Renal Flashcards
1
Q
CT kidney shows large lesion with central scar, macroscopically the lesion is mahogony in colour.
What is the likely diagnosis?
Benign or malignant?
A
Oncocytoma
Benign
2
Q
What is the most common intra abdominal tumour in children?
A
Wilm’s tumour (nephroblastoma)
3
Q
“cannon ball mets” on CXR make you think
A
Renal cell carcinoma
4
Q
Most common TYPE of renal cell carcinoma?
A
Clear cell
5
Q
Loin pain + haematuria + renal mass
A
Renal cell carcinoma
6
Q
Renal cell carcinoma is often an incidental finding. True or false?
A
True
7
Q
Which staging is used for renal cell carcinoma?
A
Robson
8
Q
Renal cell carcinoma most commonly metastasises to?
A
Lungs
9
Q
Management of renal cell carcinoma
A
Radical nephrectomy (if high risk) Partial nephrectomy (low/moderate risk)
10
Q
Which autosomal dominant syndrome has a high link with renal cell carcinoma?
A
Von Hippel Lindeau
11
Q
Managment of infected hydronephrosis
A
Percutaneous Nephrostomy
12
Q
Inflammation around the renal tissues which does NOT affect the glomerulous. There is infiltration of immune cells (neutrophil, eosinophil) what is the likely diagnosis?
A
Interstitial nephritis
13
Q
Patient develops AKI after treatment of hypertension. What is the likely diagnosis?
A
Renal artery stenosis
14
Q
Abdominal bruit makes you think
A
Renal artery stenosis
15
Q
Gold standard investigation to check for renal artery stenosis?
A
CT angiography
Maybe MR angiography?
16
Q
ACE inhibitors and renal artery stenosis
- unilateral vs bilateral
A
ACE inhibitors contraindicated in bilateral RAS
ACE inhibitors used to treat unilateral RAS
17
Q
Young female with Ehlors Danlos syndrome and hypertension. On CT angiography renal artery looks like string of beads. What is likely diagnosis?
A
Fibromuscular dysplasia
18
Q
Collection of abnormal plasma cells accumulate in bone marrow
A
Myeloma
19
Q
Bone pain, renal failure, weakness, weight loss, hypercalcaemia - paints picture of
A
Myeloma
20
Q
Bence jones proteins in urine in which condition
A
Myeloma
21
Q
Which electrolyte imbalance is most likely associated with cardiac arrhythmia?
A
Hyperkalaemia
22
Q
Tall tented T wave
Flattened P wave
Broad QRS
A
Hyperkalaemia
23
Q
Emergency management of hyperkalaemia
A
Calcium gluconate
Insuline with 50% dextrose or salbutamol
24
Q
At which level of hyperkalaemia would you consider dialysis
A
K+ > 7
K+ > 6.5 (and not responding to medical therapy)
25
Which 2 body symptoms does goodpastures syndrome affect
Kidneys
| Lungs
26
AKI + Haematuria + haemoptysis
Goodpastures syndrome
27
Goodpastures syndrome is an attack of?
Type IV collagen
28
What is seen on immunofluorescence in goodpastures syndrome
Linear IgG deposition along basement membrane
29
What is the best way to monitor kidney function
GFR
30
Proteinuria is associated with
- nephritic syndrome
- nephrotic syndrome
Nephrotic syndrome
31
In diabetic nephropathy, there is dilation/constriction in the afferent arteriole and dilation/constriction in the efferent arteriole ?
Dilation - afferent
| Constriction - efferent
32
Diabetic nephropathy - urinalysis findings
Protienuria / hyperalbuminuria
33
Management of diabetic nephropathy
Tight glycaemic control
Anti-hypertensives (ACE inhibitor - dilates efferent arteriole)
Statin
Dialysis
Transplant
34
Name 3 types of small vessel vasculitis
GPA
EGPA
microscopic polyangitis
35
cANCA suggests
GPA
36
pANCA suggests
EGPA
37
What are the 'triple whammy' drugs to avoid in an AKI?
Diuretics
NSAIDs
ACE inhibitor / ARBs
38
What is the main thing to check if you think a patient may have AKI ?
```
Creatinine (is it 50% increased from baseline / >26)
Urine output (is there <0.5mL/kg/hr)
```
39
Name 3 pre-renal causes of AKI
Hypovolaemia (haemorrhage, D+V)
Hypotension (shock, sepsis)
Renal hypoperfusion (triple whammy drugs, renal artery stenosis)
40
In normal patients, if there is decreased renal perfusion efferent arteriolar constriction/dilation occurs to maintain GFR?
efferent constriction in normal patients
41
What mediates arteriolar vasoconstriction to maintain the GFR ?
Angiotensin II
42
What is the immediate management of pre-renal AKI?
IV FLUIDS
Crystalloid (0.9% NaCl)
Stop nephrotoxic drugs
43
Untreated pre-renal AKI leads to
Acute tubular necrosis
44
Name 4 causes of renal AKI
Vascular (vasculitis)
Glomerular disease
Interstitial nephritis
Tubular injury (acute tubular necrosis)
45
Investigations carried out in ?renal AKI ?
U+E - increased creatinine, increased urea
Urinalysis - proteinuria
US - small kidneys suggest CKD normal kidney AKI
46
Immediate management of renal AKI
```
IV fluids 25ml bolus up to 1000ml
if patient still not resuscitated then
- inotropes, vasopressors
if patient STILL not resuscitated then
- dialysis
```
47
Post renal AKI causes (4)
Renal / ureteric stones
Malignancy
Strictures
BPH
Obstruction causes back pressure (hydronephrosis)
48
Management of post-renal AKI
Relieve obstruction
- Nephrostomy
- Catheter
49
BP cut off if patient has proteinuria and CKD
130/80
50
Name some risk factors for CVD progression
```
CVD
Diabetes
Hypertension
Renal artery stenosis
PKD
AKI
Small vessel vasculitis
Glomerulonephritis
Chronic NSAID use
```
51
Normal GFR is over which value ?
90
52
Stage 1 CKD
```
GFR normal (>90)
Structural change to kidney
```
53
Stage 2 CKD
GFR mildly reduced (60-89)
| Structural change to kidney
54
Stage 3A CKD
GFR moderately reduced (45-59)
| Defined on GFR alone
55
Stage 3B CKD
GFR moderately reduced (30-44)
| Defined on GFR alone
56
Stage 4 CKD
GFR severely reduced (15-29)
57
Stage 5 CKD
Renal failure
| GFR < 15 or pt on dialysis
58
The majority of people with CKD will reach end stage renal failure. True or false?
False
59
Investigations for CKD
GFR - decreasing
U+E - increased creatinine
Urinalysis - proteinuria
60
if patient has eGFR 50ml/min but normal kidneys and nothing to suggest why they have CKD then do NOT label them as a CKD patient. True or false/
True
61
CKD increases the risk of
Atherosclerosis
62
When should you consider dialysis
When eGFR around 20ml/min
63
What causes pre-renal AKI
Decreased blood flow to kidneys (which in turn decreases the GFR)
- hypovolaemia
- dehydration
- renal hypoperfusion (triple whammy meds)
64
Mangement of pre renal AKI
Fluids (0.9% saline)
65
Patient with oedema, proteinuria, hypoalbuminaemia. What is the likely diagnosis?
Nephrotic syndrome
66
What is the protein range for nephrotic syndrome?
Protein over 3g/day
67
What is the likely cell for nephrotic syndrome
- mesangial cell
- endothelial cell
- podocyte
Podocyte
| non-proliferative
68
Management of nephrotic syndrome
Fluid restriction
Salt restriction
Diuretics
ACEi / ARBs
69
What is the likely cell for nephritic syndrome
- mesangial cell
- endothelial cell
- podocyte
```
Endothelial cell
(proliferative)
```
70
Nephrotic syndrome in children
Minimal change nephropathy
71
Management of minimal change nephropathy (nephrotic syndrome)
1st line
2nd line
1st line - oral steroids
| 2nd line - cyclophosphamide
72
What is the commonest cause of nephrotic syndrome in adults?
FSGS
73
What is the most common glomerulonephritis in the wold?
IgA nephropathy
74
Macroscopic haematuria after respiratory infection. Think
IgA nephropathy
75
If someone has acute severe changes in U+Es, why do you only give 90 mins (short session) of dialysis initially?
To reduce the risk of dysequilibrium syndrome
76
Anti-GBM antibody in which condition?
Good pastures syndrome
77
Platelets are low in DIC. True or false?
True
78
Patient with diabetic nephropathy?
Good diabetic control
| ACE inhibitor
79
Iron deficiency anaemia in patient with CKD. If iron deplete, what is the treatment?
iron replacement
80
Iron deficiency anaemia in patient with CKD. If iron Replete, what is the treatment?
EPO
81
Someone with CKD, not taking medications...what could be the next treatment?
Dialysis
82
Hyperkalaemia treatment
10% 10ml Calcium gluconate
Insulin + Dextrose
Speak to renal
83
ECG changes in hyperkalaemia?
Tall tented T waves
Broad bizarre QRS
Flat P waves
84
Dialysis patient with hyperkalaemia. What is the definitive treatment?
Dialysis
85
ECG change in hypercalcaemia
Short QT interval
86
Treatment of hypercalcaemia
```
Aggressive fluid rehydration
Bisphosphinate use (zolendronic acid)
```
87
Hypernatraemia - caused by excess water loss. True or false?
True
| - pee out lots of urine
88
Sodium low, you would expect osmolality to be high/low?
Low
89
urine osmolality < plasma osmolality - what does this suggest
Diabetes insipidus
90
Urine osmolality > plasma osmolality - what does this suggest?
Osmotic diuresis
91
Treatment of mild hypernatraemia?
Replace water loss with oral water or 5% glucose IV
92
Treatment of severe hypernatraemia?
IV NaCl
93
Tumour lysis syndrome - what is the common electrolyte abnormality?
High phosphate
94
How do you manage hypokalaemia?
Sando K
95
If you are giving IV potassium, what is the maximum flow rate?
10mmol/hr
96
common cause for someone to be hypocalcaemic?
Vitamin D deficiency
97
If patient is hyponatraemic, low osmolality, full of fluid, urinary sodium is high what is the likely cause?
Diuretics
98
if the sodium level is low and hypovolaemic, what you thinking about?
LOSSES
- vomiting
- diarrhoea
- burns
99
If you detect a patient has a metabolic acidosis, what should you do nexr?
Check for anion gap
| - if raised think MUDPILES
100
Hypercalcaemia investigations
PTH
| Malignancy
101
Hyponatraemic patient - what do you do?
assess fluid status
| urinary sodium
102
What is the best type of kidney transplant?
Live donor
103
74 year old woman is hypoxic and has haemoptysis. She has a purpuric rash.
Creatinine is 430. Blood and protein on dip.
RBC casts on microscopy.
What glomerular cells are most likely to be injured?
- mesangial cells
- endothelial cells
- podocytes
How would you confirm the diagnosis?
Endothelial cells - this is likely vasculitis
Confirm diagnosis by doing ANCA
104
```
82 year old man admitted with BP 70/30, T 39, pulse 140bpm, K+ 7.0, urea 48, Cr 789, CRP 250, CXR left basal consolidation. What is the likely diagnosis?
¥ A. Rhabdomyolosis
¥ B. Goodpasture’s Syndrome
¥ C. Acute Tubular Necrosis
¥ D. Obstructive Uropathy
¥ E. Wegener’s Granulomatosis
```
C. Acute Tubular Necrosis
105
39 yo woman with 2 day history of fever, vomiting, dysuria, back pain. Examination findings: pulse-110, temp-39. Chest clear. Left loin tenderness. Urinalysis: +++leukocyte, +ve nitrite, +++protein, blood trace haemolysed. What is the likely diagnosis?
- A. UTI
- B. Acute pyelonephritis
- C. Cystitis
- D. Acute glomerulonephritis
B - acute pyelonephritis
