Week 5 (1) Flashcards
What toxins build up in ESKD?
- Urea
- Potassium
- Sodium
What does dialysis allow the infusion of?
Bicarbonate
What restrictions are on a patient with dialysis?
- Fluid - 1 litre a day
- Salt
- Potassium
- Phospahte
What does a fistula join?
An artery and a vein
What does peritoneal dialysis use the peritoneum as?
The artificial membrane
What is the water removal by osmosis driven by in periotneal dyalisis?
High glucose concentration in dialysate fluid
What are 4 bone mineral metabolism complications in ESKD?
- Phosphaste retention
- Low 1-25 vitamin D
- Hypocalcaemia
- Raised PTH
What risk increases with ESKD?
Cardiovascular
What four conditions require immediate start of dialysis?
- Resistant hyperkalaemia
- GFR less than 5
- Urea more than 45
- Unresponsive acidosis
What are the three important HLA molecules in transplant?
- HLA A
- HLA B
- HLA DR
When does hyperacute rejection occur?
Within minutes - due to preformed antibodies to the transplant
What immunosuppression is required for induction of transplant?
Steroids, MMF, CyA, tacrolimus, antibodies
What drug class act by inhibiting activation of T helper cells?
Cyclosporin and tacrolimus - calcineurin inhibitors
How are calcineurin inhibitors metabolised?
By cytochrome p450
What are renal dysfunction, hypertension, diabetes and tremors side effects of?
Calcineurin inhibitors
What drugs are antimetabolites by blocking purine synthesis?
Azthioprine
What are side effects of azathioprine?
Leucopaenia, anaemia, GI
What shoudl azathioprine not be usedc with?
Allopurinol
What is charaxcyerised by persistent albuminuria over 300 on at least 2 occassions 3 months apart?
overt diabetic nephropathy
What are 3 changes in diabetic nephropathy?
- Afferent arteriolar vasodilataion mediated by IGF-1
- Hyperfiltration
- increased GFR
During the pathogenesis of diabetic nephropathy - what happens to the mesangial?
It expands as a result of renal hypertrophy
What is Kimmelsteil-Wilson lesions?
Nodular diabetic glomerulosclerosis
In pathogeneiss of diabetic nephroapahty - what causes proteinuria?
GBM thickening and podocyte dysfunction
In diabetic nephropathy how are lipid levels controlled?
With a statin
What diabetic patients are eligible for simultaneous kidney-pancreas transplant?
Type I
What usually causes renal artery hypertension?
Renal artery stenosis
List two causes of renovascular disease?
- Fibromuscular dysplasia
2. Atehrosclerotic renovascular disease
What is referred to as reduced GFR associated with reduced renal blood flow beyond level of autoregulatory compensation?
Ischaemic nephropathy
What other conditions is fibromuscular dysplasia associated with?
Ehlers danlos
Carotid artery dissection
What usually presents wit hAKI after treatment of hpertension usually with ACEi?
Atherosclerotic renovascular disease
What lung condition can atherosclerotic renovascular disease present with?
Flash pulmonary oedema
How is ischaemic renal disease screened for?
Renal ultrasound
Renal artery duplex studies
CT angiography
MR angiography
What are contraindicated in bilateral renal artery stenosis?
ACEi
What medical therapy is used for ischemic renal disease?
Angioplasty
Angioplast + stenting
Stenting alone
What is multiple myeloma a cancer of?
Plasma cells
What do most cases of multiple myeloma feature the production of?
Paraproteins
What are 5 signs of myltiple myeloma?
- Anaemia
- Hypercalcaemia
- Renal failure
- Amyloidosis
- Recurrent infections
What investigations can you do for multiple myeloma?
- Normocytic anaemia
- Rouleaux formation
- Raised CRP/PV
- Renal impairment
- Protein electrophoresis
- Bence jones in urine
- Lytic lesions on skeletal survey
What are 4 renal manifestations of myeloma?
- AKI secondary to hypercalcaemia
- Monoclonal immunoglobulin deposition disease
- Cast nephropathy
- Amyloidosis
What is characterised by the deposition of proteinaceous material in extracellular spaces?
Amyloidosis
What yypes of amyloid does renal amyloidosis include?
Primary AL amyloid
Secondary AA amyloid
What histology represents amyloidosis?
Classically positive congo red staining showing apple-green birifringence under polarised light.
What should be done to treat patients with myeloma and ARF?
- Stop nephrotoxins (NSAIDs)
- Treat hypercalcaemia - IV NaCl to volume resuscitate, IV pamidronate
- Avoid contrast agents
- Chemotherapy to reduce tumour load - high dose dexamethasone
- Plasma exchange to remove light chains
What happens to the nose in GPA?
Evidence of bony-cartilage destruction (saddle nose)
cANCA and PR3?
GPA
pANCA and MPO
Churg strauss
What renal involvement occurs in GPA and MPA?
Haematuria nad proteinuria, AKI
What does renal biopsy show in GPA and MPA?
Segmental necrotising glomerulonephritis
On histology - what is seen in GPA and MPA?
Cresents
How is renal involvement treated in GPA and MPA?
- Immunosuppressive therapy
2. Plasma exchange
Whst is the most frequently observed abnormality in lupus nephritis?
Proteinuria
What induction therapy is used in immunosupression for proliferative disease?
High dose steroids
Cyclophosphamide/MMF
Azathioprine, rituximab, tacrolimus
What maintanence therapy is used in immunosuppression for proliferative disease?
Steroids
MMF/azathiorpine
What problems are caused by type B dose independent and unpredictable drug reactions?
Drug rashes
Bone marrow aplasia (chloramophenicol)
Hepatic necrosis - halothane
What can prolonged use of beta blockers cause?
Diabetes
What drugs are statins contraindicated in?
Statins and macrolides or statins and fibrates
What do ACEI increase the hypoglycaemic effect of?
SUs
What drug shouldnt be used with PPIs?
Clopidogrel
What drugs to patients with BPH take that would cause them urinary retention?
Decongestants or anticholinergics
What foods are potassium rich and interact with ACEI, ARBs and potassium sparinf agents?
Bananas, oranges, green leafy vegetables
What happens to the urine concentration ability in ADPKD?
Reduced
Can you get haematuria and hypertension in ADPKD?
Yes
Where can cysts spread to from ADPKD?
Liver - after 10 years
What cardiac disease can present in ADPKD?
Mitral/aortic valve prolapse
Can you get diverticular disease in ADPKD?
yes
What does ultrasound suggestive of congenital hepatic fibrosis suggest?
ARPKD
In ARPKD histologically - where are cysts seen appearing from?
Rhe collecting duct system
What inheritance is alports syndrome?
X linked inheritance
What is alports syndrome a disorder of?
Type IV collagen matrix
In alports sybdrome - what mtation leads to deficient collagenous matrix?
Mutation in COL4A5 gene
What is the characteritiv sign of alports sybdrome?
Haematuria
What three extra-renal manifestations are present in alports syndrome?
- Sensorineural deafness
- Ocular defects - anterior lenticonus
- Leiomyomatosis of oesophagus
What is characteristically seen on renal biopsy in Alports?
Variable thickness GBM
What disease is associated with an inborn error of glycosphingolipid metabolism (deficiency of a-galactosidase A)?
Anderson fabrys disease
Name an x-linked disease lysosomal storage disease?
Anderson Fabrys disease
What does anderson dabrys disease affect?
Kidneys, liver, lungs and erythrocytes
Renal failure, angiokeratomas (umbilical area), cardiomyopathy, valvular disease, stroke and acroparaesthesia?
Anderson fabrys disease
Alpha-GAL activity?
Fabrys disease
What does renal biopsy show in fabrys disease?
Concentric lamellar inclusions within lysosomes
How is fabrys treated?
enzyme replacement - fabryzyme
In medullary cystic kidney - where are the cysts seen?
In the corticomedullary junction
What is the chouce of treatment for medullary cystic kidney?
Renal transplantation - diagnosis using FH and CT scab
What renal disease is uncommon, sporadic inheritance, dilatation of collecting ducts, sponge like, cysts have calculi?
Medullary sponge kidney
How is medullary sponge kidney diagnosed?
Excretion urography - to demarcate calculi
