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RACP Written Exam Cram Series > Renal Cram > Flashcards

Renal Cram Flashcards

1
Q

Factors stimulating renin release from juxtaglomerular cells?

A

Sympathetic nervous system increase
Hypotension
Low renal blood flow - reduced sodium chloride concentration in distal tubule detected by macula densa

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2
Q

Effects of angiotensinII?

A
  1. Vasoconstriction/increase in MAP
  2. Constriction of renal efferent > afferent arterioles – increases GFR/increases Na resorption
  3. Aldosterone secretion – sodium/water retention in DCT/CD
  4. Posterior pit ADH release – increases DCT/CD Na/water resorption
  5. Thirst
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3
Q

Aldosterone effects?

A

Stimulates Na/K/ATPase pump collecting tubule

Increases sodium permeability via epithelial Na channe;

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4
Q

ADH stimulus and effects?

A

Stimulus: Hyperosmolarity and hypotension
Effects: Increases water permeability of distal collecting tubule + collecting duct via aquaporin

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5
Q

Site of sodium resorption?

A 
Proximal tubules (60-65%)
Na/K/ATPase pump
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6
Q

Site of water resorption controlled by ADH?

A

Collecting duct

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7
Q

Renal response to acidosis and alkalosis?

A

Alkalosis - reduction in HCO3 resorbed

Acidosis - secretion of additional H+

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8
Q

Why is growth poor in chronic acidosis?

A

Bone derived phosphate is used by kidneys as a buffer when bicarb levels are chronically low

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9
Q

Proximal renal tubular acidosis (type 2 RTA) features?

A

Urine pH <5.5
High urine bicarb & citrate
Secondary bone demineralisation due to phosphate wasting

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10
Q

Distal renal tubular acidosis (type 1 RTA) features?

A

Urine pH >5.5
Low urine osmol gap
Low ammonium excretion

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11
Q

How to calculate anion gap?

A

Na - (Cl + Bicarb)

Remember to adjust for albumin

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12
Q

Amino aciduria/proteinura
Glycosuria
Polyuria
Hypophosphatemia

A

Renal Fanconi

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13
Q

Renal Fanconi
Blond hair
Corneal crystals

A

Cystinosis

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14
Q

Male
Fanconi
Nephrocalcinosis

A

Dent’s

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15
Q 
Nocturia/polyuria
Muscle spasms
Low K+/Mg
Normal/high renin and aldosterone
Urine calcium low
A

Gittelman

Autosomal recessive

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16
Q 
Polyuria and dehydration
Hypokalaemia
Growth and mental retardation
High renin and aldosterone
Urine calcium high
A

Bartter

Autosomal recessive

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17
Q

Low serum osmalality
High urine osmolality
Euvolaemic
Low serum Na

A

SIADH

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18
Q

Nephrogenic DI treatment?

A 
Solute reduction (low na diet)
Water restriction 
Diuretics
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19
Q

Causes of post-renal AKI?

A

Sludge/Stones (dilated renal pelvis w no urine in bladder)
Trauma/clots
Tumours
Bladder outlet obstruction

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20
Q

Causes of pre-renal AKI?

A

True intravascular depletion - blood loss, intestinal loss, insensible loss
Effective renal hypoperfusion - hypotension (heart failure/septic shock etc)

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21
Q

Differences between pre-renal AKI and acute tubular necrosis?

A

Pre-renal AKI has high urine osmolality and low urine Na

Pre-renal AKI has bland urine, ATN has casts

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22
Q

Causes of renal AKI?

A 
Insult to renal parenchyma:
Renal vein thrombus
Vasculitis, HSP, HUS, glomerulonephropathies
Pylonephritis, interstitial nephritis
ATN
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23
Q

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI
+/- bloody diarrhoea

A

Haemolytic Uraemic Syndrome

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24
Q

Blood tests for suspected HUS?

A

FBE and film - anaemia, thrombocytopenia, schistocytes
Bilirubin - high
LDH - high
Haptoglobin - low
Coags - fibrinogen normal (excludes DIC)
UEC - K+ normal due to diarrhoea loss, AKI

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25
Q

Cause of diarrhoea positive HUS?

A

Shiga Toxin

E Coli

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26
Q

Most common cause of AKI in developed world?

A

Shiga Toxin HUS

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27
Q

Management that best decreases chance of renal failure in early HUS?

A

IV fluid resus early

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28
Q 
Recurrent episodes of
Hypertension
Haemolytic anaemia 
Thrombocytopenia
AKI
Low c3
A

Atypical HUS (complement mediated)

29
Q 
Strenuous exercise
Muscle pain
Swelling
AKI
Bright red urine
High CK
A

Rhabdomyolysis

-> manage with hyper hydration

30
Q 
Recent illness or NSAID/antibiotic 
AKI
Sterile pyuria
White cells and WBC casts
Elevated urine protein:Cr ratio
A

Acute interstitial nephritis

31
Q

Indications for renal replacement therapy?

A

Electrolyte disturbance unable to be managed medically
Symptomatic uraemia - bleeding, pericarditis, encephalopathy
Severe fluid overload - pulmonary oedema, HTN, heart failure

32
Q

CLCN5 mutation

A

Dent

33
Q 
Best imaging modality for:
Infection
Scarring
Reflux
Obstruction
Drainage
A 
Infection - US/MCU
Scarring - DMSA
Reflux - MCU, DTPA
Obstruction - DTPA or IVU
Drainage - IVU CT urogram
34
Q

Difference between DTPA and DMSA and MAG3 scans?

A

DTPA best for assessing tubes - outflow
DMSA best for assessing parenchyma - scarring
MAG3 does both well

35
Q

Kidney lesion in tuberous sclerosis?

A

Angiomyolipoma

36
Q

Features of nephritic syndrome?

A

Proteinuria, haematuria, red/white cell casts in urine
Rising creatinine
Hypertension

37
Q

Features of nephrotic syndrome?

A

Proteinuria +++

Peripheral oedema ++

38
Q

Differential diagnosis (renal causes) of macroscopic haematuria?

A 
UTI
Stones
Renal vein thrombus
IgA nephropathy 
Alport
39
Q

Heavy proteinuria
RBC & WBC on urine dip
AKI
Biopsy shows cellular crescents in glomeruli

A

Rapidly Progressive GlomeruloNephritis (RPGN)

40
Q

Nephritis + positive strep serology/anti-DNase B?

A

Post-Strep GN

41
Q

Nephritis + anti-ds DNA OR ANA positive?

A

SLE

42
Q

Persistent low c3 (>4-6 weeks) with nephritis?

A 
SLE
Membranoproliferative GN (MPGN)
43
Q

Nephritis + high IgA level?

A

IgA nephropathy

HSP

44
Q

Nephritis + pulmonary haemorrhage?

A

Goodpastures

45
Q

Goodpastures pathogenesis and biopsy findings?

A

Antibody mediated

Linear Ig staining of basement membrane

46
Q

How to differentiate glomerular haematuria from non-glomerular?

A

Glomerular - casts, dysmorphic RBCs, concurrent proteinuria

Non-glomerular - normal RBCs without casts and no proteinuria

47
Q

What causes hypertension in nephritic syndrome?

A

Salt and water retention causes suppression of renin leading to HTN

48
Q

Kidney biopsy findings in PSGN?

A

Neutrophils in capillary loops

49
Q

Double contour of glomerular basement membrane on biopsy?

A

MPGN

50
Q

HSP associated with what increases risk of progression to CKD?

A

Nephrotic syndrome at outset of disease increases risk of progression to CKD by 50%

51
Q

Gross haematuria with proteinuria
Concurrent URTI sx
Recurrent

A

Ig A nephropathy

  • Elevated IgA
  • Mesangial IgA deposition
52
Q

Insidious onset nephritis
Joint pain
Vasculitis
Uveitis

A

ANCA vasculitis

53
Q

Uveitis

Urine - protein, glucose, no RBC/WBC

A

Tubule-interstitial nephritis with uveitis syndrome

54
Q

Alport genetic mutation

A

X-linked

COL4A5 mutation

55
Q

Important features of alport?

A

Anterior lenticonus on eye exam
Deafness
Leiomyomatosis (smooth muscle tumours)
Basket weave GBM on biopsy

56
Q 
Polyuria, polydipsia
Short stature
Anaemia
Bland urinalysis
US shows normal/small kidneys with loss of corticomedullary differentiation
A

Juvenile nephronopthithis

57
Q

Nephrotic syndrome - mesangial sclerosis
Wilms tumour
Female genitalia with 46XY chromosome

A

Denys-Drash

WT1 mutation

58
Q

Syndromes associated with Wilms?

A

Beckwith-Widemann
Denys-Drash
WAGR
Frasier

59
Q

Most important dietary factor in renal stone development?

A

High sodium diet - resulting in increased sodium and therefore calcium excretion in kidney causing calcium stones

60
Q

Non-blanching skin lesions
Neuropathic pain
Heat intolerance
Proteinuria

A

Fabry disease

X-linked lysosomal storage disorder

61
Q

How to calculate fractional sodium excretion?

A

Urine sodium X serum creatinine
Divided by
Urine creatinine X serum sodium
x100 (expressed as %)

62
Q

Difference in protein defects in ARPKD and ADPKD?

A

ARPKD - fibrocystin protein defective

ADPKD - polycystin 1 & 2 proteins defective

63
Q

Renal SEs of lithium?

A

Nephrogenic DI

Due to ADH resistance

64
Q

Extra-renal manifestations of infantile nephronopthisis?

A

Retinitis Pigmentosa
Hepatic fibrosis
Cardiac defects (septal defects, situs inversus)
Skeletal abnormalities

65
Q

Management of giggle incontinence?

A

Timed voiding

Oxybutinin

66
Q

Renal and vaginal agenesis

A

Mayer-Rokitansky-Kuster-Hauser syndrome

67
Q 
Coloboma, 
Renal abnormalities, 
SNHL, 
Seizures 
Joint laxity
A

Renal-Coloboma Syndrome

PAX2 mutation

68
Q

Difference in defect location in Bartter and Gitelman syndromes?

A

Bartter - sodium resorption at loop of hence defective

Gitelman - sodium resorption at distal tubule defective

RACP Written Exam Cram Series (19 decks)

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