Renal Flashcards

Question

Minimal change disease pathophysiology

Answer 1

Minimal change disease - fusion of podocyte foot processes under electron microscopy Suspected to be immune dysfunction that leads to production of a permeability factor that disrupts the filtration barrier

Answer 2

Shortness of breath Foamy urine - excess protein loss Fatigue Poor appetite Peripheral oedema Periorbital oedema

Answer 3

Oedema Ascites Effusions

Answer 4

Bloods - FBCs, U&Es, LFTs, CRP, lipid profile, clotting profile Urine - dipstick, microscopy Imaging - renal USS, CXR Renal biopsy

Answer 5

Minimal change disease - systemic glucocorticoids (eg. prednisolone) FSGS - primary = immunosuppressive medications, secondary = treat underlying cause Membranous nephropathy - primary = immunosuppressive medications, secondary = targets the underlying cause

Answer 6

Thrombosis - DVT and PE are particularly common Hyperlipidaemia Recurrent infections Acute kidney injury

Answer 7

-Primary - circulating factor that damages podocytes leading to foot process effacement (loss of structure -> causing them to spread out & reduce effectiveness of filtration barrier) -Secondary - adaptive response to renal injury (combination of glomerular hypertrophy & hyperfiltration)

Answer 8

-Primary - autoimmune reaction against important antigens in the filtration barrier -> development of autoantibodies (against phospholipase A2 receptor) -Secondary - SLE, viral hepatitis, prostate cancer, NSAID use

Answer 9

Uraemic encephalopathy Hyperkalaemia resistant to medical treatment Metabolic acidosis uncontrolled by medical treatment Pulmonary oedema with oliguria

Answer 10

Method for performing the filtration tasks of the kidneys artificially in patients with end stage renal failure or complications of renal failure Involves removing excess fluid, solutes and waste products

Answer 11

End stage renal failure (CKD stage 5) Any of the acute indications continuing long term

Answer 12

Uses the peritoneal membrane as the filtration membrane Special dialysis solution containing dextrose is added to the peritoneal cavity Ultrafiltration occurs from the blood, across the peritoneal membrane, in to the dialysis solution Dialysis solution is then replaced, taking away the waste products that have filtered out of the blood into the solution Tenckhoff catheter – plastic tube that is inserted into the peritoneal cavity with one end on the outside (allows access to the peritoneal cavity, used for inserting and removing the dialysis solution)

Answer 13

Bacterial peritonitis – infusions of glucose solution make the peritoneum a good place for bacteria to grow Peritoneal sclerosis – thickening and scarring of the peritoneal membrane Ultrafiltration failure – occurs when the patients starts to absorb the dextrose in the filtration solution, reduces the filtration gradient making ultrafiltration less effective, becomes more prominent over time Weight gain – absorb the carbohydrates in the dextrose solution Psychosocial effects – having to change dialysis solution and sleep with a machine every night

Answer 14

Patients have their blood filtered by a haemodialysis machine Regimes can vary but a typical regime might be 4 hours a day for 3 days a week Need good access to an abundant blood supply, options are: 1) Tunnelled cuffed catheter 2) Arterio-venous fistula

Answer 15

Tube inserted into the subclavian/jugular vein with a tip that sits in the SVC/right atrium Two lumens – one for blood exiting and one where blood enters Dacron cuff – surrounds the catheter, promotes healing and adhesion of tissue to the cuff, making it more permanent and providing a barrier to bacterial infection, can stay long term Main complications – infection and blood clots

Answer 16

Artificial connection between an artery to a vein (surgical operation and a 4 week to 4 month maturation period without use) Provides a permanent, large, easy access blood vessel with high pressure arterial blood flow Typically in patient’s forearm – radio-cephalic, brachio-cephalic, brachio-basilic

Answer 17

Skin integrity Aneurysms Palpable thrill (fine vibration felt over the anastomosis) Stereotypical machinery murmur on auscultation

Answer 18

Aneurysm Infection Thrombosis Stenosis STEAL syndrome High output heart failure

Answer 19

Inadequate blood flow to the limb distal to the AV fistula AV fistula steals blood from the distal limb Blood is diverted away from where it was supposed to supply and slows straight into the venous system Causes distal ischaemia

Answer 20

AV fistula blood is flowing very quickly from the arterial to the venous system through the fistula Means there is rapid return of blood to the heart -> increases the pre-load in the heart -> hypertrophy of the heart muscle and heart failure

Answer 21

Genetic condition where the kidney develop multiple fluid-filled cysts Kidney function is impaired Palpable, enlarged kidneys may be felt on examination Autosomal dominant and recessive type (dominant is more common) Diagnosis – kidney USS and genetic testing

Answer 22

PKD-1 (chromosome 1) is majority PKD-2 (chromosome 4)

Answer 23

Cerebral aneurysms Hepatic, splenic, pancreatic, ovarian and prostatic cysts Cardiac valve disease (MR) Colonic diverticula Aortic root dilatation

Answer 24

Chronic loin pain Hypertension CVD Gross haematuria Renal stones End stage renal failure

Answer 25

Gene on chromosome 6 Rarer and more severe Often presents in pregnancy with oligohydramnios (fetus does not produce enough urine)

Answer 26

Oligohydramnios leads to underdevelopment of the lungs resulting in respiratory failure shortly after birth Patients may require dialysis within the first few days of life Can have dysmorphic features – underdeveloped ear cartilage, low set ears & flat nasal bridge Usually have end-stage renal failure before reaching adulthood

Answer 27

Tolvaptan (vasopressin receptor antagonist) – can slow development of cysts & progression of renal failure in ADPKD - Should be initiated and monitored by a specialist Mainly supportive of complications: anti-hypertensives, analgesia, abx, dialysis, renal transplant Other: genetic counselling, avoid contact sports, avoid NSAIDs & anticoagulants, regular USS to monitor cysts, regular BP, MR angiogram can be used to diagnose intracranial aneurysms

Answer 28

Matched based on HLA type A, B & C on chromosome 6 Recipients can receive treatment to desensitised them to donor HLA when there is a living donor Less they match, the more likely the transplant is to fail

Answer 29

Patient’s own kidneys are left in place Donor kidney’s blood vessels are connected with the patient’s pelvic vessels, usually the external iliac vessels Donor kidney’s ureter is anastomosed directly with the patient’s bladder Placed anterior in the abdomen and can usually be palpated in the iliac fossa area Typically hockey stick scar

Answer 30

New kidney will start functioning immediately Patients will require life long immunosuppression to reduce the risk of transplant rejection Usual regime: tacrolimus, mycophenolate, prednisolone Others: cyclosporine, sirolimus, azathioprine

Answer 31

Relating to transplant – transplant rejection (hyperacute, acute & chronic), transplant failure, electrolyte imbalances Relating to immunosuppressants – ischaemic heart disease, T2DM, infections more likely & more severe, unusual infections (PCP, CMV, PJP & TB), non-Hodgkin lymphoma, skin cancer (particularly SCC)

Renal Flashcards

(55 cards)