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DTMH Block 4 > Tropical nephrology > Flashcards

Tropical nephrology Flashcards

1
Q

What is important about the mean age of AKI in developed vs developing countries?

A

Developing countries - 37.1yo
Developed countries - 72yo

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2
Q

What factors in developing countries predispose to AKI?

A

Malnutrition
Hypovolemia with high ambient temperatures (sweating)
Higher G6PD deficiency rate

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3
Q

What is the most common cause of AKI in children?

A

HUS - diarrhoea disease

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4
Q

What is the most important infectious cause of haematuria and ARF?

A

VHF-like syndromes

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5
Q

How is Dengue fever diagnosed?

A
  1. Acute fever (+/- biphasic)
  2. Hemorrhagic tendencies
  3. Thrombocytopenia
  4. Evidence of plasma leakage
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6
Q

Which viruses belong to the arenaviridae family?

A

Lassa
Lujo
Argentine
Bolivian
Brazilian
Venezuelan

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7
Q

Which viruses belong to the bunyaviridae family?

A

Hantavirus
CCHF (nairovirus)
Garissa (orthobunyavirus)
RVF (phlebovirus)

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8
Q

Which viruses belong to the filoviridae family?

A

Ebola
Marburg

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9
Q

Which viruses belong to the flaviviridae family?

A

Dengue
Yellow fever
Omsk hemorrhagic fever
Kyasanur Forest disease

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10
Q

What are the 2 viruses in the tick borne encephalitis group that cause VHF?

A

Omsk hemorrhagic fever virus
Kyasanur Forest disease virus

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11
Q

Which VHFs often don’t result in VHF syndrome?

A

Dengue
RVF
Lassa

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12
Q

What is VHF syndrome?

A

Capillary leak
Bleeding diathesis
Hemodynamic compromise -> shock

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13
Q

Which VHFs can be treated with IV ribavirin?

A

Lassa
RVF
CCHF
HFRS (hantavirus)

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14
Q

In which VHF-like syndromes is the majority of AKI non-oliguric?

A

Ebola
Marburg
Dengue
Yellow fever
Lassa
CCHF

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15
Q

Which viruses causes hemorrhagic fever with renal syndrome?

A

Hantavirus

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16
Q

What are the principle bacterial infectious causing renal complications?

A

Salmonella
Shigella
Leptospirosis
Meliodosis
Cholera
Tetanus
Scrub typhus
Diphtheria

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17
Q

Which are the principle mycobacterial infections causing renal complications?

A

Tuberculosis
Leprosy
Usually subacute or chronic disease course

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18
Q

What are the hemodynamic factors involved in the pathogenesis of renal complications in tropical disease?

A

Prolonged febrile illness (sweating, rhabdomyolysis, catecholamines, hyperpyrexia)
GI fluid losses (severe diarrhoea)
Peripheral pooling (endotoxemia, malaria)

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19
Q

What are the majority of acute interstitial nephritis in tropical disease caused by?

A

Drugs (40%)
Infection itself <10%

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20
Q

Which infections cause acute interstitial nephritis?

A

Typhoid
Meliodosis
Leptospirosis
Dengue
Hantavirus
Leishmaniasis
Tuberculosis

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21
Q

Which glomerular syndrome is caused by scabies?

A

PIGN

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22
Q

Which glomerular syndrome is caused by leprosy?

A

NS
Amyloid

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23
Q

Which glomerular syndrome is caused by filariasis?

A

NS
IC

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24
Q

Which glomerular syndrome is caused by falciparum malaria?

A

RPGN

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25
Which glomerular syndrome is caused by streptococcus?
PIGN
26
Which glomerular syndrome is caused by non-falciparum malaria?
NS
27
Which glomerular syndrome is caused by HAV?
MPGN
28
Which glomerular syndrome is caused by salmonella?
IC (assoc with schistosomiasis and giardiasis)
29
Which parasites result in immune mediated interstitial nephritis?
L. Donovan (visceral leishmaniasis, kala azar, treated with ample B) Falciparum malaria Vivax malaria
30
Which bacteria result in immune mediated endothelial injury?
E.coli 0157 and others Shigella toxin Strep suis
31
Discuss salmonella infection with regard to renal dysfunction
Pyelonephritis ATN Glomerulonephritis Febrile phase with hematuria and proteinuria Mild with full recovery within 2w of treatment Post-infectious GN
32
Discuss shigella infection with regard to renal dysfunction
ATN (dehydration) Proliferative GN HUS w/ cortical necrosis and diffuse fibrous deposits
33
Discuss cholera infection with regard to renal dysfunction
ARF due to fluid and electrolyte loss Severe hypokalemia -> proximal tubular vacuolation Cortical necrosis
34
Discuss tetanus infection with regard to renal dysfunction
Rhabdomyolysis ANS overactivity Mild Non-oliguric
35
Discuss leptospirosis with regard to renal dysfunction
Several serotypes, contact w/ rodent urine Biphasic 1. Septicaemia (conjunctivitis) 2. Meningitis, cholestatic jaundice, ARDS, ARF ARF in almost all cases but usually mild, non-oliguric
36
What are the features of Weil's disease and which organism causes it?
Leptospirosis Hepatic necrosis Coaugulopathy
37
What renal pathology is seen in leptospirosis?
Necrotizing vasculitis Mild MPGN Interstitial nephritis
38
What renal pathology is seen in dengue fever?
ATN (interstitial edema, mononuclear cell infiltration) MPGN
39
What is the vector of HFRS?
Rodents
40
Discuss the clinical presentation of sangassou virus
Transient thrombocytopenia Conjunctival haemorrhages Palatine petechiae Truncal petechial rash Oliguria Azotemia Proteinuria Haematuria After 3d, rash disappear and patient develops polyuria
41
Which fungal toxin is often associated with the pathogenesis of Balkan nephropathy?
Ochratoxin Progressive interstitial nephropathy
42
Is AKI more common in patients with malaria from endemic or non-endemic areas?
Non-endemic (non-immune)
43
What is the pathogenesis of falciparum AKI?
Hypovolemia NO and cytokine mediated vasodilation Resistance to vasoactive hormones Cytopathic hypoxia Mechanical obstruction by infected RBCs
44
Why is peritoneal dialysis efficacy reduced in falciparum malaria AKI?
Obstruction of peritoneal microcirculation with infected erythrocytes
45
What is the most common schistosomiasis species in Africa?
Haematobium
46
Which schistosomiasis species causes immune complexes?
Mansoni Leads to 5 classes of GN - mesangioproliferative - exudative - mesangiocapillary - FSGS - amyloidosis
47
What is the "liver effect"
Interplay between portal hypertension and glomerular disease Kipper cells remove circulating immune complexes and schistosome antigens BUT as liver disease worsens, more immune complexes and antigens reach the glomeruli
48
What are the 2 major forms of renal disease in TB?
Direct infection of urinary tract Secondary amyloidosis
49
How does tuberculous interstitial nephritis appear on histology?
Chronic tubulointerstitial nephritis Caseating granulomas
50
What are the clinical manifestations of renal disease in TB?
Insidious Dysuria Macroscopic haematuria Renal colic Constitutional symptoms Urethral strictures Calcifications
51
What is the gold standard for diagnosing renal disease in TB?
3-6 first morning MSU
52
Which glomerular syndrome is associated with rifampicin?
Tubular injury Interstitial injury Crescenteric GN (rare)
53
What is the sequelae of tubular dysfunction with drug induced nephrotoxicity?
Glucosuria Hyperuricosuria Polyuria Increased urinary excretion of polyclonal light chains
54
What is the cause of renal pathology in snake bites?
Usually rhabdomyolysis Toxicity DIC
55
What are the clinical features of raw carp bile toxicity?
GI upset Hepatitis ATN
56
What are the majority of South African toxic ARF cases caused by?
Cape aloe Callilepsis laureola ("impila"
57
What renal pathology is seen in mushroom poisoning?
Severe ATN
58
What renal pathology is seen in Djenkol bean?
Crystal nephropathy Urolithiasis
59
What renal pathology is seen in impila?
ATN Hepatocellular injury Protracted hypoglycaemia
60
What renal pathology is seen in semecarpus anavardium?
Acute cortical necrosis
61
What renal pathology is seen in paraquat toxicity?
ATN Hepatic and pulmonary manifestations
62
What renal pathology is seen in copper sulphate toxicity?
ATN Acute hepatocellular failure
63

DTMH Block 4 (14 decks)

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