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Finals > Renal > Flashcards

Renal Flashcards

1
Q

what is glomerulonephritis?

A

a group of disorders where damage to the glomerular filtrating apparatus causing a leak of protein, with or without blood.

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2
Q

what is the commonest cause of nephrotic syndrome in adults?

A

membranous GN

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3
Q

what is the general treatment for any type of GN?

A

fluid and salt restriction
immunosuppression (steroids and cyclophosphamide)
ACEIs

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4
Q

which GN has a particularly poor response to steroids?

A

membranous

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5
Q

a young adult presents with haematuria following a URTI is more likely what diagnosis?

A

IgA nephropathy (Berger’s disease)

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6
Q

what kind of casts are seen in GN?

A

RBC casts

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7
Q

what kind of casts are seen in pyelonephritis and tubulointerstitial nephritis?

A

white blood cell casts

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8
Q

what kind of casts are seen in acute tubular necrosis?

A

granular muddy brown casts

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9
Q

why might a patient in AKI be breathless?

A

metabolic acidosis

pulmonary oedema

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10
Q

what are the long-term effects seen in CKD, not usually seen in AKI?

A

Anaemia, hypoclacaemia, hyperphosphataemia

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11
Q

what does a super high creatinine compared to urea imply?

A

rhabdomyolysis

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12
Q

what are the criteria for dialysis in AKI?

A

Refractory hyperkalaemia or volume overload. severe acidaemia (<7.2) or uraemia complications (encephalopathy, pericarditis).

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13
Q

what is CKD?

A

> 3m history of kidney damage leading to abnormal structure, function of GFR <60mL/min.

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14
Q

what is ESRF?

A

GFR <15ml/min or needing renal replacement therapy.

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15
Q

what are the three most common causes of CKD?

A

diabetes, hypertension, glomerulonephritis.

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16
Q

what are the extra-renal features of CKD?

A

hypertension, anaemia, fluid retention, uraemia encephalopathy, renal osteodystrophy and secondary hyperparathyroidism, uraemia cardiomyopathy and atherosclerosis.

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17
Q

what is the most common cause of death in patients with CKD?

A

CVD

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18
Q

what would you see on the ABG of a patient with CKD?

A

metabolic acidosis

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19
Q

what are two ways of estimating GFR?

A

MDRD - looks at creatinine (wide variance because of muscle mass), age, gender and race.
Cockcroft-Gault equation - looks at creatinine clearance and takes into account weight

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20
Q

what is the difference between haemofiltration and dialysis?

A

haemofiltration gets rid of toxins via convention rather than both that and osmosis as in dialysis

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21
Q

what are the contraindications to renal transplant?

A

active sepsis, expected survival <5y (not HIV, not bmi >30), active malignancy, malignancy in last 5y, active vasculitis or recent anti-GBM disease

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22
Q

which kidney is preferably transplanted into patients?

A

the left, because of the longer renal vein. when transplanted into patients, it is transplanted usually on the right side.

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23
Q

how large a growth of organisms qualifies as a UTI?

A

10^5/mL

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24
Q

what are the risk factors for UTI?

A

urinary obstruction, immunosuppression, sexual intercourse in women, renal tract abnormalities, pregnancy, foreign body (i.e. catheterisation), spermicide use, menopause

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25
Q

common causes of UTI?

A

E Coli, Staph Saprophyticus. Proteus and Klebsiella in hospital acquired.

26
Q

what length of antibiotic course should you give to men with a UTI?

A

7d (as opposed to 3d in uncomplicated women)

27
Q

from which cell do renal cell carcinomas develop?

A

proximal renal tubular epithelium

28
Q

how is RCC staged?

A 
Robson's staging 
I - confined to kidney
II - involves perinephric fat but does not spread beyond garota's fascia
III - spread to renal vein
IV - adjacent / distant organ
29
Q

what is the classic triad of RCC?

A

haematuria, flank pain (capsular stretch) and abdominal mass

30
Q

why is hypertension sometimes seen in RCC patients?

A

renin secreting tumour

31
Q

what does a triple phase CT look at in RCC?

A

non-contrast phase - looks for fat in tumour
arterial phase - assesses vascular supply
venous phase - asses local invasion, thrombi

32
Q

what are the indications for a partial nephrectomy over a total nephrectomy in RCC?

A

small tumour (<3cm)
bilateral masses
solitary kidney
poor renal function

33
Q

what are the medical options in RCC?

A

medroxyprogesterone acetate, IL2 and IFN (20% remission using these 2 meds), mTOR inhibitors such as Temsirolimus, Bevacizumab (anti-VEGF)

34
Q

how do you score prognosis in RCC?

A 
Mayo prognostic score (SSIGN)
stage
size
grade
necrosis
35
Q

what kind of tumour is a Wilm’s tumour?

A

nephroblastoma

36
Q

what kind of renal stones are there?

A

calcium oxalate (75%), magnesium ammonium phosphate, urate, hydroxyappetite, cystein

37
Q

where do renal stones form?

A

the collecting duct

38
Q

what are the three most common places for renal stones to deposit?

A

pelviureteric junction
vesicoureteric junction
pelvic brim

39
Q

what is the gold standard investigation for renal stones?

A

non-contrast spiral CT KUB

40
Q

what are the treatment options for renal stones?

A

if <5mm - just analgesia (diclofenac PR if creatinine normal, opioids if not) and high fluid intake
if >5mm - tamsulosin or nifedipine (help relax smooth muscle)
if <2cm - extracorporeal shock wave lithotripsy, if >2mm insert JJ stent first
If in renal pelvis, calyces or upper ureter - percutaneous nephrolithotomy
if stag horn - open nephrolithotomy

41
Q

what would you do if renal stones were causing obstruction?

A

percutaneous nephrostomy

insert JJ stent (wait 10d, then remove stent and do ureteroscopy)

42
Q

what is Alport’s syndrome?

A

it is an x-linked mutation of type IV collagen which plays an important role in the basement membrane in kidneys, ears and eyes. It affects boys more severely than girls.

43
Q

what is the triad seen in Alport’ syndrome?

A

haematuria, severe ocular abnormalities and sensorineural hearing loss (bilateral)

44
Q

what are the 2 mutations in PCKD?

A

PKD1 (85%) - onset at 50yo, chromosome 16

PKD2 (15%) onset at 70yo, chromosome 4

45
Q

what is adult PKD associated with?

A

berry aneurysms (8%) and liver cysts (80%). can also get cysts in pancreas and ovaries.

46
Q

how does PKD present?

A

flank pain, haematuria, recurrent UTIs, ESRF, hypertension +/- LVH

47
Q

what is treatment for AKD?

A

conservative - increase fluid intake, decrease salt intake, genetic counselling, monitor U&Es, family screening
medical - aggressive hypertension control (ACEI)
surgical - transplant

48
Q

what are the causes of renal artery stenosis?

A

atherosclerosis (80%), fibromuscular dysplasia (10%), anti-phospholipid syndrome, takayasu’s arteritis.

49
Q

how can renal artery stenosis present?

A

drug-resistant hypertension (failed to be controlled by combo of 3 drugs)

50
Q

where can renal bruits be heard and in what condition are they found?

A

they are heard in the mid-clavicular line at the costal margin, and are commonly heard in renal artery stenosis.

51
Q

what is the gold standard investigation for renal artery stenosis?

A

renal arteriography (but duplex USS is safer)

52
Q

what is better, a perfectly matched deceased donor kidney or a non-perfectly matched living donor kidney?

A

living donor

53
Q

what is the immunosuppression regime in kidney transplant?

A

induction with Basiliximab (anti-IL2R)

Maintenance with tacrolimus, azathioprine and prednisolone

54
Q

how do you treat acute t-cell mediated rejection?

A

high dose prednisolone and intensify immunsoppression

55
Q

how do you treat acute humoural rejection?

A

plasma exchange

56
Q

what are the drug toxicity effects associated with cyclosporin?

A

gum hypertrophy and hirsutism

57
Q

what are the drug toxicity effects associated with calcineurin inhibitors?

A

confusion, tremor.

58
Q

what is the train associated with nephrotic syndrome?

A

proteinuria, hypoalbuminaemia and oedema

59
Q

what causes nephrotic syndrome?

A

primary - minimal change disease, membranous, membranoproliferazive or focal-segmental GN
secondary - SLE, DN, drugs (penicilliamine, gold, anti-TNF, NSAIDs), Alport’s, amyloidosis.

60
Q

what counts of massive proteinuria in nephrotic syndrome?

A

> 3.5g/24h of proteinuria or PCR of >300-350 mg/mmol.

61
Q

frothy urine is due to what?

A

protein

Finals (12 decks)

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