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renal medicine Flashcards

1
Q

what is erythropoietin?

A
  • growth factor

- stimulates production of erythrocytes

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2
Q

When is Erythropoietin secreted?

A
  • secreted by kidney

- in response to cellular hypoxia

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3
Q

Alport syndrome is due to…

A
  • defecet in gene coding for type IV collagen

- results in an abnormal glomerular basement membrane

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4
Q

medical condition involving the death of tubular epithelial cells that form renal tubules of kidney

A

acute tubular necrosis

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5
Q

what might be seen in urinalysis of a patient with acute tubular necrosis

A

‘muddy brown casts’

high K+

deranged renal function

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6
Q

causes of AKI are divided into what three categories

A

Prerenal : ishcaemia

Intrinsic : toxins

Post renal : obstruction, backing up

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7
Q

Pre-renal causes of AKI

A

ISCHAEMIA

  • hypovolaemia secondary to diarrhoea / vomiting
  • renal artery stenosis
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8
Q

Intrinsic causes of AKI

A

glomerulonephritis

acute tubular necrosis (ATN)

acute interstitial nephritis

rhabdomyolysis

tumour lysis syndrome

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9
Q

post renal causes of AKI

A
  • kidney stone in ureter or bladder
  • benign prostatic hyperplasia
  • external compression of ureter
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10
Q

what is a recognised cause of diabetes insipidus ?

A
  • lithium
  • lithium desensitizes the kidneys ability to respond to ADH in the collecting ducts
  • demeclocycline
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11
Q

what is antithrombin III?

A
  • protease
  • inhibits coagulation by inhibiting activity of thrombin
  • nephrotic syndrome associated with a loss of antithrombin III
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12
Q

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:

A

autosomal dominant polycystic kidney disease

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13
Q

most common extra-renal manifestation of ADPKD is :

A

liver cysts

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14
Q

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:

A

post streptococcus glomerulonephritis

symptoms, previous illness and proteinuria point to PSGN

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15
Q

post streptococcus glomerulonephritis is caused by:

A

immune complex (IgG, IgM and C3) deposition in the glomeruli.

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16
Q

Alport’s syndrome characterised by:

A
  • haematuria
  • sensory hearing loss
  • ocular disturbances
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17
Q

Causes of a normal anion gap metabolic acidosis are ABCD:

A

Addisons

Bicarb loss

Chloride

Drugs

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18
Q

obesity hypoventilation will cause what type of respiratory picture

A

respiratory acidosis

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19
Q

describe some complications of nephrotic syndrome?

A
  • increased VTE risk
  • increased risk of infections
  • cardiovascular complications
  • anaemia
  • acute renal failure
  • hypovolaemic crisis
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20
Q

triad of nephrotic syndrome

A
  1. proteinuria ( > 3g/24hr)
  2. hypoalbuminaemia ( < 30g/L)
  3. oedema
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21
Q

why does nephrotic syndrome predispose an increased risk of VTE?

A
  • loss of anti-thrombin-III, proteins C and S
  • an associated rise in fibrinogen levels
  • both predispose to thrombosis
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22
Q

complications of corticosteroids

A
  • obesity
  • growth retardation
  • papilloedema
23
Q

how can primary and secondary aldosteronism be differentiated

A

look at renin levels

if renin is high then secondary cause more likely: renal artery stenosis

24
Q

55 y/o male

pc: progressive weakness, dyspnoea, hepatomegaly, proteinuria and worsening renal function

which condition explains all the patient sysmptoms?

A

amyloidosis

25
what is amyloidosis?
- describes the extraceullar deposition of an insoluble fibrillar protein termed amyloid - accumulation leads to tissue / organ dysfunction
26
fibromuscular dysplasia features?
- hypertension - CKD or more acute renal failure - 'flash' pulmonary oedema - 90% patients are female
27
Henoch-Schonlein purpura (HSP) is a
IgA mediated small vessel vasculitis
28
Blood in the urine means do what investigation?
Cystoscopy for bladder cancer
29
typical symptoms of acute interstitial nephritis?
fever and rash
30
acute interstitial nephritis is classically caused by
acute interstitial nephritis
31
what is the preferred method of access for haemodialysis?
arteriovenous fistulas
32
ecg changes - tall tented T waves - flattened P waves - shortened QT interval indicate:
hyperkalaemia
33
role of calcium resonium in management of patient?
removes potassium from body
34
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
35
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
36
urine findings in patient with acute interstitial nephritis
raised urinary white cells eosinophils IgE
37
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
38
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
39
following histology is indicative of: basement membrane thickening on light microscopy subepithelial spikes on sliver stain positive immunohistochemistry for PLA2
membranous glomerulonephritis
40
Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness - consider
haemolytic uraemic syndrome supportive management - fluids, blood transfusion and dialysis if required
41
classical triad of renal cell carcinoma:
1. haematuria 2. loin pain 3. abdominal mass
42
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)
43
few signs and symptoms of anaemia?
tachycardia fatigue pallor aortic flow murmur.
44
The mainstay of rhabdomyolysis treatment is
rapid IV fluid rehydration
45
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
46
Nephrotic syndrome is associated with a hypercoagulable state due to...
loss of antithrombin III via the kidneys
47
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:
48
what drug may be used in high doses to help prevent formation of ascites in patients with chronic liver disease
spironlactone
49
most common cause of peritonitis secondary to peritoneal dialysis
- staphylococcus epidermis
50
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
51
what might you use for the removal of calcium from the body?
1. calcium resonium 2. loop diruetics 3. dialysis
52
Haemolytic uraemic syndrome - classically caused by what organism?
E-coli
53
state four eGFR variables:
CAGE C- creatinine A- age G- gender E- Ethnicity

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