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JL Renal and Urology > Week 5 (1) > Flashcards

Week 5 (1) Flashcards

1
Q

What toxins build up in ESKD?

A
  1. Urea
  2. Potassium
  3. Sodium
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2
Q

What does dialysis allow the infusion of?

A

Bicarbonate

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3
Q

What restrictions are on a patient with dialysis?

A
  1. Fluid - 1 litre a day
  2. Salt
  3. Potassium
  4. Phospahte
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4
Q

What does a fistula join?

A

An artery and a vein

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5
Q

What does peritoneal dialysis use the peritoneum as?

A

The artificial membrane

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6
Q

What is the water removal by osmosis driven by in periotneal dyalisis?

A

High glucose concentration in dialysate fluid

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7
Q

What are 4 bone mineral metabolism complications in ESKD?

A
  1. Phosphaste retention
  2. Low 1-25 vitamin D
  3. Hypocalcaemia
  4. Raised PTH
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8
Q

What risk increases with ESKD?

A

Cardiovascular

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9
Q

What four conditions require immediate start of dialysis?

A
  1. Resistant hyperkalaemia
  2. GFR less than 5
  3. Urea more than 45
  4. Unresponsive acidosis
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10
Q

What are the three important HLA molecules in transplant?

A
  1. HLA A
  2. HLA B
  3. HLA DR
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11
Q

When does hyperacute rejection occur?

A

Within minutes - due to preformed antibodies to the transplant

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12
Q

What immunosuppression is required for induction of transplant?

A

Steroids, MMF, CyA, tacrolimus, antibodies

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13
Q

What drug class act by inhibiting activation of T helper cells?

A

Cyclosporin and tacrolimus - calcineurin inhibitors

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14
Q

How are calcineurin inhibitors metabolised?

A

By cytochrome p450

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15
Q

What are renal dysfunction, hypertension, diabetes and tremors side effects of?

A

Calcineurin inhibitors

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16
Q

What drugs are antimetabolites by blocking purine synthesis?

A

Azthioprine

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17
Q

What are side effects of azathioprine?

A

Leucopaenia, anaemia, GI

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18
Q

What shoudl azathioprine not be usedc with?

A

Allopurinol

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19
Q

What is charaxcyerised by persistent albuminuria over 300 on at least 2 occassions 3 months apart?

A

overt diabetic nephropathy

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20
Q

What are 3 changes in diabetic nephropathy?

A
  1. Afferent arteriolar vasodilataion mediated by IGF-1
  2. Hyperfiltration
  3. increased GFR
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21
Q

During the pathogenesis of diabetic nephropathy - what happens to the mesangial?

A

It expands as a result of renal hypertrophy

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22
Q

What is Kimmelsteil-Wilson lesions?

A

Nodular diabetic glomerulosclerosis

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23
Q

In pathogeneiss of diabetic nephroapahty - what causes proteinuria?

A

GBM thickening and podocyte dysfunction

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24
Q

In diabetic nephropathy how are lipid levels controlled?

A

With a statin

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25
Q

What diabetic patients are eligible for simultaneous kidney-pancreas transplant?

A

Type I

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26
Q

What usually causes renal artery hypertension?

A

Renal artery stenosis

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27
Q

List two causes of renovascular disease?

A
  1. Fibromuscular dysplasia

2. Atehrosclerotic renovascular disease

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28
Q

What is referred to as reduced GFR associated with reduced renal blood flow beyond level of autoregulatory compensation?

A

Ischaemic nephropathy

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29
Q

What other conditions is fibromuscular dysplasia associated with?

A

Ehlers danlos

Carotid artery dissection

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30
Q

What usually presents wit hAKI after treatment of hpertension usually with ACEi?

A

Atherosclerotic renovascular disease

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31
Q

What lung condition can atherosclerotic renovascular disease present with?

A

Flash pulmonary oedema

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32
Q

How is ischaemic renal disease screened for?

A

Renal ultrasound
Renal artery duplex studies
CT angiography
MR angiography

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33
Q

What are contraindicated in bilateral renal artery stenosis?

A

ACEi

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34
Q

What medical therapy is used for ischemic renal disease?

A

Angioplasty
Angioplast + stenting
Stenting alone

35
Q

What is multiple myeloma a cancer of?

A

Plasma cells

36
Q

What do most cases of multiple myeloma feature the production of?

A

Paraproteins

37
Q

What are 5 signs of myltiple myeloma?

A
  1. Anaemia
  2. Hypercalcaemia
  3. Renal failure
  4. Amyloidosis
  5. Recurrent infections
38
Q

What investigations can you do for multiple myeloma?

A
  1. Normocytic anaemia
  2. Rouleaux formation
  3. Raised CRP/PV
  4. Renal impairment
  5. Protein electrophoresis
  6. Bence jones in urine
  7. Lytic lesions on skeletal survey
39
Q

What are 4 renal manifestations of myeloma?

A
  1. AKI secondary to hypercalcaemia
  2. Monoclonal immunoglobulin deposition disease
  3. Cast nephropathy
  4. Amyloidosis
40
Q

What is characterised by the deposition of proteinaceous material in extracellular spaces?

A

Amyloidosis

41
Q

What yypes of amyloid does renal amyloidosis include?

A

Primary AL amyloid

Secondary AA amyloid

42
Q

What histology represents amyloidosis?

A

Classically positive congo red staining showing apple-green birifringence under polarised light.

43
Q

What should be done to treat patients with myeloma and ARF?

A
  1. Stop nephrotoxins (NSAIDs)
  2. Treat hypercalcaemia - IV NaCl to volume resuscitate, IV pamidronate
  3. Avoid contrast agents
  4. Chemotherapy to reduce tumour load - high dose dexamethasone
  5. Plasma exchange to remove light chains
44
Q

What happens to the nose in GPA?

A

Evidence of bony-cartilage destruction (saddle nose)

45
Q

cANCA and PR3?

A

GPA

46
Q

pANCA and MPO

A

Churg strauss

47
Q

What renal involvement occurs in GPA and MPA?

A

Haematuria nad proteinuria, AKI

48
Q

What does renal biopsy show in GPA and MPA?

A

Segmental necrotising glomerulonephritis

49
Q

On histology - what is seen in GPA and MPA?

A

Cresents

50
Q

How is renal involvement treated in GPA and MPA?

A
  1. Immunosuppressive therapy

2. Plasma exchange

51
Q

Whst is the most frequently observed abnormality in lupus nephritis?

A

Proteinuria

52
Q

What induction therapy is used in immunosupression for proliferative disease?

A

High dose steroids
Cyclophosphamide/MMF
Azathioprine, rituximab, tacrolimus

53
Q

What maintanence therapy is used in immunosuppression for proliferative disease?

A

Steroids

MMF/azathiorpine

54
Q

What problems are caused by type B dose independent and unpredictable drug reactions?

A

Drug rashes
Bone marrow aplasia (chloramophenicol)
Hepatic necrosis - halothane

55
Q

What can prolonged use of beta blockers cause?

A

Diabetes

56
Q

What drugs are statins contraindicated in?

A

Statins and macrolides or statins and fibrates

57
Q

What do ACEI increase the hypoglycaemic effect of?

A

SUs

58
Q

What drug shouldnt be used with PPIs?

A

Clopidogrel

59
Q

What drugs to patients with BPH take that would cause them urinary retention?

A

Decongestants or anticholinergics

60
Q

What foods are potassium rich and interact with ACEI, ARBs and potassium sparinf agents?

A

Bananas, oranges, green leafy vegetables

61
Q

What happens to the urine concentration ability in ADPKD?

A

Reduced

62
Q

Can you get haematuria and hypertension in ADPKD?

A

Yes

63
Q

Where can cysts spread to from ADPKD?

A

Liver - after 10 years

64
Q

What cardiac disease can present in ADPKD?

A

Mitral/aortic valve prolapse

65
Q

Can you get diverticular disease in ADPKD?

A

yes

66
Q

What does ultrasound suggestive of congenital hepatic fibrosis suggest?

A

ARPKD

67
Q

In ARPKD histologically - where are cysts seen appearing from?

A

Rhe collecting duct system

68
Q

What inheritance is alports syndrome?

A

X linked inheritance

69
Q

What is alports syndrome a disorder of?

A

Type IV collagen matrix

70
Q

In alports sybdrome - what mtation leads to deficient collagenous matrix?

A

Mutation in COL4A5 gene

71
Q

What is the characteritiv sign of alports sybdrome?

A

Haematuria

72
Q

What three extra-renal manifestations are present in alports syndrome?

A
  1. Sensorineural deafness
  2. Ocular defects - anterior lenticonus
  3. Leiomyomatosis of oesophagus
73
Q

What is characteristically seen on renal biopsy in Alports?

A

Variable thickness GBM

74
Q

What disease is associated with an inborn error of glycosphingolipid metabolism (deficiency of a-galactosidase A)?

A

Anderson fabrys disease

75
Q

Name an x-linked disease lysosomal storage disease?

A

Anderson Fabrys disease

76
Q

What does anderson dabrys disease affect?

A

Kidneys, liver, lungs and erythrocytes

77
Q

Renal failure, angiokeratomas (umbilical area), cardiomyopathy, valvular disease, stroke and acroparaesthesia?

A

Anderson fabrys disease

78
Q

Alpha-GAL activity?

A

Fabrys disease

79
Q

What does renal biopsy show in fabrys disease?

A

Concentric lamellar inclusions within lysosomes

80
Q

How is fabrys treated?

A

enzyme replacement - fabryzyme

81
Q

In medullary cystic kidney - where are the cysts seen?

A

In the corticomedullary junction

82
Q

What is the chouce of treatment for medullary cystic kidney?

A

Renal transplantation - diagnosis using FH and CT scab

83
Q

What renal disease is uncommon, sporadic inheritance, dilatation of collecting ducts, sponge like, cysts have calculi?

A

Medullary sponge kidney

84
Q

How is medullary sponge kidney diagnosed?

A

Excretion urography - to demarcate calculi

JL Renal and Urology (9 decks)

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