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Finals > Renal disease > Flashcards

Renal disease Flashcards

1
Q

What are the types of lower tract UTI

A

Cystitis and Prostatitis

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2
Q

When should ramipril be started in patients with CKD

A

Patients with chronic kidney disease should be started on an ACE inhibitor if they have an ACR > 30 mg/mmol

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3
Q

What is fibromuscular dysplasia

A

Fibromuscular dysplasia describes the proliferation of cells in the walls of the arteries causing the vessels to bulge or narrow. This most commonly affects women. These patients are susceptible to AKI after the initiation of an ACE inhibitor. The classic description is ‘string of beads’ appearance.

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4
Q

Who should be referred for a urinary tract cancer

A

Visible haematuria in over 45s that either is not associated with a UTI or that persists after successful treatment of UTI should be referred urgently under the 2-week wait pathway. This is because visible haematuria can be a sign of bladder or renal cancer.

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5
Q

Compare and contrast pre-renal azotemia and acute tubuler necrosis.

A

Pre-renal uraemia (‘azotemia’) Acute tubular necrosis
Urine sodium < 20 mmol/L > 40 mmol/L
Urine osmolality > 500 mOsm/kg < 350 mOsm/kg
Fractional sodium excretion* < 1% > 1%
Response to fluid challenge Good Poor
Serum urea:creatinine ratio Raised Normal
Fractional urea excretion** < 35% >35%
Urine:plasma osmolality > 1.5 < 1.1
Urine:plasma urea > 10:1 < 8:1
Specific gravity > 1020 < 1010
Urine Normal/ ‘bland’ sediment Brown granular casts

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6
Q

What is a normal anion gap

A

A normal anion gap is 8-14 mmol/L

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7
Q

What is diagnostic of ADPKD

A

in patients with a positive family history, diagnosis is made by the visualisation of two cysts, unilateral or bilateral, if aged <30 years. If between 30-59 years of age, two cysts in both kidneys are the diagnostic criteria. If 60 or over, the diagnostic criteria are four cysts in both kidneys.

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8
Q

What symptoms might be seen with acute interstitial nephritis

A

Sterile pyuria and white cell casts in the setting of rash and fever should raise the suspicion of acute interstitial nephritis, which is commonly due to antibiotic therapy

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9
Q

At what level should an ACE inhibitor be discontinued in patients with ckd.

A

NICE suggest that a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable, although any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs).

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10
Q

How is HUS treated?

A

In most cases of haemolytic-uraemic syndrome, the mainstay of treatment is supportive, with fluids, blood transfusions and dialysis as required.

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11
Q

What is membranous nephropathy?

A

Membranous glomerulonephritis histology:
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2

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12
Q

WHAT ARE THE CAUSES OF NORMAL ANION GAP ACIDOSIS?

A

Hyperchloraemia
Renal tubular acidosis
Addison’s disease
Diarrhoea

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13
Q

How is diabetic nephropathy investigated?

A

Screening
all patients should be screened annually using urinary albumin:creatinine ratio (ACR)
should be an early morning specimen
ACR > 2.5 = microalbuminuria

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14
Q

Who should be referred for nephrology?

A

Refer to a nephrologist if:
g4 or g5 CKD
If ACR is above >70 and no diabetes
If ACR is >30 and haematuria
If eGFR decreases by 25% or remains at 15
not controlled by 4 antihypertensives
genetic or rare syndrome

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15
Q

Who should be prescribed ACE inhibitors with CKD?

A

Patients with ACR >3 with diabetes
>30 with hypertension
and any CKD more than 70

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16
Q

What are the complications of CKD?

A

Bone abnormalities
Anaemia
Restless legs
Oedema
CKD
Acidosis

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17
Q

What should be prescribed in CKD to manage the ‘BAROCA’ complication?

A

darbepoetin alfa injections i

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18
Q

How long for an AV fistula to form?

A

The time taken for an arteriovenous fistula to develop is 6 to 8 weeks

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19
Q

What is FSGS?

A

Focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome and chronic kidney disease. It generally presents in young adults.

Causes
idiopathic
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport’s syndrome
sickle-cell

Focal segmental glomerulosclerosis is noted for having a high recurrence rate in renal transplants.

Investigations
renal biopsy
focal and segmental sclerosis and hyalinosis on light microscopy
effacement of foot processes on electron microscopy

Management
steroids +/- immunosuppressants

Prognosis
untreated FSGS has a < 10% chance of spontaneous remission

20
Q

What are the features of a nephritic syndrome?

A

haematuria, proteinuria/oedema, hypertension and oliguria

21
Q

How do you treat nephrogenic diabetes insipidus?

A

Chlorthiazide

22
Q

What should be monitored frequently with HSP?

A

Patients with active Henoch-Schonlein purpura: blood pressure and urinanalysis should be monitored to detect progressive renal involvement

23
Q

What does annual screening for diabetes nephropathy involve?

A

All diabetic patients require annual screening for albumin:creatinine ratio (ACR) in early morning specimens

24
Q

What medications are recommended in people with CKD?

A

NICE guidelines recommend prescribing an angiotensin converting enzyme (ACE) inhibitor to all patients with chronic kidney disease (CKD) who have a urinary ACR or 70mg/mmol or more. Lipid-lowering therapy with a statin is also recommended for all patients with CKD for the primary or secondary prevention of cardiovascular disease.

25
What is a feature of acute tubular necrosis?
Acute tubular necrosis - urine sodium > 40 mmol/L
26
What is interstitial nephritis?
Causes drugs: the most common cause, particularly antibiotics penicillin rifampicin NSAIDs allopurinol furosemide systemic disease: SLE, sarcoidosis, and Sjögren's syndrome infection: Hanta virus , staphylococci Pathophysiology histology: marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules Features fever, rash, arthralgia eosinophilia mild renal impairment hypertension
27
Why does nephrotic syndrome cause of hypercoagulable state?
antithrombin III via the kidneys
28
How is Goodpasture's managed?
Management plasma exchange (plasmapheresis) steroids cyclophosphamide
29
What are the causes of FSGS?
Focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome and chronic kidney disease. It generally presents in young adults. Causes idiopathic secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy HIV heroin Alport's syndrome sickle-cell Focal segmental glomerulosclerosis is noted for having a high recurrence rate in renal transplants. Investigations renal biopsy focal and segmental sclerosis and hyalinosis on light microscopy effacement of foot processes on electron microscopy Management steroids +/- immunosuppressants Prognosis untreated FSGS has a < 10% chance of spontaneous remission
30
What are the features of membranous nephropathy?
Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF). It usually presents with nephrotic syndrome or proteinuria. Renal biopsy demonstrates: electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance Causes idiopathic: due to anti-phospholipase A2 antibodies infections: hepatitis B, malaria, syphilis malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia drugs: gold, penicillamine, NSAIDs autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid Management all patients should receive an ACE inhibitor or an angiotensin II receptor blocker (ARB): these have been shown to reduce proteinuria and improve prognosis immunosuppression as many patients spontaneously improve only patient with severe or progressive disease require immunosuppression corticosteroids alone have not been shown to be effective. A combination of corticosteroid + another agent such as cyclophosphamide is often used consider anticoagulation for high-risk patients Prognosis - rule of thirds one-third: spontaneous remission one-third: remain proteinuric one-third: develop ESRF Good prognostic features include female sex, young age at presentation and asymptomatic proteinuria of a modest degree at the time of presentation.
31
What is needed to make a diagnosis of rhabdomyolysis?
The creatinine kinase should be 5 times the baseline
32
How should incomplete bladder emptying be managed with neurogenic bladder?
Self catheteritisation
33
What can be used apart from resonium to remove potassium
Calcium polystyrene sulphonate
34
What is HIVAN?
HIV associated nephropathy There are five key features of HIVAN: massive proteinuria resulting in nephrotic syndrome normal or large kidneys focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy elevated urea and creatinine normotension
35
What are some causes of membranous nephropathy?
idiopathic: due to anti-phospholipase A2 antibodies infections: hepatitis B, malaria, syphilis malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia drugs: gold, penicillamine, NSAIDs autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid
36
What are the criteria for eGFR?
eGFR variables - CAGE - Creatinine, Age, Gender, Ethnicity
36
What is the effect of too much sodium replacement?
Use of 0.9% Sodium Chloride for fluid therapy in patients requiring large volumes = risk of hyperchloraemic metabolic acidosis
37
What are some causes of FSGS?
Heroin HIV Lithium Lymphoma
38
What are the causes of membranous nepropathy?
Malignancy Infection Sarcoidosis SLE Hep B/C Idiopathic Gold / Penicillamine Srojens
39
What is pathogmonic of membranous nephropathy?
>25% of adult nephrotic syndrome Silver stain subepithelial spikes PLAR2
40
How is membranous nephropathy treated?
ACE inhibition Ponticelli method of immunosuppression
41
How is FSGS?
ACE inhibition Calcineurin inhibitor, Corticosteroids
42
What are the complications of nephrotic syndrome?
Hyperlipidemia Infection Thrombocytopenia
43
What are the examples of glomerulonephritis?
IgA nephropathy HSP Post-streptococcal glomerulonephritis Anti- GBM Rapidly progressive GN
44
What is Fabry disorder?
A lipid storage disorder X linked alpha galactosidase
45
What is acute graft failure?
<6 months Acute graft failure happens within months, is usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria Use steroids
46
What is dialysis disequilibrium syndrome?
Dialysis disequilibrium syndrome is a rare complication and usually affects those who have recently started renal replacement therapy. It is caused by cerebral oedema, but the exact mechanism is unclear. Therefore this is a diagnosis of exclusion.

Finals (24 decks)

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