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MRCP 1 > Renal > Flashcards

Renal Flashcards

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1
Q

Indications for dialysis in acute renal failure?

A

Hyperkalaemia (>6.5 of with ECG changes)
Acidosis pH <7.1
Refractory pulmonary oedema
Severe symptomatic uraemia
Uraemic pericarditis

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2
Q

Basic driver for NAGMA?

A

Loss of bicarb

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3
Q

Basic driver for HAGMA?

A

Exogenous source of acid in the plasma

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4
Q

NAGMA causes?

A

RTA
Diarrhoea
Acetazolamide
Ureteric diversion

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5
Q

HAGMA causes?

A

MUDPILES (5 are poison)

Methanol poisoning
Uraemia
DKA
Paraldehyde poisoning
Iron poisoning
Lactic acidosis, liver failure
Ethylene glycol poisoning
Salicylate poisoning

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6
Q

3 most accurate lab measurements of GFR?

A

Insulin clearance
Chromium-labelled EDTA
Iohexol

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7
Q

Loop diuretic site of action?

A

Ascending arm of LoH
Compete for chloride-binding sites

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8
Q

Site of action of thiazides?

A

Distal tubule
Compete for chloride-binding sites

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9
Q

Where do trimethoprim, cimetidine and many diuretics enter the tubular filtrate?

A

Proximal tubule

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10
Q

Spironolactone site of action (aldosterone receptors)?

A

Distal tubule AND collecting duct

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11
Q

Where does lithium enter the filtration system? (and sometimes hence cause NDI)

A

Collecting duct

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12
Q

Non-renal causes of proteniuria?

A

Fever
Severe exercise
Skin disease
UTI

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13
Q

Tubular cells casts in urine microscopy?

A

ATN or interstitial nephritis

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14
Q

Hyaline casts in urine microscopy?

A

Tamm-Horsfall glycoprotein (NORMAL)

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15
Q

Granular casts in urine microscopy?

A

Non-specific

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16
Q

Red cell casts in urine microscopy?

A

GN or tubular bleeding

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17
Q

Leukocytes casts in urine microscopy?

A

Pyelonephritis or ATN

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18
Q

Potential SE of MRA?

A

Nephrogenic systemic fibrosis - use MRA with caution in eGFR <30

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19
Q

Type 1 vs type 2 RTA

A

Type 1 = distal (far more common than type 2 (proximal)

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20
Q

Contrast nephropathy time to onset?

A

2-5 days

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21
Q

Diabetic Nephropathy Stages?

A

HS2MP (High Speed 2 Manchester Picadilly)

Hyper (High): Stage 1
Silent (Speed 2): Stage 2
Microalbumin (Manchester): Stage 3
Proteinuria (Picadilly): Stage 4

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22
Q

Most common peritoneal dialysis organism?

A

Staph epidermis

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23
Q

Post-step GN vs IgA nephropathy post URTI?

A

Post-strep GN is 1-2 weeks (post is well post)
IgA more rapid, 1-2 days (A comes first)

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24
Q

Creatinine rise in 48 hours for AKI?§>26

A

26

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25
Which test is most useful when determining whether there is prerenal uraemia or acute tubular necrosis?
Urinary sodium
26
Intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar in the context of kidney disease?
Calciphylaxis
27
3 factors affecting traditional eGFR result?
Red meat Pregnancy Muscle mass (e.g. amputees, body-builders)
28
Components of MDRD equation for eGFR?
Creatinine Age Ethnicity Gender
29
/Cranial causes of DI
Idiopathic Head injury Pituitary surgery Craniopharyngiomas Infiltrative Histiocytosis X Sarcoidosis DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome) Haemochromatosis
30
Wolfram's sydrome?
DIMOAD Cranial DI Diabetes Optic atrophy Deatness
31
Rapid worsening of renal function on introduction of an ACEi? (often presents with flash pulmonary oedema) What is the gold standard Ix according to the latest NICE guidelines
Renal artery stenosis MRA
32
How does calcium resonium work?
Decreases enteral absorption of potassium to increase excretion
33
Nephrotic syndrome patient who develops flank pain and haematuria?
Renal vein thrombosis
34
BPH management?
First line A-1 e.g. tamsulosin Second line 5 alpha reductase e.g. finasteride
35
Staghorn composition?
Struvite (ammonium magnesium phosphate) AMP
36
Mechanical valves INR?
aortic: 3.0 mitral: 3.5
37
Prevention of oxalate stones?
cholestyramine or pyridoxine
38
Prevention of calcium stones?
Thiazide
39
Time to use for AV fistula?
6-8 weeks
40
Why are you hypercoaguable in nephrotic syndrome?
Loss of antithrombin III
41
Most common cause of GN?
IgA nephropathy
42
Does IgA progress to ESRF?
25% do
43
Histology of IgA?
Mesangial proliferation IgA complex deposition Elevated complement (remember this is also seen in HSP)
44
How do you differentiate between IgA and HSP given that the histology is the same?
HSP affects multiple systems, IgA only kidneys
45
What do you need to give alongside gosrelin for prostate Ca?
Cyproterone acetate
46
What is Tolvaptan used for and how does it act?
ADPKD Vasopressin 2 receptor antagonist
47
Effacement/fusion of podocytes?
Minimal change disease (you can only see this on electron microscopy however hence minimal change)
48
Nephrotic syndrome in children? What do you do? Second line treatment?
Assume minimal change Give steroids Cyclophosphamide
49
Driver of minimal change?
Cytokine driven damage to the podocytes allowing leakage
50
Prognosis in minimal change?
Overall good 1/3 one episode 1/3 infrequent relapses 1/3 frequent relapses which stop before adulthood
51
Androgen receptor blocker used in prostate Ca?
Bicalutamide
52
Antibodies in primary membranous GN?
anti-PLA2R
53
Alcohol induced polyuria mechanism?
Anti-diuretic hormone (ADH) suppression in the posterior pituitary gland
54
Most likely renal outcome of HSP?
Full recovery 1/3/ have a relapse
55
Renal, eye disease and deafness?
Think alports
56
Anterior lenticonus?
Alports
57
Type of collagen deficiency in Alport's?
Type IV
58
Inheritance in Alport's (most commonly)?
X linked dominant
59
Splitting of the macula densa and "woven-basket appearance"?
Alport's
60
Gene in Alport's?
COL4A
61
Bladder Ca RFs
Smoking Exposure to aniline dyes - for example working in the printing and textile industry - examples are 2-naphthylamine and benzidine Rubber manufacture Cyclophosphamide Risk factors for squamous cell carcinoma of the bladder include: Schistosomiasis Smoking
62
Vitamin D supplementation in advanced CKD?
Alfacalcidol
63
Congo red staining: apple-green birefringence?
Amyloid
64
Unwell patient, triad of pulmonary haemorrhage, GN, anti-GBM antibiodies
Anti-GBM disease (Goodpasture's)
65
Most common form of PKD?
PKD1
66
Chromosomes affected in ADPKD?
PKD1 - 16 PKD2 - 4
67
Dialysis-related amyloid?
B2 microglobulin amyloid Presents like PMR with carpal tunnel
68
Where is EPO produced?
Interstitial fibroblasts in the renal cortex
69
Untreated UTI in a diabetes who then presents with obstructive symptoms?
Renal papillary necrosis
70
Small calculi in the papillary zones with surrounding increased density on excretion urography?
Medullary sponge kidney
71
Peritoneal dialysis patient with sepsis but dialysis culture shows lots of organisms including anaerobes?
Think bowel perf
72
Bone minerals in CKD
High - phosphate PTH Low - Calcium Vitamin D
73
Most important HLA to match for transplant?
DR (directly relevant)
74
Ig responsible for hyperacute graft rejection?
IgG
75
Idiopathic membranous GN (typical in middle aged person presenting with nephrotic syndrome) antibody?
Antiphospholipase A2
76
Spike and dome appearances on renal biopsy? Subendothelial deposits?
Membranous GN
77
ADPKD, which type is more common?
Type 1 (85%)
78
Chromosome abnormalities in ADPKD?
Type 1 - chromosome 16 Type 2 - chromosome 4 (there are more of type 1)
79
Treatment sometimes used in ADPKD?
Tolvaptan (vasopressor receptor 2 antagonist)
80
GPA history and nephritic syndrome biopsy findings?
Crescentic GN
81
Electrolyte side effect of plasma exchange?
Hypocalcaemia
82
Biopsy findings in Goodpastures?
IgG deposition (linear)
83
Sounds like Conn's but HIGH plasma renin?
Bilateral RAS
84
Associations of IgA nephropathy (other than URTI)?
Alcohol cirrhosis IBD HSP
85
Treatment in severe HUS?
Plasma xchange
86
Heroin use and GN?
Focal segmental GN
87
Most common cardiac feature in ADPKD?
Mitral prolapse
88
CMV treatment post transplant?
Ganciclovir - severe Valaciclovir/valganciclovir - mild
89
PJP treatment post renal transplant?
Co-trim
90
Sounds like Conns, normotensive, hypokalaemic, high renin and aldosterone BUT low magnesium?
Gitelman syndrome
91
Renal biopsy in HIV nephropathy?
Focal segmental glomerulosclerosis with collapsed tuft and tubuloreticular structures
92
Most important function of proximal convoluted tubule?
Sodium reabsorption
93
GN in partial lipodystrophy?
Mesagiocapillary type 2
94
Mesangiocapillary GN associatons?
Partial lipodystrophy (type II) Hep C
95
Focal segmental glomerulosclerosis associations
Diabetes Heroin use HIV
96
Goodpasture HLA assoc?
DRB1
97
Anti rejection med causing hyperkalaemia?
Tacrolimus
98
Timing of CMV/EBV post transplant?
CMW around 6 weeks post EBV around 6 months post
99
Familial renal cancer?
VHL
100
Cast nephropathy vs light chain deposition disease in myeloma
Cast often severe and irreversible renal damage, progressive with Bence Jones proteinuria AND NORMAL ALBUMIN Light chain deposition often mild dysfunction with significant albuminuria Renal amyloidosis AL - nephrotic syndrome with mild impairment and lamda deposition on the membrane

MRCP 1 (24 decks)

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