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MRCP 1 > Renal > Flashcards

Renal Flashcards

1
Q

Indications for dialysis in acute renal failure?

A

Hyperkalaemia (>6.5 of with ECG changes)
Acidosis pH <7.1
Refractory pulmonary oedema
Severe symptomatic uraemia
Uraemic pericarditis

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2
Q

Basic driver for NAGMA?

A

Loss of bicarb

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3
Q

Basic driver for HAGMA?

A

Exogenous source of acid in the plasma

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4
Q

NAGMA causes?

A

RTA
Diarrhoea
Acetazolamide
Ureteric diversion

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5
Q

HAGMA causes?

A

MUDPILES (5 are poison)

Methanol poisoning
Uraemia
DKA
Paraldehyde poisoning
Iron poisoning
Lactic acidosis, liver failure
Ethylene glycol poisoning
Salicylate poisoning

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6
Q

3 most accurate lab measurements of GFR?

A

Insulin clearance
Chromium-labelled EDTA
Iohexol

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7
Q

Loop diuretic site of action?

A

Ascending arm of LoH
Compete for chloride-binding sites

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8
Q

Site of action of thiazides?

A

Distal tubule
Compete for chloride-binding sites

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9
Q

Where do trimethoprim, cimetidine and many diuretics enter the tubular filtrate?

A

Proximal tubule

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10
Q

Spironolactone site of action (aldosterone receptors)?

A

Distal tubule AND collecting duct

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11
Q

Where does lithium enter the filtration system? (and sometimes hence cause NDI)

A

Collecting duct

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12
Q

Non-renal causes of proteniuria?

A

Fever
Severe exercise
Skin disease
UTI

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13
Q

Tubular cells casts in urine microscopy?

A

ATN or interstitial nephritis

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14
Q

Hyaline casts in urine microscopy?

A

Tamm-Horsfall glycoprotein (NORMAL)

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15
Q

Granular casts in urine microscopy?

A

Non-specific

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16
Q

Red cell casts in urine microscopy?

A

GN or tubular bleeding

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17
Q

Leukocytes casts in urine microscopy?

A

Pyelonephritis or ATN

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18
Q

Potential SE of MRA?

A

Nephrogenic systemic fibrosis - use MRA with caution in eGFR <30

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19
Q

Type 1 vs type 2 RTA

A

Type 1 = distal (far more common than type 2 (proximal)

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20
Q

Contrast nephropathy time to onset?

A

2-5 days

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21
Q

Diabetic Nephropathy Stages?

A

HS2MP (High Speed 2 Manchester Picadilly)

Hyper (High): Stage 1
Silent (Speed 2): Stage 2
Microalbumin (Manchester): Stage 3
Proteinuria (Picadilly): Stage 4

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22
Q

Most common peritoneal dialysis organism?

A

Staph epidermis

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23
Q

Post-step GN vs IgA nephropathy post URTI?

A

Post-strep GN is 1-2 weeks (post is well post)
IgA more rapid, 1-2 days (A comes first)

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24
Q

Creatinine rise in 48 hours for AKI?§>26

A

26

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25
Q

Which test is most useful when determining whether there is prerenal uraemia or acute tubular necrosis?

A

Urinary sodium

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26
Q

Intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar in the context of kidney disease?

A

Calciphylaxis

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27
Q

3 factors affecting traditional eGFR result?

A

Red meat
Pregnancy
Muscle mass (e.g. amputees, body-builders)

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28
Q

Components of MDRD equation for eGFR?

A

Creatinine
Age
Ethnicity
Gender

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29
Q

/Cranial causes of DI

A

Idiopathic
Head injury
Pituitary surgery
Craniopharyngiomas
Infiltrative
Histiocytosis X
Sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
Haemochromatosis

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30
Q

Wolfram’s sydrome?

A

DIMOAD

Cranial DI
Diabetes
Optic atrophy
Deatness

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31
Q

Rapid worsening of renal function on introduction of an ACEi? (often presents with flash pulmonary oedema)

What is the gold standard Ix according to the latest NICE guidelines

A

Renal artery stenosis

MRA

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32
Q

How does calcium resonium work?

A

Decreases enteral absorption of potassium to increase excretion

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33
Q

Nephrotic syndrome patient who develops flank pain and haematuria?

A

Renal vein thrombosis

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34
Q

BPH management?

A

First line A-1 e.g. tamsulosin
Second line 5 alpha reductase e.g. finasteride

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35
Q

Staghorn composition?

A

Struvite (ammonium magnesium phosphate)
AMP

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36
Q

Mechanical valves INR?

A

aortic: 3.0
mitral: 3.5

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37
Q

Prevention of oxalate stones?

A

cholestyramine or pyridoxine

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38
Q

Prevention of calcium stones?

A

Thiazide

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39
Q

Time to use for AV fistula?

A

6-8 weeks

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40
Q

Why are you hypercoaguable in nephrotic syndrome?

A

Loss of antithrombin III

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41
Q

Most common cause of GN?

A

IgA nephropathy

42
Q

Does IgA progress to ESRF?

A

25% do

43
Q

Histology of IgA?

A

Mesangial proliferation
IgA complex deposition
Elevated complement
(remember this is also seen in HSP)

44
Q

How do you differentiate between IgA and HSP given that the histology is the same?

A

HSP affects multiple systems, IgA only kidneys

45
Q

What do you need to give alongside gosrelin for prostate Ca?

A

Cyproterone acetate

46
Q

What is Tolvaptan used for and how does it act?

A

ADPKD
Vasopressin 2 receptor antagonist

47
Q

Effacement/fusion of podocytes?

A

Minimal change disease
(you can only see this on electron microscopy however hence minimal change)

48
Q

Nephrotic syndrome in children? What do you do? Second line treatment?

A

Assume minimal change
Give steroids
Cyclophosphamide

49
Q

Driver of minimal change?

A

Cytokine driven damage to the podocytes allowing leakage

50
Q

Prognosis in minimal change?

A

Overall good
1/3 one episode
1/3 infrequent relapses
1/3 frequent relapses which stop before adulthood

51
Q

Androgen receptor blocker used in prostate Ca?

A

Bicalutamide

52
Q

Antibodies in primary membranous GN?

A

anti-PLA2R

53
Q

Alcohol induced polyuria mechanism?

A

Anti-diuretic hormone (ADH) suppression in the posterior pituitary gland

54
Q

Most likely renal outcome of HSP?

A

Full recovery
1/3/ have a relapse

55
Q

Renal, eye disease and deafness?

A

Think alports

56
Q

Anterior lenticonus?

A

Alports

57
Q

Type of collagen deficiency in Alport’s?

A

Type IV

58
Q

Inheritance in Alport’s (most commonly)?

A

X linked dominant

59
Q

Splitting of the macula densa and “woven-basket appearance”?

A

Alport’s

60
Q

Gene in Alport’s?

A

COL4A

61
Q

Bladder Ca RFs

A

Smoking
Exposure to aniline dyes
- for example working in the printing and textile industry
- examples are 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide

Risk factors for squamous cell carcinoma of the bladder include:
Schistosomiasis
Smoking

62
Q

Vitamin D supplementation in advanced CKD?

A

Alfacalcidol

63
Q

Congo red staining: apple-green birefringence?

A

Amyloid

64
Q

Unwell patient, triad of pulmonary haemorrhage, GN, anti-GBM antibiodies

A

Anti-GBM disease (Goodpasture’s)

65
Q

Most common form of PKD?

A

PKD1

66
Q

Chromosomes affected in ADPKD?

A

PKD1 - 16
PKD2 - 4

67
Q

Dialysis-related amyloid?

A

B2 microglobulin amyloid
Presents like PMR with carpal tunnel

68
Q

Where is EPO produced?

A

Interstitial fibroblasts in the renal cortex

69
Q

Untreated UTI in a diabetes who then presents with obstructive symptoms?

A

Renal papillary necrosis

70
Q

Small calculi in the papillary zones with surrounding increased density on excretion urography?

A

Medullary sponge kidney

71
Q

Peritoneal dialysis patient with sepsis but dialysis culture shows lots of organisms including anaerobes?

A

Think bowel perf

72
Q

Bone minerals in CKD

A

High - phosphate
PTH

Low - Calcium
Vitamin D

73
Q

Most important HLA to match for transplant?

A

DR
(directly relevant)

74
Q

Ig responsible for hyperacute graft rejection?

A

IgG

75
Q

Idiopathic membranous GN (typical in middle aged person presenting with nephrotic syndrome) antibody?

A

Antiphospholipase A2

76
Q

Spike and dome appearances on renal biopsy? Subendothelial deposits?

A

Membranous GN

77
Q

ADPKD, which type is more common?

A

Type 1 (85%)

78
Q

Chromosome abnormalities in ADPKD?

A

Type 1 - chromosome 16
Type 2 - chromosome 4
(there are more of type 1)

79
Q

Treatment sometimes used in ADPKD?

A

Tolvaptan (vasopressor receptor 2 antagonist)

80
Q

GPA history and nephritic syndrome biopsy findings?

A

Crescentic GN

81
Q

Electrolyte side effect of plasma exchange?

A

Hypocalcaemia

82
Q

Biopsy findings in Goodpastures?

A

IgG deposition (linear)

83
Q

Sounds like Conn’s but HIGH plasma renin?

A

Bilateral RAS

84
Q

Associations of IgA nephropathy (other than URTI)?

A

Alcohol cirrhosis
IBD
HSP

85
Q

Treatment in severe HUS?

A

Plasma xchange

86
Q

Heroin use and GN?

A

Focal segmental GN

87
Q

Most common cardiac feature in ADPKD?

A

Mitral prolapse

88
Q

CMV treatment post transplant?

A

Ganciclovir - severe
Valaciclovir/valganciclovir - mild

89
Q

PJP treatment post renal transplant?

A

Co-trim

90
Q

Sounds like Conns, normotensive, hypokalaemic, high renin and aldosterone BUT low magnesium?

A

Gitelman syndrome

91
Q

Renal biopsy in HIV nephropathy?

A

Focal segmental glomerulosclerosis with collapsed tuft and tubuloreticular structures

92
Q

Most important function of proximal convoluted tubule?

A

Sodium reabsorption

93
Q

GN in partial lipodystrophy?

A

Mesagiocapillary type 2

94
Q

Mesangiocapillary GN associatons?

A

Partial lipodystrophy (type II)
Hep C

95
Q

Focal segmental glomerulosclerosis associations

A

Diabetes
Heroin use
HIV

96
Q

Goodpasture HLA assoc?

A

DRB1

97
Q

Anti rejection med causing hyperkalaemia?

A

Tacrolimus

98
Q

Timing of CMV/EBV post transplant?

A

CMW around 6 weeks post
EBV around 6 months post

99
Q

Familial renal cancer?

A

VHL

100
Q

Cast nephropathy vs light chain deposition disease in myeloma

A

Cast often severe and irreversible renal damage, progressive with Bence Jones proteinuria AND NORMAL ALBUMIN

Light chain deposition often mild dysfunction with significant albuminuria

Renal amyloidosis AL - nephrotic syndrome with mild impairment and lamda deposition on the membrane

MRCP 1 (24 decks)

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