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1MRCP Part 1 > Renal > Flashcards

Renal Flashcards

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1
Q

Cause of Nephrogenic Diabetes Insipidus
Mechanism

A

Hypercalcaemia
Causes down-regulation of aquaporin 2, reduced water absorption in collecting ducts, more dilute urine
Lithium works the same way

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2
Q

Site affected in Tubular Acidosis
Type 1
Type 2

A

Type 1 = distal tubules
Type 2 = proximal tubules

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3
Q

Associated with Horseshoe Kidney

A

Turner’s Syndrome

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4
Q

Pre renal uraemia =

A

pre renal cause of AKI

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5
Q

Lithium Toxicity
- Grading
- Symptoms

A

Severe = >2.5 lithium level
Sx = coarse tremor, confusion and seizures

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6
Q

Glomerulonephritis associated with low complement

A

Infectious causes
SLE

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7
Q

Drug induced lupus VS lupus

A

Drug induced does NOT usually involve the CNS or renal system

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8
Q

Drug used in PKD
- Mechanism of action

A

Tolvaptan
- vasopressin receptor 2 antagonist, evidence slows renal function decline

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9
Q

Child
Hypokalaemia
Normotension + normal renal function

A

Bartter’s syndrome
Defective chloride absorption in ascending loop of Henle - no co-transport of K+

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10
Q

Causes of hypocalcaemia (4)

A

Acute pancreatitis
Hypoparathyroidism
Pseudohypoparathyroidism
- mutation in PTH channel, unable to respond to PTH = low calcium
Rhabdomyolysis
- myoglobulin causes AKI, messes up absorption, calcium lost

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11
Q

Association with renal cell carcinoma

A

Paraneoplastic hepatic dysfunction syndrome
= raised ALP, abnormal liver enzymes, hepatomegaly

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12
Q

Uraemic polyneuropathy
- Difference between that and GBS

A

Sensory loss
- GBS is predominantly motor loss

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13
Q

Test of choice for renal artery stenosis

A

MR angiography

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14
Q

Medication prophylaxis for calcium stones in hypercalciuria

A

Thiazide diuretics

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15
Q

Medication prophylaxis for oxolate stones (2)

A

Cholestyramine
Pyridoxine

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16
Q

Chromosome associated with ADPKD

A

Chromosome 16
?6 looks like a kidney

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17
Q

What occurs in the first stage of diabetic nephropathy?

A

Increase in the GFR

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18
Q

What is the inheritance of Alport’s syndrome?

A

X-linked dominant

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19
Q

What is the pathophysiology of Bartter’s syndrome?

A

NKCC2 channel mutation in the ascending loop of Henle

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20
Q

How are ACE inhibitors renal protective?

A

= efferent arteriole vasodilation
= decreases the GFR
= decreases the proteinuria

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21
Q

Management of urge incontinence AND old/frail

A

Mirabegron is an option

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22
Q

Pain + likely PKD

A

Haemorrhage into renal cyst

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23
Q

Nephropathy associated with hepatitis B

A

Membranous

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24
Q

HLA matching most important prognostically in renal transplant

A

HLA-DR

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25
Gitelmann's Syndrome
= similar blood results to thiazide diuretic Acts on Na/Cl co-transporter
26
Investigation finding in membranous nephropathy Management of membranous nephropathy
ACE-I - steroids not shown to have benefit Ix: subendothelial deposits
27
1st line drug class in BPH
Alpha-1 antagonist
28
Association GN with syphillis
Rapidly progressive glomerulonephritis
29
Alport's syndrome - inheritance - association
X-linked dominant Retinitis Pigmentosa
30
Differentiating between ATN and prerenal uraemia
Urinary sodium ATN = tubules cannot reabsorb sodium, high urine Na+ Prerenal uraemia = reduced perfusion, conserve sodium to increase blood volume, low urine Na+
31
Findings in diabetic nephropathy (2)
Kimmelstiel Wilson nodules Basement membrane thickening
32
Sequale of diabetic nephropathy Management
Hyperfiltration (transient rise in GFR) > latent > microalbuminuria ACEI or ARB
33
Mechanism of hypocalcaemia in CKD
Reduced production of 1-25 dihydroxyD Results in secondary hyperparathyroidism to try and raise calcium levels
34
Anaemia in renal disease - investigations - management
Ferritin (aiming >200) Use of once weekly epo, aiming Hb 100-120 after 4 months of treatment
35
Side effects of epo (4)
HTN Seizures Red cell aplasia Thrombosis
36
What is the most important matching in renal transplant?
HLA DR Dr of kidneys will transplant the kidney
36
What is calciphylaxis? How does it present? What can trigger?
= calcific uraemic arteriopathy Px: occlusive, painful purpura Can be triggered by warfarin
37
What mediates hyperacute organ rejection?
IgG preformed antibodies = type II hypersensitivity reaction
38
What mediates acute organ rejection? What is it defined as?
= CD8+ mediated Within 6 months - usually HLA mismatch or CMV
39
Renal artery thrombosis VS vein thrombosis following renal transplant
Artery = sudden complete loss of urinary output Needs urgent surgical input Vein = haematuria, pain, reduced urine output and swelling Poor prognosis
40
Presentation of urinary leak following renal transplant Investigation finding
Reduced urine output, abdominal pain, pyrexia US: perigraft collection
41
Transplant Management - immunosuppression - initial - later/long term management - when steroids?
Initial = monoclonal Ab + calcineurin inhibitor Later = MMF + calcineurin inhibitor Add steroids if adverse reaction that is steroid responsive >1 ocassion
42
Calcineurin Inhibitors (2) Adverse effects (2)
Ciclosporin Tacrolimus AE: nephrotoxic, hyperglycaemia
43
Mechanism of action of ciclosporin
Binds to cyclophillin and inhibits calcineurin
44
Mechanism of action of Tacrolimus
Binds to FKBP and inhibits calcineurin
45
Mechanism of action of calcineurin
Is a phosphatase that mediates T cells via IL-2
46
What is the mechanism of action of MMF?
Inhibits IMPDH which inhibits purine synthesis = decreases proliferation of B and T cells
47
Genetic association with PKD Type 1
Chromosome 16 PKD1 gene More common
47
Mechanism of action of Sirolimus Adverse effect
Blocks IL-2 receptor therefore inhibiting T cell proliferation Hyperlipidaemia
47
Adverse effects of MMF (2)
Marrow suppression Diarrhoea
48
Example of monoclonal antibody used in renal transplants
Daclizumab
49
Genetic association with PKD Type 2
Chromosome 4 PKD2 gene
50
Autosomal recessive PKD - genetics - presentation
Chromosome 6 Much rarer - renal failure in childhood, liver fibrosis
51
Nephrotic Syndrome = Mechanism behind thrombosis
= oedema, proteinuria, hypoalbuminaemia Renal loss of anti-thrombin III (protein C and protein S)
52
Causes of nephrotic syndrome (6)
Glomerulonephritis SLE Amyloid Gold Penicillamine Hepatitis B
53
Minimal change disease - pathogenesis - causes (3) - investigation finding - management
T cell mediated causing GBM damage Causes: EBV, idiopathic, Hodgkin's lymphoma Ix: podocyte fusion Mx: steroids (if nil response cyclophosphamide)
54
What glomerulonephritides cause nephrotic syndrome?
Minimal change disease Membranous GN Focal Segmental GN
55
Which GN is associated with Hodgkin's lymphoma?
Minimal change disease
56
Which GN is the most common?
Membranous
57
Membranous GN - associations (3) - investigation findings (3) - management (2)
Ax: hepatitis B, malaria, malignancy Ix: anti-phospholipase A2 antibody positive, thickened basement membrane, IgG/C3 deposits Mx: initially ACEI, then steroids/cyclophosphamide if no response
58
Which GN is associated with malignancy?
Membranous
59
Which GN is associated with malaria?
Membranous
60
Focal Segmental GN - associations (3) - investigation (2) - management (2)
Ax: HIV, heroin use, Alport's syndrome Ix: segmental sclerosis, hyalinosis Mx: steroids, immunosuppression
61
What GN is associated with HIV?
Focal segmental GN
62
What GN is seen in Alport's Syndrome?
Focal Segmental GN
63
Nephritic Syndrome =
= HTN, proteinuria, haematuria
64
Causes of nephritic syndrome (5)
Glomerulonephritis SLE Post-streptococcal Endocarditis Hepatitis C
65
IgA nephropathy - when occurs? - associations (3) - investigation findings - management
Usually within 1-2 days of URTI Ax: HSP, coeliac, dermatitis herpetiformis Ix: IgA/C3 immunofluoresence Conservative management
66
What GN is associated with HSP?
IgA nephropathy
67
Rapidly progressive GN - associations (2) - investigation findings (2)
Ax: Goodpasture's, ANCA vasculitis Ix: epithelial crescents, red cell casts
68
Which GN is seen in Goodpasture's?
Rapidly progressive
69
Diffuse proliferative = - investigations (2) - management (2)
= lupus nephritis Ix: wire loop appearance, immune complex deposition Mx: HTN management, steroids
70
Which GN have a mixed picture?
Diffuse proliferative Membranoproliferative
71
Membranoproliferative - types - presentation - management
Type 1 - cryoglobulinaemia, hepatitis C Type 2 - partial lipodystrophy = proteinuria, haematuria, oedema, low C4 levels Mx: steroids
72
What is Type II membranoproliferative GN associated with?
Partial lipodystrophy
73
What is Type I membranoproliferative GN associated with?
Cyroglobulinaemia Hepatitis C
74
Hepatitis and association with GN
B - membranous C - membranoproliferative
75
Distal renal tubular acidosis - pathogenesis - biochemical change - associations (3)
= failure to excrete H+ - Hypokalaemia Ax: RA, SLE, Sjogren's
75
What RTA is rheumatoid arthritis associated with?
Type I (distal)
76
Fanconi's syndrome associated RTA?
Type II (proximal) RTA
77
Proximal renal tubular acidosis - pathogenesis - biochemical change - associations (3)
= failure to reabsorb bicarbonate - Hypokalaemia Ax: cystinuria, fanconi's syndrome, Wilson's
78
What is Type 4 RTA? - biochemistry - associations (3)
= hypoaldosteronism Ax: Addison's, DM, spironolactone
79
Prevention of calcium renal stones - oxalate stones
= thiazide diuretics - cholestyramine or pyridoxine
80
Issue with struvite or xanthine stones?
Radiolucent - need CT KUB non-contrast to be able to see
81
Associations with renal cell carcinoma (3)
Von-Hippel Lindau Tuberous sclerosis Smoking
82
Genetic association with Wilm's Tumour - condition
Chromosome 11 - WT1 gene Beckwith Wiedemann
82
Complications of RCC (4)
Polycythaemia Hypercalcaemia HTN Paraneoplastic hepatic dysfunction
83
What is targeted in Goodpasture's?
IgG anti-GBM antibodies target T4 collagen in BM
83
Defect in Alport's Syndrome - genetics
= defect in T4 collagen X-linked dominant
84
Investigation finding in Goodpasture's
IgG linear deposits
85
Phenylketonuria - genetics and inheritance - investigation - investigation findings
Autosomal recessive Chromosome 12 Ix: Guthrie test = high levels of phenylalanine, low tyrosine
86
Investigation for cystinuria - problem
Cyanide nitroprusside Defective transport of amino acids
87
What is the defect in homocystinuria?
Deficiency of cystathionine beta synthase = increased levels of homocystine
88
Investigation for homocystinuria? Management?
Cyanide Nitroprusside test Vitamin B6 - pyridoxine
89
Indication for HD in methanol overdose
Methanol levels >50

1MRCP Part 1 (20 decks)

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