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Internal Medicine Notes > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What are the two important matchings for kidney transplant

A

HLA and ABO

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2
Q

What are the three important loci for HLA matched individuals

A

DR

A

B

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3
Q

Should repeated blood transfusions be avoided in patients waiting for renal transplant

A

Yes.It causes HLA sensitisation

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4
Q

What are the two factors that cause HLA sensitisation

A

Repeated blood transfusions

Pregnancy

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5
Q

Name three drugs that are used as immunosuppression in post renal transplant

A

Steroids

Azathiaoprine

ciclosporin

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6
Q

Name the five newer drugs used in post renal transplant

A
  1. FK 506
  2. Mycophenolate
  3. Rapamycin
  4. Sirolimus
  5. Daclizumab
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7
Q

Is premature coronary artery disease common after a renal transplant

A

yes

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8
Q

What cancers are common after a renal transplant

A

Skin cancers

Lymphoma

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9
Q

One complication of ciclosporin

A

HTN

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10
Q

Name six complications after a renal transplant

A
  1. Skin cancers and lymphoma
  2. HTN following ciclosporin
  3. Opportunistic infections
  4. Premature coronary artery disease
  5. Denovo glomerulonephritis
  6. Steroid treatment
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11
Q

When will one suspect rejection of a transplanted kidney

A

Tender graft

decreased urine output

raised creatinine

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12
Q

How will you evaluate a graft rejection

A

Graft biopsy

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13
Q

Histology of acute graft rejection

A

Lymphocytic interstitial infiltrate

Destruction of epithelial cells

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14
Q

Histology of chronic rejection

A

Interstitial fibrosis

tubular atrophy

Proliferation of arterial intima

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15
Q

Three treatment options for acute rejection

A

High dose methyl prednisolone

Anti lymphocyte globulin

Anti T lymphocyte monoclonal antibody

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16
Q

Treatment of chronic graft rejection

A

No specific treatment. Treat CRF

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17
Q

3 advantages of a renal transplant over dialysis

A
  1. Better quality of life
  2. reduced medical expenses
  3. reduction in risk of death
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18
Q

What is the role of PANCREAS KIDNEY TRANSPLANTATION

A

Prolongs survival in patients with ESRD with diabetes

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19
Q

What percentage of polycystic kidney disease have HTN

A

75%

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20
Q

When only one kidney has multiple cysts

A

Multi cystic renal dysplasia

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21
Q

Name one most common hereditary disorder

A

Polycystic kidney disease

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22
Q

Conditions with bilateral renal cysts

A

Multiple simple cysts

Tuberous sclerosis

Von Hippel Lindau

AR PKD in children

23
Q

In the diagnosis of polycyctic kidney diseases what are the various age cut offs ?

A

< 30 years

30 to 50 Years

>60 years

24
Q

Diagnosis of polycyctic kidney disease in

<30 years

A

At least 2 cysts unilateral or bilateral

25
Q

Diagnosis of polycystic kidney disease in patients aged 30 to 59 years

A

two renal cysts in each kidney

26
Q

diagnosis of polycystic kidney disease in patients aged more than 60 years

A

4 renal cysts in each kidney

27
Q

In which other organs are the cysts also seen as part of the polycyctic kidney disease

A

Liver

Spleen

Lung

Pancreas

Testes/ovaries/epidydimis

Uterus

Bladder

Broad ligament

Thyroid

28
Q

What are the cardiovascular manifestations reported in ADPKD

A

MVP

29
Q

Where in the kidney do the cysts form

A

In the BOWMANS Capsule

30
Q

What are the renal manifeatations of Adult Polycystic Kidney Disease

A

Decrease in Renal Concentrating ability

Increase secretion of Renin (Hypertension)

Increase secretion of erythropietin

31
Q

Can we get polycythemia in Autosomal Dominant Adult Polycystic Kidney Disease

A

Rarely

32
Q

What are the NON CYSTIC MANIFESTATIONS of ADPKD

A

CNS….Berry Aneurysms

CVS…………MVP

33
Q

Who first described IgA nephropathy

A

Berger

34
Q

Which is the most common forms of glomerulonephritis worldwide

A

IgA Nephropathy

35
Q

What are the characteristics of IgA glomerulonephritis

A

Episodes of hematuria with deposition of IgA in the mesangium

36
Q

IgA glomerulonephritis is more common among which gender

A

Male

37
Q

What is the peak incidence of IgA nephropathy

A

2 to 3 decade

38
Q

Familial forms of IgA nephropathy is common in which ethnic group

A

Northern Italy

Eastern Kentucky

39
Q

IgA nephropathy is similar to which disease clinically and lab wise

A

H S purpura

40
Q

How will you differentiate between IgA nephropathy and HS purpura

A

HS purpura occurs in younger age group

systemic symptoms

abdominal pains

preceding infection

41
Q

IgA deposits in the mesangium can occur in other conditions too, name them

A

Bronchiectasis

chronic interstitial pneumonia

chronic liveR disease

crohns

gastic adenocarcinoma

dermatitis herpetiformis

mycosis fungoides

leprosy

ankylosing spondylitis

relapsing polychondritis

sjogrens

42
Q

What is the histology picture on light microscopy in IgA nephropathy

A

DPGN

segmental sclerosis

43
Q

What are the two common presentations of IgA nephropathy

A

Asymptomatic Microscopic hematuria

recurrent episodes of hematuria during or preceding a upper respiratory infection often accompanied by proteinuria

44
Q

What is the rare presentation of IgA nephropathy

A

Renal failure and rapidly progressive disease

45
Q

Is IgA nephropathy a benign disease

A

yes

46
Q

Can IgA nephropathy have a complete remission

A

5 to 30% have complete remission

47
Q

Patients with IgA nephropathy who do not have complete remission present with

A

Hematuria with well preserved renal function

48
Q

In patients with IgA nephropathy who have a progressive disease what is the clinical progress

A

Renal failure is seen in 25 to 30 percent of patients over 25 to 30 years

49
Q

What is the optimal treatment for IgA nephropathy

A

No consensus on optimal treatment

ace inhibitors in patients with proteinuria

some smaller studies …tonsillectomy, steroid drugs fish oils

50
Q

When can one get suspicious of microscopic hematuria

A

As few as 3 to 5 RBCs Ina well spun sediment from first voided morning urine is suspicious

51
Q
A
52
Q

Name two diseases that can cause gross hematuria

A

IgA nephropathy

sickle cell disease

53
Q

Name some diseases that can also cause microscopic hematuria

A

Cystic kidney disease

interstitial nephritis

papillary necrosis

renal stones

BPH

Renal vascular injury

Hypercalciuria

Internal Medicine Notes (12 decks)

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