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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
Cause of diarrhoea positive HUS?
Shiga Toxin | E Coli
26
Most common cause of AKI in developed world?
Shiga Toxin HUS
27
Management that best decreases chance of renal failure in early HUS?
IV fluid resus early
28
``` Recurrent episodes of Hypertension Haemolytic anaemia Thrombocytopenia AKI Low c3 ```
Atypical HUS (complement mediated)
29
``` Strenuous exercise Muscle pain Swelling AKI Bright red urine High CK ```
Rhabdomyolysis | -> manage with hyper hydration
30
``` Recent illness or NSAID/antibiotic AKI Sterile pyuria White cells and WBC casts Elevated urine protein:Cr ratio ```
Acute interstitial nephritis
31
Indications for renal replacement therapy?
Electrolyte disturbance unable to be managed medically Symptomatic uraemia - bleeding, pericarditis, encephalopathy Severe fluid overload - pulmonary oedema, HTN, heart failure
32
CLCN5 mutation
Dent
33
``` Best imaging modality for: Infection Scarring Reflux Obstruction Drainage ```
``` Infection - US/MCU Scarring - DMSA Reflux - MCU, DTPA Obstruction - DTPA or IVU Drainage - IVU CT urogram ```
34
Difference between DTPA and DMSA and MAG3 scans?
DTPA best for assessing tubes - outflow DMSA best for assessing parenchyma - scarring MAG3 does both well
35
Kidney lesion in tuberous sclerosis?
Angiomyolipoma
36
Features of nephritic syndrome?
Proteinuria, haematuria, red/white cell casts in urine Rising creatinine Hypertension
37
Features of nephrotic syndrome?
Proteinuria +++ | Peripheral oedema ++
38
Differential diagnosis (renal causes) of macroscopic haematuria?
``` UTI Stones Renal vein thrombus IgA nephropathy Alport ```
39
Heavy proteinuria RBC & WBC on urine dip AKI Biopsy shows cellular crescents in glomeruli
Rapidly Progressive GlomeruloNephritis (RPGN)
40
Nephritis + positive strep serology/anti-DNase B?
Post-Strep GN
41
Nephritis + anti-ds DNA OR ANA positive?
SLE
42
Persistent low c3 (>4-6 weeks) with nephritis?
``` SLE Membranoproliferative GN (MPGN) ```
43
Nephritis + high IgA level?
IgA nephropathy | HSP
44
Nephritis + pulmonary haemorrhage?
Goodpastures
45
Goodpastures pathogenesis and biopsy findings?
Antibody mediated | Linear Ig staining of basement membrane
46
How to differentiate glomerular haematuria from non-glomerular?
Glomerular - casts, dysmorphic RBCs, concurrent proteinuria | Non-glomerular - normal RBCs without casts and no proteinuria
47
What causes hypertension in nephritic syndrome?
Salt and water retention causes suppression of renin leading to HTN
48
Kidney biopsy findings in PSGN?
Neutrophils in capillary loops
49
Double contour of glomerular basement membrane on biopsy?
MPGN
50
HSP associated with what increases risk of progression to CKD?
Nephrotic syndrome at outset of disease increases risk of progression to CKD by 50%
51
Gross haematuria with proteinuria Concurrent URTI sx Recurrent
Ig A nephropathy - Elevated IgA - Mesangial IgA deposition
52
Insidious onset nephritis Joint pain Vasculitis Uveitis
ANCA vasculitis
53
Uveitis | Urine - protein, glucose, no RBC/WBC
Tubule-interstitial nephritis with uveitis syndrome
54
Alport genetic mutation
X-linked | COL4A5 mutation
55
Important features of alport?
Anterior lenticonus on eye exam Deafness Leiomyomatosis (smooth muscle tumours) Basket weave GBM on biopsy
56
``` Polyuria, polydipsia Short stature Anaemia Bland urinalysis US shows normal/small kidneys with loss of corticomedullary differentiation ```
Juvenile nephronopthithis
57
Nephrotic syndrome - mesangial sclerosis Wilms tumour Female genitalia with 46XY chromosome
Denys-Drash | WT1 mutation
58
Syndromes associated with Wilms?
Beckwith-Widemann Denys-Drash WAGR Frasier
59
Most important dietary factor in renal stone development?
High sodium diet - resulting in increased sodium and therefore calcium excretion in kidney causing calcium stones
60
Non-blanching skin lesions Neuropathic pain Heat intolerance Proteinuria
Fabry disease | X-linked lysosomal storage disorder
61
How to calculate fractional sodium excretion?
Urine sodium X serum creatinine Divided by Urine creatinine X serum sodium x100 (expressed as %)
62
Difference in protein defects in ARPKD and ADPKD?
ARPKD - fibrocystin protein defective | ADPKD - polycystin 1 & 2 proteins defective
63
Renal SEs of lithium?
Nephrogenic DI | Due to ADH resistance
64
Extra-renal manifestations of infantile nephronopthisis?
Retinitis Pigmentosa Hepatic fibrosis Cardiac defects (septal defects, situs inversus) Skeletal abnormalities
65
Management of giggle incontinence?
Timed voiding | Oxybutinin
66
Renal and vaginal agenesis
Mayer-Rokitansky-Kuster-Hauser syndrome
67
``` Coloboma, Renal abnormalities, SNHL, Seizures Joint laxity ```
Renal-Coloboma Syndrome | PAX2 mutation
68
Difference in defect location in Bartter and Gitelman syndromes?
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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