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MRCP 2 > renal > Flashcards

renal Flashcards

1
Q

Hep B chronic presents with renal disease

A

membranous glomerulonephritis is the most common.

membranoproliferative in hep c
AKA mesangiocapillary

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2
Q

Worst prognosis of lupus nephritis

A

Diffuse is worst and most common

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3
Q

highest rate of recurrence in renal transplant patients

A 
Membranoproliferative glomerulonephritis (notably type II) reoccurs in 80-100% of cases
AKA mesangiocapillary

PCKD and Alport’s do not reoccur in renal transplant

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4
Q

fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension

A

Acute interstitial nephritis

Usually due to drugs, penicillin, rifampicin, NSAIDs,

Can get Tubulointerstitial nephritis with uveitis (red eyes) esp in young women

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5
Q

Which renal tubular acidosis has hyperkal?

A

T4

reduction in aldosterone leads in turn to a reduction in proximal tubular ammonium excretion

hypoaldosteronism, diabetes

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6
Q

Renal impairment,palpable purpura rash, pANCA, crescent on renal biopsy

A

Microscopic polyangiitis

Rapidly progressive glomerulonephritis

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7
Q

Patient with anti GBM disease with haematuria management

A

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

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8
Q

Which factor is most likely to prevent contrast induced neph?

A

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

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9
Q

Post strep glomerulonephritis causes

A

Diffuse proliferative glomerulonephritis (1-2 weeks rather than days for IgA )
low C3

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10
Q

CKD bone disease giant cell focal lesion

A

Browns disease caused by Secondary hyperparathyroidism

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11
Q

Young person with recurrent kidney stones

A

?cystinuria

auto recessive

Management with hydration and D-penicillamine

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12
Q

Crescent changes on renal biopsy

A

Rapidly progressive glomerulonephritis

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13
Q

Urinary calcium in hyperparathyroidism

A

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

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14
Q

LOW urinary calcium in the presence of hypercalcaemia

A

suggestive of either familial hypocalciuric hypercalcaemia or thiazide diuretic use

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15
Q

Most common glomerulonephritis in adults

A

Membranous glomerulonephritis

Related to malignancy in 5-20%
Related to Hep B

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16
Q

Renal biopsy showing the basement membrane is thickened with subepithelial electron dense deposits

a ‘spike and dome’ appearance

A

Membranous glomerulonephritis

give ACEi

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17
Q

Contraindications to peritoneal dialysis

A 
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
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18
Q

Patient presents with recurrent UTIs, kidney stones and fam hx.

Normal serum calcium, high urine calcium and oxolate. Diagnosis and management?

A

Primary hyperoxaluria

Citrate and magnesium
Increases urinary pH to make Ca Oxalate more soluble

19
Q

Which Renal tubular acidosis has development of nephrocalcinosis and renal stones?

A

RTA 1

failure of H+ secretion into the lumen of the nephron. leading to inability to acidify the urine pH to < 5.3

20
Q

CKD: mineral bone disease management

A

Reduce dietary phosphate

alfacalcidol to correct Vit D, and consequently hypocal

21
Q

22yr old pt presents with PE

Urinary protein:creatinine ratio 940 mg/mmol (<30)

After one week of corticosteroids ratio was 130 mg/mmol

A

hypercoagulable state due to nephrotic syndrome

Minimal change disease responds that rapidly to steroids

Focal segmental glomerulosclerosis may do but over months

22
Q

pt with systemic sclerosis develops hypertension and AKI. Management

A

Systemic sclerosis renal crisis

Overactivation of the renin angiotensin aldosterone system

Tx ACEi

23
Q

Membranous glomerulonephritis management

A

ACEi

24
Q

pt w cancer and nephrotic syndrome

A

membranous has malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia

25
Q

commonest type of glomerulonephritis in adults

A

membranous

26
Q

investigation for suspected IgA nephropathy

A

USS to make sure kidneys are a reasonable size before proceeding with diagnostic renal biopsy

27
Q

typical hx of lupus nephritis

A

arthralgia, anaemia, thrombocytopenia, erythematous rash on her lower limbs, and borderline leukopenia

28
Q

free lambda light chains

A

AL amyloidosis

(the L stands for Light chains)

Myeloma kidney (if w hypercal and raised serum protein electrophoresis)

29
Q

investigation for Waldenström macroglobulinaemia

A

monoclonal IgM paraproteinaemia

30
Q

diagnosis of cystinuria

A

Kidney stones classically yellow and crystalline, semi-opaque on XR

cyanide-nitroprusside test

31
Q

D-penicillamine

A

Treatment for Cystinuria and Wilson’s disease

32
Q

how long to recover from acute tubular necrosis?

A

1-3weeks

most common cause of AKI, due to ischaemia or toxins

33
Q

urinalysis of acute tubular necrosis

A

muddy brown casts

or renal tubule epithelial cells in urine

34
Q

muddy brown casts

A

pathognomonic urinalysis of acute tubular necrosis

35
Q

what renal disease is assx w solvent abuse?

A

renal calculi, proteinuria and distal renal tubular acidosis

36
Q

indications for renal replacement therapy

A

Acidosis (Metabolic)
Electrolyte abnormalities (especially severe hyperkalemia)
Ingestions/toxins (aspirin, lithium, methanol, ethylene glycol)
Overload
Uraemia

37
Q

Focal segmental glomerulosclerosis classic presentation

A

proteinuria / nephrotic syndrome / chronic kidney disease
commonest nephrotic syndrome in adults

effacement of foot processes on electron microscopy

38
Q

Hep C chronic presents with renal disease

A

membranoproliferative glomerulonephritis
AKA mesangiocapillary

‘tram-track’ appearance on biopsy electron microscope
-subendothelial and mesangium immune deposits of electron-dense material

Hep b membranous

39
Q

Frank haematuria in sickle cell anaemia

A

renal papillary necrosis

– clubbed calyces and ring signs on IV urogram

40
Q

renal disease in HIV

A

focal segmental glomerulosclerosis

Protease inhibitors such as indinavir can precipitate intratubular crystal obstruction

41
Q

features of post-streptococcal glomerulonephritis

A 
weeks rather than days after infection
predominantly proteinuria 
Low C3
starry sky appearance
subepithelial lumps
42
Q

Mnemonic for renal papillary necrosis:

A 
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

43
Q

Anti-streptolysin O

A

ASO titre is for post-strep glomerulosnephritis

44
Q

fever, rash, arthralgia, renal impairment w eosinophilia

A

acute interstitial nephritis

most commonly caused by drugs… penicillins , Rifampacin, NSAIDs

MRCP 2 (13 decks)

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