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Endocrinology / Renal Medicine > Renal Conditions > Flashcards

Renal Conditions Flashcards

1
Q

What is the definition of CKD?

A

Chronic Kidney Disease:

Evidence of kidney damage by structural / functional abnormalities for >3 months with or without a reduction in eGFR. This may manifest by abnormal imaging, symptoms of kidney disease (e.g. haematuria, proteinuria) or pathological abnormalities. This may lead to a reduction in eGFR.

OR

Reduction in eGFR to 3 months with or without evidence of other kidney damage as described above.

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2
Q

What is a normal eGFR?

A

> 90 mL/min

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3
Q

How are the stages of CKD defined?

A

Stage 1 = Normal or increased GFR (>90 mL/min) with evidence of other kidney damage
Stage 2 = Slightly decreased GFR (60 - 90 mL/min) with evidence of kidney damage
Stage 3 = Moderately decreased GFR (30 - 60 mL/min) with or without other evidence of kidney damage
Stage 4 = Severe decrease in GFR (15 - 30 mL/min) with or without other evidence of kidney damage
Stage 5 = Established renal failure when GFR

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4
Q

A patient with CKD has asymmetric kidneys and hypertension. What is the likely cause of their CKD presentation?

A

Ischaemic nephropathy - Most likely with asymmetric kidneys

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5
Q

A patient with CKD has macroscopic haematuria and macroscopic proteinuria. What is the likely cause of their CKD presentation?

A

Chronic glomerulonephritis. Common causes are IgA nephropathy, SLE, FSGS, systemic vasculitis, membranous nephropathy

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6
Q

A young patient presents with hypertension and moderate proteinuria (not in the nephrotic range). What is the likely cause of their presentation?

A

Reflux nephropathy i.e. vesico-uteric reflux

This is a condition of childhood (under 5yrs old) where there is urinary reflux, but it is often missed until these symptoms arise in young adults.

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7
Q

What are the 2 leading genetic causes of CKD?

A
  • Autosomal dominant polycystic kidney disease

- Alport’s Syndrome

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8
Q

What would be the suspected diagnosis in a patient with deafness (either of themselves on in the family) and haematuria?

A

Alport’s Syndrome - A genetic cause of CKD. Kidney biopsy would show abnormal glomerular basement membrane.

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9
Q

What are the key targets for management of CKD?

A

Blood pressure
Hyperlipidaemia
Treat the underlying condition e.g. diabetes, glomerulonephritis

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10
Q

List some complications of chronic kidney disease

A

Failure of excretory mechanisms - Uraemia toxicity
Failure of regulatory mechanisms - Reduction in the ability to regulate fluid and electrolyte balance…affecting water, sodium, potassium, calcium, phosphate
Endocrine complications - Anaemia due to decreased erythropoietin production, Vitamin D deficiency due to failure of 1-hydroxylase activation of Vit D, Renin increased due to inappropriate activation of renin-angiotensin system

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11
Q

What is the treatment for someone with uraemia toxicity due to decreased GFR in chronic kidney disease?

A

Dialysis or renal transplant

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12
Q

What happens to calcium, vitamin D and parathyroid hormone levels in chronic kidney disease?

A

Calcium and vitamin D decrease
Parathyroid hormone increases (secondary hyperparathyroidism due to decreased serum calcium, loss of parathyroid gland inhibition by Vit D, and increased phosphate levels)

NB - Calcium may appear normal due to stimulation of calcium release from bone by parathyroid hormone

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13
Q

What happens to phosphate levels in chronic kidney disease?

A

Increase

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14
Q

How would you treat hyperphosphataemia in chronic kidney disease?

A

Phosphate binders e.g. Calcichew (this also contains calcium)
Regulate dietary intake of phosphate

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15
Q

True / False - GFR is an appropriate measure of kidney function in acute kidney injury

A

False - GFR is based on creatinine levels and is only accurately measured when creatinine is at a steady state. This is not the case in acute kidney injury.

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16
Q

What are the stages of acute kidney injury?

A

Stage 1 = 1.5 x rise in baseline serum creatinine OR rise in creatinine >26 micro mol/L over 48 hours OR oliguria > 6 hours
Stage 2 = 2 x rise in baseline serum creatinine OR oliguria > 12 hours
Stage 3 = 3 x rise in baseline serum creatinine OR rise in creatine >354 micromol/L OR oliguria > 24 hours OR anuria > 12 hours

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17
Q

What are the 3 features of uraemic syndrome?

A

Vomiting
Encephalopathy
Serositis i.e. inflammation of pleura and pericardium

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18
Q

What are the functions of the kidney?

A
  • Excretion of waste products and chemicals (including drugs)
  • Regulation of water and salt for fluid balance
  • Blood pressure control
  • Electrolyte balance
  • Hormonal e.g erythropoietin, vit D
  • Gluconeogenesis
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19
Q

What are the 3 types of rejection from kidney transplantation?

A

Hyperacute - within minutes/hours, due to pre-formed antibodies to the donor
Acute - within days/weeks
Chronic - may take months/years

Acute and chronic rejection may be humeral (antibody mediated) or cellular (immune cell mediated)

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20
Q

Give 2 examples of calcineurin inhibitors

A

Tacrolimus, ciclosporin

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21
Q

What are some of the problems with dialysis?

A

Large molecules do not pass through the semi-permeable membrane
Hypotension
Time consuming
Access problems
Complications at access site e.g. thrombosis, infection

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22
Q

Give 2 examples of anti-proliferative agents given to transplant patients for immunosuppression

A

Azathioprine

Mycophenolate

23
Q

List some causes of pre-renal AKI

A

Hypo perfusion of the kidneys by:

  • Hypotension e.g. haemorrhage, heart failure causing low output state, sepsis
  • Drugs e.g. nephrotoxics, diuretics, ACE Inhibitors, ARBs
  • Cirrhosis
  • Dehydration e.g. in diarrhoea & vomiting
24
Q

List some causes of post-renal AKI

A

Malignancy
Stones
Benign prostatic hypertrophy

25
Q

List some causes of intrinsic renal disease in AKI

A

Tubular - Acute tubular necrosis usually with a pre-renal cause or maybe due to radiological contrast, nephrotoxic drugs, etc
Glomerular - Glomerulonephritis, SLE, drugs
Interstitial - Infiltration by lymphoma, infection etc.
Vascular - Vasculitis, large vessel occlusion by thrombosis or dissection, malignant hypertension

26
Q

How might you differentiate between a pre-renal and an intrinsic cause of AKI?

A

Urine specific gravity: >1.020 in pre-renal, 500 in pre-renal, 40 in intrinsic
Fractional excretion of sodium: 1% in intrinsic

27
Q

What might be the change in BP, urine and GFR of patients with a) Nephrotic syndrome and b) Nephritic syndrome

A

a) Nephrotic Syndrome: Normal to mild raised BP, proteinuria +++ (>3.5g per day), Normal to mildly decreased GFR
b) Nephritic Syndrome: Moderate to severely raised BP, haematuria (variable spectrum from mild to macroscopic), moderate to severely decreased GFR

28
Q

23 year old male presents with recurrent episodes of macroscopic haematuria - what’s the most likely cause of his symptoms?

A

IgA nephropathy - a common primary cause of nephritic syndrome

29
Q

What is the treatment for IgA nephropathy?

A

Strict BP control using ACE-Inhibitor

30
Q

What might a renal biopsy show in someone with IgA nephropathy?

A

Mesangial cell proliferation, with deposition of IgA and C3 picked up on immunofluorescence

31
Q

What is anti-GBM disease?

A

Anti-Glomerular Basement Membrane Disease

Antibodies to Type IV collagen in the glomerular basement membrane

32
Q

List some primary causes of nephrotic syndrome

A

Mesangiocapillary glomerulonephritis
Minimal change disease
Membranous nephropathy

33
Q

List some secondary causes of nephrotic syndrome

A

Diabetes
SLE
Amyloid
Hepatitis B and C

34
Q

List some primary causes of nephritic syndrome

A

IgA nephropathy

Mesangiocapillary glomerulonephritis

35
Q

List some secondary causes of nephritic syndrome

A 
SLE
Post-streptococcal infection
Vasculitis (Henoch Schonlein Purpura)
Anti-GBM disease
Cryoglobulinaemia
36
Q

Nephrotic Syndrome is a triad of…?

A

Proteinuria >3.5g per day

Hypoalbuminaemia

37
Q

What is the commonest cause of nephrotic syndrome in children?

A

Minimal change disease

38
Q

What is the treatment for minimal change nephropathy?

A

Steroids

Cyclophosphamide or ciclosporin/tacrolimus may be used in recurrent relapses

39
Q

What will renal biopsy show in membranous nephropathy?

A

Diffusely thickened glomerular basement membrane with IgG and C3 deposits.

40
Q

List come causes of focal segmental glomerulosclerosis

A 
Vesicoureteric reflux
Alport's syndrome
IgA nephropathy
Sickle-cell disease
Vasculitis
41
Q

Which organism is commonly responsible for an ascending urinary tract infection?

A

E. coli

42
Q

What symptoms would you expect in a patient with cystitis?

A

Urinary frequency, dysuria, offensive smelling urine, haematuria, suprapubic pain

43
Q

What symptoms would you expect in a patient with acute pyelonephritis?

A

Loin pain, fever, vomiting

44
Q

What is renal tubular acidosis?

A

Normal anion gap metabolic acidosis, caused by the inability of the kidney to adequately acidify urine.

45
Q

What are the types of renal tubular acidosis?

A

Type 1 = Distal
Type 2 = Proximal
Type 3 = Hyperkalaemic

46
Q

List some features of acute nephritic syndrome (acute glomerulonephritis)

A

Acute onset haematuria with casts and dysmorphic red cells, non-nephrotic range proteinuria, oedema, hypertension and transient renal impairment

47
Q

Which cells does renal cell carcinoma originate from?

A

Proximal renal tubular epithelium

48
Q

What is hydronephrosis?

A

Dilation of the renal pelvis due to a urinary tract obstruction

49
Q

Where are the 3 most common sites for renal stones to accumulate?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

50
Q

What is the most common type of renal stone?

A

Calcium oxalate

51
Q

What is the difference between urine sodium in pre-renal and intrinsic renal AKI?

A

In pre-renal, urinary sodium is low because there is increased reabsorption of sodium to try and maintain circulating volume. In intrinsic renal AKI there is high urinary sodium due to destruction of glomerular filtration apparatus.

52
Q

What are the diagnostic criteria for AKI?

A
  • Rise in serum creatinine >26umol in 48 hours
  • Rise in serum creatinine >1.5x baseline (measured within 3 months)
  • Oliguria 6 hours
53
Q

What is the common finding on urinalysis in acute tubular necrosis?

A

‘Muddy brown casts’

Endocrinology / Renal Medicine (6 decks)

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