High yield Flashcards

Question

Simple renal cysts significance?

Answer 1

- Generally increase in size over time ## Footnote - do not impact renal fn no further follow up required further f.u with CT contrast IF - septated cyst, calcifciation or cluster of cysts potentially masking solid lesion

Answer 2

nephrotic range proteinuria \> 3.5g day hypoalbuminaemia peripheral oedema - associated with hyperlipidaemia thrombotic disease more frequently observed disturbance of podocyte functn or endothelial/gbm/podocyte interface

Answer 3

* more common after repeated infections and in children described in first time travellers * 4 necessary criteria for DHF * fever or recent hx of acute fever * hemorrhagic manifestations * low platelet count - less than 100,000 * objective evidence of leaky capillaries * elevated hematocrit 20% or more over baseline * low albumin * pleural or other effusions

Answer 4

* biomarker of AKI * endogenous cysteine proteinase inhibitor * produced at a constant rate by all nucleated cells - released into plasma * 99% filtered by glomeruli - no tubular secretion or reabosorption into plasma * after filtration --\> completely absorbed in to prox tubular cells * hence NONE in urine * **SO PLASMA cystatin C is good marker of GFR and Urine cystatin C is a good marker of tubular injury**

Answer 5

1. Viridans strep - mutans, mitis, bovis 2. Enterococcus 3. HACEK group - 5% - haemophilus, acinomycetamcomitans Others - culture neg - rare 7%, Q fever, Bartonella, coag neg staph

Answer 6

Valve replacement indications - heart failure - paravalvular extension - uncontrolled infection/difficult organism - recurrent embolic events despite appropriate Ab - mobile vegetations above 10mm

Answer 7

Cinacalcet directly lowers parathyroid hormone levels by increasing the sensitivity of the calcium sensing receptors to activation by extracellular calcium, resulting in the inhibition of PTH secretion

Answer 8

2-4 weeks IV benzylpenicillin IV 4hrly + 2 weeks IV gent (low dose) or ceftriaxone 2g IV for 4 weeks (outpt course) or benzylpenicillin as a single agent for 4 weeks

Answer 9

* 1st phase - abrupt onset of fevers 39-40 for 2-3 days, severe back pain, HA, retro-orbital pain, arthralgias, maculopaplular rash, metallic taste * 2nd phase - D-3-6, A/N/V/D, lymphadenopathy * 3rd phase - defervescence for 1-2days * 4th phase - fever recrudescence, morbilliform rash, skin desquamation * 5th phase: cnvalescence with prolonged lethargy

Answer 10

vasopressin V2 receptor antagonist that inhibit cyst growth and decline of renal function - however only 2-3 % less increase in renal volumes - ? not widely used yet used in PCKD - suppression of vasopressin release reduces second messenger systems - cAMP identified as promoters of kidney-cyst cell proliferation and luminal fluid secretion

Answer 11

- Deposition of IgG and C3 along the GBM - IgG4 most commonly associated idiopathic membranous nephropathy - most commonly idiopathic - **commonest cause of nephrotic syn in adults** - malignancy responsible for 5-10percent of cases - solid tumour such as cancer of lung or colon - SLE - 10-20% of cases of lupus nephritis have a MN picture - Spontaneous remission of proteinuria occurs in 5 to 20 percent of cases * Partial remission ( * incidence of end‐stage renal disease ~14 percent at 5 year

Answer 12

retrovirus of the lentiviridae family human HIV-1 is genetically similar to chimp isolates HIV 2 rare in aus, less virulent cellular target of HIV - CD4 T cells - predominant target in all tissues

Answer 13

used most often in cases of FSGS and membranous nephropathy - response to immuosup tx slow or partial issues to address - proteinuria, oedema, HTN, dyslipidaemia, thrombotic risk - proteinuria - target BP 125/75, proteinuria \> 1g/day - use ACEI or ARB, aldo antag- spiro - diuretics - loop, thiazides (greater anti-hypertensive effect than diuretic) - statins - pro-thrombotic - decreased levels of anti-thrombin III - urinary losses , anticoag when alb less than 20,

Answer 14

- pre-hydration - N/Saline (IV) - minimise contrast volume - use non-ionic contrast which is low or iso-osmolar - discontinue nephrotoxins (ACEI or ARB) - NAC (variable effect, also results in minor lowering of Creatinine) - 1200mg BD shown benefit compared to low dose - ? Statins - ongoing trials - periprocedural haemofiltration - no benefit

Answer 15

* reduction in kidney perfusion --\> ATP depletion in renal tubular epithelial cells - causes cell death (apoptosis / necrosis) * prox tubular cells are susceptible - high metabolic rate 2\* to ion transport, limited capacity for anaerobic glycolysis * endothelial injury with microvascular congestion, hypoerfusion particularly in the S3 segment of nephron - outer stripe of medulla * SEPSIS - cytokines and bacterial factors - binds TLR4 on tubular cells and causes cell damage through oxidative stress * microvascular changes - hypo-perfusion in peritubular capillaries - generation of reactive oxygen and nitrogen species

Answer 16

- Ceftriaxone!!! + azithromycin and doxy to cover for chlyamdia - established fluoroquinolone resistance

Answer 17

* FBE - haemoyltic anaemia, WCC normal/low, no eosinophilia, thrombocytopenia common * Thick and thin blood smear * antigen capture tests - rapid dx 15-20mins * ICT

Answer 18

2 weeks of IV fluclox and gent has been used

Answer 19

* Primaquine * eliminates liver forms of P vivax and ovale * need G6PD screen * total dose of primaquine received is important * no other alternatives

Answer 20

- Pre renal: hypovolemia, hypotension, CCF, aortic dissection - Renal - ATN, tubular injury - ischaemic, toxic - drugs causing acute tubulo-interstitial nephritis, infetions, acute GN - pauci-immune, anti-gbm - Post renal - obstruction - staghorn calculi, retroperitoneal fibrosis.

Answer 21

- was an RCT of 7000 patients compared albumin as resus fluid vs N/Saline - Showed NO overall benefit in mortality or need for RRT fluids containing synthetic colloid - HES - found to be associated with increased need for renal replacement therapy - and increased mortality

Answer 22

Focal – involving some of the glomeruli Segmental – involving a portion of the affected glomerulus Electron microscopic findings same as MCD- Effacement of podocyte foot processes pathogenesis - injury to the podocyte via an immune mechanism - associated with progressive renal insufficiency in 25-50% of cases Tx - immunosupp tx for primary FSGS, no role for secondary forms - glucocorticoids, cyclosporin - in conj for resistant cases,

Answer 23

**Proteinuric -nephrotic** - minimal change, FSGS and membranous **Haematuric - nephritic -** IgA nephropathy, SLE, Pauci-immune GN, anti GBM, post step **Both** - membrano-proliferative GN - mesangio capillary GN

Answer 24

4-6 weeks of IV benzylpenicillin or amoxil/AMP + Gentamicin (4-6weeks) combination of AMP with ceftriaxone may be effective for enterococci resistant to AMP - use Vanc + Gent SE: ototoxicity and renal failure if E.faecalis - then replace gent with ceftriaxone - therefore Amp + Cef

Answer 25

- frequently due to carbapenemase - hydrolyse all B-lactams incl carbapenems - esp ppl from india, asia and hospitals in america MUST know - New Delhi metallo- beta lactamase - does not occur in isolation, co-transmission of other resistance elements

Answer 26

Lab findings - early neutropenia with subsequent lymphocytosis, mildly raised ALT and AST severe disease- low platelet count - less than 100,000 elevated transaminases 3-5 of ULN Dx - serology - 4 fold rise in antibody titre over 2 weeks flavivirus PCI, NS1 antigen Mx - symptomatic, supportive

Answer 27

- middle eastern respiratory syndrome coronovirus - pt presents with pneumonia and ARDS - human to human transmission possible - consider in travelllers from middle east in the last 14 days - mortality rate 55%

Answer 28

* Treat/remove causes/ exacerbating factors * fluids, renal perfusion- resus * mx of hyper K and acidosis * RRT as required - fluid overload, azotemia * stress ulcer prophylaxis * modify med dosing

Answer 29

TTE - sensitivity less than 60%, specificty 98% TOE - sens very high, spec very high - neg predictive value 99-100% in NVE, Pos PV 90% - PVE 86-94%, 88-100%

Answer 30

Ceftriaxone 3-4 weeks + gent for 2 weeks - active against bartonella/strep/HACEK for Bartonella endocarditis - switch to IV doxy or azithromycin + ? gent Q fever endocarditis - doxy + plaquenil (12-18months) + RIF

Answer 31

delta 32 mutation in CCR5 - found in 10% caucasians - heterozygous associated with slower HIV disease progression

Answer 32

NO - do not become abnormal until GFR reduced by 50% - begin to change late after injury occurs confounding - muscle mass, age, sex, nutrition, meds (steroids)

Answer 33

1. infections - SBE usually viridans, TB, intra-abdominal abscess, HIV related infection 2. connective tissue diseases - PMR, Giant cell arteritis, vasculitis (PAN), SLE, thyroiditis 3. Malignancy - lymphoma, necrotic mets, Renal cell cancer 4. other - drug fever, factitious Remember role of PET scan

Answer 34

4-6 weeks IV fluclox - 2g 4hrly MRSE or MRSE - vancomycin 4-6 weeks - Rifampicin + Fusidic acid in prosthetic valve endocarditis \*\*TG - states if vanc resistance or intermediate - then use daptomycin or linezolid\*\*\*

Answer 35

- occurs in severe liver dysfunction - progressive oliguria with very low urinary sodium ( - sepsis, hypovolemia due to diuretics/paracentesis - splanchnic circulation dilatation, intra-renal arteriolar constrction - POOR prognosis Prevention - IV albumin reduces AKI after paracentesis, vasoconstriction with terlipressin (improves short term survival and renal fn)

Answer 36

* Those with heavy proteinuria- Less likely to spontaneously remit * Those with renal dysfunction - Disease more likely to progress Cyclophosphamide and steroid based regimens 1st line immunosppressive therapy 2nd line - cyclosporine - provided preserved GFR, rituximab

Answer 37

emptying - S2-4 parasympathetic innervation via pelvic nerves mediated by M2 & M3 receptors filling - sympathetic T11-L2 innervation via hypogastric nerve mediated by B3 receptors Urethra - closure is via external sphincter S2-4 pudental N - somatic originating in onuf's nucleus closure - male bladder neck - alpha1A adrenergic opening NOS/NO

Answer 38

- sensory bladder afferents - complex suburothelial sensory network - myelinated Adelta fibres - 30% - mechanoreceptors mediating sense of fullness via spinobulbospinal pathway via pontine micturition centre - PMC - unmyelinated C fibres - 70% - normally silent, high mechanical threshold, activated by noxious stimuli eg. infection after spinal dysfuntion - drive spinal segmental reflex pathway

Answer 39

* pauci immune - anca associated vasculitis * linear IgG - anti- gbm * immune complex deposition - SLE, IgAN, PIGN, MPGN

Answer 40

- PKD1 gene on chromosome 16, encodes protein polycystin 1 more rapid deterioration in renal function increased number of cysts cysts at an earlier age - cf PKD-2 median age of ESRD at age 54 compared to 74 for PKD-2 on chromosone 4

Answer 41

15-29 - 3 or more cysts - unilateral or bilateral 30-39 - 3 or more cysts unilateral or bilateral 40-59 - 2 or more cysts in each kidney greater than 60 - 4+ cysts in each kidney

Answer 42

- polycystic liver disease - intracranial aneurysms - in 6% of pts with neg fmx, 16% with fmx - thoracic aortic, cervico-cephalic dissections, coronary artery aneuysms - valvular heart disease - mitral valve prolapse and aortic incompetence

Answer 43

• Prognosis dependent upon * Severity of proteinuria * Degree of renal dysfunction * Degree of background renal damage on renal biopsy * Response to therapy

Answer 44

Glucocorticoids cornerstone of therapy • Cyclosporin (in conjunction with glucocorticoids) in resistant cases - Provided renal function is preserved * Other agents – less studied * Cyclophosphamide * Tacrolimus * Mycophenolate * Sirolimus * Rituximab

Answer 45

1) cyclophosphamide and steroid based regiments 1st line immunosuppresive therapy alt immunosuppresive therapies - cyclosporine 2nd line - provided preserved eGFR rituximab

Answer 46

M-Type Phospholipase A2 receptor as Target antigen in idiopathic membranous nephropathy - apparently (anti-phospholipase A2 receptor antibodies) correlate with clinical status in idiopathic membranous nephropathy

Answer 47

the non-dihydropiridine calcium channel blockers - verapamil - diltiazem needed to reach target blood pressure of 125/75 for nephrotic syndromes

Answer 48

- decreased levels of anti-thrombin III due to urinary losses - increased platelet activation - presence of high molecular weight fibrinogen moieties in the circulation - additional possiblilty is that immune mediated injury in the glomerulus results in increased procoagulant activity sufficient to have a systemic effect 10-40% of cases have deep vein or renal vein thrombosis

Answer 49

Common to all causes * Mesangial hypercellularity * Endocapillary proliferation * Duplication of the glomerular basement membrane (producing double contours)

Answer 50

- usually in association with chronic infections - predominantly hep C

Answer 51

immune complex mediated - deposition of immune complexes in the glomeruli resulting from persistent antigenaemia - development of antigen-antibody complexes - chronic infectons (hep c) Complement mediated MPGN - commencing and involving regulation of C3 , loss of complement regulation independent of antigen/antibody stimulation

Answer 52

poor quality of evidence available - can use immunosuppressive therapy plasma infusion OR **non specific inhibition of complement cascade - Eculizumab - anti C5 monoclonal antibody - inhibition of C5 activation**

Answer 53

Evidence suggesting chronicity: 1. Normocytic anaemia 2. ↑phosphate, ↓calcium, ↑PTH, osteodystrophy 3. Small, echogenic kidneys

Answer 54

treat if hb less than 100 - aim for 100-120 egfr less than 60 for pbs funding functional iron deficiency with EPO therapy - aim Tsat 20-50%, ferritin 300-500 need to give enough iron as relative functional iron deficiency

Answer 55

Targets: CARI guidelines Parameter Target PO4 0.8–1.60 mmol/L Ca 2.1–2.4 mmol/L [Ca x PO4] iPTH 2–3 times the upper normal limit

Answer 56

**\* Control PO4 with phosphate binders** - Ca Carbonate (Calsup), Sevelamer (Renagel), Lanthanum (Fosrenol) **\* Use Calcitriol (Vit D3) to titrate up Ca2+** - Measure PTH 2-3 monthly - PTHectomy if autonomous - i.e. High PTH & Ca, whilst off all Ca/Vit D agents. **\* Calcimimetics eg. Cinacalcit (Sensipar)** - Parathryroid sensitised to respond to lower ca levels. - Improve survival surrogotes PTH, Ca, PO4, [CaxPO4] - BUT – ‘Evolve’ trialno survival benefitPBS de-listing 8/15

Answer 57

I Minimal mesangial LN normal light microscopy II Mesangial Proliferative LN III Focal LN IV Diffuse LN \>50% of glomeruli involved V Pure Membranous LN VI Advanced Sclerosing LN ≥ 90% of glomeruli

Answer 58

• Subendothelial immune deposits /wire loops * Hypercellularity * Leukocyte infiltration * Fibrinoid necrosis /hyaline thrombi * IF- deposits of IgG,C1q,C3,IgA,IgM

Answer 59

* steroids * IV methylpred x 3 pulses or pred 1mg/kg/day then wean * cyclophosphamide * improves renal remission rate, less risk of doubling Cr /ESRF * either IV cyclo monthly for 3-6 months then MMF or Aza * IV route less toxic than oral (cumulative dose accumulation - infertility ) * mycophenolate * 1-3g/day in 2 divided doses * Rituximab

Answer 60

- gonadal toxicity major infection herpes zoster bladder toxicity malignancy bone marrow suppression **cumulative dose of 14g - haemorrhagic cystitis**

Answer 61

* Inhibitor of inosine monophosphate dehydrogenase * Inhibits purine synthesis * Anti-proliferative effects on lymphocytes * myco is as effective as cyclophos at inducing remission * less major infection and minimizes gonadal toxicity * SE * gastrointestinal upset * pancyotpaenia * infection * malignancy - skin - NEEDS YEARLY SURVEILLANCE

Answer 62

* myco, aza at least as effective as cyclo with less toxicity * maintanence treatment for at least 2 yrs * ? lifelong if relapse * myco superior in maintaining renal response post induction and preventing relapse

Answer 63

* murine/human monoclonal antibody * anti-CD 20, b cell depletion * no benefit over standard treatment in LUNAR trial * however possible role in severe refractory or relapsing disease

Answer 64

* Autoantibodies reacting with myeloperoxidase(MPO) or proteinase 3 (PR3) * Characteristic cytoplasmic (c-ANCA) or perinuclear (p-ANCA) IF staining on ethanol fixed neutrophils. * Three major * wegner's granulomatosis - 90% ANCA +, 80-90% PR3 * microscopic polyangitis - 70% ANCA, most have MPO * renal limited vasculitis - most anca +, 75-80% MPO

Answer 65

* cyclophos - 3-6 months, oral vs IV as IV smaller cumulative dose * steroids - iV methylpred pulse than pred in severe disease * in severe disease ANCA + vasculitis - plasma exchange resulted in higher rate of renal recovery * esp in severe renal failure, concurrent anti-gbm antibodies and anca pos, pul haemorrhage

Answer 66

* aza verus cyclophos * aza for 18months shown to be as effective as cyclo to minimise relapse * aza more effective than mycophenolate at maintaining remission in ANCA associated vasculitis * rituximab - as alternative to cyclo - no difference in adverse events, as effective

Answer 67

Urine albumin : Creatinine ratio (UACR) males 2.5-25mg/mmol females 3.5-35mg/mmol Albumin excretion rate (AER) 30-300mg/ 24hrs 20-200μ g/min in timed collection If positive then further 1-2 checks within 3 months

Answer 68

Urine albumin : Creatinine ratio (UACR) males \>25mg/mmol females \>35mg/mmol Albumin excretion rate (AER) \>300mg/ 24hrs \>200μ g/min in timed collection

Answer 69

- ARAS part of generalised atherosclerosis common in pts with or without HT - typically involves the proximal 1/3rd of main renal aa men and women age over 55 ostial/proximal renal aa radiologically eccentric or concentric lesions - total occlusion and ischaemic atrophy

Answer 70

in women aged 30-40 mid-distal renal artery, bilateral in 60% radiologically string of beads can affect carotid, visceral and peripheral arteries total occlusion and ischaemic atrophy is rare **perimedial fibroplasia can threaten, cause dissection**

Answer 71

60 – 65% sodium reabsorbed Site of HCO3 - reabsorption All glucose and amino acids reabsorbed Site of solute secretion * anions (urate, ketoacid, penicillins, cephalosporins, radiocontrast media, diuretics) * cations (cr, cimetidine, Li) Target carbonic anhydrase inhibitors • Mild metabolic acidosis

Answer 72

* 25-30% of sodium reabsorption * concentration of medulla and counter current system * mg and ca transport passive * frusemide decreases mg absorption - less positive lumen * claudin 16 gene encodes for mg transport paracellular pathway * **mutations in paracellin 1 gene - hypomagnesemia and nephrocalcinosis**

Answer 73

* autosomal recessive * normotensive * hypokalaemic, metabolic alkalosis * hypercalciuria +/- hypomg * increase in urine prostaglandin E * increase renin and aldo * neonatal presentation * Affects NKCC - losing sodium, cannot retain hence high renin and aldo to compensate

Answer 74

* 5% of total NACL absorption * thiazide action - indapamide * mg and ca reabsorption * Mg absorption via TRPM6/M7 - this is inhibited by tacrolimus * 2-5% of mg absorbed * Thiazides * inhibit Na/CL co-transporter * compete for Cl site * decrease absorption of Na * increase calcium reabsorption - prevention of renal calculi

Answer 75

* Autosomal recessive - ***disorder of NaCl transporter*** * Salt wasting * Normotensive, metabolic alkalosis, hypokalemia, * hypomagnesemia, hypocalciuria (similar thiaside) * Increase renin and aldosterone * Urine prostaglandin E normal * Diagnosed late childhood or adulthood * Musculoskeletal presentation

Answer 76

* •Autosomal dominant * •Hypertension 2nd /3rd decade * •Normal anion gap acidosis * •Hyperkalemia * •Hypercalciuria * •High aldosterone levels * •Treatment thiasides * •Mirror image to thiaside use

Answer 77

**Amiloride and Triamterene, High dose trimethoprim** * close sodium channels directly * Amiloride used to inhibit Lithium entry into cells Spironolactone and Eplerenone * competitively antagonises aldosterone at receptor level * Eplerenone more specific less anti‐testosterone side effects

Answer 78

* Autosomal dominant (chromosome 16) * Early onset H/T + hypokalemic metabolic alkalosis * decreased plasma renin and aldosterone levels *  Increased number of Na channels * Mutation identified in  or  subunit of Na channel (unable to catabolise Na channel) * Presentation similar to apparent minerocorticoid excess (Licorice) * Amiloride and Triamterene, not Spironolactone used for treatment as they close the channels

Answer 79

Fine tuning by renin angiotensin Electronegative lumen promotes K+ and H+ excretion Aldosterone increase number of sodium channels increase Na reabsorption and secretion of K+ ANP binds to basolateral receptor decreases Na channels Li enters these cells via Na channels

Answer 80

* Anion gap Na+ ‐ (Cl‐+ HCO3) *  Anion gap 8‐15 *  Measure of unmeasured anions (albumin ,Phosphate and sulphate)  Anion gap increased * Decrease K+, Ca2+ or Mg2+ * Increase anions – lactate, ethylene ketones * 2\* to increased lactate, methanolol, alcohol, rhabdo, renal failure or ketoacidosis  Anion gap decreased * Low albumin (correction .25 x albumin g/L) * Multiple myeloma

Answer 81

Urine anion gap = [Na+] + [K+] – [Cl‐] GI causes: “neGUTive” UAG + • Infusion ++ amounts Na Cl  Positive anion gap • Type 1 RTA, Type 4 RTA, renal failure  Impaired renal acid excretion Urinary anion gap unreliable pH \> 6.5 U Na Toluene/lactic/ketoacidosis

Answer 82

* Distal defect ---\>  decreased H+ secretion * K+ secreted instead of H+ (hypokalemia) * Urine pH \> 5.5 * Hypercalciuria * Most acidotic of the three types of RTA * Renal Calculi * • Hypercalciuria * • Hypocitraturia * Confirmatory test –Ammonium Cl acidification * primary causes * idiopathic, sporadic, mutation in H+-ATPase and AE1 gene , association nerve deafness * secondary causes * autoimmune - sle, sjogrens, RA, drugs - PPI, lithium, chronic hep, renal transplant , thyroid disorders *

Answer 83

Failure of proximal tubular reabsorption of HCO3 Acidosis is milder that in type 1 RTA (HCO3 ‐ 12‐20 mmol/L) Urine pH varies with serum HCO3 ‐ (pH Threshold distal reabsorption of HCO3 ‐Treatment may require high dose HCO3 ‐ (10‐15 mmol/kg/day) Often associated with generalised proximal tubule dysfunction (Fanconi syndrome - generalised prox tube dysfunction) Confirmatory test fractional excretion of Bicarbonate \> 25%

Answer 84

Aldosterone deficiency or distal tubule resistance to Aldosterone Decrease in Na+ absorption Decreased H+ and K+ secretion hyperkalemia and acidosis Urine pH Impaired ammonium production Acquired causes - dec renin 2\* to Diabetic nephro, NSAIDs, interstital nephritis, normal renin dec aldo - ACEI arb, heparin, primary adrenal response dec response to aldo - meds - spiro, tac, sle, amloid **treatment - dietary restriction of Na and frusemide**

Answer 85

granulomatous polyangitis eponymous description of disease entity small vessel vasculitis affecting respiratory tract vessels – nose to lungs and renal vessels

Answer 86

* anti GBM antibodies cause this disease * mainly present with rapidly progressive disease * areas of necrosis and crescents * antibody – IgG – deposits on the basement membrane * always a cresenteric disease * combination of haemoptysis, renal failure and linear IgG deposits points to a diagnosis of good pasture’s syndrome. * An antibody to alpha 3 component of type IV collagen * More common in men * Bimodal distribution – peaks in 20-30 and 60-70, associated with HLA DR2 * Ix – renal biopsy and raised transfer factor secondary to pul haemorrhage * Management – plasma exchange, steroids and cyclophosphamide * ANCA related nephropathies are associated with crescentic glomerulonephritis

Answer 87

PROTEINURIA!!!!! - degree of proteinuria - esp not responding to tx generally the strongest predictor for renal decline in glomerular diseases interaction between BP & proteinuria - reflects glomerular injury BP control still essential - generally more treatable - proteinuria and albuminuria is also a predictor of CV events and all cause mortality in CKD Tx - ACEI, ARB, fish oil, glucocorticoids and cyclophosphamide

Answer 88

so ideal treatment is cyclo IV to reduce cumulative dose, can use rituximab as alternative plasmapheresis is used short term in achieving dialysis independence in ANCA pos vasculitis presenting as dialysis requiring - serum Cr greater than 500 - also in pts with pul haemorrhage or co-existing anti-GBM antibody but u also need to use cyclophosphamide as induction therapy

Answer 89

- cyclophosphamide and prednisolone alternating monthly for 6 months - remember PLA2R Ab - present in 70% of idiopathic MN and negative in secondary MN steroids alone do not work for iMN can use for 6 or 12 months another target for idiopathic MN is THSD7A

Answer 90

So - transplant donors are generally from a highly selected population - lower risk of ESKD - higher risk than healthy non donors - but absolute risk is LOW - cannot transplant melanomas - even past hx - as high death rates ABOI no longer an absolute contraindication in living donor kidney Tx - generally requires antibody removal pre- TX - antibody remoal for low antibody titres - kidney exchange program for high titres- to avoid unsuccessful attempt at Ab removal or higher risk of early rejection

Answer 91

1 CVD!!!!! 2. withdrawal from dialysis - however now nearly the same as CVD 3. infection 4. vascular - stroke, GI bleed, bowel infarction first few months - high risk of infections

Answer 92

* 1,25 OH vitamin D reduces PTH secretion - directly or indirectly via relative hypercalcaemia * increases GI absorption of Calcium and phosphate - unwanted SEs * avoid relative hypercalcaemia, hyperphosphataemia and low PTH - adynamic bone disease - vascular calcification *

Answer 93

for patients with CRF and egfr 15-45 mls/min