Nephrology Flashcards
(208 cards)
1
Q
Causes of anaemia in CKD ?
A
Decreased erythropoietin production
Increased Hepcidin level (Acute phase reactant )
2
Q
Steps to avoid contrast induced nephropathy ?
A
Stop Metformin
3
Q
Fluid prescription : how to give pottasium, sodium, glucose ?
A
Sodium - 1mmol/kg
Potassium - 1 mmol/kg
Water - 30ml/Kg
Glucose - 50-100g
4
Q
Sodium in 1L 0.9% saline ?
A
154 mmol/l
5
Q
Glucose in 1L of 5% Dextrose ?
A
50 mmol/l
6
Q
Sodium in 1L of Hartman’s ?
A
130mmol/l
7
Q
Pottasium in 1 L of hartmans?
A
5
8
Q
Renal Biopsy in HIV Nephropathy :
A
Focal Segmental Glomerulosclerosis
9
Q
Nephrotic or nephritic in HIV Nephropathy ?
A
Nephrotic picture
10
Q
Kidney size in HIV ass Nephropahty ?
A
Normal or large kidneys
11
Q
Wegner’s Renal Biopsy :
A
Glomerular Crescents.
12
Q
In Wegner’s, Which ANCA is positive ?
A
C- ANCA positive.
13
Q
Recurrent sinusitis + Hematuria + Oliguria + C ANCA Positive. Dx?
A
Wegner’s
Renal biopsy= Glomerular crescents.
14
Q
Wegner’s
A
Recurrent sinusitis/Epistaxis + Hematuria + Oliguria + C ANCA Positive + Renal Biopsy—Glomerular Crescents.
15
Q
Partial Lipodystrophy( loss of subcutaneous tissue in fat) is seen in :
A
Membranoproliferative glomerulonephritis Type 2.
16
Q
Membranoproliferative glomerulonephritis Type 2 causes:
A
Partial lipodystrophy
17
Q
Membranoproliferative Glomerulonephritis Type 1 causes :
A
cryoglobulinaemia, hepatitis C
18
Q
Spironolactone acts on :
A
Collecting ducts.
19
Q
Post streptococcal infection is ass with which glomerulonephritis ?
A
Diffuse Proliferative glomerulonephiritis
20
Q
Diffuse Proliferative glomerulonephiritis Association :
A
SLE
Post streptococcal infection in children.
21
Q
Calcium oxalate stone prevention ?
A
Thiazide diuretics—It increases reabsorption of calcium—so less calcium excretion in urine—so less chance of calcium oxalate stones.
22
Q
AKI criteria :
A
a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days.
a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
23
Q
Paraneoplastic hepatic dysfunction syndrome :
A
K/C/O Renal cell carcinoma + C/o- Abdominal discomfort + RUQ pain +
Elevated ALP+ GGT+ Increased prothrombin time + Hepatosplenomegaly + without hepatic mets.
24
Q
Use of 0.9% Sodium Chloride for fluid therapy in patients requiring large volumes = risk of developing :
A
Risk of hyperchloraemic metabolic acidosis.
25
Contrast-induced nephropathy occurs___
2 -5 days after administration
26
Aldosterone and renin ratio :
BOTH high ? >
-both low ? >
-high aldosterone and renin is low :
Renal artery stenosis.
Liddel’s syndrome. L=Low=Liddle
Primary hyperaldosteronism.
27
CKD stage 1 , 2 and 5 :
CKD stage 1 : > 90
CKD stage 2: > 60-90
CKD stage 5 : < 15ml/min
28
Nephritic syndrome causes mnemonic :
Gm Dear RIA :
Good pasture
Membranoproliferative
Diffuse proliferative
IgA Nephropathy
Alport syndrome.
29
SLE is associated with :
Diffuse proliferative
30
Diffuse proliferative glomerulonephritis associated with :
SLE
Streptococcal infection in children.
31
Graft rejection is mediated by :
IgG
G=Graft rejection= IgG
32
Wilm’s tumour is ass with :
Beckwith Wiedmann Syndrome.
33
Renal biopsy findings in IgA nephropathy ?
Mesangial hypercellularity
34
Which lab findings will be normal in Goodpasture ?
Complement levels are normal
35
A 72-year-old man is diagnosed with prostate cancer and goserelin (Zoladex) is prescribed. Which one of the following is it most important to co-prescribe for the first three weeks of treatment?
Anti-androgen treatment such as cyproterone acetate should be co-prescribed when starting gonadorelin analogues due to the risk of tumour flare.
36
The recent history of tonsillitis + Urine dipstick- protein 1+, blood 3+, nitrites negative.
Post streptococcal glomerulonephritis.
37
Henoch-Schonlein purpura?
HSP
Hinge pain—Joint pain
Stomach pain
Purpura—palpable purpura ( Non thrombocytopenia )
Kidney—Hematuria/Proteinuria—Kidney failure.
38
Is thrombocytopenia a feature of HSP ?
No.
39
Stage 1 of Diabetic Nephropathy:
Hyperfilteration—Increase in GFR
40
Stage 4 of Diabetic Nephropahty:
Persistent Proteinuria + Hypertension.
Diffuse Glomerulosclerosis and Kimmelstein Wilson nodules.
41
Hematuria + Hemoptysis , Dx?,
Goodpasture syndrome
42
Which Ig deposits in Goddasture?
Linear IgG deposits in Goodpasture.
43
C/o DVT—Sudden onset loin pain+ deteriorating renal function +
Renal vein thrombosis.
44
Minimal change disease electron microscopy :
Effacement of foot podocytes.
Or podocyte fusion.
45
Effacement of foot podocytes.
Or podocyte fusion.
Minimal change disease.
46
Rx for Minimal change disease :
Oral prednisolone.
47
Binge alcohol can lead to which electrolyte imbalance ?
Binge alcohol—act on Posterior pituitary—ADH suppression—polyuria—Hypernatremia.
SIADH ( will cause high adh , due to which , urine will be concentrated and serum dilute)
Alcohol binge will cause ADH suppression , due to which urine will be dilute and serum concentrated
48
H/o Malignancy + Pitting oedema + Frothy urine
Membranous Glomerulonephritis
49
Membranous Glomerulonephritis association :
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
50
Membranous Glomerulonephritis biopsy findings :
Basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance
51
Finasteride treatment of BPH may take___ before results are seen
6 Months.
52
Diagnosing test of Vesicoureteric reflux disease ?
Micturating cystography(MCUG)
53
H/o recurrent sinusitis + Hematuria + Oliguria + worsening urea and creatinine :
Granulomatosis with polyangitis. ( Wegner’s )
54
Granulomatosis with polyangitis. ( Wegner’s )
H/o recurrent sinusitis + Hematuria + Oliguria + worsening urea and creatinine
55
Non-seminoma germ cell testicular tumours (e.g. teratomas) are associated with:
Raised hCG and AFP.
56
Pre renal uraemia : Urinary sodium :
< 20 ( Kidney is normal, absorbs back all the Na, H20, Urea)
57
Pre renal uraemia: FeNA ( fractional excretion of Na )
<1 % ( Kidney is normal, absorbs back all the Na, H20, Urea)
58
Pre renal uraemia : Fractional Urea excretion :
< 35 % (Kidney is normal, absorbs back all the Na, H20, Urea)
59
Pre renal Uraemia : BUN(Urea) / Creat :
Kidney is normal, absorbs back all the Na, H20, Urea)
Urea is absorbed—So numerator decrease— Ratio increases.
60
Infection ass with renal transplant :
Cytomegalovirus.
61
Heroin use is a risk factor for:
focal segmental glomerulosclerosis.
62
focal segmental glomerulosclerosis
Heroin use
63
Granulomatosis with polyangitis(Wegner’s) ass with which Glomerulonephritis ?
It’s ass with : Rapidly progressive Glomerulonephritis (crescentic)
64
Testicular seminomas Is ass with :
Non Seminoma germ cell t
seminoma—Raised HCG ( semen causes pregnancy , bHCG is raised in pregnancy—so seminomas have high Hcg level )
Non seminoma—alpha fetoprotein
65
Intrinsic AKI is caused by which antibiotic ?
Gentamycin.
66
No preceding illness—sudden onset malaise + pallor + —No diarrhoea+ abd pain — microangiopathic haemolytic anaemia (Coombs negative) + Schistocytes + Thrombocytopenia+ Renal failure
Atypical Hemolytic Uraemic syndrome.
67
Differentiate Atypical HUS with HUS and TTP
TTP: pentad.
HUS: Preceding diarrhoea + Abdomen pain
68
Interstitial nephritis Common cause :
NSAIDs
69
Interstial nephritis features :
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
70
Which part has defect in fanconi :
PCT
71
Electrolyte imbalance in Fanconi :
Increased urinary excretion of glucose and phosphate.
Hypokalemia
Low calcium and phosphate.
72
73
K/C/O Renal cell carcinoma + C/o- Abdominal discomfort + RUQ pain +
Elevated ALP+ GGT+ Increased prothrombin time + Hepatosplenomegaly + without hepatic mets.
Paraneoplastic hepatic dysfunction syndrome
74
Tacrolimus common side effect:
Hand tremors
75
vitamin D supplement in end-stage renal Disease :
Alfacalcidol is used as a vitamin D supplement in end-stage renal disease because it does not require activation in the kidneys
76
Proteus mirabilis infection predisposes To :
Struvite stones
77
Struvite stones Is ass with which microbe :
Proteus mirabilis infection
78
Productive cough + sputum—Jt pain + abd pain + constipation + increased calcium in blood—Lt sided varicocele. Dx?
Renal Cell Carcinoma
79
Does RCC cause Increase in growth hormone ?
No.
80
Does RCC cause increase in renin ?
Yes—Leads to aldosterone—absorbs Na and H2O—Secondary Hypertension.
81
Does RCC cause increase Parathyroid ?
Yes—Increase in serum calcium
82
Does Rcc cause increase in ACTH production ?
Yes—Ectopic ACTH production—Increase in serum Cortisol—Cushing’s syndrome.
83
Autosomal Recessive Polycystic Kidney diagnosed how?
Can be diagnosed on prenatal ultrasound.
84
Marker of poor prognosis in IgA Nephropathy ?
Male gender.
Proteinuria (especially > 2 g/day), Hypertension,
Smoking.
Hyperlipidaemia.
ACE genotype
85
Marker of good prognosis in IgA Nephropathy ?
Frank Hematuria.
86
Infections causing Membranous nephropathy ?
hepatitis B, malaria, syphilis
87
Drugs causing Membranous Nephropathy ?
Gold, Penicillamine, NSAIDs
88
Mnemonic for causes of papillary necrosis :
POSTCARDS
Pyelonephritis.
Obstruction of the urogenital tract, Sickle cell disease.
Tuberculosis.
Cirrhosis of the liver, Analgesia/alcohol abuse,
renal vein thrombosis.
Diabetes mellitus, and systemic vasculitis.
89
Does syphilis cause Papillary necrosis ?
Syphilis
90
Drugs causing retroperitoneal fibrosis ?
Methysergide
91
Causes of Retroperitoneal Fibrosis ?
Riedel's thyroiditis
previous radiotherapy
sarcoidosis
inflammatory abdominal aortic aneurysm
92
Which SLE meds is safe in pregnancy ?
Azathioprine
93
Which Med causes false negative PSA ?
Finasteride
94
Abiraterone acetate MOA:
Blocks cytochrome P450 17 alpha-hydroxylase— It blocks androgen production in the testes and adrenal glands, and in prostatic tumour tissue.
95
Calcium resonium MOA:
Removal of potassium from the body—By by preventing enteral absorption— It exchanges potassium for the Ca++
96
Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys.
Dx and Ix :
Renal artery stenosis.
Ix: MR Angiography.
97
Renal artery stenosis Ix ?
MR Angiography.
98
Renal Artery Stenosis Clinical Feature :
Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys.
99
Which antibodies in Membranous Glomerulonephritis ?
anti-phospholipase A2 antibodies
100
Diabetes insipidus in patients taking lithium mechanism:
lithium desensitizes the kidney's ability to respond to ADH in the collecting ducts
101
Young female, hypertension and asymmetric kidneys
Fibromuscular dysplasia.
102
Fibromuscular Dysplasia Ultrasound:
Assymetric kidneys
103
K/C/O End renal Disease + intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar:
Calciphylaxis.
104
Calciphylaxis.
K/C/O End renal Disease + intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar:
105
Urinary incontinence 1st line :
Oxybutinin
106
A 45-year-old woman presents to the Emergency Department with generalised weakness, bone pain, and frequent urination. On examination, she exhibits mild tenderness in her back.
+ Hypokalemia + Hypocalcemia + Hypoposphatemia + increased urinary excretion of glucose + increased urinary excretion of phosphate :
Fanconi Syndrome—defect in PCT.
107
Fanconi syndrome defect where ?
Defect in PCT ( Shoe—RTA 2 very proximally located to FAN )
108
Fanconi syndrome features :
Adult + Fatigue + Bone pain
Hypokalemia + Hypocalcemia + Hypoposphatemia + increased urinary excretion of glucose + increased urinary excretion of phosphate.
109
Which RTA in Fanconi ?
RTA type 2
110
Bicalutamide MOA :
Androgen receptor Blocker.
Used in CA prostrate.
111
Renal Biopsy in Goodpasture’s :
IgG Deposits in basement membrane.
112
Main Rx of Rhabdomylosis :
IV Fluids.
113
eGFR variables:
CAGE
Creatinine
Age
Gender
Ethnicity
114
Is Serum Urea a eGRF Variable ?
No
115
Acute management of renal colic
IM Diclofenac
116
Membranoproliferative glomerulonephritis secondary to partial lipodystrophy. Which type of complement is likely to be low?
C3
117
SLE is ass with which Glomerulonephritis ?
Class 4 Diffuse Proliferative Glomerulonephritis.
118
Hemolytic Uraemic Syndrome causative organism ?
E coli.
119
HUS Triad :
AKI + Microangiopathic Hemolytic anaemia + Thrombocytopenia
120
Drugs to be avoided in AKI :
DAMN drugs
Diuretics
Ace inhibitors/ARBs
Metformin
NSAID
121
Is aspirin safe in AKI ?
Yes
122
In urine dip, lack of nitrates rules out what ?
Rules out Infection
123
In urine dip, Presence of protein rules out what ?
Presence of protein rules out—Pre renal and post renal causes of AKI
124
3 causes of Intrinsic AKI:
Glomerulonephritis—Proteinuria & Hematuria.
Acute interstial Nephritis—Inflamatory process—Therefore presence of WBC.
Acute tubular Necrosis—Not inflammatory process—No WBC
125
On Spironolactone—Develops Painful Gyanaecomastia. Next step ?
Switch from Spironolactone to Eplerenone
126
Which cancer in Transplant patients ?
Squamous cell carcinoma
127
Tolvaptan MOA :
Vasopressin receptor 2 antagonist.
Toll Gate preventing(Antagonist) cars from crossing
128
ADPKD Rx:
Tolvaptan—Vasopressin receptor 2 antagonist.
129
Which medication removes potasium from the body rather than shifting potassium between fluid compartments in the short-term?
Cacium Resonium
130
Normal anion gap acidosis cause :
Diarrhoea
TPN
Rental Tubular Acidosi—Can’t hold on to Bicarbonate
Fistula
131
HIV ass Nephropathy Rx:
Anti retroviral therapy
132
Rx for Squamous cell carcinoma ?
Surgical Excision and biopsy
133
Nephrogenic DI mutation ?
Mutation in Vasopressin receptor 2
134
Family H/o recurrent stones + patient- C/o Recurrent stones. Dx:
Cystinuria
135
Cystinuria or Homocystinuria. Which is the cause of recurrent renal stones ?
Cystinuria
136
Apart from IV Fluids, what is the Rx of HUS ?
Plasma Exchange.
137
Prognosis of Minimal change disease in 10 year old child ?
Good prognosis but with later relapses.
138
Goserelin MOA :
GnRH Agonist.
139
Which test is positive in Cystinuria ?
Cyanide Nitropruside test.
140
Cyanide Nitroprusside test is positive in ?
Cystinuria and Homocystinuria
141
Cause of transient non visible Hematuria ?
Sex
UTI
Periods
Exercise
142
Long term benefit of Erythropoietin injection ?
Improved Exercise Tolerance
143
Rx for Membranous Nephropathy :
ACE inhibitor
144
Holiday history + Tender swollen right testis. Dx and Rx:
Epididymo orchitis
Rx: IM Ceftriaxone + doxycycline for 2 weeks
145
Electrolyte cause of Nephrogenic DI :
Hypercalcemia— Calcium deposits in the kidneys interfere with their ability to concentrate urine.
Hypokalemia
146
Does Demeclocyline cause Nephrogenic DI ?
Yes—By Blocing V2 receptor
147
Is long bone fracture side effect of Erythropoietin ?
No—Bone ache is the side effect.
148
Is pure red cell aplasia the side effect of Erythropoietin ?
Yes
149
Is hypertension the side effect of erythropoietin ?
Yes
150
Fanconi, which RTA ?
RTA type 2–proximal RTA
151
AA Amyloidosis is ass with ?
Rheumat condition
152
AL Amyloidsosis is ass with ?
AL—Liquid—Hemat condition
153
Which stain in amyloidosis ?
Congo red stain—Apple green Birefringes
154
Which inheritance in Alport ?
X Linked Dominant( Large X shaped Fighter Jet)
155
Renal Biopsy in Alport ?
Basket weave appearance
splitting on the lamina densa resulting in an abnormal glomerular-basement membrane.
156
Progressive renal failure + SNHL+ Opthal—Lenticonus. Dx?
Alport
157
Screening for adult polycystic kidney ?
Ultrasound
158
Kidney issues + Bleed on brain
ADPKD
159
Which hearing loss in Alport ?
SNHL
160
Renal transplant HLA matching, which one reduces risk of rejection ?
HLA DR
161
HIV is ass with which Glomerulonephritis?
Focal Segmental Glomerulosclerosis
162
Nephrotic syndrome in children / young adults:
Minimal Change Disease
163
How to prevent the formation of ascites in patients with chronic liver disease?
Spironolactone—Aldosterone antagonist
164
Which antibodies in Goodpasture?
Anti Glomerular Basement membrane antibodies
Goodpasture—Anti GBM
165
Calcium Oxalate stones prevention ?
Pyridoxine
166
Which chromosome in ADPKD ?
Chromosome 16
167
Suspected Rhabdomylosis, which blood test to do ?
Plasma Creatine Kinase.
168
Nephritic picture + Coeliac’s disease. Dx ?
IgA Nephropathy is ass with Coeliac’s
169
the most common glomerulonephropathy linked to renal vein thrombosis?
Membranous Glomerulonephritis
170
Most common nephrotic syndrome ass with thrombosis ?
Membranous Glomerulonephritis
171
K/C/O Membranous Glomerulonephritis + Deteriorating renal function + Left Flank Pain. Dx?
Renal Vein Thrombosis
172
Kidney shape in HIV Nephropathy ?
Normal or Large kidneys
173
Which gene defect in ADPKD ?
PKD1 gene defect
174
Is Hypertension a feature of Minimal Change Disease ?
No
175
Why do patients with chronic kidney disease have a raised phosphate level?
Decreased Renal Excretion
176
First line in BPH ?
Alpha 1 antagonist ( Tamsulosin )—then give 5 alpha reductase inhibitor
177
if the initial ACR is between 3 mg/mmol and 70 mg/mmol, Then ?
Repeat the test
178
ADPKD Inheritance ?
Autsomal Dominant
179
Wegner’s Glomerulonephritis ?
Crescentric Glomerulonephritis
180
Factors which affect eFGR variables?
Pregnancy
Muscle Mass
181
In HUS, what will the blood work show ?
Fragmented red blood cells
182
Recovery in HSP ?
Full Renal Recovery
183
Aquaporin 2 channel defect can lead to :
Diabetes Insipidous
184
Confirmatory test for renal stones ?
NCCT
185
ADPKD is ass with which gene ?
Chromosome 4
186
Hematuria + < 40 years. Referral to ?
Nephrology
187
Hematuia + > 40. Referral to ?
Urology
188
Staghorn calculus composition ?
Ammonium Magnesium
189
What deficiency in nephrotic syndrome leads to hypercoaguable state ?
Anti Thrombin 3 deficiency
190
Another name for Goodpasture :
Anti Glomerular basement membrane disease
191
Which collagen defect in Alport ?
Collagen 4
192
preferred method of access for haemodialysis
Arteriovenous Fistula
193
Nephrotic features—left sided flank pain and Hematuria. Dx:
Renal vein thrombosis—D/t Hypercoaguable state.
194
URTI infection 3 weeks ago—Now Hematuria.
PSGN
IgA occurs in 3 days.
195
Most common infection in peritoneal dialysis :
Staph epidermidis
196
Alpha 1 Antagonist example :
Doxazosin
Tamsulosin
197
Alpha 1 Antagonist side effects :
Postural hypotension
Dizziness
198
How to differentiate Wegner’s from Goodpasture :
While Wegner’s can cause similar symptoms to Goodpasture's syndrome, such as haemoptysis, cough and renal impairment, it would typically also present with systemic features such as fever, weight loss and malaise. Furthermore, GPA often leads to an elevation in inflammatory markers like ESR or CRP which is not evident in this case.
199
Hyperkalemia. Most appropriate method to lower pottasium level :
Insulin/dextrose
Not calcium gluconate—it stabilises the myocardium, hence it’s an adjunct therapy, not primary.
200
Complication of plasma exchange :
Hypocalcemia
201
CKD on haemodialysis - most likely cause of death is
IHD
202
Cystine stones what kind of shadow in X-ray ?
Cystine=cysti=50-50—Semi Opaque in appearance
203
Complications in ADPKD :
Hepatomegaly due to hepatic cyst
Mitral valve prolapse
204
Uric acid stone is :
Radio lUcent—so requires usg or CT-KUB
205
Indicator for renal replacement therapy In AKI :
hyperkalaeamia which is refractory to medical management
206
following factors is most associated with an increased risk of developing bladder cancer
Aniline dye
207
208
