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MRCP 1 > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

Renal rejection: minutes to hours

A

Hyperacute rejection

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2
Q

Renal rejection: <6 months

A

Acute graft failure

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3
Q

Renal rejection: >6 months

A

Chronic graft failure

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4
Q

Cause of hyperacute rejection

A

Antibodies against ABO or HLA antigens

Examples of type II hypersensitivity

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5
Q

Cause of acute rejection

A

Mismatched HLA - Cell-mediated (cytotoxic T cells)

CMV infection

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6
Q

Acute rejection: Mx

A

Steroids and immunosuppressants

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7
Q

Chronic graft failure: causes

A

Antibody and cell mediated causing fibrosis to the transplanted kidney

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8
Q

Chronic kidney disease: bone labs

A

Low vitamin D
High phosphate
Low calcium
Secondary hyperparathyroid

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9
Q

IgA nephropathy: features

A

Macroscopic haematuria in young people following upper respiratory tract infection

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10
Q

IgA nephropathy: associations

A

Alcoholic cirrhosis
Coeliac disease / dermatitis herpetiformis
HSP

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11
Q

Mesangial hypercellularity

Positive immunofluorescence for IgA and C3

A

IgA nephropathy: histology

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12
Q

Difference between IgA nephropathy and post-strep GN

A
  • Post strep associated with low complement levels
  • Post strep associated with proteinuria
  • Post strep is weeks following infection
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13
Q

IgA nephropathy: treatment

A

Persistent proteinuria - ACEi

Renal failure - steroids

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14
Q

IgA nephropathy: poor prognostic factors

A

Male, proteinuria >2g, hypertension, hyperlipidaemia, ACE DD

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15
Q

Post-strep GN: features

A

7-14 days post infection

Haematuria, proteinuria, hypertension, oliguria

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16
Q

Post-strep GN: histology

A

Subepithelial humps caused by immune complex deposits

Granular or starry sky appearance on immunofluoresecnce

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17
Q

SLE: class II

A

Mesangial GN

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18
Q

Focal and segmental proliferative GN

A

SLE: class III

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19
Q

Diffuse proliferative GN (most common)

A

SLE: class IV

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20
Q

Diffuse membranous GN

A

SLE: class V

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21
Q

Sclerosing GN

A

SLE: class VI

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22
Q

Glomeruli endothelial and mesangial proliferation, wire loop appearance
Granular appearance

A

SLE Class IV: histology

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23
Q

SLE kidney disease: Mx

A

Steroids +/- mycophenolate or cyclophosphamide

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24
Q

ATN: urine sodium

A

Raised

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25
ATN: urine osmolality
Low
26
ATN: Fractional sodium excretion
>1%
27
ATN: response to fluid challenge
Poor
28
ATN: serum urea:creatinine ratio
normal
29
DM: stage 1 nephropathy
Hyper-filtration | Increase in GFR
30
DM: stage 2 nephropathy
Silent / latent phase | GFR elevated
31
DM: stage 3 nephropathy
Incipient nephropathy | Microalbuminuria
32
DM: stage 4 nephropathy
Overt nephropathy Persistent proteinuria HTN
33
DM: stage 5 nephropathy
ESRF
34
What is Fanconi syndrome?
Generalised reabsorptive disorder in the PCT
35
Fanconi syndrome: features
``` Type 2 (proximal) RTA Polyuria Aminoaciduria Glycosuria Phosphaturia Osteomalacia ```
36
Basement membrane is thickened with subepithelial electron dense deposits Spike and dome appearance
Membranous GN: histology
37
Membranous GN: causes
``` Idiopathic (anti-phospholipase A2 antibodies) Infections: HBV, malaria, spyhilis Malignancy Drugs Autoimmune disease ```
38
GN: nephritic syndrome
Rapidly progressive IgA nephropathy Alport
39
GN: nephrotic syndrome
``` Minimal change disease Membranous GN Focal segmental glomerulosclerosis Amyloidosis Diabetic nephropathy ```
40
GN: mixed
Diffuse proliferative Membranoproliferative Post-strep
41
Radio-opaque stones
Calcium oxalate Mixed calcium - phosphate stones Phosphate stones
42
Radio-lucent stones
Urate | Xanthine stones
43
Semi-opaque stones
Cystine stones
44
Hypercalcaemia causes what stones?
Calcium stones
45
Risk reduction of calcium stones
High fluid intake Low protein and salt diet Thiazide diuretics
46
Risk reduction oxalate stones
Cholestyramine | Pyridoxine
47
Risk reduction uric acid stones
Allopurinol | Bicarbonate
48
Alport inheiritance
X-linked dominant
49
Alport defect
type IV collagen
50
Alport features
``` Microscopic haematuria Progressive renal failure Bilateral sensorineural deafness Lenticonus Retinitis pigmentosa ```
51
Alport: renal histology
Splitting of lamina densa
52
Causes of retorperitoneal fibrosis
``` Riedel's thyroiditis Radiotherapy Sarcoid Inflammaty AAA Methysergide ```
53
Anion gap
(Na + K) - (Cl - HCO3) | Range: 8-16
54
HSP: features
Palpable purpuric rash over buttocks and extensors Abdo pain Polyarthritis IgA nephropathy
55
Management in ADPKD
Tolbapatan (vasopressin receptor 2 antagonist)
56
ADPKD features
``` HTN Recurrent UTI Abdo pain Renal stones Haematuria CKD Liver cysts Berry aneurysms MV prolapse ```
57
Papillary necrosis causes
``` POSTCARDS Pyelonephritis Obstruction Sickle cell TB Cirrhosis of liver Analegsia/alcohol overuse Renal vein thrombus DM Systemic vasculitis ```
58
Indications for plasma exchange
``` GBS Myasthenia gravis Goodpasture's ANCA positive vasculitis TTP/HUS Cryoglobulinaemia Hyperviscosity ```
59
HIV nephropathy: features
``` Proteinuria (nephrotic syndrome) Normal or large kidneys Focal segmental glomerulosclerosis Elevated urea and creatinine Normotension ```
60
Minimal change disease: features
Nephrotic syndrome | Normotension
61
Normal glomeruli | Electron microscopy shows fusion of podocytes
Minimal change disease: biopsy
62
Rapidly progressive glomerulonephritis: features
nephritic syndrome
63
Rapidly progressive glomerulonephritis: causes
Goodpasture's Wegener's SLE
64
FSGS: causes
``` Idiopathic IgA nephropathy HIV Heroin Alport's syndrome Sickle cell ```
65
Focal and segemental sclerosis and hyalinosis on light microscopy Effacement of foot processes
FSGS: Biopsy
66
Nephritic syndrome: causes
Rapidly progressive GN IgA nephropathy Alport syndrome
67
Mixed nephrotic and nephritic syndrome: causes
Diffuse proliferative GN Membranoproliferative GN Post-strep
68
Nephrotic syndrome: causes
``` Minimal change disease Membranous GN FSGS Amyloidosis Diabetic nephropathy ```
69
Metabolic acidosis: normal anion gap
``` GI losses: diarrhoea, ureterosigmoidostomy, fistula RTA Acetazolamide Ammonium chloride injection Addison's ```
70
Metabolic acidosis: raised anion gap
Lactate: shock, sepsis, hypoxia Ketones: DKA, alcohol Urate: renal failure Acid poisoning: salicyclates, methanol
71
Renal transplant: initial regime
Ciclosporin/tacrolimus with monoclonal antibody
72
Renal transplant: maintenance
ciclosporin/tacrolimus with MMF or sirolimus
73
Wilm's tumour: features
Abdominal mass, painless haematuria, flank pain, anorexia
74
Wilm's tumour: Mx
Nephrectomy, chemotherapy, radiotherapy
75
AL amyloidosis
- Most common - Light chain fragment - Myeloma, Waldenstrom's, MGUS
76
AL amyloidosis: features
Nephrotic syndrome, cardiac and nephrotic involvement, macroglossia, periorbital eccymoses
77
AA amyloidosis
Acute phase reactant | Chronic inflammation / infection
78
Eythropoitein: SE
HTN, bone aches, flu like symptoms, skin rashes, urticaria, red cell aplasia, Raised PCV, IDA
79
Plasma exchange: complications
Hypocalcaemia, metabolic acidosis, removal of systemic medication, coagulation factor depletion, immunoglobulin depletion
80
Gosereline
Synthetic GnRH agonist
81
Bicalumtmaide
Non-steroidal anti-androgen
82
Abiraterone
Androgen synthesis inhibitor
83
HLA importance
DR > B > A

MRCP 1 (16 decks)

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