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MRCP Part 2 > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

When to refer AKI to nephrology?

A

Transplant
Stage 3
CKD stage 4-5
Candidate for renal replacement

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2
Q

Indications for acute dialysis?

A

AEIOU

Acidosis- pH <7.2
Electrolytes- resistant hyperK
Intoxication- drug overdose
Oedema (refractory pulmonary oedema)
Uraemia (encephalopathy or pericarditis)

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3
Q

What is nephritic syndrome?

A

Haematuria +++
Small amount of proteinuria (+/++)
Oedema and HTN

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4
Q

Causes of nephritic syndrome?

A

IgA nephropathy
Rapidly progressive GN
Alport syndrome

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5
Q

What is IgA nephropathy AKA?

A

Berger’s disease

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6
Q

What is IgA nephropathy AKA berger’s disease?

A

Nephritic syndrome

Haematuria 1-2 days post URTI in young adults as IgA deposition causes glomerular injury

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7
Q

Associations with IgA nephropathy?

A

HSP
Alcoholic cirrhosis
Coeliac disease

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8
Q

Renal biopsy in IgA Nephropathy AKA berger’s disease?

A

Diffuse mesangial hyper cellularity
IgA and C3

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9
Q

Management of IgA nephropathy AKA berger’s disease?

A
  • Haematuria + proteinuria <500 + normal eGFR: FU only
  • Persistent proteinuria >500 + normal/ slightly raised: ACEi
  • Active disease + falling eGFR or not responding: corticosteroids
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10
Q

Good prognostic factor in IgA nephropathy?

A

Frank haematuria

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11
Q

Poor prognosis in IgA nephropathy?

A

Male
Proteinuria >2
HTN
Smoking
Hyperlipidaemia

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12
Q

What is Alport syndrome?

A

X linked dominant disorder of type 4 collagen causing abnormal basket weave basement membrane

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13
Q

Presentation of Alport syndrome?

A

Microscopic haematuria
Progressive renal failure in childhood
Bilateral sensorineural hearing loss
Lenticonus
Retinitis pigmentosa

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14
Q

Biopsy with alport syndrome?

A

Lack of collagen with splitting of the lamina densa
Basket weave appearance

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15
Q

Alport syndrome diagnosis?

A

Molecular genetic testing (X linked dominant)
Biopsy- basket weave and splitting of the lamina densa

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16
Q

Risk of what other renal disease with alport syndrome post transplant?

A

Good Pastures syndrome - anti GBM antibodies

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17
Q

What is Nephrotic syndrome?

A

+++ Proteinuria >3.5g
Hypoalbuminuria
Peripheral oedema

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18
Q

Complications of nephrotic syndrome?

A

VTE including renal vein thrombosis due to loss of antithrombin III- give warfarin
Hyperlipidaemia
CKD
Infection
HypoCa

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19
Q

What are the causes of nephrotic syndrome?

A

MAD MF

Minimal change disease
Amyloidosis
Diabetic nephropathy
Membranous GN
FSGN

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20
Q

Most common cause of nephrotic syndrome in children?

A

Minimal change disease

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21
Q

Most common cause of nephrotic syndrome in adults?

A

Membranous glomerulonephritis

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22
Q

What is minimal change disease?

A

T cell and cytokine damage to GBM which can be idiopathic, NSAID, rifampicin, hodgkins lymphoma or mono

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23
Q

How is minimal change disease seen?

A

Nephrotic syndrome
Normotension
Highly selective proteinuria- albumin and transferrin

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24
Q

Biopsy of minimal change disease?

A

Normal glomeruli on light microscopy
Fusion podocytes with enhancement of foot processes on electron microscopy

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25
Treatment of minimal change disease?
Steroids If resistant: cyclophosphamide
26
What is membranous glomerulonephritis?
Immune mediated disease of the glomerular basement membrane due to: - anti phopsholipase A2 antibodies - Malignancy - Infections: hep B, malaria, syphilis - Gold, penicillamine, NSAIDs - SLE, thyroiditis, RA
27
What malignancies are associated with membranous glomerulonephritis?
Prostate Lung Lymphoma Leukaemia
28
Biopsy of membranous glomerulonephritis?
BM thickening Subepithelial immune complex deposition Spike and dome pattern
29
Treatment of membranous glomerulonephritis?
ACEi or ARB + cyclophosphamide
30
Prognosis of membranous glomerulonephritis?
1/3 resolve 1/3 proteinuria 1/3 ESRD
31
What is focal segmental glomerulosclerosis?
Nephrotic syndrome with HIV/ heroin use associated with APOL1 gene with high recurrence rate in renal transplant
32
Biopsy of FSGS?
Focal and segmental sclerosis Effacement of foot processes
33
Treatment of FSGS?
High dose steroids + ciclosporin
34
What is amyloidosis?
Deposition of amyloid seen with congo red staining apple green birefringence
35
Diagnosis of amyloidosis?
Biopsy of skin/ rectal mucosa/ fat with apple green birefringence on congo red staining
36
3 types of amyloidosis?
AL AA Beta 2 microglobin
37
What is AL amyloidosis?
Most common type L for light chain immunoglobulin Due to myeloma, waldenstroms, MGUS
38
Presentation of AL amyloidosis?
Nephrotic syndrome with cardiac, neuro involvement
39
What is AA amyloidosis?
A protein seen in chronic infection and inflammation: TB, bronchiectasis, RA
40
Who is beta 2 microglobin amyloidosis seen in?
Renal dialysis patients
41
What causes a mixed picture of nephritic and nephrotic syndrome?
PMD Post Strep GN Membranoproliferative GN Diffuse proliferative GN
42
What is diffuse proliferative glomerulonephritis?
Post strep GN in a child Most common renal disease in SLE
43
What is membranoproliferative GN AKA mesangiocapillary glomerulonephritis?
Immune complex deposition and complement activation with 3 types
44
Type 1 membranoproliferative GN?
Hep C Cryoglobulinaemia Subendothelial deposits Tram tracks 'double contour'- electron dense material
45
Type 2 membranoproliferative GN?
Partial lipodystrophy Factor H deficiency Low C3 Intramembranous deposits
46
Type 3 membranoproliferative GN?
Hep B and C
47
What is Post strep GN?
Haematuria 1-3 weeks post strep infection causing immune complex IgG, IgM, C3 deposition in the glomeruli
48
What kind of strep causes post strep glomerulonephritis?
Group A beta haemolytic strep pyogenes
49
Post strep GN features?
Haematuria Proteinuria HTN High ASOT and DNAse B Low C3
50
Biopsy of Post strep GN?
Subepithelial bumps Starry sky
51
Management of post strep GN?
Supportive management
52
What is Good pastures syndrome?
Anti-GBM antibodies against type 4 collagen seen with pulmonary haemorrhage and rapidly progressive glomerulonephritis
53
Renal biopsy in good pastures (anti GBM disease)?
Crescentic Linear IgG along basement membrane
54
Management of anti-GMB disease (good pastures)?
Plasma exchange Steroids + cyclophosphamide
55
Wegner's grnaulomatosis is linked to what renal concern?
Rapidly progressive GN - Nephritic syndrome - Crescentic epithelium
56
What is renal papillary necrosis?
Necrosis of the renal papillae due to: - acute pyelonephritis - Sickle cell disease - Chronic analgesia use- NSAIDs - Obstructive nephropathy - TB - DM
57
Presentation of renal papillary necrosis?
Haematuria Proteinuria Loin pain Fever
58
Diagnosis of renal papillary necrosis?
IV urography cup and spill appearance
59
Causes of Acute tubular necrosis?
Ischaemia Toxins- gentamicin, cisplatin, NSAIDs, contrast, rhabdo, uric acid
60
How is acute tubular necrosis seen?
Muddy brown casts in urine High Na, Low osmolality
61
Management of acute tubular necrosis?
Correct cause Haemofiltration
62
What is the difference between ATN and prerenal uraemia?
Prerenal uraemia is when hypoperfusion to the kidney results in renal dysfunction with reserved ability to retain water and sodium - Low urinary sodium - High urine osmolality ATN occurs when necrosis means it cant hold sodium and water leading to - High urinary sodium - Low urine osmolality
63
What is contrast induced nephrotoxicity?
25% rise in creatinine within 2-5 days of IV contrast in CT or PCI
64
What is acute interstitial nephritis?
Drug induced AKI
65
How is acute interstitial nephritis seen?
AKI Rash Fever Eosinophillia
66
Causes of acute interstitial nephritis?
Abx NSAID Diuretics Allopurinol
67
How is tubulointersitial nephritis with uveitis seen?
Young women with uveitits, fever and weight loss
68
Causes of rhabdomyolysis?
Long lie Seizure Burns Exercise Statins (with clarithromycin/ fusidic acid/ colchicine) Cocaine MDMA
69
Cola coloured urine?
Rhabdomyolysis
70
CK for rhabdomyolysis?
X5 ULN or >1000
71
Electrolytes in rhabdomyolysis?
HyperK HyperPO HypoCa
72

MRCP Part 2 (6 decks)

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