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STEPH BPT 2021 > RENAL > Flashcards

RENAL Flashcards

(91 cards)

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1
Q

Angiotensin effect on arteriolar resistance

A

Constricts efferent >afferent arteriole (AT1 receptor)

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2
Q

Afferent arteriole dilators

A

Prostaglandin
NO
Dopamine (low dose)

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3
Q

Afferent arteriole constrictors

A

Adenosine
Noradrenaline (SNS)
Vasopressin
Endothelin

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4
Q

AT2 receptor action

A

Vasodilatation

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5
Q

Renal autoregulatin response

A

Via changes in afferent arteriole tone
> Prostaglandin and NO causing dilation
> Adenosine causing constriction

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6
Q

Angiotensin II action

A 
Increases SNS 
Increases aldosterone secretion from adrenals 
Arteriole vasoconstrictor 
ADH production 
Increases tubular Na/Cl reabsoorption
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7
Q

Tubule segment that is not permeable to water

A

Ascending thin and thick loops

distal convoluted tubule

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8
Q

Tubule segment that is not permeable to sodium

A

descending thin loop of henle

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9
Q

ADH receptor

A

G coupled receptor on basolateral membrane. Leads to aquaporin-2 insertion on apical membrane and aquaporin-3 on basolataeral

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10
Q

Tubule segment associated with complete resorption of glucose, amino acids, majority of bicarbonate and phosphate

A

Proximal tubule

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11
Q

Sodium transporter in the loop of henle (Thick ascending limb)

A

NKCCT (Na x1 K x1 Cl x2)

Blocked by frusemide

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12
Q

Sodium transporter in the distal tubule

A

Na-chloride cotransporter on apical membrae, Na-K-ATPase in basolateral membrane
Na-Cl CTP blocked by Thiazide diuretics

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13
Q

Electrolyte effects thiazide

A

Hypokalaemia
Hyponatraemia
Metabolic Alkalosis
Hypercalcaemia

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14
Q

Sodium transporters in the proximal tubule

A

Organic molecules co transporter (eg Na-glucose, Na-amino acids)
Na/H exchanger

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15
Q

Sodium transporter in the collecting duct

A

Na/K-ATPase in basolateral membrane of principal cells

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16
Q

Aldosterone action

A

Acts on receptors on basolateral membrane
in distal tubule, increases mRNA synthesis in the nucleus leading to increases Na-K ATPase
Results in Na reabsorption and K excretion
Due to effect of increased K in duct, results in Hydrogen excretion

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17
Q

The action of Type A intercalated cell

A

Excretion of H+

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18
Q

Action of Type B intercalcated call

A

Excretion of HCO3-

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19
Q

Amiloride action

A

Blocks apical Na channels (ENac) in principal cells

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20
Q

Site of hypoosmotic tubular contents

A

Thick ascending loop (impermeable to water)

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21
Q

Tubular site of PTH for calcium reabsorption

A

Thick ascending limb and distal tubules

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22
Q

Role of FGF-23

A

Decrease serum PO4
Acts on FGF receptor and coreceptor klotho in proximal tubule, decreasing PO4 reabsorption
Decreases calcitriol, in turn reducing phosphate GI absorption

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23
Q

High FGF-23 levels

A

Early marker of CKD-MBD

Increase CVD mortality risk, causes LVH

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24
Q

Barter syndrome

A

Defect in NaCl resorption in ascending thick limb
Hypokalaemia
Metabolic alkalosis
Hypercalcaemia

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25
Barter syndrome Type 3
Affects basolateral Cl channel CIC-Kb impacting on NKCCT
26
Barter syndrome Type 5
``` Affects Calcium sensing receptor Hypocalcaemia Hypokalaemia Metabolic alkalosis Hypomagnesaemia ```
27
Drug class leading to barter type 5 effect
Aminoglycosides
28
Gitelman syndrome
Hypokalaemia Metabolic alkalsosis Hypomagnesaemia Hypocalcaemia
29
Liddle's
``` EnaC function increased Hypokalaemia Hypertension Metabolic alkalosis Treated with amilioride ```
30
Minimal obligatory urinary loss volume
430ml
31
Insensible daily losses
500ml
32
Site of K reabsoroption
proximal tubule
33
Drug that inhibits ADH
Alcohol
34
NAGMA
Chloride excess Addissons GI Extra - RTA
35
HAGMA
``` Ketoacidosis Lactic acidosis Ethalene/methanol salicyclic acid Uraemia Metformin CO ```
36
Type 1 RTA (Distal tubule)
H+ secretion is defective NAGMA Alkalotic urine (>5.5) Hypercalcaemia
37
Type 2 RTA (proximal tubule)
HCO3 reabsorption defect NAGMA Amino-aciduria, glycosuria, phosphaturia Fanconi syndrome
38
Type 4 RTA
NAGMA | Hyperkalaemia
39
Causes of Type 4 RTA
``` Hyperkalaemia leads to impaired ammonia production Diabetes Hypoaldosteronism ACEi Spironolactone ```
40
Metabolic alkalosis
``` Vomiting Diuretics Corticosteroid excess Barter's syndrome Gitleman's syndrome ```
41
Active vitamin D
1, 25 dihydroxycholecalciferol | =Calcitriol
42
Secondary Hyperparathyroidism parameters
High phosphate Low calcium High PTH
43
Treatment of Secondary Hyperparathyroidism
Low phosphate diet Phosphate binders Calcitriol to suppress PTH
44
Treatment of tertiary Hyperparathyroidism
Parathyroidectomy
45
EPO targets
Hb 100 - 110
46
CMV prophylaxis
Valganciclovir
47
CMV treatment
Ganciclovir
48
CMV resistant treatment
Forscarenet Cidofovir
49
Cancer risk in kidney tx
SCC | Lymphoma
50
Elevated levels of soluble urokinase plasminogen activator receptor (suPAR) is associated with which condition?
FSGS suPAR has been shown to bind and activate podocyte β3 integrin, which leads to podocyte foot process effacement that is characteristic of proteinuric renal diseases
51
Fanconi's syndrome
``` RTA phosphaturia renal glucosuria (with a normal plasma glucose concentration) aminoaciduria tubular proteinuria. ```
52
Primary membranous nephropathy antibody
PLA-2R | Spike and dome on silver stain
53
Wire loops
Lupus nephritis
54
Full house
IGM IGG IGA C3 C1 seen in lupus
55
MPGN findings
Double basement membrane/ tram tracking
56
Membranous nephropathy histology findings
Spike and dome
57
Diffuse linear IgG staining Woth crescents
Anti-GBM
58
Onion skin hypertrophy on histology
Scleroderma renal crisis
59
Diagnostic criteria for AD PCKD
2 or more cysts in one kidney and at least one in the contra lateral kidney by age 30 Or 4 or more in each kindey of over 60 Yo
60
Age to screen for PCKD
20
61
When to screen for cerebral aneurysm in PCKD
Patients with previous aneurysm Family Hx Persistent headache Rescreen if size <5mm
62
Indication for revascularistion of renal artery stenosis?
``` Short duration of BP elevation Failure of medical therapy to control BP Intolerance to medical therapy Recurrent flash oedema Refractory heart failure ```
63
Diagnostic approach to Renal artery stenosis
>75% stenosis on CT angiography | Peak velocity above 200cm/second
64
Sirolimus action
mTOR inhibitor | mTOR inhibits IL-2 transduction resulting in arrest in G1-S phase arrest
65
Side effect of sirolimus
Hyperlipidaemia due to inhibitor of lipoprotein lipase
66
Treatment of acute renal transplant rejection
IV methylpred ATG lymphocyte depleting Ab Indefinite steroids Plex/IVIG/Rituximab if antibody mediated Rescue: Tacro or MMF
67
IgAnephropathy findings
Mesangial hypercellularity | Positive immunofluorescence for IgA and C3
68
Markers of good prognosis for IgA nephropathy
Frank Haematuria
69
Stage I Lupus nephritis
Minimal mesangial lupus nephritis
70
Stage II lupus nephritis
Mesangial proliferation LN
71
Stage III lupus nephritis
Focal LN < 50% gloms involved
72
Stage IV LN
Diffuse LN > 50% gloms involved
73
Stage V LN
Pure membranous LN
74
Stage VI LN
Advanced sclerosising LN > 90% gloms involved
75
Lupus nephritis histology
``` Subendothelial immune deposits/wire loops Hypercellularity Leulocyte infiltration Fibrinoid necrosis Hyaline thrombi Crescents in severe LN ```
76
Protective effect of ACE/arb in diabetics with normal urine albumin and normal BP
Protects against retinopathy | Does not protect against renal disease
77
Target of anti-G antibodies
Type 4 collagen
78
Drugs cleared by HD
``` BLAST barbiturates Lithium Alcohols Salicylates Theophyllines ```
79
Causes of primary hyperaldosteronism
``` Bilateral adrenal hyperplasia (most common) Adrenal adenoma Familial hyperaldosteronism Adrenal carcinoma (lesion>4cm) Ectopic ```
80
When to perform adrenal vein sampling
Primary hyperaldosteronism + Normal CT or Bilateral abnormalities or Unilateral abnormality and patient over 35
81
Conns syndrome
Primary hyperaldosteronism
82
Target for iron in ESRF
Ferritin >200 Transferritin sat >20% Treat with IV iron
83
Cause of Type 1 (Distal) RTA
Sjogrens
84
Causes of acute renal transplant rejection
``` T Cell vs B cell acute rejection Differential diagnoses: – Volume depletion – ATN – Interstitial nephritis – Drugs: Calcineurin toxicity, Bactrim. – Obstruction – HUS – Infection with CMV, BK virus (beyond 4 weeks) ```
85
Gold standard for diagnosing fibromuscular dysplasia
intra-arterial digital subtraction angiography | String of beads appearance
86
Patient with resistant HTN with normal renal function, first test for evaluating renovascular HTN
ACEI renography or Doppler US
87
histological feature of chronic allograft nephropathy
Chronic interstitial fibrosis
88
Immunosuppressants safe for pregnancy
Cyclosporin and Azathioprine
89
Cyclosporin side effects
**Nephrotoxicity Hyperlipidemia Hypertension Hirsutism HUS-mostly dose related Hepatotoxicity Fluid retention Hyperkalemia Hypertrichosis Gum hyperplasia Diabetes Tremor Neurotoxicity
90
Foods containing high amounts of oxylate
spinach, rhubarb, nuts, and wheat bran
91
Target iron measures CKD
Target ferritin >100/TSat >20% pre-dialysis

STEPH BPT 2021 (17 decks)

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