP Part 2 > Renal > Flashcards

Renal Flashcards

1
Q

Features of Alport’s syndrome

A

Microscopic haematuria

Sensorineural deafness

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2
Q

Radio-opaque renal stones

A

Calcium oxalate
Calcium phosphate
Mixed calcium oxate/phosphate
Struvite (triple phosphate)

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3
Q

Radio-lucent renal stones

A

Urate

Xanthine

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4
Q

Semi-opaque renal stones

A

Cystine

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5
Q

AKI stage I - by creatinine

A

1.5-1.9X baseline
or
Increase >26.5

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6
Q

AKI stage I - by urine output

A

<0.5ml/kg/hr for 6-12 hrs

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7
Q

AKI stage II - by creatinine

A

2.0-2.9X baseline

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8
Q

AKI stage II - by urine output

A

<0.5ml/kg/hr for =>12 hrs

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9
Q

AKI stage III - by creatinine

A 
3.0X baseline
or
Increase => 353.6
or
started renal replacement
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10
Q

AKI stage III - by urine output

A

anuria =>12 hrs

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11
Q

Drugs associated with retroperitoneal fibrosis

A

Bromocriptine
Beta-blockers
Methysergide

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12
Q

Drugs which exacerbate calciphylaxis

A

Warfarin

Calcium containing compounds

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13
Q

IgA nephropathy (Berger’s disease) presentation

A

1 -2 DAYS after URTI
Macroscopic haematuria
Young people

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14
Q

Patient with CKD - when start investigating for anaemia

A

Hb falls below 110 OR if symptomatic

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15
Q

AKI with ‘allergic’ features (fever, rash, IgE, eosinophils)

A

Acute interstitial nephritis (AIN)

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16
Q

Commonest causes of nephrotic syndrome

A

MMF:
Minimal change disease
Membranous nephropathy
Focal segmental glomerulosclerosis

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17
Q

Urine sodium in pre-renal AKI

A

Low <20 mmol/L

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18
Q

24 hr protein excretion in nephrotic syndrome

A

> 3g/24hr

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19
Q

Urine microscopy findings in acute tubular necrosis (ATN)

A

Granular casts + renal epithelial cells

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20
Q

Renal biopsy findings in focal segmental glomeruloscerosis

A

Scarring ‘sclerosis’ and effacement of foot processes

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21
Q

Indications for plasma exchange in ANCA-associated vasculitis

A

Rapidly progressive renal failure
Pulmonary haemorrhage
anti-GBM disease

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22
Q

Management of IgA nephropathy (Berger’s disease)

A

Observation

Consider ACEi if significant HTN or high creatinine

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23
Q

Definition of microalbuminuria

A

Albumin:creatinine ratio >2.5

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24
Q

Medication to reduce recurrence of calcium stones

A

Thiazides

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25
Infectious causes of membranous glomerulonephritis
Hep B Malaria Syphilis
26
Causes of membranous glomerulonehritis
``` Idiopathic Infections Malignancy NSAIDs SLE, thyroiditis, RA ```
27
Antibodies present in idiopathic membranous glomerulonephritis
anti-phospholipase A2
28
Alport patient with failing renal transplant
Think Goodpastures
29
Granular casts (brown/muddy, acellular casts) are found in which type of AKI?
ATN - Acute Tubular Necrosis | Also in dehydration + exercise
30
Which type of nephrotic syndrome shows rapid response to steroid therapy (rapid improvement in proteinuria)
Minimal Change Disease
31
CKD stage 1 defined as
eGFR >90 + sign of kidney damage on another test
32
CKD stage 2
eGFR 60-90 + some sign of kidney damage
33
CKD stage 3a
eGFR 45-59
34
CKD stage 3b
eGFR 30-44
35
CKD stage 4
eGFR 15-29
36
CKD stage 5
eGFR <15 ml/min
37
Cause of AKI in septic shock
Acute tubular necrosis | or rarely: cortical necrosis
38
Causes of acute tubular necrosis (ATN)
Sepsis/shock Contrast media Myoglobin (rhabomyolysis) Aminogloycosides
39
Causes of acute interstitial nephritis/tubulointerstitial nephritis (AIN)
NSAIDs, penicillin, rifampicin, furosemide, allopurinol SLE, sarcoid, Sjogren Staphylococcus
40
1st-line management of hypertension in CKD 4/5
ACEi
41
2nd-line management of hypertension in CKD 4/5
Furosemide
42
Haematuria in sickle cell anaemia, think:
Papillary necrosis
43
Management of 15-39yo with ADPKD and eGFR>90
ACEi with target BP < 110 / 75 mmHg
44
Alports appearance under light microscopy
Normal
45
Alports appearance under electron microscopy
'Basket weave' appearance of basement membrane
46
Management of nephrogenic diabetes insipidus
Thiazide
47
Young women with AKI, visual disturbance, weight loss, think:
Tubulointerstitial nephritis with uveitis (TINU)
48
USS kidney shows 'clubbed calyces' in which condition
Papillary necrosis
49
Target ferritin level in CKD stage 4/5 (not undergoing haemodialysis)
> 100 ng/ml
50
Target transferrin saturation in CKD stage 4/5
> 20%
51
Target Hb in CKD stage 4/5
100 - 120
52
Target ferritin level in CKD stage 4/5 (undergoing haemodialysis)
> 200 ng/ml
53
Biopsy findings in membranous glomerulonephritis
Diffuse thickening of BM 'Spike & dome': Subepithelial deposits of IgG AND complement
54
Biopsy findings in Goodpastures
Linear deposition of IgG in BM
55
Hepatitis C is most commonly associated with which type of glomerulonephritis
MesangioCapillary GN
56
Renal complication of Indinavir
Renal stones (needle-shaped crystals)
57
Renal complication of Tenofovir
Acute Tubular Necrosis Fanconi syndrome
58
Pattern of glomerulonephritis seen in HIV-associated nephropathy
FSGS with capillary collapse
59
Renal conditions that reoccur after renal transplant
Membranoproliferative GN IgA nephropathy FSGS Membranous GN
60
Indications for dialysis in CKD stage 5
Symptomatic from fluid overload or uraemia (lethargy, itch, confusion, nausea) or Asymptomatic with eGFR 5 - 7
61
Presentation of post-streptococcal glomerulonephritis
1 - 2 WEEKS post strep infection Haematuria ("cola urine") Proteinuria, oedema Low complement
62
Pattern of GN seen in post-streptococcal glomerulonephritis
Diffuse proliferative glomerulonephritis
63
Measurement of anion gap
(Na + K) - (HCO3 - Cl)
64
Normal anion gap
10 - 18
65
Causes of metabolic acidosis with normal anion gap (hyperchloremic metabolic acidosis/bicarb loss)
Gastrointestinal bicarb loss RTA Addisons Acetazolamide
66
Causes of metabolic acidosis with raised anion gap
``` Lactate (shock, hypoxia) Ketones Urate (renal failure) Methanol, Ethanol glycol Salicylates 5-oxoproline (paracetamol) ```
67
Management of membranous lupus nephritis (class V lupus nephritis)
ACEi for HTN IV methylprednisolone (severe) Immunosuppressant (cyclophosphamide/MMF)
68
ADPKD with CKD 2/3 and rapidly progressing disease, consider
Tolvaptan (vasopressin R2 antagonist)
69
AA amyloidosis associated with which diseases
(Poorly controlled) chronic inflammation eg RA, Ankylosing Spondylitis
70
Management of patient with visible haematuria coinciding with intercurrent URTI (and clinically well)
Routine referral to renal | to establish diagnosis and risk of future renal impairment
71
Where to biopsy for suspected AA amyloidosis
Skin, rectal mucosa or abdominal fat (less invasive than renal)
72
Membranous glomerulonephritis - all patients should receive..
ACEi/ARB | Consider anti-coagulant
73
Membranous glomerulonephritis - management of severe/progressive disease
ACEi/ARB Corticosteroid + Immunosuppressant (eg cyclophosphamide/MMF/chlorambucil/ciclosporin)
74
1st line investigation of testicular mass
USS testes | then tumour markers if suspicious for malignancy
75
Management of Goodpastures
Plasmapheresis + steroids + cyclophosphamide
76
Features of fibromuscular dysplasia (FMD)
Young Renal vascular disease/cerebrovascular disease 'String of beads' appearance
77
Indications for urgent dialysis
Symptomatic uraemia Pulmonary oedema, despite full medical management K >6.5 despite, full medical management Metabolic acidoses pH < 7.1 Remove toxins eg lithium
78
Presentation of CMV infection post-renal transplant
1-4 months after transplant/after stopping prophylaxis Fever, myalgia AKI
79
Which renal transplant recipients do not receive CMV prophylaxis (valganciclovir)
If recipient and donor both test negative for CMV
80
Anti-hypertensive used in systemic sclerosis renal crisis (and other renal vasculitis)
ACEi
81
1st line management of minimal change disease
Steroids +/- ACEi if HTN/AKI
82
2nd line management of minimal change disease
Immunosuppressant (eg Cyclophosphamide)

MRCP Part 2 (15 decks)

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