Clinical (Week 4) Flashcards Preview

Year 2 - Renal (DP) > Clinical (Week 4) > Flashcards

Flashcards in Clinical (Week 4) Deck (274):
1

What is a hamartoma?

A tumour with the correct constituencies of the organ it's from but in wrong distribution

2

What is the most common renal pelvis tumour?

Transitional cell carcinoma

3

What is the most common renal parenchymal tumour?

Renal cell carcinoma

4

What is the most common renal embryonic tumour?

Nephroblastoma (Wilm's Tumour)

5

What sort of CT is useful in diagnosing a urological malignancy?

Triple phased contrast enhanced

6

What is the most common benign asymptomatic renal lesion?

Renal cyst (70%)

7

How do we investigate renal cysts and why can we use this modality?

USS (it is fluid-filled)

8

When would we biopsy an angiolypoma?

If fat-sparse:
- Risk of bled

9

What feature of vessels in an angiolypoma make it prone to bleeds?

They are fragile

10

How can we measure lesion density on a CT of angiolypomas?

Hounsfield

11

What is Wunderlich's Syndrome?

Collapse due to retroperitoneal bleed in an angiolypoma

12

How does an oncocytoma appear on CT?

Central scar:
- Stellate due to central necrosis
-> No angiogenesis therefore benign

13

What is the only way to definitively diagnose an oncocytoma and why is a biopsy not totally useful?

Nephrectomy
Biopsy has a high false negative rate

14

What is the classic triad of symptoms in a renal cell carcinoma?

Loin pain (40%)
Renal masses (25%)
Frank haematuria (60%)

15

Which of the following is not a paraneoplastic effect of renal cell carcinoma:
- Weight loss
- Hyperthyroidism
- Anaemia
- Hypertension
- Hypercalcaemia (As it produces parathyroid-like hormone)

Hyperthyroidism

16

What is the M:F ratio for the incidence of a renal cell carcinoma?

2:1

17

What is the peak incidence age for renal cell carcinoma?

65-75 years

18

What type of cancer of a renal cell carcinoma and where is it found?

Adenocarcinoma
The PCT

19

How do renal cell cancers appear histologically?

Clear cells
Papillary subtypes

20

If there are bilateral or multifocal renal cell carcinomas, what condition should you suspect and what implications does this have?

Von Hippel-Lindau:
- Implications for surgery

21

What is the first line investigation for renal cell carcinoma, and what is the best investigation?

1st line - USS
Gold standard:
- Triple phase contrast CT

22

What is the downside to using biopsy in the diagnosis of renal cell carcinomas?

High false negative rate

23

What staging system is used for renal cell carcinomas?

Robson

24

True or false; Direct perinephric fat invasion is rare in renal cell carcinomas?

True

25

How do renal cell carcinomas tend to spread?

Lymphatics
Via IVC

26

Where do renal cell carcinomas commonly spread?

Lungs ('Cannon ball' metastases)
Liver
Bone
Brain

27

What is the standard treatment for a renal cell carcinoma? What does the treatment involve?

Radical nephrectomy (preferably laparoscopically):
- Whole kidney within Gerota's fascia
- Perinephric fat removed

28

When is the standard treatment for a renal cell carcinoma most often carried out?

Within a month of diagnosis

29

When would the adrenal gland be removed in the treatment of renal cell carcinoma and why is it not routinely removed?

If it is involved
Reduces the risk of adrenal insufficiency (Addison's syndrome)

30

How is a partial nephrectomy carried out? What implications does this have on the operation?

Under cold ischaemic:
- Must be done in 20-30 minutes

31

What is the benefit to a partial nephrectomy?

It is nephron sparing:
- Maintains renal function
- Increases QoL and life expectancy

32

What surgical approaches can be taken in a partial nephrectomy?

Open
Robotic laparoscopy

33

What is the main risk of a partial nephrectomy?

Pseudoaneurysm due to healing vessels

34

Apart from nephrectomies, what two other treatment options are available for renal cell carcinoma?

Radiofrequency ablation
Cryoablation

35

How do we measure the performance status in metastatic renal cell carcinoma?

ECOG

36

What type of drug is Sunitinib? How does it work?

Tyrosine Kinase inhibitor:
- VEG-F and PDG-F inhibition
- Reduces neovascularisation

37

What benefit does using Sunitinib in the treatment of renal cell carcinoma have?

26 vs 20 month progression-free survival

38

What are the five year survival rates of Stage 1-4 renal cell carcinomas?

Stage 1 -> 75%
Stage 2 -> 50%
Stage 3 -> 35%
Stage 4 -> 5%

39

What are Balanitis Xerotica Obliterans and Leukoplakia?

Pre-malignant cutaneous penile cancers

40

What is Balanitis Xerotica Obliterans a form of?

Lichen sclerosus et atrophicus (Lichen sclerosus)

41

How does Balanitis Xerotica Obliterans present?

White patches
Fissuring -> Pain
Bleeding
Scarring

42

Where does Balanitis Xerotica Obliterans occur?

Prepuce
Glans
Urethral extension

43

What is the potential for malignant transformation in Balanitis Xerotica Obliterans?

Low

44

What can predispose to Balanitis Xerotica Obliterans?

Poor hygiene

45

What is Erythroplasia of Queryat?

Squamous cell carcinoma in situ on the:
- Glans
- Prepuce
- Shaft

46

How does Erythroplasia of Queryat appear?

Red, velvety patches

47

What is the name of a squamous cell carcinoma in situ on the rest of the genitalia (ie not Glans, Prepuce or shaft)?

Bowen's Disease

48

What is it important to differentiate a Squamous cell carcinoma in situ from?

Zoon's Balanitis

49

When would we circumcise a Squamous cell carcinoma in situ?

If present on the prepuce alone

50

How else can we treat a Squamous cell carcinoma in situ?

Topical 5-fluorouracil

51

Red, raised area on the penis with a foul smelling, fungating mass and phimosis is the typical presentation in what?

Penile carcinoma

52

How do we diagnose a penile carcinoma?

USS
Biopsy (if invasive)
CT -> For distal LNs
MRI
Bone scam

53

What is the incidence rate and peak age for penile carcinoma?

1.5 per 100,000 men
80 years old

54

What infection is penile carcinoma linked to?

HPV 16

55

What type of cancer is a penile carcinoma?

Squamous cell carcinoma

56

If there is inguinal node invasion of a penile carcinoma, how do we approach the treatment?

1. Assess prognosis
2. Radionucleotide Sentinel Node Biopsy
3. Inguinal lymphadenectomy

57

What chemotherapy agents are used in the treatment of penile cancer?

5-Fluorouracil
Cis-platin

58

What is the most common germ cell testicular tumour?

Seminoma

59

What are some examples of non-seminomatous germ cell tumours?

Teratoma
Embryonal
Yolk sac
Choriocarcinoma

60

What does ITGCN stand for in terms of germ cell testicular tumours?

Intra-tubular germ cell neoplasia

61

How does a testicular tumour typically present?

Painless, insensitive testicular swelling

62

How many testicular tumours are due to metastases and where do they usually come from? How do they present?

10%:
- Neck LNs
- Dyspnoea

63

What is the best investigation for testicular tumours?

USS (95% sensitivity and specificity)

64

When would CXR and CT be used in investigation testicular tumours?

Staging
Abdominal and thorax metastases

65

In what germ cell testicular cancer is α-feto protein never raised?

Pure seminoma

66

In what germ cell testicular cancers is hCG raised?

5-10% of pure seminomas
60% of teratomas

67

What can LDH be used to indicate in germ cell testicular cancers?

Tumour burden

68

What are testicular tumour markers usually used to gauge?

Effectiveness of therapy

69

What approach is taken in orchidectomies? Why is this approach taken?

Inguinal:
- Prevents damage to surrounding layers
- Reduces local recurrance
-> Due to clamping of cessels

70

What is the incidence of testicular tumours and what age is the peak incidence?

5 per 100,000 men
20-35 years

71

What is the increase in incidence of testicular tumours if there are undescended testes?

30 times risk

72

What are the three types of teratomas?

Differentiated
Intermediate
Undifferentiated

73

In trophoblastic teratomas, what percentage have a raised hCG?

100%

74

What fraction of residual masses have the following characteristics:
- Only fibrous tissue
- Mature (benign) teratoma
- Residual tumour

Only fibrous tissue - A third
Mature (benign) teratoma - A third
Residual tumour - A third

75

Which of the following does not result from uraemia:
- Pericarditis
- Encephalopathy
- Bronchitis
- Neuropathy
- Asterixis
- Gastritis

Bronchitis

76

What effect does kidney disease have on Vitamin D? What does this result in?

Cannot be converted into the active form (Calcitriol)
Results in:
- Bone disease
- Vascular calcification

77

What effect will kidney failure have on phosphate levels?

Phosphate will not be filtered into the filtrate as well so hyperphosphataemia will result

78

Why does renal failure result in anaemia?

Reduced production of erythropoietin

79

Why can dyspepsia happen in renal failure?

Increased risk of peptic ulcers

80

In renal failure there are a number of urinary tract features, what are they?

Frequency
Urgency Polyuria

81

How do NSAIDs affect the kidneys?

Reduced eGFR

82

What antibiotics can affect the kidneys?

Gentamicin -> Toxic
Trimethoprim -> Fluid retention
Penicillins

83

What happens to JVP in renal failure?

It is increased

84

What is accelerated hypertension classed as?

Diastolic BP >120mmHg

85

What is leukonychia a sign of?

Hypoalbuminaemia

86

Gouty tophi are seen in what kind of kidney disease?

CKD

87

Vasculitis skin rash and systemic vasculitis are signs of what renal disease?

Acute glomerulonephritis

88

What type of vasculitis is HSP?

IgA

89

What is the usual specific gravity of urine and what does this indicate?

1.01-1.02
[Urine]

90

What can cause urine to appear red?

Haemoglobin
RBC
Free Hb
Myoglobin

91

Alkaline urine is seen in what?

UTI

92

If RBCs appear isomorphic in urine microscopy, what does this indicate?

It is a lower urinary tract cause

93

If RBCs appear dysmorphic in urine microscopy, what does this indicate?

They are from the glomerulus (been forced out so become misshapen)

94

What is a normal result of a 24hr urine collection for protein?

95

What is a normal protein:creatinine ratio?

96

What is classed as asymptomatic low grade proteinuria?

A protein:creatinine ratio of 0.5-1g/day (100mg/mmol)

97

What is classed as heavy proteinuria?

A protein:creatinine ratio of 1-3g/day (~300mg/mmol)

98

How is nephrotic syndrome classed in terms of protein:creatinine ratio?

>3g/day

99

Increased urine protein can indicate what?

Increased risk of dialysis need in the future

100

What causes urinary casts to form? Where is this secreted from?

Precipitation of Tamm-Horsfall mucoprotein:
- Renal tubule cells

101

What causes pronounced formation of urinary casts? What precipitates this?

Protein denaturation:
- Reduced urine flow
- Low pH

102

Hyaline casts in the urinary are usually benign; true or false?

True

103

What do RBC urinary casts indicate?

Nephritic syndrome

104

What do leukocyte urinary casts indicate?

Infection
Inflammation

105

What do granular urinary casts indicate?

CKD

106

What chemicals can show up as crystals on urine microscopy? Which is the most common?

Calcium oxalate (most common)
Urate
Phosphate
Cysteine

107

Hypertension shows ECG changes indicative of what?

LVH and strain

108

What is Stage 1 CKD in terms of description and GFR?

Kidney damage with normal or increased GFR
GFR >90

109

What is Stage 2 CKD in terms of description and GFR?

Kidney damage with mildly reduced GFR
GFR 60-89

110

What is Stage 3 CKD in terms of description and GFR?

Moderatley reduced GFR:
- GFR 30-59

111

What is Stage 4 CKD in terms of description and GFR?

Severely reduced GFR:
GFR 15-29

112

What is Stage 5 CKD in terms of description and GFR?

Kidney failure:
- GFR

113

What is kidney damage in terms of CKD 1 and 2?

Evidence of disease:
- Haematuria
- Proteinuria

114

What is oliguria classified as?

115

What features need to be present for a patient to have an AKI?

Reduction in GFR over hours/days/weeks
+/- Oliguria
With normal/impaired baseline renal function

116

Proteinuria (>3g/day) (mostly albumin), Hypoalbuminaemia, Oedema (limb and periorbital), Hypercholesterolaemia and often normal GFR are signs of what?

Nephrotic syndrome

117

AKI, Oliguria, Oedema, Hypertension and Active urinary sediment (RBCs, RBC and granular casts and proteinuria) are signs of what?

Nephritic syndrome

118

Can CKD be diagnosed from one eGFR calculation?

No

119

How is GFR measure directly and why is it not routinely used?

Nuclear medicine:
- Time consuming
- Expensive

120

How do we usually calculate an eGFR?

Creatinine clearance

121

Why does creatinine clearance overestimate GFR?

Creatinine is secreted into the tubules

122

What is serum creatinine a product of?

Muscle breakdown

123

For white and asian males, what is the calculation for eGFR if creatinine is in mg/dL?

186 x Creatinine^-1.154 x Age^-0.203

124

For white and asian males, what is the calculation for eGFR if creatinine is in μmol/L?

32788 x Creatinine^-1.154 x Age^-0.203

125

What correction factors are applied to the eGFR calculation for:
1. Women
2. Black people

1. Multiply whole equation by 0.742
2. Multiply whole equation by 1.212

126

When is eGFR mostly accurate?

If GFR

127

If a patient has a low muscle mass, what effect does this have on eGFR?

It is overestimated

128

If a patient has a high muscle mass, what effect does this have on eGFR?

It is underestimated

129

When is eGFR valid?

If [Creatinine]p is stable

130

What percentage of patients are in Stage 1 or 2 CKD?

7%

131

What is Stage 3a of CKD?

GFR 45-59ml/min

132

What is Stage 3b of CKD?

GFR 30-44ml/min

133

What percentage of patients are in Stage 3 CKD?

5%

134

What percentage of patients are in Stage 4 CKD?

0.2%

135

What percentage of patients are in Stage 5 CKD?

0.1%

136

What are some common causes of CKD?

DM
Hypertension
Vascular disease
Chronic glomerulonephritis
Reflux nephropathy
Polycystic kidney disease

137

When do symptoms of CKD tend to appear?

When GFR

138

Which of the following is not a typical non-specific sign of CKD:
- Tiredness
- Poor appetite
- Itch
- Weight loss
- Sleep disturbance

Weight loss

139

Impaired urine concentrating in CKD can cause what?

Nocturia

140

What medications can be used to both reduce proteinuria and control BP?

ACEi
ARBs

141

What are some cautions when using ACEi/ARB/Spironolactone in CKD?

Modest decline in GFR at first
Hyperkalaemia

142

How can CVS risk be reduced in CKD?

Control BP and proteinuria
Stop smoking
Statins

143

Apart from erythropoietin, what else should we check as a cause of anaemia in CKD?

Vitamin B12
Folate

144

What is the initial treatment for anaemia in CKD?

IV iron

145

If after the first line treatment for anaemia in CKD the patient is still anaemic, what do we do?

Epo. injection (weekly/fortnightly)

146

What is the target Hb in a CKD patient?

10.5-12.5g/dL

147

What does CKD initially cause in regards to Vit. D and calcium metabolism?

Reduced calcium absorption
Secondary hyperparathyroidism

148

What effect does advanced CKD have on Phosphate and what happens due to this?

Increased serum phosphate -> Increased PTH secretion

149

What effect do increased phosphate and calcium have on the cardiovascular system?

Vascular calcification (Become stiff)
(Can also affect heart valves)

150

How can we treat bone disease in CKD?

Alfacalcidol (Hydroxylated/Activated Vit D)
Phosphate binders:
- Reduced gut absorption
- eg. Calcium carbonation/acetate + Sevelamer

151

When is dialysis considered?

If GFR

152

How long does an arteriovenous fistula take to form?

6 weeks

153

How long do you have to wait before the catheter can be used in peritoneal dialysis?

1-2 weks

154

How soon can patients be registered for cadaveric kidney transplant?

Within 6 months of dialysis beginning

155

What is the definition of AKI?

Abrupt (26.4μmol/L
- OR rise in Cr by 50%
- OR a decline in urine output

156

What are the 3 criteria that can be used to diagnose Stage 1 AKI (KDIGO staging)?

Serum creatinine criteria:
- Increase >26μmol/L
- OR Increase >1.5-1.9 x Reference Cr
Urine output criteria:
- 6 consecutive hours

157

What are the 2 criteria that can be used to diagnose Stage 2 AKI (KDIGO staging)?

Serum creatinine criteria:
- Increase >2-2.9 x Reference Cr
Urine output criteria:
- 12 consecutive hours

158

What are the 5 criteria that can be used to diagnose Stage 3 AKI (KDIGO staging)?

Serum creatinine criteria::
- Increase >3 x Reference Cr
- OR Increase to >354μmol/L
- OR need for renal replacement therapy
Urine output criteria:
- 24 consecutive hours
- OR Anuric for 12 hours

159

What can all the pre-renal causes of AKI be classified as?

Functional causes

160

The following three conditions all cause pre-renal AKI; how can they come about?
- Hypovolaemia
- Hypotension
- Renal hypoperfusion

Hypovolaemia:
- Haemorrhage
- D&V/Burns
Hypotension:
- Cardiogenic shock
- Distributive shock (Sepsis/Anaphylaxis)
Renal hypoperfusion:
- NSAIDs/COX-2
- ACEi/ARBs
- Hepatorenal syndrome

161

What is pre-renal AKI essentially?

Reversible volume depletion leading to:
- Oliguria
- Increased serum creatinine

162

What is oliguria defined as?

163

What effect do ACE inhibitors have on the efferent arterioles and what does this cause? How does renal perfusion affect this?

Efferent arteriole vasodilation -> Reduced filtration pressure:
- If mildly decreased perfusion -> Mildly reduced GFR
- If hugely decreased perfusion -> Huge GFR drop

164

Put the following steps of the pathophysiology of Pre-renal AKI in order:
- Reduced effective intravascular volume
- Sodium and water retention
- Oliguria
- Volume depletion/Sepsis
- Increased levels of ADH and Aldosterone
- AKI

1. Volume depletion/Sepsis
2. Reduced effective intravascular volume
3. Increased levels of ADH and Aldosterone
4. Sodium and water retention
5. Oliguria
6. AKI

165

How much of the cardiac output do the kidneys receive?

20%

166

What is the commonest presentation of AKI and what causes it?

Acute Tubular Necrosis
Due to untreated pre-renal AKI

167

What are the common causes of Acute Tubular Necrosis?

Sepsis
Severe dehydration

168

What are some less common causes of Acute Tubular Necrosis?

Rhabdomyolysis
Drug toxicity

169

What type of AKI is acute tubular necrosis?

Renal

170

What feature is pathognomonic of Acute Tubular Necrosis?

Muddy brown casts in the urine

171

In acute tubular necrosis, what is the fractional sodium excretion?

Above 2-3%

172

In pre-renal AKI, what is the fractional sodium excretion?

173

How can we assess hydration?

BP
HR
Urine output
JVP
Capillary refill
Oedema

174

What solution must we not give as a fluid challenge for hypovolaemia?

5% dextrose

175

When should we seek help in treating hypovolaemia?

If no change after >1L given

176

What is the underlying pathology behind renal AKI?

Inflammation or damage to cells

177

Renal AKI is typically split by the structures affected, what is it divided into?

Vascular
Glomerular
Interstitial
Tubular

178

What are vascular causes of renal AKI?

Vasculitis
Renovascular disease

179

What are some causes of interstitial nephritis?

Drugs
TB
Sarcoidosis

180

What can cause a tubular injury?

Ischaemia (Prolonged hypeperfusion [pre-renal AKI])
Gentamicin
Contrast
Rhabdomyolysis

181

Uraemia will have what signs in renal AKI?

Itch
Pericarditis

182

What history features may suggest renal disease?

Sore throat
Rash
Joint pains
D&V
Haempotysis

183

What electrolytes on U+Es are markers of renal function?

Na+
K+
Urea
Creatinine

184

If, on FBC, there are low platelets, what might be causing the renal AKI?

Haemolytic Uraemic Syndrome
Thrombotic Thrombocytopaenic Purpura

185

Abnormal clotting can suggest what in renal disease?

Disseminated Intravascular Coagulation
Sepsis

186

When is anaemia seen in renal disease?

If CKD
If due to myeloma

187

Haematoproteinuria suggests what?

Active glomerulonephritis

188

Anti-GBM antibodies

Goodpasture's

189

How can we test for myeloma and in what age group would we routinely do these investigations?

Protein electrophoresis
Bence Jones Protein
In everyone >50 years old

190

What are urgent indications for a renal biopsy?

Rapidly progressive glomerulonephritis
Positive immunology and AKI

191

How can we be sure that performing a renal biopsy will be safe?

Normal clotting (No Warfarin/Aspirin)
Normotensive
No hydronephrosis

192

If fluid resuscitation doesn't work in the treatment of AKI, what might we deliver?

Inotropes
Vasopressors

193

When is dialysis commenced in AKI?

If anuric and uraemic (>40)
Hyperkalaemia:
- >7
- OR >6.5 and unresponsive to therapy
Severe acidosis (pH

194

What is severe acidosis defined as?

pH

195

What is severe uraemia defined as?

>40mmol/L

196

What is the general pathophysiology of post-renal AKI?

1. Urine flow obstruction
2. Hydropnephrosis
3. Loss of concentrating ability

197

How is post-renal AKI treated?

Catheter
Nephrostomy
Ureteric stenting

198

What is hyperkalaemia defined as?

>5.0mmol/L

199

What is life-threatening hyperkalaemia defined as?

>6.5mmol/L

200

At a serum potassium level of 6-7mmol/L, what ECG changes will be seen?

Tented T waves

201

At a serum potassium level of 7-8mmol/L, what ECG changes will be seen?

Flattened P waves
Increased PR interval (>0.12-0.20 seconds)
Depressed ST segment
Tented T waves

202

At a serum potassium level of 8-9mmol/L, what ECG changes will be seen?

Atrial standstill (absent P waves)
Prolonged QRS (>0.06-0.10 seconds)
Further tenting of T waves

203

At a serum potassium level of >9mmol/L, what ECG changes will be seen?

Sine-wave pattern

204

How do we protect the myocardium in hyperkalaemia?

10ml of 10% Calcium Gluconate over 2-3 minutes
(OR 5ml 10% Calcium Chloride)

205

Can the myocardial protection treatment in hyperkalaemia be repeated?

Yes (up to 40ml of calcium gluconate)

206

How long does the protective effect over the myocardium last?

207

How does insulin move K+ back into the cells?

1. Binds to its cellular receptor
2. Increases Na-K-ATPase activity
3. K+ taken up into cells

208

How do we administer insulin in hyperkalaemia?

Actrapid:
- 10-15IU in 50ml of 50% Dextrose over 30mins

209

How long does insulins affect last for in the treatment of hyperkalaemia?

2-4hrs

210

How regularly can insulin therapy be used in hyperkalaemia?

Every 4 hours

211

How regularly must we check blood glucose after insulin therapy (for hyperkalaemia) and what do we do in it drops?

Every 6 hours
Infuse 10% glucose if glucose drops

212

How else can we move K+ back into cells?

Nebulised salbutamol for 90 minutes

213

What does calcium resonium do?

Reduces gut absorption of K+

214

If a 25 year old IVDU is found collapsed at home and his renal function has deteriorated, what is the most likely cause?

Rhabdomyolysis

215

Which of the following does not cause hyperkalaemia:
- Spironolactone
- Ramipril
- Amiloride
- Furosemide
- Atenolol

Furosemide

216

What is the second most common cause of Stag 5 CKD (after DM)?

Chronic glomerulonephritis

217

What is glomerulonephritis?

Immune mediated disease affecting the glomeruli with secondary tubulointerstitial damage

218

How does humoral glomerulonephritis arise?

Intrinsic or Planted Ag results in the deposition of circulating immune complexes

219

What causes a proliferative glomerulonephritis and what is the main presenting feature?

Damage to endothelial/mesangial cells
Haematuria (+/- proteinuria)

220

What causes a non-proliferative glomerulonephritis and what is the main presenting feature?

Damage to podocytes
Proteinuria (NO haematuria)

221

What would you expect to see on urine microscopy of a patient with glomerulonephritis?

Dysmorphic RBCs
RBC + granular casts
Lipiduria

222

What is microalbuminaemia defined as?

30-300mg Albumin/day

223

What kind of glomerulonephritis can present as an AKI?

Rapidly Progressive Glomerulonephritis (RPGN)

224

Nephritic syndrome is indicative of what kind of process; proliferative or non-proliferative?

Proliferative

225

Nephrotic syndrome is indicative of what kind of process; proliferative or non-proliferative?

Non-proliferative

226

How can nephrotic syndrome result in more infections?

Loss of opsonising antibodies

227

Which of the following is not a complication of nephrotic syndrome:
- Renal vein thrombosis
- Pulmonary embolism
- Volume depletion
- Vitamin D deficiency
- Hyperthyroidism

Hyperthyrodisim (actually causes subclinical hypothyroidism

228

What are the majority of cases of GN?

Idiopathic/Primary

229

What is secondary GN associated with?

Infections/Drugs
Malignancy
Systemic disease:
- ANCa associated vasculitis
- SLE
- Goodpasture's
- HSP

230

What type of ANCA is PR3 and what is it seen in (mainly)?

c-ANCA
GPA

231

What type of ANCA is MPO and what is it seen in (mainly)?

p-ANCA
Microscopic polyangiitis and EGPA

232

What do proliferative and non-proliferative GN refer to?

Absence or presence of mesangial cell proliferation

233

What is cresenteric GN?

Presence of crescents:
- Epithelial cell extracapillary proliferation
eg. RPGN in vasculitis

234

What are the target BPs in GN?

235

What sort of supplements might have a benefit in GN?

Omega-3 fatty acids
Fish oil

236

What corticosteroids are used in GN?

PO prednisolone
IV methylprednisolone

237

What alkylating agents are used in GN?

Cyclophosphamide
Chlorambucil

238

What calcineurin inhibitors are used in GN?

Cyclosporin A (CSA)
Tacrolimus

239

What two other drugs are used in GN (ie. Not steroids/alkylating agents/calcineurin inhibitors)?

Azathioprine
Mycophenalate Mofetil (MMF)

240

What other non-drug immunosuppression can be used in the treatment of GN?

Plasmapharesis
Antibodies:
- IV Ig
- Monoclonal T or B cell antibodies

241

Which of the following is not used in the general treatment of nephrotic syndrome:
- Fluid and salt restriction
- Statins
- Diuretics
- ACEi/ARBs
- Anticoagulation
- IV albumin

Statins (though anticoagulation use is questionable)

242

What is complete remission of nephrotic syndrome?

243

What is partial remission of nephrotic syndrome?

244

Who is minimal change nephropathy most common in?

Children (77% of cases)

245

On renal biopsy, how does minimal change nephropathy appear?

Normal on:
- Light microscopy
- Immunofluorescence
Foot process fusion (podocyte) on electron microscopy

246

What drug treatment will induce remission in 94% of patients with minimal change nephropathy?

Oral steroids

247

What are the second line drugs for minimal change nephropathy if the first line doesn't work?

Cyclophosphamide
Cyclosporin A (CSA)

248

True or false; minimal change nephropathy will not cause progressive renal failure?

True

249

What is the possible cause of minimal change nephropathy?

IL-3

250

Who is focal segmental glomerulosclerosis most common in?

Adults (35% of cases)

251

What can causes secondary focal segmental glomerulosclerosis?

HIV
Heroin
Obesity
Reflux nephropathy

252

What does focal segmental glomerulosclerosis appear like on renal biopsy?

Light microscopy:
- Minimal Ig deposition
Immunofluorescence:
- Minimal complement deposition

253

How many cases of focal segmental glomerulosclerosis will be induced into remission by oral steroids?

60%

254

How many cases of focal segmental glomerulosclerosis progress to ESRD and how long does this take?

50% in 10 years

255

What is the aetiology of focal segmental glomerulosclerosis?

Soluble urokinae plasminogen activator receptor (suPAR) in 67%
Increased integrins
Podocytes effacement

256

Who is membranous nephropathy most common in?

Adults:
- 2nd commonest cause of nephrotic syndrome
- 15-30%

257

What infections are secondary causes of V?

Hepatitis
Prasites

258

What connective tissue disease is linked to membranous nephropathy?

SLE

259

What malignancies are associated with membranous nephropathy?

Carcinomas
Lymphoma

260

What drugs are associated with membranous nephropathy?

Gold
Penicillamine

261

How does membranous nephropathy appear on renal biopsy?

Subepithelial immune complex deposition in BM (making it appear thicker)

262

How is membranous nephropathy treated?

Steroids
Alkylating agents
B-cell monoclonal antibodies

263

How many cases of membranous nephropathy progress to ESRD and how long does this take?

30% in 10 years

264

What can precipitate microscopic haematuria in IgA nephropathy?

Respiratory/GI infection

265

Where is IgA nephropathy most common?

Worldwide (most common cause of GN worldwide)

266

What is IgA nephropathy associated with and how would it present?

HSP:
- Arthritis
- Colitis
- Purpura

267

How does IgA nephropathy appear on renal biopsy?

Light microscopy:
- Mesangial cell proliferation and expansion
Immunofluorescence:
- IgA deposits in mesangium

268

How many cases of IgA nephropathy progress to ESRD and how long does this take?

25% in 10 years

269

How is IgA nephropathy treated?

BP control
ACEi/ARB
Fish oil

270

What is present in the urine of Rapidly Progressive Glomerulonephritis patients?

Active sediment:
- RBCs
- RBC + granular casts

271

How does Rapidly Progressive Glomerulonephritis appear on renal biopsy?

Glomerular crescents

272

What are some ANCA-positive causes of Rapidly Progressive Glomerulonephritis?

GPA
Microscopic polyangiitis

273

What are some ANCA-negative causes of Rapidly Progressive Glomerulonephritis?

Goodpasture's
HSP/IgA
SLE

274

How is Rapidly Progressive Glomerulonephritis treated?

Steroids:
- IV Methylprednisolone/PO Prednisolone
Cytotoxics:
- Cyclophsphamide/MMF/Azathioprine
Rituximab (B-cell CD20 receptor monoclonal antibodies)
Plasmapharesis