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MRCP Part 1 > Nephrology > Flashcards

Nephrology Flashcards

(58 cards)

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1
Q

PSGN - when does it present?

A

Weeks post URTI

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2
Q

IgA nephropathy - when does it present?

A

Days post URTI

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3
Q

How does PSGN present?

A

Proteinuria

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4
Q

How does IgA nephropathy present?

A

Haematuria

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5
Q

Who does PSGN affect?

A

Young children

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6
Q

Who does IgA nephropathy affect?

A

Young men

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7
Q

Bloods in PSGN

A

High ASO titre, low C3

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8
Q

Histology in PSGN

A

EM: subepithelial humps
Histology: diffuse proliferative glomerulonephritis
Immuno: starry sky

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9
Q

Histology in IgA nephropathy

A

Histology: mesangial hypercellularity
Immunofluorescence: IgA and C3 light up

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10
Q

Pathophysiology of PSGN

A

IgG, IgM and C3 complexes deposit in the glomeruli

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11
Q

Pathophysiology of IgA nephropathy

A

IgA complexes deposit in the mesangium

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12
Q

Management of IgA nephropathy

A

Haematuria + preserved GFR = watch and wait

Proteinuria + preserved GFR = ACEi

Proteinuria + reduced GFR = prednisolone

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13
Q

How do NSAIDs cause AKI?

A

They block vasodilation of afferent arteriole

Results in reduced renal perfusion

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14
Q

Indications for Dialysis

A 
A - acidosis 
E - electrolyte disturbance (hyperkalaemia)
I - intoxications
O - overload 
U - uraemia encephalopathy
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15
Q

Drugs which can be removed by dialysis

A

SLIME:

  • Salicylates
  • Lithium
  • Isopropanol
  • Methanol
  • Ethylene glycol
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16
Q

Definition of AKI

A
  • Cr rise by 26mmol in 48h, or
  • Cr rise by 50% in 7 days, or
  • Oliguria for 6h in adults
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17
Q

Investigations in in renal artery stenosis secondary to fibromuscular dysplasia

A
  • Urine dip: normal
  • US: asymmetrical kidneys
  • Renal artery visualisation e.g. Doppler
  • MR angiography: string of beads
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18
Q

Management of renal artery stenosis

A

1st line: ACEi + statin + aspirn

2nd line: Revascularisation + medical + DAPT

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19
Q

What treatment is contraindicated in bilateral renal artery stenosis, and why?

A

ACE inhibitors are contindicated in bilateral renal artery stenosis.

  • Angiotensin II preferentially vasoconstricts the efferent arterioles, maintains eGFR despite reduced perfusion arterioles.
  • Therefore ACE inhibitors would cause vasodilation of efferent arterioles and overall reduced eGFR
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20
Q

Features of hyperacute renal transplant rejection

A

Minutes - hours

  • Type 2 hypersensitivity reaction
  • Host antibodies against graft antigens
  • Thrombosis and necrosis
  • Mx: graft removal
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21
Q

Features of acute renal transplant rejection

A

< 6 months

  • T-cell mediated/CMV infection
  • Due to HLA mismatch (usually HLA-DR)

Generally asymptomatic with rising Cr, proteinuria

Mx: steroids

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22
Q

Chronic renal transplant failure

A

> 6 months

HLA-A or B

Recurrence of original renal disease
- MCGN > IgA > FSGS

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23
Q

Calcium phosphate renal stones are associated with what condition?

A

Renal tubular acidosis

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24
Q

Prevention of uric acid stones

Study These Flashcards
A
  • urinary alkalisation e.g. sodium bicarbona

- allopurinol if raised serum urate

25
Prevention of oxalate stones
Pyridoxine | Colestyramine
26
Prevention of renal calculi (general)
Increased fluid intake Reduce salt Thiazide diuretics
27
Rhabdomyolysis triad
AKI Hyperkalaemia Metabolic acidosis
28
Drugs which can cause rhabdomyolysis
Statins (esp if with clarithromycin) Ecstasy
29
Diagnostic criteria for rhabdomyolysis
5x increased CK in absence of cardiovascular or CNS injury
30
Electrolytes in rhabdomyolysis
Raised K, PO4 Low Ca
31
Presentation of PKD
Flank pain Recurrent UTIs HTN
32
What heart condition is PKD associated with?
mitral prolapse
33
Drugs which can cause acute interstitial nephritis
5 Ps: - Penicillin - Pee (diuretics) - Pain (NSAIDs) - alloPurinol - rifamPicin
34
Acute interstitial nephritis - presentation
Fever Arthralgia Rash
35
Acute interstitial nephritis investigations
Urine dip: sterile pyuria Bloods: eosinophilia Biopsy: interstitial oedema in the connective tissue
36
Conditions which show podocyte foot process effacement on EM
Focal segmental glomerulosclerosis Minimal change disease Membranous glomerulonephritis
37
How does focal segmental glomerulosclerosis present?
NEPHROTIC SYNDROME
38
Findings on microscopy in FSGS
LM: focal and segmental hyalinosis and sclerosis EM: effacement of podocyte foot processes
39
Antibody in idiopathic membranous glomerulonephritis
Anti-phospholipase A2 antibodies
40
Histology in membranous glomerulonephritis
EM: Subepithelial electron-dense deposits which resemble a "spike and dome" appearance Effacement of podocyte foot processes
41
Management of membranous glomerulonephritis
- All patients: ACEi or ARB | - Severe or progressive disease: steroids + cyclophosphamide Steroid monotherapy is not effective
42
How does membranous nephropathy present?
Nephrotic syndrome | most common glomerulonephritis in adults
43
How does FSGS present?
Nephrotic syndrome
44
How does minimal change disease present?
Nephrotic syndrome
45
How does Alport syndrome present?
Nephritic syndrome Eyes: Lenticonus, retinosa pigmentosum Ears: bilateral sensorineural deafness
46
Which HLA is Goodpastures disease associated with?
HLA-DR2
47
How does Goodpastures disease present?
Nephritic syndrome + pulmonary haemorrhage
48
Biopsy findings in Goodpasture's
- Epithelial crescents in glomeruli | - Immuno: Linear IgG deposits along GBM
49
Features of acute tubular necrosis
Raised urine sodium >40 Urine Osm <350 Normal Ur:Cr ratio Poor response to fluid challenge Muddy brown casts
50
Features of pre-renal uraemia
Raised serum Ur:Cr ratio Good response to fluid challenge Urine Na < 20 Urine Osm > 500 Normal sediment
51
Effects of sevelamer
Reduce intestinal phosphate absorption Reduce serum lipids Reduce serum uric acid levels
52
Drugs which cause "haematuria"
Rifampicin | Doxorubicin
53
Who should be referred for haematuria 2WW?
Under 45 with visible haematuria in absence of UTI OR after successful treatment of UTI Over 60 with non-visible haematuria with raised WCC and dysuria
54
Where does renal cell cancer most commonly arise?
proximal tubular epithelium
55
Risk factors for renal cancer
Smoking von Hippel Lindau Tuberous sclerosis
56
What is Stauffer syndrome?
Seen in renal cell cancer | Hepatomegaly + cholestasis
57
Tumour markers in testicular cancer
Seminoma: hCG Non-seminoma: AFP (or bHCG)
58
Glomerulonephritis with low complement
- Post-streptococcal glomerulonephritis - Subacute bacterial endocarditis - Systemic lupus erythematosus - Mesangiocapillary glomerulonephritis

MRCP Part 1 (8 decks)

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