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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
Q

Which glomerular syndrome is caused by streptococcus?

A

PIGN

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26
Q

Which glomerular syndrome is caused by non-falciparum malaria?

A

NS

27
Q

Which glomerular syndrome is caused by HAV?

A

MPGN

28
Q

Which glomerular syndrome is caused by salmonella?

A

IC (assoc with schistosomiasis and giardiasis)

29
Q

Which parasites result in immune mediated interstitial nephritis?

A

L. Donovan (visceral leishmaniasis, kala azar, treated with ample B)
Falciparum malaria
Vivax malaria

30
Q

Which bacteria result in immune mediated endothelial injury?

A

E.coli 0157 and others
Shigella toxin
Strep suis

31
Q

Discuss salmonella infection with regard to renal dysfunction

A

Pyelonephritis
ATN
Glomerulonephritis
Febrile phase with hematuria and proteinuria
Mild with full recovery within 2w of treatment
Post-infectious GN

32
Q

Discuss shigella infection with regard to renal dysfunction

A

ATN (dehydration)
Proliferative GN
HUS w/ cortical necrosis and diffuse fibrous deposits

33
Q

Discuss cholera infection with regard to renal dysfunction

A

ARF due to fluid and electrolyte loss
Severe hypokalemia -> proximal tubular vacuolation
Cortical necrosis

34
Q

Discuss tetanus infection with regard to renal dysfunction

A

Rhabdomyolysis
ANS overactivity
Mild
Non-oliguric

35
Q

Discuss leptospirosis with regard to renal dysfunction

A

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
Q

What are the features of Weil’s disease and which organism causes it?

A

Leptospirosis
Hepatic necrosis
Coaugulopathy

37
Q

What renal pathology is seen in leptospirosis?

A

Necrotizing vasculitis
Mild MPGN
Interstitial nephritis

38
Q

What renal pathology is seen in dengue fever?

A

ATN (interstitial edema, mononuclear cell infiltration)
MPGN

39
Q

What is the vector of HFRS?

A

Rodents

40
Q

Discuss the clinical presentation of sangassou virus

A

Transient thrombocytopenia
Conjunctival haemorrhages
Palatine petechiae
Truncal petechial rash
Oliguria
Azotemia
Proteinuria
Haematuria

After 3d, rash disappear and patient develops polyuria

41
Q

Which fungal toxin is often associated with the pathogenesis of Balkan nephropathy?

A

Ochratoxin
Progressive interstitial nephropathy

42
Q

Is AKI more common in patients with malaria from endemic or non-endemic areas?

A

Non-endemic (non-immune)

43
Q

What is the pathogenesis of falciparum AKI?

A

Hypovolemia
NO and cytokine mediated vasodilation
Resistance to vasoactive hormones
Cytopathic hypoxia
Mechanical obstruction by infected RBCs

44
Q

Why is peritoneal dialysis efficacy reduced in falciparum malaria AKI?

A

Obstruction of peritoneal microcirculation with infected erythrocytes

45
Q

What is the most common schistosomiasis species in Africa?

A

Haematobium

46
Q

Which schistosomiasis species causes immune complexes?

A

Mansoni
Leads to 5 classes of GN
- mesangioproliferative
- exudative
- mesangiocapillary
- FSGS
- amyloidosis

47
Q

What is the “liver effect”

A

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
Q

What are the 2 major forms of renal disease in TB?

A

Direct infection of urinary tract
Secondary amyloidosis

49
Q

How does tuberculous interstitial nephritis appear on histology?

A

Chronic tubulointerstitial nephritis
Caseating granulomas

50
Q

What are the clinical manifestations of renal disease in TB?

A

Insidious
Dysuria
Macroscopic haematuria
Renal colic
Constitutional symptoms
Urethral strictures
Calcifications

51
Q

What is the gold standard for diagnosing renal disease in TB?

A

3-6 first morning MSU

52
Q

Which glomerular syndrome is associated with rifampicin?

A

Tubular injury
Interstitial injury
Crescenteric GN (rare)

53
Q

What is the sequelae of tubular dysfunction with drug induced nephrotoxicity?

A

Glucosuria
Hyperuricosuria
Polyuria
Increased urinary excretion of polyclonal light chains

54
Q

What is the cause of renal pathology in snake bites?

A

Usually rhabdomyolysis
Toxicity
DIC

55
Q

What are the clinical features of raw carp bile toxicity?

A

GI upset
Hepatitis
ATN

56
Q

What are the majority of South African toxic ARF cases caused by?

A

Cape aloe
Callilepsis laureola (“impila”

57
Q

What renal pathology is seen in mushroom poisoning?

A

Severe ATN

58
Q

What renal pathology is seen in Djenkol bean?

A

Crystal nephropathy
Urolithiasis

59
Q

What renal pathology is seen in impila?

A

ATN
Hepatocellular injury
Protracted hypoglycaemia

60
Q

What renal pathology is seen in semecarpus anavardium?

A

Acute cortical necrosis

61
Q

What renal pathology is seen in paraquat toxicity?

A

ATN
Hepatic and pulmonary manifestations

62
Q

What renal pathology is seen in copper sulphate toxicity?

A

ATN
Acute hepatocellular failure

63
Q
A

DTMH Block 4 (14 decks)

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