renal Flashcards
Hep B chronic presents with renal disease
membranous glomerulonephritis is the most common.
membranoproliferative in hep c
AKA mesangiocapillary
Worst prognosis of lupus nephritis
Diffuse is worst and most common
highest rate of recurrence in renal transplant patients
Membranoproliferative glomerulonephritis (notably type II) reoccurs in 80-100% of cases AKA mesangiocapillary
PCKD and Alport’s do not reoccur in renal transplant
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
Acute interstitial nephritis
Usually due to drugs, penicillin, rifampicin, NSAIDs,
Can get Tubulointerstitial nephritis with uveitis (red eyes) esp in young women
Which renal tubular acidosis has hyperkal?
T4
reduction in aldosterone leads in turn to a reduction in proximal tubular ammonium excretion
hypoaldosteronism, diabetes
Renal impairment,palpable purpura rash, pANCA, crescent on renal biopsy
Microscopic polyangiitis
Rapidly progressive glomerulonephritis
Patient with anti GBM disease with haematuria management
Goodpastures, rapidly progressive glomerulonephritis
1) check for causes of antibody production -exposure of solvents hydrocarbons metal dust smoking
2) immunosuppressants to stop further antibodies
3) plasma exchange to remove antibodies
Which factor is most likely to prevent contrast induced neph?
Volume expansion with 0.9% saline pre and post is most important
Metformin can lead to lactic acidosis so stop for 48h if high risk
Post strep glomerulonephritis causes
Diffuse proliferative glomerulonephritis (1-2 weeks rather than days for IgA )
low C3
CKD bone disease giant cell focal lesion
Browns disease caused by Secondary hyperparathyroidism
Young person with recurrent kidney stones
?cystinuria
auto recessive
Management with hydration and D-penicillamine
Crescent changes on renal biopsy
Rapidly progressive glomerulonephritis
Urinary calcium in hyperparathyroidism
You would expect it to be high
LOW urinary calcium in the presence of hypercalcaemia is suggestive of either familial hypocalciuric hypercalcaemia or thiazide diuretic use
LOW urinary calcium in the presence of hypercalcaemia
suggestive of either familial hypocalciuric hypercalcaemia or thiazide diuretic use
Most common glomerulonephritis in adults
Membranous glomerulonephritis
Related to malignancy in 5-20%
Related to Hep B
Renal biopsy showing the basement membrane is thickened with subepithelial electron dense deposits
a ‘spike and dome’ appearance
Membranous glomerulonephritis
give ACEi
Contraindications to peritoneal dialysis
Absolute Pt/carer not competent Inguinal, umbilical, diaphragmatic hernias Ileo/colostomy Abdo wall infections
Relative Hx of Abdo surgery, due to adhesions Morbid obesity Huge PCKD Severe gastroparesis Severe lung disease
Patient presents with recurrent UTIs, kidney stones and fam hx.
Normal serum calcium, high urine calcium and oxolate. Diagnosis and management?
Primary hyperoxaluria
Citrate and magnesium
Increases urinary pH to make Ca Oxalate more soluble
Which Renal tubular acidosis has development of nephrocalcinosis and renal stones?
RTA 1
failure of H+ secretion into the lumen of the nephron. leading to inability to acidify the urine pH to < 5.3
CKD: mineral bone disease management
Reduce dietary phosphate
alfacalcidol to correct Vit D, and consequently hypocal
22yr old pt presents with PE
Urinary protein:creatinine ratio 940 mg/mmol (<30)
After one week of corticosteroids ratio was 130 mg/mmol
hypercoagulable state due to nephrotic syndrome
Minimal change disease responds that rapidly to steroids
Focal segmental glomerulosclerosis may do but over months
pt with systemic sclerosis develops hypertension and AKI. Management
Systemic sclerosis renal crisis
Overactivation of the renin angiotensin aldosterone system
Tx ACEi
Membranous glomerulonephritis management
ACEi
pt w cancer and nephrotic syndrome
membranous has malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
commonest type of glomerulonephritis in adults
membranous
investigation for suspected IgA nephropathy
USS to make sure kidneys are a reasonable size before proceeding with diagnostic renal biopsy
typical hx of lupus nephritis
arthralgia, anaemia, thrombocytopenia, erythematous rash on her lower limbs, and borderline leukopenia
free lambda light chains
AL amyloidosis
(the L stands for Light chains)
Myeloma kidney (if w hypercal and raised serum protein electrophoresis)
investigation for Waldenström macroglobulinaemia
monoclonal IgM paraproteinaemia
diagnosis of cystinuria
Kidney stones classically yellow and crystalline, semi-opaque on XR
cyanide-nitroprusside test
D-penicillamine
Treatment for Cystinuria and Wilson’s disease
how long to recover from acute tubular necrosis?
1-3weeks
most common cause of AKI, due to ischaemia or toxins
urinalysis of acute tubular necrosis
muddy brown casts
or renal tubule epithelial cells in urine
muddy brown casts
pathognomonic urinalysis of acute tubular necrosis
what renal disease is assx w solvent abuse?
renal calculi, proteinuria and distal renal tubular acidosis
indications for renal replacement therapy
Acidosis (Metabolic)
Electrolyte abnormalities (especially severe hyperkalemia)
Ingestions/toxins (aspirin, lithium, methanol, ethylene glycol)
Overload
Uraemia
Focal segmental glomerulosclerosis classic presentation
proteinuria / nephrotic syndrome / chronic kidney disease
commonest nephrotic syndrome in adults
effacement of foot processes on electron microscopy
Hep C chronic presents with renal disease
membranoproliferative glomerulonephritis
AKA mesangiocapillary
‘tram-track’ appearance on biopsy electron microscope
-subendothelial and mesangium immune deposits of electron-dense material
Hep b membranous
Frank haematuria in sickle cell anaemia
renal papillary necrosis
– clubbed calyces and ring signs on IV urogram
renal disease in HIV
focal segmental glomerulosclerosis
Protease inhibitors such as indinavir can precipitate intratubular crystal obstruction
features of post-streptococcal glomerulonephritis
weeks rather than days after infection predominantly proteinuria Low C3 starry sky appearance subepithelial lumps
Mnemonic for renal papillary necrosis:
POSTCARDS Pyelonephritis, Obstruction of the urogenital tract, Sickle cell disease, TB, Cirrhosis Analgesia/Alcohol abuse Renal vein thrombosis, DM Systemic vasculitis
– clubbed calyces and ring signs on IV urogram
Anti-streptolysin O
ASO titre is for post-strep glomerulosnephritis
fever, rash, arthralgia, renal impairment w eosinophilia
acute interstitial nephritis
most commonly caused by drugs… penicillins , Rifampacin, NSAIDs
