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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

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2
Q

What is the most common intra abdominal tumour in children?

A

Wilm’s tumour (nephroblastoma)

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3
Q

“cannon ball mets” on CXR make you think

A

Renal cell carcinoma

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4
Q

Most common TYPE of renal cell carcinoma?

A

Clear cell

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5
Q

Loin pain + haematuria + renal mass

A

Renal cell carcinoma

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6
Q

Renal cell carcinoma is often an incidental finding. True or false?

A

True

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7
Q

Which staging is used for renal cell carcinoma?

A

Robson

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8
Q

Renal cell carcinoma most commonly metastasises to?

A

Lungs

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9
Q

Management of renal cell carcinoma

A 
Radical nephrectomy (if high risk) 
Partial nephrectomy (low/moderate risk)
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10
Q

Which autosomal dominant syndrome has a high link with renal cell carcinoma?

A

Von Hippel Lindeau

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11
Q

Managment of infected hydronephrosis

A

Percutaneous Nephrostomy

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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

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13
Q

Patient develops AKI after treatment of hypertension. What is the likely diagnosis?

A

Renal artery stenosis

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14
Q

Abdominal bruit makes you think

A

Renal artery stenosis

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15
Q

Gold standard investigation to check for renal artery stenosis?

A

CT angiography

Maybe MR angiography?

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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

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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

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18
Q

Collection of abnormal plasma cells accumulate in bone marrow

A

Myeloma

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19
Q

Bone pain, renal failure, weakness, weight loss, hypercalcaemia - paints picture of

A

Myeloma

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20
Q

Bence jones proteins in urine in which condition

A

Myeloma

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21
Q

Which electrolyte imbalance is most likely associated with cardiac arrhythmia?

A

Hyperkalaemia

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22
Q

Tall tented T wave
Flattened P wave
Broad QRS

A

Hyperkalaemia

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23
Q

Emergency management of hyperkalaemia

A

Calcium gluconate

Insuline with 50% dextrose or salbutamol

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24
Q

At which level of hyperkalaemia would you consider dialysis

A

K+ > 7

K+ > 6.5 (and not responding to medical therapy)

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25
Q

Which 2 body symptoms does goodpastures syndrome affect

A

Kidneys

Lungs

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26
Q

AKI + Haematuria + haemoptysis

A

Goodpastures syndrome

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27
Q

Goodpastures syndrome is an attack of?

A

Type IV collagen

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28
Q

What is seen on immunofluorescence in goodpastures syndrome

A

Linear IgG deposition along basement membrane

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29
Q

What is the best way to monitor kidney function

A

GFR

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30
Q

Proteinuria is associated with

  • nephritic syndrome
  • nephrotic syndrome
A

Nephrotic syndrome

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31
Q

In diabetic nephropathy, there is dilation/constriction in the afferent arteriole and dilation/constriction in the efferent arteriole ?

A

Dilation - afferent

Constriction - efferent

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32
Q

Diabetic nephropathy - urinalysis findings

A

Protienuria / hyperalbuminuria

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33
Q

Management of diabetic nephropathy

A

Tight glycaemic control
Anti-hypertensives (ACE inhibitor - dilates efferent arteriole)
Statin

Dialysis
Transplant

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34
Q

Name 3 types of small vessel vasculitis

A

GPA
EGPA
microscopic polyangitis

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35
Q

cANCA suggests

A

GPA

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36
Q

pANCA suggests

A

EGPA

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37
Q

What are the ‘triple whammy’ drugs to avoid in an AKI?

A

Diuretics
NSAIDs
ACE inhibitor / ARBs

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38
Q

What is the main thing to check if you think a patient may have AKI ?

A 
Creatinine (is it 50% increased from baseline / >26) 
Urine output (is there <0.5mL/kg/hr)
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39
Q

Name 3 pre-renal causes of AKI

A

Hypovolaemia (haemorrhage, D+V)
Hypotension (shock, sepsis)
Renal hypoperfusion (triple whammy drugs, renal artery stenosis)

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40
Q

In normal patients, if there is decreased renal perfusion efferent arteriolar constriction/dilation occurs to maintain GFR?

A

efferent constriction in normal patients

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41
Q

What mediates arteriolar vasoconstriction to maintain the GFR ?

A

Angiotensin II

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42
Q

What is the immediate management of pre-renal AKI?

A

IV FLUIDS
Crystalloid (0.9% NaCl)
Stop nephrotoxic drugs

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43
Q

Untreated pre-renal AKI leads to

A

Acute tubular necrosis

44
Q

Name 4 causes of renal AKI

A

Vascular (vasculitis)
Glomerular disease
Interstitial nephritis
Tubular injury (acute tubular necrosis)

45
Q

Investigations carried out in ?renal AKI ?

A

U+E - increased creatinine, increased urea
Urinalysis - proteinuria
US - small kidneys suggest CKD normal kidney AKI

46
Q

Immediate management of renal AKI

A 
IV fluids 25ml bolus up to 1000ml 
if patient still not resuscitated then 
- inotropes, vasopressors 
if patient STILL not resuscitated then 
- dialysis
47
Q

Post renal AKI causes (4)

A

Renal / ureteric stones
Malignancy
Strictures
BPH

Obstruction causes back pressure (hydronephrosis)

48
Q

Management of post-renal AKI

A

Relieve obstruction

  • Nephrostomy
  • Catheter
49
Q

BP cut off if patient has proteinuria and CKD

50
Q

Name some risk factors for CVD progression

A 
CVD 
Diabetes 
Hypertension 
Renal artery stenosis 
PKD 
AKI 
Small vessel vasculitis 
Glomerulonephritis 
Chronic NSAID use
51
Q

Normal GFR is over which value ?

52
Q

Stage 1 CKD

A 
GFR normal (>90) 
Structural change to kidney
53
Q

Stage 2 CKD

A

GFR mildly reduced (60-89)

Structural change to kidney

54
Q

Stage 3A CKD

A

GFR moderately reduced (45-59)

Defined on GFR alone

55
Q

Stage 3B CKD

A

GFR moderately reduced (30-44)

Defined on GFR alone

56
Q

Stage 4 CKD

A

GFR severely reduced (15-29)

57
Q

Stage 5 CKD

A

Renal failure

GFR < 15 or pt on dialysis

58
Q

The majority of people with CKD will reach end stage renal failure. True or false?

59
Q

Investigations for CKD

A

GFR - decreasing
U+E - increased creatinine
Urinalysis - proteinuria

60
Q

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/

61
Q

CKD increases the risk of

A

Atherosclerosis

62
Q

When should you consider dialysis

A

When eGFR around 20ml/min

63
Q

What causes pre-renal AKI

A

Decreased blood flow to kidneys (which in turn decreases the GFR)

  • hypovolaemia
  • dehydration
  • renal hypoperfusion (triple whammy meds)
64
Q

Mangement of pre renal AKI

A

Fluids (0.9% saline)

65
Q

Patient with oedema, proteinuria, hypoalbuminaemia. What is the likely diagnosis?

A

Nephrotic syndrome

66
Q

What is the protein range for nephrotic syndrome?

A

Protein over 3g/day

67
Q

What is the likely cell for nephrotic syndrome

  • mesangial cell
  • endothelial cell
  • podocyte
A

Podocyte

non-proliferative

68
Q

Management of nephrotic syndrome

A

Fluid restriction
Salt restriction
Diuretics
ACEi / ARBs

69
Q

What is the likely cell for nephritic syndrome

  • mesangial cell
  • endothelial cell
  • podocyte
A 
Endothelial cell 
(proliferative)
70
Q

Nephrotic syndrome in children

A

Minimal change nephropathy

71
Q

Management of minimal change nephropathy (nephrotic syndrome)
1st line
2nd line

A

1st line - oral steroids

2nd line - cyclophosphamide

72
Q

What is the commonest cause of nephrotic syndrome in adults?

73
Q

What is the most common glomerulonephritis in the wold?

A

IgA nephropathy

74
Q

Macroscopic haematuria after respiratory infection. Think

A

IgA nephropathy

75
Q

If someone has acute severe changes in U+Es, why do you only give 90 mins (short session) of dialysis initially?

A

To reduce the risk of dysequilibrium syndrome

76
Q

Anti-GBM antibody in which condition?

A

Good pastures syndrome

77
Q

Platelets are low in DIC. True or false?

78
Q

Patient with diabetic nephropathy?

A

Good diabetic control

ACE inhibitor

79
Q

Iron deficiency anaemia in patient with CKD. If iron deplete, what is the treatment?

A

iron replacement

80
Q

Iron deficiency anaemia in patient with CKD. If iron Replete, what is the treatment?

81
Q

Someone with CKD, not taking medications…what could be the next treatment?

82
Q

Hyperkalaemia treatment

A

10% 10ml Calcium gluconate
Insulin + Dextrose
Speak to renal

83
Q

ECG changes in hyperkalaemia?

A

Tall tented T waves
Broad bizarre QRS
Flat P waves

84
Q

Dialysis patient with hyperkalaemia. What is the definitive treatment?

85
Q

ECG change in hypercalcaemia

A

Short QT interval

86
Q

Treatment of hypercalcaemia

A 
Aggressive fluid rehydration
Bisphosphinate use (zolendronic acid)
87
Q

Hypernatraemia - caused by excess water loss. True or false?

A

True

- pee out lots of urine

88
Q

Sodium low, you would expect osmolality to be high/low?

89
Q

urine osmolality < plasma osmolality - what does this suggest

A

Diabetes insipidus

90
Q

Urine osmolality > plasma osmolality - what does this suggest?

A

Osmotic diuresis

91
Q

Treatment of mild hypernatraemia?

A

Replace water loss with oral water or 5% glucose IV

92
Q

Treatment of severe hypernatraemia?

93
Q

Tumour lysis syndrome - what is the common electrolyte abnormality?

A

High phosphate

94
Q

How do you manage hypokalaemia?

95
Q

If you are giving IV potassium, what is the maximum flow rate?

96
Q

common cause for someone to be hypocalcaemic?

A

Vitamin D deficiency

97
Q

If patient is hyponatraemic, low osmolality, full of fluid, urinary sodium is high what is the likely cause?

98
Q

if the sodium level is low and hypovolaemic, what you thinking about?

A

LOSSES

  • vomiting
  • diarrhoea
  • burns
99
Q

If you detect a patient has a metabolic acidosis, what should you do nexr?

A

Check for anion gap

- if raised think MUDPILES

100
Q

Hypercalcaemia investigations

A

PTH

Malignancy

101
Q

Hyponatraemic patient - what do you do?

A

assess fluid status

urinary sodium

102
Q

What is the best type of kidney transplant?

A

Live donor

103
Q

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?

A

Endothelial cells - this is likely vasculitis

Confirm diagnosis by doing ANCA

104
Q 
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
A

C. Acute Tubular Necrosis

105
Q

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
A

B - acute pyelonephritis

Y4 (23 decks)

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