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Renal Flashcards

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1
Q

Elevated PTH is a cause of hyperK in renal failure T/F

A

F - elevated PTH is a cause of hyperCa in renal failure

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2
Q

What is the treatment of idiopathic hypercalciuria?

A

Oral thiazide diuretics - they normalise Ca excretion by stimulating Ca reabsorption in the distal tubule

Note: dietary restriction of Ca is not rec as it is required for growth

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3
Q

Prune belly syndrome is assoc with that GU abnormality?

A

Undescended testes

Other important associations of undescended testes:
SMA
Myotonic dystrophy
X linked ichthyosis
Kallman syndrome
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4
Q

Joubert syndrome is assoc with what renal abnormality?

A

Nephronopthisis

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5
Q

Clinical features of fanconi anaemia?

A

Limb defects
Renal malformations
Bone marrow failure
Predisposition to malignancy

NB different to fanconi renal tubulopathy syndrome - proximal tubular defect with loss of electrolytes, AA and glucose in urine

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6
Q

Turner syndrome is assoc with horseshoe kidney T/F

A

T

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7
Q

Patient’s with nephrotic syndrome should follow a high protein diet T/F

A

F - mod protein, no salt added and fluid restricted diet in oedematous phase

Studies have shown there is no significant benefit on plasma albumin conc or growth from a high protein diet

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8
Q

Patients with Bartter syndrome are hypertensive T/F

A

F - normotensive

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9
Q

Lab abnormalities in Bartter syndrome?

A

Metabolic hypokalaemic alkalosis
Hypercalciuria
Increased renin and aldosterone

Note: normal Mg, normal BP

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10
Q

Nephrotic syndrome usually presents in those > 11 yrs T/F

A

F - age less than 1 or greater than 11 is atypical for nephrotic syndrome

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11
Q

Which RTA has hyperK?

A

Type 4

Note: type 2 and 1 have hypoK

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12
Q

Which RTA is assoc with RA and Sjogren’s?

A

Type 1

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13
Q

Which RTA is assoc with SLE or sickle cell disease?

A

Type 4

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14
Q

HypoCa in renal failure is due to skeletal resistance to PTH T/F

A

T

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15
Q

HypoCa in renal failure is due to hypophosphataemia

T\F

A

F - hyperphosphataemia is assoc with hypoCa

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16
Q

Renal dysplasia is usually assoc with posterior urethral valves T/F

A

T

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17
Q

How does medullary sponge kidney usually present?

A

Often asymptomatic and found incidentally on imaging.

But if symptomatic - UTI, kidney stones or haematuria

Note: it is not a heritable disorder

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18
Q

Medullary sponge kidney usually bilateral or unilateral?

A

Usually bilateral (75%)

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19
Q

Where are cysts found in medullary sponge kidney?

A

In the collecting system

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20
Q

Autosomal dominant polycystic kidney disease is on what Chr?

A

Chr 16 (85% of cases) and rest on Chr5

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21
Q

In post strep glomerulonephritis C3 is typically high T/F

A

F - C3 is typically low and normalizes after 2-4 months

Note: CH50 is also low

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22
Q

In post strep glomerulonephritis C3 is typically low T/F

A

T

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23
Q

Is post strep glomerulonephritis more common in males or females?

A

Males

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24
Q

What values would you expect urinary Na conc and FeNa to be in pre renal injury (compared to ATN)

A

Urinary Na conc < 20mmol and low FeNa (<1%)

This both indicate renal tubal function is intact

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25
Likely causes of nephrocalcinosis in an otherwise healthy 6 month old?
Renal tubular acidosis, Bartter syndrome Also prolonged loop diurectic use
26
Natural hx of multi cystic dysplastic kidney disease?
Can be seen on antenatal USS, has no function and most will involute with age Note: no fxn on DMSA isotope scan is characteristic, they are usually unilateral
27
AR polycystic kidney disease vs AD on ultrasound
AR - enlarged and echogenic kidneys (cysts are so small and diffuse) AD - discrete cysts
28
AR polycystic kidney disease is assoc with HTN and varying degrees of hepatic fibrosis T/F
T
29
In patients with nephrotic syndrome what ages should a referral to a nephrologist be considered?
Age < 12 month or >10 yrs Other referral criteria: macroscopic or persistent microscopic haematuria; impaired renal function not attributable to hypovolaemia; persistent HTN; decreased C3; rash or arthropathy; failure to induce remission with 28 days of pred at 60mg/m2
30
In HSP serum IgA is often elevated T/F
True - it is an IgA medicated vasculitis
31
In children with HSP nephritic features are associated with a poor prognosis T/F
False - nephrotic syndrome is assoc with a poor prognosis; nephritic features is assoc with a poor prognosis in adults
32
What renal condition is levamisole used? Typical dosing and duration of therapy
Patient with frequent relapses of nephrotic syndrome Dosing is every other day for 1-2 yrs Note: MOA is antihelminth that has immune modulator effects
33
What monitoring is needed for pts on levamisole?
FBC every 3 months as it can cause neutropenia
34
New onset gross haematuria in a patient newly diagnosed with nephrotic syndrome is concerning for what complication?
Renal vein thrombosis Note: rare but important complication, the hypovolaemia can predispose them to thrombosis
35
Compare timing of respiratory infection in IgA nephropathy and post strep glomerulonephritis?
IgA nephropathy happens at same time as URI | PSGN happens 1-2 weeks after strep infection
36
Which type of DI will respond to desmopressin? Nephrogenic or central?
Central - as brain is not producing AHD Note: in nephrogenic kidneys are resistant to ADH and hence desmopressin will have no effect
37
In minimal change disease when biopsied the light microscopy will be normal and electron microscopy will show thinning of the capillary basement membrane T/F
F - electron micro will show fusion of foot processes of the glomerular epithelial cells (it is true light micro is normal)
38
In a patient who has severe acute pain (eg secondary to a fracture) and CKD what analgesia is appropriate morphine or fentanyl?
Fentanyl - metabolised by the liver and has no active metabolites that could accumulate in CKD Note: morphine is metabolised to multiple metabolites that can accumulate in CKD
39
What are the lab abnormalities in Gitelman syndrome?
Met alkalosis HypoK, hypocalciuria, hypoMg Elevated plasma renin and aldosterone Note: BP is normal
40
Blood pressure in Liddle syndrome and Bartter syndrome
Liddle - elevated BP Bartter - normal BP
41
Renin and aldosterone in Liddle syndrome?
Low Note: higher in Bartter and Gitelman
42
Lab value to distinguish Gitelman from Bartter?
Mg - v low in Gitelman and normal/mild dec in Bartter
43
How much and for how long must proteinuria be present to make a diagnosis of relapse in nephrotic syndrome?
3+ or more for 3 or more days in a row
44
Do cystinuria and cystinosis cause renal stones?
Cystinuria causes renal stones Cystinosis does not
45
What are the 2 most common causes of acute renal failure from infancy to adolescence?
HUS and post strep GN
46
What are red cell casts characteristic of?
Nephritic syndrome Note: they indicate a microscopic amount of bleeding within the kidney
47
Around what age and how does cystinosis typically present?
In infancy with failure to gain appropriate weight
48
How does nephronophthisis typically present?
Polydipsia and polyuria It then progresses to ESRD over months to years
49
Extra renal manifestations of nephronophthisis?
Hepatic fibrosis Cardiac anomalies Situs inversus
50
Plt transfusion is part of the typical mgmt of HUS T/F
F - it is theoretically contraindicated as it could accelerate thrombus formation
51
Name 3 steroid resistant nephrotic syndromes?
FSGN MPGN Membranous nephropathy associated with Hep B infection
52
What steroid resistant nephrotic syndrome is associated with hypocomplementaemia?
Membranoproliferative GN
53
What is the pentad of symptoms in TTP (thrombotic thrombocytopenia purpura)
``` Thrombocytopenia Microangiopathic haemolytic anaemia with red cell fragmentation on a blood film Fever AKI Neuro symptoms ```
54
Which of these is associated with circulating immune complexes minimal change disease or membranoproliferative GN or both
Membranoproliferative
55
What is the main clinical feature that differentiates RTA type 1 (distal) from type 2 (proximal)
Nephrolithiasis is present in type 1 Note: type 1 is due to failure of acidification of urine at the collecting ducts and hence urine pH is persistently alkaline and favours the precipitation of Ca phos leading to stone formation type 2 is due to a failure of bicarb reabs but urine can still be acidified by the collecting ducts
56
Describe the first 2 steps in vit D metabolism and where they occur
Vit D --> 25- hydroxyVit D (in liver) --> 1,25 dihydroxyVit D (in kidney)
57
What effect, if any, does Vit D have on PTH?
Vit D inhibits PTH Note: Vit D also increases Ca + phos absorption from the gut, increases reabsorption of Ca + phos from the kidneys and enhances bone turn over
58
What values would be expected for PTH and Ca in untreated renal osteodystrophy?
Elevated PTH | Low Ca
59
Is one kidney is more commonly affected in PUJ (pelvico-ureteric junction) obstruction?
Yes- left kidney (2 times as often as the right)
60
How common is pelvico-ureteric junction obstruction?
1 in 750-1000 fetuses Note: males and females are equally affected. Usually managed conservatively.
61
What is the association between CKD and thyroid disease?
CKD is often associated with sick euthyroid state with a reduction in T3 and T4 levels
62
What is the typical presentation of a duplex kidney
As there are 2 ureters for one kidney the 2nd ureter may insert inferior to the bladder neck a typical history is constant dribbling of urine despite normal voiding volume Or can present with recurrent UTIs
63
Hepatic fibrosis is associated with what renal pathology?
AR polycystic kidney disease
64
Complement levels are low in IgA nephropathy T/F
F - they are normal Contrast to post strep GN where C3 is low and C4 can be slightly low too
65
Complement levels are low in post strep GN
T
66
Low C3 levels are found in what GNs
1. Renal limited: post strep; C3 glomerulonephropathy and mesangioproliferative 2. Systemic: SLE, subacute bacterial endocarditis
67
What is the most common cause of hypertension in infancy?
Renal parenchymal disease
68
What are the main triggers for secretion of renin
Hypovolaemia and hypoNa Note: fxn of RAA is to retain Na and water
69
What are the indications for biopsy in HUS?
1. Hypertension 2. Proteinuria (UPCR > 200mg/mmol, with increasing trend, more than 4 weeks after diagnosis) 3. Nephritic or nephrotic syndrome 4. Macroscopic haematuria with proteinuria
70
One absolute indication for biopsy in nephrotic syndrome?
Failure to respond to 60mg/m2 of oral prednisolone for 6 weeks
71
Haemodialysis is the dialysis of choice for the haemodynamically unstable patient T/F
F - petitoneal dialysis is preferred in haemodynamical instability due to it's slow and continuous nature in correcting fluid volumes Note: peritoneal dialysis is 1/8 as effect as haemo at altering solute and 1/2 as effective in fluid removal
72
Type 1 RTA is associated with what drugs?
Li Amphotericin B Cisplatin Toluene
73
Lab def of hypercalciuria?
> 0.2 random urine ca: cr
74
Which RTA is associated with Fanconi syndrome?
Type 2
75
In addition to SN hearing loss what is another extra renal manifestation of Alport syndrome?
Occular abnormalities Such as perimacular pigment changes and lenticonus (a conical projection of the anterior or posterior surface of the lens of the eye)
76
Those with a history of kidney stones should be advised to follow a low Calcium diet T/F
F - they should ensure they are eating enough Ca. Dietary calcium actually decreases the risk of stones by binding with oxalate in the stomach and intestines before oxalate reaches the kidneys/urine Note: they should decrease foods that contain oxalate (spinach, rhubarb, cashews, almonds); also animal protein and soft drinks
77
Those with a history of kidney stones should be advised to decrease vit C intake T/F
T
78
Causes of spurious hyperK (pseudohyperK)
Haemolysis of serum sample Thrombocytosis Leukocytosis
79
What happens to TBW (total body water), intra and extracellular water as a person goes from infancy to childhood?
Total body water decreases Intracellular water increases Extracellular water decreases Note: TBW is inversely related to body fat, neonates have low body fat
80
Clinical presentation of idiopathic hypercalciuria?
``` Recurrent haematuria (may be painful) Microscopic haematuria Diffuse abdo pain ```
81
Acute post strep glomerulonephritits associated with impetigo which antibody should be tested for?
Anti DNase B Note: ASO titres do not rise as readily with skin infection as they do with pharyngitis

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