Nephrology Flashcards
(168 cards)
1
Q
hyaline casts can be seen in
A
normal urine
after exercise
during fever
loop diuretics
2
Q
hyaline casts consist of what protein
A
Tamm Horsfall protein
3
Q
bland (minimal abnormalities under microscope) urinary sediment suggest
A
pre renal uraemia
4
Q
urinalysis in SLE is to rule out
A
proteinuria
5
Q
most common and severe form of renal complication in SLE
A
diffuse proliferative glomerulonephritis
6
Q
diffuse proliferative glomerulonephritis in SLE has what appearance
A
wire loop - endothelial and mesangial proliferation
immune complex
granular appearance on immunofluorescence
7
Q
mx of renal complication of SLE
A
- treat hypertension
if class 3 or 4 - glucocorticoids and either mycophenolate or cyclophosphamide
8
Q
large doses of spironolactone used in
A
ascites
9
Q
effects of spironolactone
A
hyperkalaemia and gynaecomastia (less common with eplerone)
10
Q
statins if co prescribed with – can cause rhabdomyolysis
A
clarithrmycin
11
Q
AKI with 5 times raised creatinine
A
rhabdo
12
Q
pts on immunosuppressants after transplant are at increased risk of
A
skin cancers
13
Q
2 drugs that may be used in renal transplant
A
cyclosporin and tacrolimus
14
Q
renal transplant presenting within mins to hrs
A
hyperactute rejection - due to antibodies to ABO or HLA
15
Q
mx of hyperactive rejection
A
graft must be removed
16
Q
acute graft failure presenting <6mionths - mismated HLA picked up
A
asymtpmatic but rising creatinine, pyuria and proteinuria
17
Q
acute graft failure mx
A
steroids and immunosupresants
18
Q
HLA antigens imporantce
A
DR>B>A
19
Q
renal failure defined as GFR less than
A
15
20
Q
haemodialysis is how often
A
3 times per week each lasting 3-5hrs
21
Q
at least 8 weeks before haemodialyssi they need surgery to create the site for it by making a what
A
AV fistula
22
Q
peritoneal dialysis can
A
don’t really need to come into Hospital
23
Q
tranported kidney needs to be attached to
A
external iliac vessels
24
Q
NSAIDS and sickle cell can cause renal papillary necrosis
A
25
renal papillary necrosis can present with
visible haematuria, loin pain, proteinuria
26
rapidly progressive glomerulonephritis associated with
epithelial crescents in majority of glomeruli
27
post streptococcal glomerulonephritis is most commonly caused by
Strep pyogenes
28
what titre are used to confirm the diagnosis of recent streptococcal infection in post strep glomerulonephritis
raised anti-streptolysin O
29
electron microscopy - humps caused by immune complex deposits
imunnoflurosence - starry sky
post strep glomerulonephritis
30
lithium is a cause of
polyuria
31
what is the most common organism to cause peritonitis from peritoneal dialysis
stap epidermis
32
contrast media nephrotoxicity may be defined as
25% increase in creatinine occurring within 3 days of IV administration of contrast
33
procedures that can cause contrast induced nephroapthy
CT with contrast
coronary angiography
PCI
34
around 5% of patients who've undergone PCI develop a transient rise in the plasma creatinine concentration of more than ---- µmol/L
88
35
Patients who are high-risk for contrast-induced nephropathy should have ------ withheld for a minimum of 48 hours and until the renal function has been shown to be normal. This is due to the risk of lactic acidosis.
metformin
36
do what to reduce contrast nephroapthy
IV fluids before and after
37
why in nephrotic syndrome complications there is an increased risk of VTE
loss of antithrombin and plasminogen in urine
38
triad of nephrotic
proteinuria curing hypoalbuminaemia nad oedema
39
nephrotic causes
Primary causes: Minimal change disease, focal segmental glomerulosclerosis (FSGS), membranous nephropathy.
Secondary causes: Diabetes mellitus, systemic lupus erythematosus (SLE), amyloidosis, infections (HIV, hepatitis B and C), drugs (NSAIDs, gold therapy
40
in nephrotic syndrome what happens to the thyroxine binding globulin
lowers the total but not free thyroxine levels
41
most common cause of nephrotic syndrome in kids
Minimal change
42
proteinuria in minimal change is
highly selective - only intermediate protein which as albumin and transferrin leak through glomerulus
43
if steroids not work for minimal change
cyclophosphamide
44
anion gap calculated by
Na +k -( cl +HCO3)
45
If a question supplies the ---- level then this is often a clue that the anion gap should be calculated. The normal range = 10-18 mmol/L
chloride
46
normal anion met acidosis
GI losses, renal tubular acidosis, Addisons or acetozolamide
47
electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a 'spike and dome' appearance
membranous glomerulonephritis
48
membranous nephroapthy is frequently associated with
malignancy
49
mx of membranous nephroapthy
acei or arb - as shown to reduce proteinuria
50
electron microscopy: subendothelial and mesangium immune deposits of electron-dense material resulting in a 'tram-track' appearance
membranoproliferative glomerulonephritis
51
what has a poor prognosis bt may give them steroids
membranoproliferative
52
most common cause of glomerulonephritis worldwide
IgA nephropath y
53
IgA nephroapthy considerable overlap with
HSP
54
mesangial hypercellularity
IgA
55
other differentiating between Ina and post strep
post strep has low complement
post strep is more prteinuria although haematuria can occur
56
when do you not need treatment for IgA
if minimal proteunira and normal GFR
57
in IgA when give Acei
persistent proteinuria or slightly reduced or normal GFR
58
Hypokalaemia predisposed to digoxin toxicity especially if also on
diuretics
59
U wave
hypokalaemia
60
symptoms of hypoakalemia
muscle weakness and hypotonia
61
drugs that can aggravate hyperkalaemia
acei
62
hyperkalaemia is severe if over
6.5
63
what occurs first in hyperkalaemia on ecg
Peaked tall t waves
64
what can shift K from extracellular to intra
Insulin/dextrose infusion
salbutamol
65
for removing K from body using calcium resonium what is better eneam or oral
enema
66
what other drug can lower K
loops
67
mx of HIV associated nephropath y
compliance of antiretroviral therapy
68
HIV nephroapthy can cause
nephrotic syndrome due to (FSGS)
69
where is palpable purpuric rash in HSP
buttocks and extensors surfaces
70
features of HSP
rash, abdo pain, polyarthtis, IgA nephropahty
71
mx of HSP
analgesia for arthritis and geenrally suportive
72
what should be monitored in HSP to detect progressive renal involvement
Blood pressure and urinalysis
73
haemolytic uraemia syndrome triad
- aki
- microangiopathic haemolytic anaemia
-thrombocytopenia
74
most common cause of HUS
shiva toxin producing e.coli
75
most useful initial test for HUS
blood film
76
as there is MAHA in HUS you may see
schistocytes
77
hus mx
supportive
78
eculizumab may have a role in
HUS
79
stool what for shiga toxin
PCR
80
patients under the age of --- years with normal renal function, no proteinuria and who are normotensive do not need to be referred and may be managed in primary care
40
81
sclerosis and hyalinosis on microscopy and also has effacement of foot process
focal segmental glomerulosclerosis
82
steriods for fsgs
think sclerosis
83
maintenance fluids for adult
25-30ml/kg of water
1mmol/kg of K,Na,Cl
500-100g of glucose
84
first 24hrs of admition
25-30mk/kg/day of sodium chloride 0.18% in 4% glucose with 27ml K
85
0.9% saline
if large volumes are used there is an increased risk of hyperchloraemic metabolic
acidosis
86
most fluid in humans is stored
intracellular
87
what is the most common cause of falcon syndrome in children
cystinosis
88
falcon syndrome is disorder of
proximal convoluted tubule
89
falcon syndrome features
renal tubular acidosis
polyuria
90
erythropoietin use
treat anaemia associated with CKD
91
s/e of erythropoietin
accelerate hypertension that can lead to encephalopathy and seizures
92
why might a pt fail to response to erythropoietin therapy
iron deficiency
93
analogue of EPO that is good
darbepoetin
94
what do to screen for diabetic nephorapthy
albumin:creatinien ratio (should be an early morning specimen)
95
mx of diabetic nephroapthy
dietary protein restriction, acei or arb if urinary ACR is over 3
96
Diabetes insipidus is a deficiency of
adh
97
deficiency in ADH referred to as
cranial DI
98
insensitivity of kidney to ADH is
nephorgenic DI
99
wolframs syndrome has
DI, Diabetes and eye and ear issues
100
lithium can cause nephrogenci DI as it
desensitises the kidneys ability to respond to ADH
101
what has high plasma osmolality and low urine
DI
102
ix for DI
water deprivation test
103
wha test can differentiate cranial from nephrogenic DI
desmopressin test - an increase in urine osmolality suggests cranial
104
mx of cranial
desmopressin - as its a deficiency
105
mx of nephrogenic DI
thaizides and low salt and low protein diet
106
what is preferred for measuring proteinuria
albumin:creatine ratio over protein:creatine ratio!!!!!!
107
proteinuria especially is an important marker fro CKD in
diabetics
108
for ACR sample if between 3-7- then do another to check. If first over 70 then
not required to do another one
109
clinical important proteinuria if ACR >
3
110
egfr below 15
kidney failure
111
key mx of proteinuria
acei /arbs
112
what other drug may help in proteinuria CKD
SGLT2i
113
what causes osteomalacia in CKD
high phosphate - drags calcium from bones
114
first line mx of mineral bone disease in CKD
reduce phosphate intake
115
example of a phosphate binder that may be used in ckd bone mx
sevelamer
116
what can be caused by secondary hyperparathytoridism in ckd
brown tumour
117
NICE suggest that a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable, although any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs). A rise greater than this may indicate underlying renovascular disease.
acei
118
what is a useful antihypertensive in those with CKD particularly if the GFR falls below 45 &has the added benefit of lowering K
furosemide. however if become dehydrates then cosndeireation should be given to stop it
119
why might serum creatinine not prove an accurate estimate of renal function
due to differences in muscle
120
eGFR uses
serum creatinine
age
gender
ethnicity
121
factors which can affect eGFR
preg
muscle mass
eating red meat 12hrs before sampel
122
if normal u&es and no proteinuria in ckd above egfr 60 do you treat
no
123
osteitis fibrosa cystica
aka hyperparathyroid bone disease - think CKD
124
anaemia in ckd becomes apparent when egfr below
35
125
anaemia in ckd associated with development of
left ventricular hypertrophy
126
what to do before give erythropoeriz stimulating agents in CKD anaemia
check and correct if needed iron status
127
hepcidin levels in ckd
increased
128
how long does it take for AV fistulas to develop
6-8weeks
129
renal biopsy shows multiple cylindrical lesions
arpkd
130
potters syndrome secondary to oligohyramnios
arpkd
131
arpkd
fibrocystin- protein defect
132
anti glomerular basement menbrane disease is also
goodpastures
133
goodpastues antibodies against collagen type
4
134
what is the glomerulonephritis in good pastures
rapidly progressing - rapid onset AKI
135
IgG deposits along basement membrane
goodpasturs
136
what factor is raised in good pastures secondary to pulmonary haemorrhages
transfer factor
137
mx of goodparues
plasma exchange (plasmapheresis)
steroids
138
normal anion gap is between
8-14
139
most alport syndrome inheritance
x linked dom
140
alport defect in gene that codes for
Tpe 4 collagen that mades glomerular basement membrane
141
disease of alports is more severe in
men
142
microscopy shows splitting of lamina dense of the glomerular basement membrane resulting in a basket weave appearance
alport syndrome
143
microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
retinitis pigmentosa
renal biopsy: splitting of lamina densa seen on electron microscopy
alport syndrome
144
A favourite question is an Alport's patient with a failing renal transplant. This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture's syndrome like picture
145
features of auto com polycystic kidney disease
- hypertension
-recurrent its
-flank pain
-haematura
palpabel kidneys
146
in ADPKD what is the most common extreme renal manifestation
liver cysts (may cause hepatomegaly )
147
berry aneurysms in -- can cause SAH
ADPKD
148
ADPKD associated with mitral valve
prolapse
149
what type is more common in ADPKD
1
150
screening for ADPKD
abdo US
151
what drug can slow progression of cyst development in ADPKD
TOLVAPTAN
152
nephrotic drugs
antihypertensives and aminoglycosdes
153
normal or bland sediment suggest
pre renal cause of AKI
154
AKI may be detected if
- reduced urine output
- fluid overload(pulmonary and peripheral oedema)
-rise in K, urea, creatinine( arryhtmias secondary to K Changes, pericarditis or encephalopathy due to uraemia)
155
AKI bloods
U&es = sodium, K , urea, creatinine
156
when renal replacement therapy
hyperkalaemia
pulmonary oedema
acidosis
uraemia (pericarditis, encephalopathy )
157
best ways to differentiate AKI from CKD
renal US
158
finding on renal US that suggest CKD over AKI
ckd have bilateral small kidneys - exception is ADPKD, early stages of diabetic nephroapthy ...
159
another feature that suggest CKD rather than AKI
Hypocalcaemia
160
most common drug cause of acute interstitial nephritis
antibiotics eg penicillin
161
fever, rash, arthralgia, eosinophilia
acute interstitial nephritis
162
ix of acute interstitial nephritis shows
sterile pyuria
white cell casts
163
marked oedema on histology is
acute interstitial nephritis
164
what other drug of many can cause acute interstitial nephritis
NSAIDS
165
benzo and opiate overdose cause
resp acidosis
166
altitude causes
resp alkalossi
167
met alkalosis
vomiting, diuretics
168
