Renal Revision Flashcards
Should you use an ARB in addition to an ACE?
probably not - may reduce albuminuria further but doesn’t lower BP or reduce progression of CKD and does increase risk of hyperkalaemia and AKI
Which CKD patients get the most benefit from SGLT2 inhibitors?
macroalbuminuric patients
Is there evidence for SGLT2 inhibitors at eGFR < 30?
no
What is the target antigen in IgA nephropathy?
galactose deficient IgA from mucosal surface
When would you use steroids in IgA nephropathy?
only after 3-6 months of optimised supportive treatment and proteinuria is still >1g/day
Is recurrence of IgA nephropathy common post transplant?
yes but there is late graft loss (approx 10% at 10 years)
What is the difference between amount of proteinuria required for renal decline in IgA vs membranous GN and FSGS?
in IgA only need >1g/day whereas with the other need >5g/day
What percentage of patients with idiopathic membranous nephropathy have positive PLA2R Ab?
70-80%
Should a malignancy screen be done in patients with positive PLA2R Ab with membranous nephropathy?
No - very unlikely to be secondary
Is PLA2R Ab prognostic?
Yes - if persistent/rising then unlikely to remit spontaneously and so should start immunosuppression earlier
What is the immunosuppressive treatment for membranous nephropathy?
rituximab - as good as cyclosporin in inducing remission and remaining relapse free - however not on PBS
What other treatment is required for membranous nephropathy?
anticoagulation, statin, diuretics, salt and fluid restriction
When is plasma exchange indicated for ANCA vasculitis?
when there is pulmonary haemorrhage or sometimes if rapidly progressive
What is the problem with using cylophosphamide in ANCA vasculitis?
increased toxicity with cumulative doses
Which is better for maintenance therapy in ANCA vasculitis azathioprine or mycophenolate?
azathioprine
