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AKT > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

ADPKD 1 and 2
Which is more common
Chrm?

A

ADPKD 1
Chrm 16 ADPKD 1
Chrm 4 ADPKD 2

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2
Q

Screening investigation of choice for ADPKD
Diagnostic criteria
<30
30-59
>60

A

US abdominal
two cysts, unilat or bilat <30
two cysts both kidney 30-59
four cysts in both kidneys >60

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3
Q

Mx ADPKD (1) on (3) conditions

A

Tolvaptan

IF
CKD stage 2 or 3 at start of treatment
AND
Evidence of rapidly progressing disease
AND
Company provides it with agreed discount

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4
Q

Features of ADPKD (6)

A

HTN
Recurrent UTIs
AP
Renal stones
Haematuria
CKD

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5
Q

Extra renal manifestations of ADPKD (4)

A

Liver cysts
Berry aneurysms
Mitral valve prolapse
Cysts in other places

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6
Q

What is Alport’s syndrome?
Inheritance

Gender

A

X linked dominant
Defect in gene coding for type IV collagen resulting in an abnormal GBM

M>F (more severe in male)

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7
Q

Features Alport’s syndrome (5)

A

Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus (protrusion of the lens surface)
Retinitis pigmentosa

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8
Q

Renal biopsy for Alport’s syndrome (2)

A

Longitudinal splitting of lamina densa of GBM
Basket weave appearance

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9
Q

MDRD uses what four variables for eGFR

A

Age
Serum creatinine
Gender
Ethnicity

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10
Q

Factors which can impact the eGFR (3)

A

Pregnancy
Muscle mass
Eating red meat 12 hours prior to sample being taken

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11
Q

CKD eGFR 1-5
Classification

A

1 >90 with some sign of kidney damage
2 60-90
3a 45-59
3b 30-44
4 15-29
5 <15

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11
Q

CKD
Mineral bone disease management (4)

A

Reduced dietary intake of phosphate
Phosphate binders
Vitamin D
Parathyroidectomy

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11
Q

ACR interpretation

A

3-70 repeat sample
If >70 then no repeat sample needed
Must be a first pass morning urine

If >3 then clinically important proteinuria

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12
Q

When to refer to nephrologist for CKD? (2)
Consider if (1)

A
  1. If ACR >70 (unless caused by DM)
  2. If ACR >30 with persistent haematuria

Consider if
ACR 3-29 with persistent haematuria and other RF

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13
Q

Mx of proteinuria (2)

A
  1. ACE inhib if co-existent HTN and CKD if ACR >30
  2. If >70 then ACE inhib even if no raised BP
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14
Q

Visible haematuria
Loin pain
Proteinuria
=

A

Renal papillary necrosis

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15
Q

Post Strep GN
Which bacteria?
Typically occurs when?
Prognosis

A

7-14 days post group A beta haemolytic strep infection (Strep pyogenes)
Good prognosis

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16
Q

Post Strep GN features (6)

A

Young children
Proteinuria more than haematuria
HTN
Oliguria
Low C3
Raised ASO titre

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17
Q

IgA nephropathy features (3)

Study These Flashcards
A

Develops 1-2 days post URTI
Young males
Macroscopic haematuria

18
Q

Renal biopsy post strep GN

Study These Flashcards
A

Granular/ starry sky

19
Q

IgA nephropathy associated conditions (3)

Study These Flashcards
A

Alcoholic cirrhosis
Coeliac
Henoch-Schonlein purpura

20
Q

IgA nephropathy histology

Study These Flashcards
A

Mesangial hypercellularity

21
Q

IgA nephropathy prognosis
Markers for good prognosis (1)
Poor prognosis (5)

Study These Flashcards
A

25% have ESRF
Frank haematuria

  1. Male
  2. proteinuria >2g/day
  3. HTN
  4. Smoking
  5. Hyperlipidaemia
22
Q

Henoch Schonlein purpura overlaps with?
Features (4)

Study These Flashcards
A

IgA nephropathy

Features:
1. Palpable purpuric rash over buttocks and extensor surface of arms and legs
2. AP
3. Polyarthritis
4. Features of IgA nephropathy e.g haematuria

23
HSP prognosis What two things should be monitored? How many relapse?
Self limiting Very good prognosis BP and urinalysis should be monitored 1/3 have a relapse
24
Minimal change disease Causes (5)
drugs: NSAIDs, rifampicin Hodgkin's lymphoma, thymoma infectious mononucleosis
25
Difference between nephrotic and nephritic syndrome
Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine Nephrotic syndrome is a condition involving the loss of significant volumes of protein via the kidneys (proteinuria) which results in hypoalbuminaemia. The definition of nephrotic syndrome includes both massive proteinuria (≥3.5 g/day) and hypoalbuminaemia (serum albumin ≤30 g/L).
26
Cranial versus nephrogenic DI
Cranial - decreased secretion of ADH Nephrogenic - insensitivity to ADH
27
Causes of cranial DI (4)
Idiopathic Post head injury Pituitary surgery Haemochromatosis
28
What is DIDMOAD?
the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
29
Causes of nephrogenic DI (4)
Genetic Hypercalcaemia Hypokalaemia Lithium
30
Ix DI High/low plasma osmolality high/low urine osmolality A urine osmolality of what excludes DI What other investigation can be done?
high plasma osmolality, low urine osmolality a urine osmolality of >700 mOsm/kg excludes diabetes insipidus water deprivation test
31
Diabetes insipidus mx (2) Central DI can be treated with? (1)
Thiazides Low salt/ protein diet Desmopressin
32
Nephrotic syndrome examples (4)
Minimal change Membranous GN FSGM Diabetic nephropaathy
33
Nephritic syndrome examples (3)
Rapidly progressive GN IgA nephropathy Alport syndrome
34
Most common cause of GN in children
Minimal change
34
Causes of transient non visible haematuria (4)
UTI Menstruation Vigorous exercise (settles after 3 days) Sexual intercourse
35
Which drugs can cause red/orange urine? (2)
Rifampicin Doxorubicin
36
How do you define persistent non visible haematuria?
Blood being present in 2 out of 3 samples tested 2-3 weeks apart
37
Who should be referred under the 2 week wait?
=>45yo with unexplained visible haematuria w/o UTI OR visible haematuria that persists after successful treatment of UTI OR >= 60yo with unexplained non visible haematuria AND dysuria/ raised WCC
38
Who should get a non urgent referral to urology regarding haematuria?
>=60yo with recurrent or persistent unexplained UTI
39
Minimal change prognosis
1/3 have just one episode 1/3 have infrequent relapses 1/3 have frequent relapses which stop before adulthood
40
Minimal change mx (2)
steroids cyclophosphamide
41
Minimal change Features (3) BP Nephritic or nephrotic
Normotension Nephrotic syndrome Highly selective proteinuria
42
Minimal change Renal biopsy Light microscopy (1) Electron microscopy (1)
normal glomeruli on light microscopy electron microscopy shows fusion of podocytes and effacement of foot processes

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