Nephro Flashcards by Alicia Jeremiah

What is the MOA of tolvaptan used in ADPKD?

vasopressin receptor 2 antagonist–VaPTAn = VasoPressin Two Antagonist

-slows down vacuolisation .. as aquaporin up regulation leads to cyst formation can be given at stage 3

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Where is the defect in ADPKD type 1 and type 2 respectively?

Type 1 : Chromosome 16
Type 2 : Chromosome 4

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What infection predisposes to struvite (ammonium magnesium phosphate, triple phosphate) kidney stones in Xanthogranulomatous pyelonephritis? What are its features?

Proteus mirabilis

Features: staghorn calculi, foamy (lipid laden) macrophages

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What is Stauffer syndrome and its features?

It is a paraneoplastic disorder associated with renal cell cancer.
-typically presents as cholestasis/hepatosplenomegaly
- thought to be secondary to increased levels of IL-6
-elevated plateletsnand prolonged PT
-without hepatic mets or jaundice

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What is the screening test for ADPKD?

USS

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What are the features of diffuse proliferative glomerulonephritis (mixed)?

-classical post-streptococcal glomerulonephritis in child (presents 1-2 weeks after a streptococcal throat infection or 3-6 weeks after a skin infection)
-presents as nephritic syndrome / acute kidney injury
-most common form of renal disease in SLE

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What are the extra-renal manifestations of ADPKD?

-liver cysts–hepatomegaly (most common)
-berry aneurysms–SAH
-mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
-cysts in other organs

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What are some indications for plasma exchange (also known as plasmapheresis)

-Guillain-Barre syndrome
-myasthenia gravis
-Goodpasture’s syndrome
-ANCA positive vasculitis if rapidly progressive renal failure or pulmonary haemorrhage
-TTP/HUS
-cryoglobulinaemia
-hyperviscosity syndrome e.g. secondary to myeloma

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What is the main benefit of EPO injections?

Improved exercise tolerance
-correct the anaemia, which leads to improved oxygen delivery to tissues.

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How does thiazide diuretics help in someone with hypercalciuria and renal stones?

It decreases calcium excretion and stone formation by reducing urinary calcium levels through enhanced reabsorption in the distal tubules.

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What are the features of Alport’s syndrome?

-Microscopy:basket-weave appearance (longitudinal splitting of the lamina densa of the glomerular basement membrane)
-sensorineural hearing loss
-inherited in an X-linked dominant fashion
-defect in the gene which codes for type IV collagen
-lenticonus: protrusion of the lens surface into the anterior chamber
-retinitis pigmentosa

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What investigation is used for reflux nephropathy/vesicoureteric reflux (VUR)?

Micturating cystography (MCUG)

-DMSA scan may also be performed to look for renal scarring - this is typically located at the upper and lower pole and is associated with cortical thinning

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What are the patterns for aldosterone:renin ratio in renal artery stenosis, liddle’s syndrome and primary hyperaldosteronism?

BOTH high ? > renal artery stenosis
-both low ? > liddle’s syndrome (Liddle’s syndrome = L = LOW for both )
-high aldosterone and renin is low : primary hyperaldosteronism

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What are factors that increase the likelihood of pulmonary haemorrhage in anti-glomerular basement membrane (GBM) disease (Goodpasture’s syndrome)?

-smoking
-lower respiratory tract infection
-pulmonary oedema
-inhalation of hydrocarbons
-young males

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What nephropathy is frequently associated with malignancy? What are some features?

Membranous nephropathy
-oedema, frothy urine
-electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a ‘spike and dome’ appearance
-idiopathic: anti-phospholipase A2 antibodies

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What is a complication of nephrotic syndrome?

Renal vein thrombosis
-Nephrotic syndrome is associated with a hypercoagulable state due to loss of antithrombin III and plasminogen via the kidneys.

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What are some associations of retroperitoneal fibrosis?

Riedel’s thyroiditis
previous radiotherapy
sarcoidosis
inflammatory abdominal aortic aneurysm
drugs: methysergide

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What are some features of Goodpasture’s syndrome?

-IgG deposits on renal biopsy
-anti-GBM antibodies
-haemoptysis and deranged renal function with multifocal airspace opacification (pulmonary renal syndrome)

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What is the MOA of bicalutamide used in prostate ca?

non-steroidal anti-androgen
-blocks the androgen receptor

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What are the features of HIV-associated nephropathy (HIVAN)

-massive proteinuria resulting in nephrotic syndrome
-normal or large kidneys
-focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy -associated with podocyte proliferation
-elevated urea and creatinine
-normotension

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What is the mainstay of rhabdomyolysis treatment?

Rapid IV fluid rehydration
-urinary alkalinization is sometimes used

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What tumour markers are elevated in germ cell tumours?

seminomas: hCG may be elevated in around 20%
non-seminomas (embryonal, yolk sac, teratoma and choriocarcinoma): AFP and/or beta-hCG are elevated in 80-85%
LDH is elevated in around 40% of germ cell tumours

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What are the causes of membranous glomerulonephritis?

ADMIIn
-idiopathic: due to anti-phospholipase A2 antibodies
-infections: hepatitis B, malaria, syphilis
-malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
-drugs: gold, penicillamine, NSAIDs
-autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

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What is Beckwith-Wiedemann syndrome?

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An inherited condition associated with organomegaly, macroglossia, abdominal wall defects, Wilm’s tumour and neonatal hypoglycaemia.

How does spironolactone cause gynaecomastia?

-Aldosterone antagonist--acts on cortical collecting duct It interferes with binding of testosterone to androgen receptors, increases metabolic clearance of testosterone, and results in increased metabolism of androgens to estradiol.

What is the MOA of abiraterone acetate used for prostate ca?

A selective androgen synthesis inhibitor that works by blocking cytochrome P450 17 alpha-hydroxylase

How does alcohol bingeing cause polyuria?

It leads to ADH suppression in the posterior pituitary gland -similar to cranial diabetes insipidus or partial cranial diabetes insipidus and typically causes hypernatraemia

What drug should be used for lupus nephritis in pregnancy?

Azathioprine

When HLA matching for a renal transplant, what is the relative importance of the HLA antigens ?

DR > B > A

What is atypical HUS?

A non-specific term encompassing several diseases which feature microangiopathic haemolytic anaemia (MAHA; non-immune haemolytic anaemia, i.e. Coombs negative) with schistocytes (due to fragmentation of red blood cells) and thrombocytopenia, with renal failure (AKI) but without diarrhoeal symptoms.

What are the eGFR variables?

CAGE - Creatinine, Age, Gender, Ethnicity

What is the first line medication for BPH? What is its MOA?

alpha-1 antagonists e.g. tamsulosin, alfuzosin -decrease smooth muscle tone of the prostate and bladder

What cancer are patients who have received an organ transplant at risk of?

Skin cancer (particularly squamous cell carcinoma) due to long-term use of immunosuppressants

What is the biopsy finding of GPA?

glomerular crescents--proliferation of parietal epithelial cells in Bowman’s space due to severe capillary wall damage GPA-chronic sinusitis or upper airway involvement

What are the features of FSGS?

-effacement of foot processes on electron microscopy -high recurrence rate in renal transplants. -heroin is a RF

What are the causes of nephrogenic DI?

-genetic-eg: ADH receptor (VR2 gene)-AVPR2 -electrolytes -hypercalcaemia -hypokalaemia -lithium -demeclocycline -tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis -haemochromatosis

What is a common tacrolimus-associated side effect?

Tremor

The classic presentation of IgA nephropathy is episodic macroscopic haematuria, often following a mucosal infection such as an upper respiratory tract infectionHow is coeliac disease linked with IgA nephropathy?

Due to the shared pathophysiology of abnormal IgA immune responses.

What is the most common viral infection in solid organ transplant recipients?

CMV

Where do aldosterone antagonists (spironolactone) act on?

The cortical collecting ducts -prevents ascites

ATN or prerenal uraemia?

In prerenal uraemia think of the kidneys holding on to sodium to preserve volume -Urinary sodium can help differentiate

What is the first line treatment of minimal change disease- nephrotic syndrome seen in children?

Oral prednisolone

What are amyloidosis biopsy findings?

Congo red stain shows apple-green birefringence under polarised light

What Ig mediates hyperacute rejection?

IgG

How do schistocytes come about in HUS?

The damaged endothelium causes mechanical fragmentation of red blood cells as they pass through the damaged vessels, leading to the characteristic appearance of schistocytes on the blood film.

What are the markers of good and bad prognosis in IgA nephropathy?

markers of good prognosis: frank haematuria markers of poor prognosis: male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidaemia, ACE genotype DD

What is the most common cause of peritonitis secondary to peritoneal dialysis (PD)? What antibiotics does the BNF recommend?

Coagulase-negative Staphylococcus (epidermidis) -Vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid OR -vancomycin added to dialysis fluid + ciprofloxacin by mouth

What is a feature of uric acid nephrolithiasis (stones)?

Uric acid nephrolithiasis are radiolucent, requiring ultrasonography or CT KUB (without contrast)

Should younger patients with haematuria be referred to nephrology or urology?

Most haematuria protocols suggest sending younger patients (e.g. < 40 years) to nephrology

Why should anti-androgen treatment such as cyproterone acetate be co-prescribed when starting gonadorelin analogues (Goserelin (zoladex))?

Due to the risk of tumour flare. This phenomenon is secondary to initial stimulation of LH release by the pituitary gland resulting in increased testosterone levels. The BNF advises starting cyproterone acetate 3 days before the gonadorelin analogue.

What gene defect is responsible for ARPKD? How is it diagnosed?

-due to a defect in a gene located on chromosome 6 which encodes fibrocystin, a protein important for normal renal tubule development. -Diagnosis: prenatal ultrasound

What liver involvement is seen in ARPKD? What would renal biopsy show?

-typically have liver involvement, for example portal and interlobular fibrosis. -Renal biopsy: multiple cylindrical lesions at right angles to the cortical surface.

What are the causes of AIN?

Causes drugs: the most common cause, particularly antibiotics penicillin rifampicin NSAIDs allopurinol furosemide systemic disease: SLE, sarcoidosis, and Sjogren's syndrome infection: Hanta virus , staphylococci

Which renal stones are semi-opaque and which are radio-lucent on XR?

cystine stones: semi-opaque urate + xanthine stones: radio-lucent

How would a calciphylaxis lesion present ? What drugs would contribute to it?

Calciphylaxis lesion are intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar. -warfarin and calcium containing compounds.

What is useful in the prevention of oxalate renal stones?

Pyridoxine (vit B6), cholestyramine Pyridoxine works by acting as a cofactor for the enzyme alanine:glyoxylate aminotransferase (AGT), which is deficient or dysfunctional in primary hyperoxaluria type 1.

What is seen on renal biopsy of minimal change disease?

-normal glomeruli on light microscopy -electron microscopy shows fusion of podocytes and effacement of foot processes

What are the causes of a raised anion gap? normal range = 10-18 mmol/L

lactate: -shock -sepsis -hypoxia ketones: -diabetic ketoacidosis -alcohol urate: renal failure acid poisoning: salicylates, methanol

What is the time taken for an arteriovenous fistula to develop?

6 to 8 weeks

Nephro Flashcards

(59 cards)