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Renal Flashcards

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1
Q

What do urine dipstics struggle to pick up?

A

Non-albuminic proteinuria

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2
Q

AIN - 5P’s

A

Pee - diuretic (part sulfur)
PPI
Pain - NSAIDs
Penicillins and cephalasporins
RifamPin

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3
Q

3 criteria for brain death testing

A

GCS 3
No brainstem reflexes
APnoea test

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4
Q

Causes of high omsolar gap

A

Methanol, ethanol, sorbitol (alcohols)

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5
Q

Mechanism of frusemide resistance

A

Increased Na absorption other sites in nephron –> called ‘braking’

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6
Q

Poor predictors in IgA nephropathy
- predict ESKD

A

Proteinuria > 1g/day
HTN
Cr

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7
Q

Moa of insulin in hyperkalaemia

A

Enhances Na/K pump in skeletal muscle

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8
Q

Bartter’s site?

A

Thick Asc LoH - loop diuretic

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9
Q

Gittelman’s site

A

DCT - thiazide

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10
Q

Bartter’s vs Gittelman’s differences

A

Bartter’s - nephrocalcinosis

Gittelman’s - hypercalcaemia, hypomagnesiaemia

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11
Q

Liddle syndrome
- features
- defect

A

Increased Na channel activity at distal collecting duct

Present’s as Conn’s but low aldosterone

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12
Q

Treatment of Liddle

A

Traimterone or amiloride (distal Na channel blockers)

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13
Q

Tacrolimus benefits A/E over cyclosporin

A

Less acute rejection and graft loss

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14
Q

Tacro A/E compared with cyclosporin

A

More diabetes
More hypomagnesiaemia
More HTN/PRES

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15
Q

Cyclosporin A/E more than tacro

A

Gum hypertrophy
Hirsutism
Dyslipidaemia

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16
Q

Calciphylaxis management

A

Correction of CaPO4 product
Sodium thiosulfate

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17
Q

Linear IgG

A

Anti-GBM

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18
Q

IgA and IgG, but IgA greater

A

IgA nephropathy or HSP

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19
Q

IgG and C3 seen only - suggestive of?

Causes?

A

Immune complex

External to GBM = post-strep

Internal/mesangium = MPGN
- Autoimmune/cryo
- M protein/amyloid

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20
Q

Full house - C1q, IgM, IgA, C3, IgG

A

Lupus

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21
Q

No IgG or C3

A

Pauci immune

RPGN - ANCA vasculitis

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22
Q

Benefits of MMF over AZA

A

No drug interaction with xanthine oxidase

No TPMT testing

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23
Q

A/E of MMF compared to AZA

A

More diarrhoea

Teratogenic

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24
Q

A/E of mTOR over CNI

A

Wound infection
Teratogenic

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25
Benefits of mTOR over CNI
Less SCC/BCC Less CMV infection (often used if high risk of reactivation)
26
Triple phosphate
Struvite
27
Alkaline urine and stones
Struvite
28
Coffin lid shaped
Struvite
29
Which stones to treat with urinary alkalinisation
Uric - 6.5-7 Cysteine - > 7
30
Type 1 RTA associated with which stones?
Ca oxalate
31
Envelope shaped
Ca oxalate
32
Rhomboid shaped calculi
Uric acid
33
Good to make make Ca and Oxalate soluble in urine
Citrate
34
LM shows C3 but no IGG - 2 options?
Dense deposit disease - have sausage waxy shaped C3 glomerulopathy
35
Monocytes/t cells in Bowman's space on Light micrsocopy
Crescents --> RPGN
36
PLA2R positive and proteinuria - when to biopsy?
Renal impairment Any other doubt re diagnosis - other risk factors (diabetes, Hep etc)
37
PLA2R negative but proteinuria
Needs kidney biopsy Can have negative serum PLA2R in end stage disease
38
Management of PLA2R Mem GN
< 3.5g proteinuria - monitor PCR and PLA2R >3.5g - initiate immunosuppressive therapy with ritux, CNI, or steroids and Cyclo
39
All patients should also be investigated for? when diagnosed with memb GN
Age related malignancy
40
Antibody which associated with progression to CKD 2/3 FSGS have elevated levels
SuPAR
41
FSGS - congenital and acquired -primary
Congenital - supportive, no response to steroid Primary - steroids
42
Initial treatment of IgA
ACE/ARB BP control - aim < 140 Salt and water restriction
43
Who gets glucocorticoids in IgA
Those > 1g proteinuria per day AFTER 6 months supportive therapy
44
Oral C5a inhibitor
Avacopan - Useful in ANCA vasculitis as adjunct
45
Factors which restrain C3/complement activation Deficiencies in this make patients susceptible to C3 glomerula disease
Factor H and I
46
Granular casts
ATN
47
Muddy brown casts
ATN
48
Maltese crosses
Oval/lipid bodies - nephrotic syndrome
49
SGLT-2 perioperative
Stop 3 days before surgery Start when eating and drinking - for small cases after they return home
50
Biggest predictor of progression of CKD
Proteinuria
51
Effects of FGF-23 on - Kidney - GIT - Parathyroids
Kidney - binds klotho co-receptor, reduces PO4 reasborption. Reduces calcitriol production, so reduces intestinal PO4 absorption Binds klotho receptor on parathyroids --> suppressed PTH
52
Deficiency of klotho
Causes - Reduce renal phosphate excretion - No suppression of PTH
53
1,25 hydroxyvitamin D - other name
Calcitriol
54
Cholecalciferol other name
Vit D3
55
Where is 25 hydroxyvitamin D made
Liver - from Vit D3 from skin/UV light and diet
56
Target Hb level on dialysis and EPO
110-115
57
Factor most predictive of effective haemodialysis
Time on haemodialysis
58
Risk factors for ischaemic ATN post transplant
DCD - warm isch time higher Higher ischaemic time HDx Age of donor
59
Post renal Tx, 6 weeks with stent removal and subsequent Cr rise
Likely distal ureteric stenosis
60
Decoy cells
BK virus
61
UL97 mutation prevention activation of ganciclovir - what to do for CMV
Use foscarnet
62
Most commo immunosuppression related malignancy
Skin
63
Low Mg post Tx, cause?
2nd to tacrolimus
64
WHere is urine acidified and alkalanised?
Collecting ducts - have highest proportion of a and b intercalated cellsq=
65
Urine pH cutoff in RTA
5.5`
66
Most common cause nephrotic syndrome adults
Membranous
67
Biggest predictor renal failure in PCKD
Measured total kidney volume
68
Collapsing glomerulosclerosis
HIV
69
Most specific for GN in urine?
Red cell casts Dysmorphic red cells can be seen by examining morphology, but not as specific
70
Best negative predictive value for PCKD
U/S (or imaging) excluding cysts
71
Which type of AIN usually doesn't respond to steroids
NSAID induced
72
Most common GN
IgA
73
Causes of NAGMA
ABCD Addison's Bicarb loss - GI (diarrhoea) or renal (RTA) Chloride excess Diuretic - acezatolamide
74
Most severe histopath finding of T cell mediate rejection
Transmural arteritis
75
Aminoglcyoside renal complication faetures
D5-7 rise in Cr Urine output preserved ATN rare
76
Strep skin infections - which AB positive
Anti-DNA ase-B (can have negative ASOT)
77
Rhabdomyolysis vs acute AKI from sepsis - electrolyte differences
RHabdo - will have elevated phosphate and reduce Ca due to muscle breakdown AKI - will have normal phosphate, FGF23 can increase to compensate and reduce phosphate levels (unless already have CKD)
78
Pathophys of aminoglycoside ATN - which site of nephron?
Proximal tubule

BPT (18 decks)

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