Renal OH NO Flashcards by Shagma Botome

Significant feature of nephrotic syndrome

Protein loss

prOtein= nephrOtic

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Significant feature of nephritic syndrome

Haematuria

blood loss due to Inflammation= nephrItic

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Gold standard investigation to confirm nephrotic syndrome

24hr urine collection

>3g/day diagnoses

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Level of protein in 24hr urine collection diagnostic of nephrotic syndrome

> 3g/day

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Most common nephrotic picture in children?

Minimal Change Disease

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What is the change in Minimal Change Disease?

Podocytes fuse

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Treatment for Minimal Change disease

Steroids

Cyclophosphamide if steroid resistant

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Test for amyloidosis in kidney

Congo red staining (apple green birefringence)

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What nephrotic picture is Anti-PLA2r antibodies associated with?

Membranous Glomerulopathy

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Complications of nephrotic syndrome (4)

Thromboembolism
Infection risk
Renal impairment
Atherosclerosis (high lipids)

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Back pain and renal failure

Diagnosis?

Myeloma

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Tests for myeloma? (3)

Urine Bence Jones protein
Serum Electrophoresis
Serum Free Light Chains (Kappa & Lambda)

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What happens in myeloma

Abnormal plasma cells overproduce immunoglobulin

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Who gets Granulomatosis with Polyangiitis?

Old people

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Difference between microscopic polyangiitis and granulomatous polyangiitis?

GPA has upper resp tract involvement (sinuses + nasal cavity)

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GPA antibodies

cANCA

Anti -PR3

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MPA Antibodies

pANCA

Anti-MPO

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Why is complement low in lupus?

Used up in complexes

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Cannon balls on CXR

Renal mets

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Loin to Groin pain. What is it?

Renal Colic

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UTI & travel to India. Likely organism?

Carbapenemase producing klebsiella/ enterobacteriae

dem shits resistant

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What does Proteus sp. UTI cause?

Foul urine

Renal Calculi

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Beading of the renal artery suggests

Fibromuscular Dysplasia

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UTI with foul smelling urine and renal calculi causative organism?

Proteus Sp.

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What is proven by RBC casts in urine

Haematuria is due to glomerular cause

Muddy brown casts of epithelial cells

Acute Tubular Necrosis | pathognomic

Saddle nose

GPA (due to URT granuloma/involvement)

Cut surface like a potato

Testicular seminoma

Blue dot sign suggests

Testicular torsion | agghhhhh

Who gets Goodpasture's Syndrome

Young people | presence of anti-GBM antibodies

Painless Haematuria is probably

Malignancy

Renal failure, eye problems and bilateral sensorineural deafness. Diagnosis?

Alport syndrome | disorder in type IV collagen found at all of these sites

Patient with renal failure and family history of stroke and renal failure. Diagnosis?

Polycystic Kidney Disease

Why is PKD associated with stroke?

Causes berry aneurysms

String bead renal artery. Diagnosis?

Fibromuscular dysplasia

Muddy brown casts in urine

Acute Tubular Necrosis (ATN)

What is an AKI, define it

Sudden decrease in kidney function

Main side effect of AKI?

Hyperkalaemia AKI = a K high!

Treat AKI Hyperkalaemia? (2)

1. Calcium gluconate (cardioprotective) 2. Insulin IV (forces K into cells) 3. +/- nebulised salbutamol

What is the assumed pathology in kids with a nephrotic picture?

Minimal Change Disease

Treatment of minimal change disease

Oral steroids (94% remission)

What happens in Focal Segmental Glomerulosclerosis? (FSGS)

Ig/ complement deposition causes scarring/sclerosis

Treatment of FSGS?

Corticosteroids

What is Membranous Nephropathy?

Autoimmune inflammation of glomeruli

Antibody found in >75% Membranous Nephropathy

Anti-PLA2r | PLAYErrrrrrr

What is seen on silver stain of Membranous Nephropathy? (2)

Thickened basement membrane | Spike and Dome on Electron Microscopy

Best treatment for Membranous Nephropathy?

Immunosuppressants | eg Rituximab knocks out B cells

What does Rituximab do?

Knocks out B cells

What disease is IgA nephropathy associated with?

Henoch Schonlein Purpura

Describe Hencoh Schonlein purpura? (3)

Non-blanching rash of lower limbs Vasculitis Abdominal Pain

Classical description of IgA nephropathy? | finding and trigger

Micro-haematuria following strep throat or tonsilitis

What is seen on renal biopsy in IgA Nephropathy? (2)

IgA deposits | Mesangial Cell Proliferation

What is Rapidly Progressive Glomerulonephritis? (RPGN)

Rapid decline of kidney function leading to requiring dialysis in days/weeks

What is classically seen on renal biopsy in RPGN?

Glomerular crescents

Thickened Basement Membrane with Spiked Dome appearance. Diagnosis?

Membranous GN

Heroin user presents with oedema & proteinuria. Likely diagnosis?

FSGS

Tram track immune deposits on renal biopsy. Diagnosis?

Membranoproliferative GN

What is SNHL in Alport Syndrome due to?

Disordered type IV collagen

Most common nephrotic picture in adults?

Membranous Nephropathy

Facial feature in membranoproliferative glomerulonephritis?

Partial lipodystrophy (precedes renal disease by years)

For how long must investigations be abnormal to diagnose CKD?

3 months

What is the most common kidney malignancy in adults?

Renal Cell Carcinoma

What is the most common kidney malignancy in children?

Nephroblastoma

What renal pathology is associated with sickle cell anaemia?

Renal Papillary Necrosis | due to infarcted sickle cells

Which drugs can cause Acute Interstitial Nephritis? (3)

NSAIDs Antibiotics (Beta Lactams and sulphonamides) Loop/ Thiazide diuretics

Urine finding seen in Acute Interstitial Nephritis?

Eosinophils

At what measurement of creatinine is dialysis indicated?

Creatinine never indicates dialysis

What percentage of cardiac output goes to the kidneys?

About 20%

Does Angiotensin ii have greater effect on afferent or efferent glomerular arterioles?

Efferent

Kimmelstiel-Wilson nodules are highly suggestive of?

Diabetic Nephropathy

Thickened GBM with IgG under podocytes. Diagnosis?

Membranous Nephropathy

Spike and Dome appearance. Diagnosis?

Membranous Nephropathy

Heroin user presents with Nephrotic Syndrome. Likely diagnosis?

FSGS

Basket Weave appearance of GBM suggests what?

Alport's Syndrome | thinning and spitting of GBM due to disordered type IV collagen

Tram-track renal biopsy. Diagnosis?

Membranoproliferative Glomerulonephritis (MPGN)

Major viral cause of Membranoproliferative Glomerulonephritis (MPGN)?

Hepatitis C

Haematological malignancy associated with Minimal Change Disease?

Hodgkin's Lymphoma

How long after URTI symptoms does IgA Nephropathy present?

1-2 days | A first letter of alphabet, days much shorter than weeks as seen in Post-Strep GN

How long after URTI symptoms does Post-Strep Glomerulonephritis present?

1-3 weeks

Nitrites in urine indicate what?

UTI

Treat a 3mm ureteric stone?

Watchful waiting up to 5mm

Treat a 7mm ureteric stone? (2)

Shockwave Lithotripsy or if discussed Medical treatment 5-10mm (eg alpha blocker to expulse stone)

When is surgery indicated for a ureteric stone? (2)

Pain not tolerated | Stone unlikely to pass

When is Percutaneous Nephrolithotomy indicated?

Stone is bigger than 2cm

What is the most invasive surgery for ureteric/renal stones?

Percutaneous Nephrolithotomy

First line treatment for the majority of renal/ureteric stones?

Shockwave Lithotripsy

Main causes of Renal Artery Stenosis? (2)

Atherosclerosis | Fibromuscular Dysplasia