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renal Flashcards

1
Q

what virus causes Measles mumps and rubella

A

RNA. paromyoxvrus (measles morbilivirus)

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2
Q

most common viral hepatitis worldwide

route of spread for the viral heps

A

HEP A

A- FO
B+C - blood
D - always with B
E - Zoo+ FO

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3
Q

child with a high fever and spots on uvula, and as fever settles rash appears ? name and viral cause

A

roseola
HHV-6

NAGAYAMA spots

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4
Q

what marker is used to distinguish iron overload from haemochromatosis and other causes

A

transferrin saturations
high in haemochromatosis low in others

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5
Q

lacey rash on kids face - called and virus cause by ?

A

erythema infectiosum/slapped cheek/ fifths disease
parvovirus B19

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6
Q

what is diagnostic criteria of an AKI

A
  1. rise in createnine of 26 within 48 hrs
  2. an increase of 50% createnine in 7 days
  3. oligouria (<0.5ml/kg/hr) for > 6 hrs in adults
  4. 25% fall in eGRF in kids in 7 days
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7
Q

drugs that should be stopped in AKI

A

ACEI, ARB, NSAID, aminoglyc, diuretic
DIG, met lithium due to toxiciity

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8
Q

what is given in hyperkalaemia to stabalise cardiac memebrane

A

IV Calcium Gluconate

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9
Q

what size of gallstone can be left to pass psontaneously

A

<5mm

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10
Q

CKD that causes large not small kidneys

A

ADPKD
diabetic nephropathy
amyloidosis
HIV assoc nephropathy

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11
Q

most common casue of CKD

A

diabetic nephropathy

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12
Q

how does scarlet fever casue a rash

A

GAS releases erythrogenic toxin

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13
Q

what is management of different volvulus

A

sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed

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14
Q

out of PSC and PBC which is both intra and extr hepatic

A

PSC is intra and extra

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15
Q

most common complications of measels (2)

A

otiis media - most common
pneumonia - most common cause of death

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16
Q

where is water reabsorbed from in the kidney

A

PCT, descending loh and CD

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17
Q

what does ADH do and where does it act

A

stimulates aquaporin in CD of kidney

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18
Q

in the PCT what is HCO3 resorption driven by

A

sodium

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19
Q

types of nephrotic syndrome

A
  1. minimal change
  2. membranous GN
  3. focal segmental glomerulonephritis
  4. amyloidosis
  5. diabetic nephropathy
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20
Q

types of nephritic syndrome

A
  1. rapidly progressing GN
  2. IgA nephrpathy
  3. Alport syndrome
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21
Q

triad of nephrotic syndrome

A
  1. proteinuria
  2. oedema
  3. hypoalbinaemia
    + hypercholoesterol
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22
Q

what cells does nephrotic syndrome affect

A

podocytes

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23
Q

how does nephrotic syndrome cause thrombosisi

A

loss of antithrombin III, protein C and S and associated increase in fibrinogen

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24
Q

what would be seen on renal biopsy in minimal change disease

A

occasional IgM in mesangium
podocyte foot effacement

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25
Q

causes of minimal change disease

A

idiopathic
drugs - NSAID
hodgkins
MONO

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26
Q

middle aged itchy woman and treatment

A

PBC
- first-line: ursodeoxycholic acid
slows disease progression and improves symptoms
- pruritus: cholestyramine
- fat-soluble vitamin supplementation

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27
Q

commonest casue of GN in adults

A

membranous GN

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28
Q

spikes on renal biopsy

A

membranous GN

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29
Q

treatment of membranous GN

A

ACE/ARB
immunisupp

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30
Q

what is the clinical picture of nephritic picture

A

haematuria
proteinuri <3g
sterile pyuria
HTN
oligouria

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31
Q

what is deposited on the basemenet membraen i nmembranous GN

A

IgG and C3

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32
Q

IgA nephropathy associated conditions

A

alcoholic cirrhosis
coeliac. dermatitis herpetiformis
HSP

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33
Q

what anti body is tested for in post streptococcal GN

A

anti-streptolysin o

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34
Q

what complement protein is low in post strep Gn

A

C3

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35
Q

starry sky on renal biopsy

A

post strep Gn

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36
Q

what is seen on renal biopsy in alports syndrome

A

basket weave - splitting of lamina dense

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37
Q

if someone has renal failure and haemoptysis what shoud you think ?

A

GPA or goodpasteurs

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38
Q

what chromosome is HLA found on

A

chromosome 6

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39
Q

different types of renal graft rejection and timeframe

A
  1. hyperacute rejection - mins to hrs
  2. acute graft failure - <6mnths
  3. chronic graft failure >6mnth
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40
Q

what is the pathogenesis of hyperacute graft failure

A

due to pre-existing antibodies eg ABO

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41
Q

tx of hyperacute graft rejection

A

remove transplant

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42
Q

pathogenesis of acute graft failure

A

mismatched HLA - t cell mediated

43
Q

what would indicate acute graft failure

A

increased createnine pyuria and proteinuria

44
Q

tx of acute graft rejection

A

steroids and immunosuppresion

45
Q

how does acute interstital nephritis present and assoc features

A

HTN and AKI
rash arthralgia, fever, eosinophilia

46
Q

causes of acute interstitial nephritis

A

drugs, SLE, sarcoid

47
Q

what would be seen in urinalysis in acute interstitia nephritis

A

sterile pyuria white cell casts

48
Q

what causes acute tubular necrosis

A

ischaemia or nephrotoxins

49
Q

features of acute tubular necrosis

A

features of an AKI - increase createnine, urea and potassium
muddy brown casts

50
Q

what is the most common casue of an AKI

A

Acute tubular necrosisi

51
Q

what is the most common type of renal tubular acidosis and pathophysiology

A

TYPE 4 - reduction of aldosterone causes a decrease in PT ammonia excretion

52
Q

what is pathophysiology of type 1 renal tubular acidosis

A

inability to excrete Hydrogen in DCT

53
Q

what would the urine pH be in a Type 1 renal tubular acidosis

A

above 6

54
Q

is type 1 renal tubualr acidosis hyper or hypokalaemia

A

hypokalaemia

55
Q

type 4 renal tubular acidosis- hypo or hyperkalaemia and what is urinary pH

A

hyperkalaemia and pH is less than 6

56
Q

what type of acidosis/alkalosis is seen in renal tubular acidosos and what is anion gap

A

hyperchloraeic metabolic acidosis with a normal anion gap

57
Q

most common type of renal cell cancer

A

clear cell

58
Q

classic triad of renal cancer

A

loin pain
haematria
abdo mass

59
Q

what paraneoplastic syndrome can renal cancer give

A

EPO - polycythaemia
ACTH
PTHrP - hypercalcamia

60
Q

what testicular pathology can renal cell cancer cause

A

varicolcele due to compression of pampiniform plexus

61
Q

what is treatment of a renal cell cancer less htan 7 cm

A

partial nephrectomy

62
Q

what is treatment if a patient has transitional cell cancer of the kidney

A

nephrouretectomy

trasiional cell is bladder cancer

63
Q

treatment of wilms tumour

A

nephrectomy and chemo eg vinaristine duxorubicin

64
Q

what drugs can cause acute urinary retention

A

TCA’s - amitriptyline
Anticholinergics
opioids
NSAIDS
disopyramide

65
Q

what is acute urinary retnetion most commonly secondary to

A

benign prostatic hypertension

66
Q

how to differetiaite between acute and chronic urinary retention

A

acute - painful
chronic- painless

67
Q

what examinations shoud be performed in acute urinary retention

A

PR, PV and neuro exam

68
Q

what is diagnostic investigation in urinary retention

A

USS

69
Q

what volume of fluid is indicative of urinary retention

A

> 300cc

70
Q

if USS ambiguous as to urinary retention hat should be done

A

cathertise and if over 15 mins <200cc not rentention
if >400 then retention

71
Q

what is post -op dieuresis

A

polyuric state after relief of obstruction
due to loss of medullary conc radietn

72
Q

what differentiates high pressure retention in comparison to low pressure retention

A

hydronephrosis

73
Q

treatment of uncomplicated UTI (and durtion )

A

Nitro/ Trime for 3 days

74
Q

when should you culture for an uncomplicated UTI

A

haematuria or >65

75
Q

management of an asymptomatic UTI in preganant women

A

nitro for 7 days and test for cure

76
Q

shoudl you culture for pregannat women with UTI

A

yes - nitro/amox

77
Q

treatment for men with UTI

A

culture and 7 day prescription of nitro or trime

78
Q

if a child present with recurretn UTIS what shoudl you expect

A

vesicoureteric reflux

79
Q

what is a common complication of vesicoureteric reflux

A

scarring

80
Q

what is a complication of renal scarring secondary to VUR in kids

A

hypertension - scar produces renin

81
Q

commonest renal stones

A

calcium oxalate

82
Q

key risk factors for calicum based renal stones

A

hypercalcaemia and dehydration

83
Q

how are struvite renal stones made

A

bacteria hydrolse urea in urine to ammonia creating struvite

84
Q

what infections predispose struvite renal stones

A

proteus and Ureaplasma urealyticum - alkali environment

85
Q

ground glass renal stone

A

cystine

86
Q

cystine renal stone are due to what

A

auto recessive conditiion

87
Q

risk factors for urate renal stones

A

GOUT and ILeostomy - loss of bicarb

88
Q

what drugs are assoc with renal stones

A

loop diureticsm - cause hypocalcaemia but hypercalcinuria
steroids, and theophylline

89
Q

what drug prevent renal stones

A

thiazides

90
Q

management of renal stones

A

<5mm pass spontaneously

91
Q

pain mangement of renal stones

A

IM diclofenac

92
Q

causes of renal artery stenosis

A

atherosclerosis
fbromuscular dysplasia

93
Q

features of renal artery stenosis

A

HTn, CKD and flash PO

94
Q

how and where to LOH diuretics work

A

work on the ascending loop of henle
they block the NA-CL-K co trasnporter on apical side of membrane
therefore osmosis does not occur and water does not follow Na into interstitium

95
Q

how and where do thiazides work

A

the work on the DCT - block NACL co transporter - there fore water and salt remain in lumen

96
Q

treatment of good pasteurs disease

A

steroids and cyclophosphamide

97
Q

common neuro symptoms in ANCA vasculiits

A

mononeuritis multiplex

98
Q

qhat type of collagen does Goodpasteurs target

A

type IV collagen

99
Q

common causes of acute interstitial nephritis

A

PPI and Fluclox

100
Q

why may Acute interstitial nephritis presetn with pain

A

due to capsular stretch from inflammation

101
Q

most important post organ trasnplant infection

A

CMV

102
Q

is TIBC low or high in anaemia of chronic disease

A

low/normal in chronic disease

high in iron deficiency

103
Q

what shoudl be doen for an INR between 5-8 with no bleedign

A

withhold 1-2 doses of warfarin adn reducce susequent doses

104
Q

what iron studies are seen in haemochromatosis
tranferrin, ferritin adn TIBC

A

high transferring, high ferritin and low TIBC

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