renal medicine Flashcards
what is erythropoietin?
- growth factor
- stimulates production of erythrocytes
When is Erythropoietin secreted?
- secreted by kidney
- in response to cellular hypoxia
Alport syndrome is due to…
- defecet in gene coding for type IV collagen
- results in an abnormal glomerular basement membrane
medical condition involving the death of tubular epithelial cells that form renal tubules of kidney
acute tubular necrosis
what might be seen in urinalysis of a patient with acute tubular necrosis
‘muddy brown casts’
high K+
deranged renal function
causes of AKI are divided into what three categories
Prerenal : ishcaemia
Intrinsic : toxins
Post renal : obstruction, backing up
Pre-renal causes of AKI
ISCHAEMIA
- hypovolaemia secondary to diarrhoea / vomiting
- renal artery stenosis
Intrinsic causes of AKI
glomerulonephritis
acute tubular necrosis (ATN)
acute interstitial nephritis
rhabdomyolysis
tumour lysis syndrome
post renal causes of AKI
- kidney stone in ureter or bladder
- benign prostatic hyperplasia
- external compression of ureter
what is a recognised cause of diabetes insipidus ?
- lithium
- lithium desensitizes the kidneys ability to respond to ADH in the collecting ducts
- demeclocycline
what is antithrombin III?
- protease
- inhibits coagulation by inhibiting activity of thrombin
- nephrotic syndrome associated with a loss of antithrombin III
31 y/o male
- has ongoing renal condition
- suffers haematuria and loin pain
- caused his underlying anaemia
- numerous echogenic spaces in kidneys
- mother had condition
indicative of:
autosomal dominant polycystic kidney disease
most common extra-renal manifestation of ADPKD is :
liver cysts
20 y/o female
pc: 5 day hx painless light brown urine. 3 episodes over 5 days.
no dyspareunia, urgency or pain.
afebrile
pmh: previous URTI
urine dip: positive for ketones and blood
indicative of:
post streptococcus glomerulonephritis
symptoms, previous illness and proteinuria point to PSGN
post streptococcus glomerulonephritis is caused by:
immune complex (IgG, IgM and C3) deposition in the glomeruli.
Alport’s syndrome characterised by:
- haematuria
- sensory hearing loss
- ocular disturbances
Causes of a normal anion gap metabolic acidosis are ABCD:
Addisons
Bicarb loss
Chloride
Drugs
obesity hypoventilation will cause what type of respiratory picture
respiratory acidosis
describe some complications of nephrotic syndrome?
- increased VTE risk
- increased risk of infections
- cardiovascular complications
- anaemia
- acute renal failure
- hypovolaemic crisis
triad of nephrotic syndrome
- proteinuria ( > 3g/24hr)
- hypoalbuminaemia ( < 30g/L)
- oedema
why does nephrotic syndrome predispose an increased risk of VTE?
- loss of anti-thrombin-III, proteins C and S
- an associated rise in fibrinogen levels
- both predispose to thrombosis
complications of corticosteroids
- obesity
- growth retardation
- papilloedema
how can primary and secondary aldosteronism be differentiated
look at renin levels
if renin is high then secondary cause more likely: renal artery stenosis
55 y/o male
pc: progressive weakness, dyspnoea, hepatomegaly, proteinuria and worsening renal function
which condition explains all the patient sysmptoms?
amyloidosis
what is amyloidosis?
- describes the extraceullar deposition of an insoluble fibrillar protein termed amyloid
- accumulation leads to tissue / organ dysfunction
fibromuscular dysplasia features?
- hypertension
- CKD or more acute renal failure
- ‘flash’ pulmonary oedema
- 90% patients are female
Henoch-Schonlein purpura (HSP) is a
IgA mediated small vessel vasculitis
Blood in the urine means do what investigation?
Cystoscopy for bladder cancer
typical symptoms of acute interstitial nephritis?
fever and rash
acute interstitial nephritis is classically caused by
acute interstitial nephritis
what is the preferred method of access for haemodialysis?
arteriovenous fistulas
ecg changes
- tall tented T waves
- flattened P waves
- shortened QT interval
indicate:
hyperkalaemia
role of calcium resonium in management of patient?
removes potassium from body
which of the following medication should be stopped due to risk of worsening renal function:
- aspirin
- lithium
- metformin
- naproxen
- simvastatin
NSAIDs should be stopped in AKI : so naproxen
41 y/o
discharged from hospital post community acquired pneumonia, managed at home with penicillin.
a day later:
pc: low grade fever, widespread erythematous rash and paint throughout her joints and lower back
initial blood slow significantly elevated creatine.
diagnosis:
acute interstitial nephritis presents with allergic type picture
- raised urinary WCC
- IgE and eosinophils
- impaired renal function
urine findings in patient with acute interstitial nephritis
raised urinary white cells
eosinophils
IgE
40 y/o male pc bone and joint pain.
pmh: polycystic kidney disease
vitamin D deficiency
low PTH
patient has:
- secondary hyperparathyroidism
- kidney function has decreased
- kidneys aren’t able to convert enough vitamin D into the active form
In the bloods, urea is more than twice the normal range whilst creatinine is only just above the upper limit; this is indicative of
dehydration
following histology is indicative of:
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
membranous glomerulonephritis
Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness - consider
haemolytic uraemic syndrome
supportive management
- fluids, blood transfusion and dialysis if required
classical triad of renal cell carcinoma:
- haematuria
- loin pain
- abdominal mass
features of renal carcinoma besides the classic triad of haematuria, loin pain and abdominal mass
- pyrexia of unknown origin
- left varicocele (due to occlusion of left testicular vein)
- endocrine effects: may secrete erythropoietin (polycythaemia, PTH, hypercalcaemia, renin, ACTH)
few signs and symptoms of anaemia?
tachycardia
fatigue
pallor
aortic flow murmur.
The mainstay of rhabdomyolysis treatment is
rapid IV fluid rehydration
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
Nephrotic syndrome is associated with a hypercoagulable state due to…
loss of antithrombin III via the kidneys
The anion gap is calculated by:
(sodium + potassium) - (bicarbonate + chloride)
A normal anion gap is 8-14 mmol/L
It is useful to consider in patients with a metabolic acidosis:
The anion gap is calculated by:
(sodium + potassium) - (bicarbonate + chloride)
A normal anion gap is 8-14 mmol/L
It is useful to consider in patients with a metabolic acidosis:
what drug may be used in high doses to help prevent formation of ascites in patients with chronic liver disease
spironlactone
most common cause of peritonitis secondary to peritoneal dialysis
- staphylococcus epidermis
for a patient who is hyperkalaemic and has associated ECG changes, describe the first priority treatment:
IV calcium gluconate: to stabilise the myocardium
insulin/dextrose infusion: short-term shift in potassium from ECF to ICF
other treatments such as nebulised salbutamol may be given to temporarily lower the serum potassium
what might you use for the removal of calcium from the body?
- calcium resonium
- loop diruetics
- dialysis
Haemolytic uraemic syndrome - classically caused by what organism?
E-coli
state four eGFR variables:
CAGE
C- creatinine
A- age
G- gender
E- Ethnicity
