Printed notes Flashcards
1
Q
what are mesangial cells?
A
specialised smooth muscle cells that support the glomerulus and regulate blood flow and GFR
2
Q
how is the GBM charged?
A
negatively
3
Q
what is the anion gap ?
A
difference between total cations and total anions
4
Q
what charge are cations and anions?
A
cations = + anions = -
5
Q
can negatively charged particles such as albumin pass through the GBM?
A
no
6
Q
what substance does baroreceptors control the release of ?
A
ADH
7
Q
what are the specialised cells in the afferent arteriole called?
A
juxtaglomerular cells
8
Q
where is the most Na reabsorbed in the nephron?
A
PCT
9
Q
what ion channel is present in the ascending limb ?
A
Na/K/2Cl triple symporter
10
Q
what is Ca reabsorption under the control of?
A
PTH
11
Q
what is Na reabsorption under the control of?
A
aldosterone
12
Q
where in the nephron does pH and K regulation occur?
A
medullary collecting duct
13
Q
what channels does water pass through in the cortical collecting duct?
A
aquaporin 2- channel
14
Q
what paraneoplastic effects can renal cancers have?
A
EPO - polycythaemia
Renin - HTN
ACTH - cushings
PTHrP - hypercalcaemia
15
Q
give an example of carbonic anhydrase inhibitor that is used for glaucoma ?
A
acetazolamide
16
Q
what affect does carbonic anhydrase inhibitors have on the kidneys ?
A
decreases bicarbonate reabsorption
17
Q
give an example of a loop diuretic?
A
furosemide
18
Q
what is the mechanism of action of thiazide diuretics ?
A
inhibit NaCl in DCT
19
Q
what is the mechanism of action of loop diuretics ?
A
inhibit Na/K/2Cl symporter in thick ascending limb
20
Q
what is the mechanism of action of K sparing diuretics ?
A
Spiro: aldosterone antagonist
Amiloride: blocks DCT/CD luminal Na channel
21
Q
what is a side effect of carbonic anhydrase inhibitors ?
A
drowsiness
renal stones
metabolic acidosis
22
Q
what is a side effect of thiazide diuretic ?
A
hypokalaemia
hyperglycaemia
increased urate
23
Q
what condition is contra indicated with thiazide diuretics ?
A
gout
24
Q
what two molecules can give a false positive for haematuria ?
A
myoglobin, porphyria
25
what molecule can give a false positive for proteinuria ?
bence jones proteins
26
what are causes of proteinuria?
```
DM
minimal change
membranous GN
amyloidosis
SLE
HTN
UTI
```
27
when is creatinine synthesised?
during muscle turn over
28
what is urea produced form and in what cycle?
produced form ammonia by liver in ornithine cycle
29
what would an isolated increased urea suggest?
hypo perfusion
| dehydration
30
state some post renal causes of renal disease ?
```
Stone
Neoplasm
Inflammation: stricture
Prostatic hypertrophy
Posterior urethral valves
Infection: TB, schisto
Neuro: post-op, neuropathy
```
31
state some uraemia symptoms ?
```
pruritus
weight loss
lethargy
confusion
metallic taste
paraesthesia
restless legs
chest pain
```
32
state some symtpoms of Na retention ?
polyuria, polydipsia, breathlessness
33
state some signs of fluid overload ?
oedema
increased JVP
HTN
34
what breathing is seen in acidosis ?
kussmauls breathing
35
what are some symptoms of hyperkalaemia ?
palpitations
chest pain
weakness
36
what sign is seen on X-rays with osteomalacia ?
looser zones
37
what is Urethral Syndrome?
symptomatic but no bacteriuria
38
what are the different types of urolithiasis ?
calcium oxalate
triple phosphate
urate
39
what antibiotic is used for pyelonephritis ?
Cefotaxime
40
what investigations should be done for GN?
Basic: FBC, U+E, ESR
Complement (C3 and C4)
Abs: ANA, dsDNA, ANCA, GBM
Serum protein electrophoresis and Ig
Infection: ASOT, HBC and HCV serology
Dipstick: proteinuria ± haematuria
Spot PCR
MCS
Bence-Jones protein
41
what are the causes of GN?
```
Idiopathic
Immune: SLE, Goodpastures, vasculitis
Infection: HBV, HCV, Strep, HIV
Drugs: penicillamine, gold
Amyloid
```
42
what would be seen on IgA nephropathy biopsy ?
IgA deposition in mesangium
43
what is the treatment for IgA nephropathy?
steroids
44
what are some complications of nephrotic syndrome ?
infection - from reduced Ig, complement activity
VTE
hyperlipidaemia
45
will nephrotic syndrome have an increased or decreased JVP?
decreased
| - fluid deplete
46
what is the treatment for proliferative GN?
supportive
47
what is the treatment for crescentic GN?
plasmapheresis and immunosuppression
48
state some systemic diseases that can cause nephrotic syndrome?
GM - glomerulosclerosis
SLE - membraneous
amyloidosis
49
what is the treatment for minimal change GN?
steroids
50
what does the biopsy of minimal change should?
normal light micro, fusion of podocytes on EM
51
what does the biopsy of membraneous nephropathy should?
subepithelial immune complex deposits
52
what immunoglobulin is deposited in FSGS?
IgM
53
what causes acute interstitial nephritis ?
Immune-mediated hypersensitivity ̄c either drugs or other Ag acting as haptans
54
what is the commonest cause of acute interstitial nephritis ?
drug hypersensitivity
55
what drugs can cause of hypersensitivity and acute interstitial nephritis?
NSAIDs
Abx: Cephs, penicillins, rifampicin, sulphonamide Diuretics: frusemide, thiazides
Allopurinol
Cimetidine
56
what immune disorders can cause acute interstitial nephritis
SLE, Sjogrens
57
what is the presentation of acute interstitial nephritis ?
Fever, arthralgia, rashes
AKI → olig/anuria
Uveitis
58
what does urinalysis show for acute interstitial nephritis ?
haematuria, proteinuria, sterile pyuria
59
what immunoglobulin will be increased with acute interstitial nephritis ?
IgE
60
what is the treatment for acute interstitial nephritis ?
Stop offending drug
| Prednisolone
61
what will CT show for analgesic nephropathy?
CT w/o contrast (papillary calcifications)
62
what is chronic TIN (tubulo-interstitial nephropathy)
fibrosis and tubular loss
63
what causes chronic TIN?
Reflux and chronic pyelonephritis DM
| SCD or trait
64
what can cause nephrocalcinosis ?
```
Malignancy
↑PTH
Myeloma
Sarcoidosis
Vit D intoxification
RTA
```
65
state three endogenous nephrotoxins ?
Haemoglobin, myoglobin
Urate
Ig: e.g. light chains in myeloma
66
what medication is nephrotoxic?
NSAIDs
```
Antimicrobials: AVASTA
Aminoglycosides
Vancomycin
Aciclovir
Sulphonamides
Tetracycline
Amphotericin
ACEi
```
Immunosuppressants Ciclosporin
Tacrolimus
Contrast media
Anaesthetics: enflurane
67
what increases in the blood with rhabdomyolysis ?
K+, PO4, urate
| Myoglobin, CK
68
what causes rhabdomyolysis ?
Ischaemia: embolism, surgery
Trauma: immobilisation, crush, burns, seizures,
compartment syndrome
Toxins: statins, fibrates, ecstasy, neuroleptics
69
what colour is the urine with rhabdomyolysis ?
red/brown
70
what is present in the urine with rhabdomyolysis ?
Hb but not RBCs
71
what is the treatment of rhabdomyolysis
Rx hyperkalaemia
| IV rehydration: 300ml/h
72
what blood tests should be done for CKD?
↓Hb, U+E, ESR, glucose, ↓Ca/↑PO4, ↑ALP, ↑PTH
Immune: ANA, dsDNA, ANCA, GBM, C3, C4, Ig, Hep
Film: burr cells
73
what is found in the urine with myeloma?
BJP (Bence jones proteins)
74
what are some complications of CKD?
```
Cardiovascular disease
Renal osteodystrophy
Fluid (oedema)
HTN
Electrolyte disturbances: K, H
Anaemia
Leg restlessness
Sensory neuropathy
```
75
what condition is Rugger Jersey spine seen?
osteosclerosis
76
what is a bone complication of CKD?
renal osteodystrophy
77
what is the mechanism of renal osteodystrophy?
↓ 1-hydroxylase → ↓ vit D activation → ↓ Ca → ↑ PTH
Phosphate retention → ↓ Ca and ↑ PTH (directly)
↑ PTH → activation of osteoclasts ± osteoblasts
Also acidosis → bone resorption (phosphate lost to excrete H ion in kidneys)
78
what life style changes can be made for CKD?
Exercise
Healthy wt.
Stop smoking
Na, fluid and PO4 restriction
79
what is HTN treated with in DM kidney disease?
ACEi
| ARB
80
what four medications can be given to help with renal bone disease ?
Phosphate binders: sevelamer, calcichew
Vit D analogues: alfacalcidol (1 OH-Vit D3)
Ca supplements
Cinacalcet: Ca mimetic
81
what can be given for restless legs with CKD?
clonazepam
82
what could cause rising Cr in transplant patient ?
Rejection
Obstruction
ATN
Drug toxicity
83
state the pathology of DM renal disease which results in HTN?
Hyperglycaemia → renal hyperperfusion → hypertrophy and ↑ renal size
Hypertrophy and metabolic defects inc. ROS production → glomerulosclerosis and nephron loss
Nephron loss → RAS activation → HTN
84
how is a diagnosis of amyloid kidney disease?
large kidneys in US
| biopsy
85
what renal disease does sarcoidosis result in ?
TIN
| ↑Ca
86
what renal disease does myeloma result in ?
ATN - damage from light chains
87
what is the treatment of myeloma renal disease?
Ensure fluid intake of 3L/d to prevent further impairment
88
what renal disease does NSAIDs result in ?
ATN
89
SLE renal disease proteinuria should be treated with?
ACEI
90
SLE renal disease aggressive GN should be treated with?
immunosuppression
91
what rheumatological condition can have renal crisis as a complication?
diffuse systemic sclerosis
- other complications include small bowel bacteria overgrowth, pulmonary fibrosis
92
what is a renal crisis?
malignant HTN + ARF
93
what is the treatment for renal crisis?
ACEi
94
what is the gold standard investigation for renovascular disease?
renal angiography
95
what is the treatment for renovascular disease?
angiography and stenting
96
what organism causes HUS?
E. coli O157:H7: verotoxin
97
what does HUS stand for ?
Haemolytic Uraemic Syndrome
98
what cells are seen on blood film for HUS?
Schistocytes
99
does HUS have normal clotting ?
yes
100
what is the treatment for HUS?
Usually resolves spontaneously
| Dialysis or plasma exchange may be needed
101
what condition has Genetic or acquired deficiency of ADAMTS13?
Thrombotic Thrombocytopenia Purpura (TTP)
102
what is the treatment for Thrombotic Thrombocytopenia Purpura (TTP)?
Plasmapheresis, immunosuppression, splenectomy
103
what are the features of thrombotic thrombocytopenia purpura?
```
Fever
CNS signs: confusion, seizures
MAHA
Thrombocytopenia
Renal failure
```
104
what does MAHA stand for?
microangiopathic hemolytic anemia
105
what is Fanconi Syndrome?
Disturbance of PCT function → generalised impaired reabsorption
106
what are the features of Fanconi syndrome ?
Polyuria (osmotic diuresis)
| Hypophosphataemic rickets (Vit D resistant) Acidosis, ↓K
107
what is Bartter’s Syndrome?
Blockage of NaCl reabsorption in loop of Henle (as if taking frusemide)
Congenital salt wasting
108
what is Gitelman Syndrome?
Blockage of NaCl reabsorption in DCT (as if taking thiazides)
Congenital salt wasting
