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TAS > RENAL > Flashcards

RENAL Flashcards

1
Q

Which kidney is higher than the other?

A

The left is higher than right

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2
Q

Which kidney is biopsied?

A

generally lower pole of right kidney

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3
Q

What is the function of the thick ascending loop of henle?

A

Sodium, potassium, chloride transport

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4
Q

What is the function of the proximal tubules?

A

Glucose transport
Phosphate transport
Amino acid transport

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5
Q

What is the function of the collecting ducts?

A

Water transport
Sodium, potassium transport

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6
Q

What is the function of the distal tubules?

A

Proton (H+) secretion
Sodium chloride transport

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7
Q

What are the disorders affecting the ascending limb of henle?

A

Bartter syndrome

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8
Q

What are the disorders affecting collecting ducts?

A

Nephrogenic diabetes insipidus
Pseudohypoaldosteronism
Liddle syndrome

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9
Q

What are the disorders affecting the proximal convoluted tubules?

A

Renal glycosuria
Hypophosphataemic rickets
Isolated, generalized aminoaciduria
the last two combined make fanconi syndrome

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10
Q

What are the disorders affecting the distal tubules?

A

Distal renal tubular acidosis
Gitelman syndrome

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11
Q

Describe the clinical features of fanconi syndrome + what fanconi syndrome is

A

Genralized proximal tubular disorder with initally well preserved glomerular function.
Growth faltering, polyuria and rickets in association with a normal plasma anion gap, metabolic acidosis, hypophosphataemia, hypokalaemia and generalized aminoaciduria.

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12
Q

What is the commonest cause of fanconi syndrome in Europe?

A

Nephropathic cystinosis
Disorder of lysosomal cystine transport of , resulting in excessive intracellular accumulation of free cystine in many organs including the kidney, eyes and thyroids.

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13
Q

What is inheritance of nephropathic cystinosis?

A

AR

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14
Q

What is the treatment for nephropathic cystinosis?

A

Mercaptamine, which prevents accumulation of lysosomal cystine.

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15
Q

hypokalaemic, hypochloraemic metabolic alkalosis with salt wasting + hypocalcurea + hypomagnesaemia

A

Gitelman Syndrome

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16
Q

hypokalaemic, hypochloraemic metabolic alkalosis with salt wasting + hypercalcurea + normal Mg2+

A

Bartter Syndrome

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17
Q

Damage to what mutation and where is difference between Gitelman and Bartter syndrome?

A

Bartter- Ascending loop of henle furosemide-sensitive sodium–potassium–chloride channel (NKCC2)
Gitelman- distal convoluted tubule thiazide-sensitive sodium–chloride channel (NCCT)

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18
Q

What is classical clinical presentaation of Bartter vs Gitelman?

A

Barter - early childhood, faltering growth, poor feeding, dehydration + lethargy
Gitelman teenager, muscle weakness and cramps, and short stature

19
Q

RTA type 1 can be characterised as what?
What are lab findings?

A

failure to secrete H+ ions in distal convoluted tubule
metabolic acidosis, hyPOkalaemia urine pH>5.5

20
Q

RTA type 2 can be characterised as what? What are lab findings?

A

Bicarbonate wasting in proximal convoluted tubule
metabolic acidosis hyPOkalaemia, urine pH<5.5 + Urine has rasied bicarb, glucose and amino acids (Like fanconi!)

21
Q

RTA type 4 can be characterised as what?
What are lab findings?

A

Impairment in formation of ammonia
metabolic acidosis, hyPERkalaemia

22
Q

How does RTA type 1 typically present?

A

renal colic, renal stones, faltering growth

23
Q

How does RTA type 2 typically present?

A

Faltering growth and rickets
Fanconi syndrome

24
Q

What is the commonest abnormality of renal tract?

A

Hydro­nephrosis secondary to pelvi-ureteric junction obstruction (PUJO)

25
Q

Define nephrotic syndrome

A

proteinuria, oedema and hypoalbuminaemia together with hyperlipidaemia.

26
Q

What is nephrotic syndrome most commonly secondary to?

A

minimal change disease

27
Q

What is the percentage of patients whose nephrotic syndrome relapses?

A

70%

28
Q

define nephrotic syndrome relapse

A

Urine albumin 3+ or 4+ (or proteinuria >4 mg/m2/h) in three consecutive early morning specimens having been in remission previously

29
Q

Define nephrotic syndrome remission

A

Urine albumin nil or trace (or proteinuria <4 mg/m2/hour) in three consecutive early morning urine specimens

30
Q

Define frequent relapse in relation to nephrotic syndrome

A

Two or more relapses in initial six months or more than three relapses in any twelve months

31
Q

Define steroid dependence in relation to nephrotic syndrome

A

Two consecutive relapses when on alternate day steroids or within 14 days of its discontinuation

32
Q

Define steroid resistance in relation to nephrotic syndrome

A

Absence of remission despite therapy with daily prednisolone at a dose of 2 mg/kg/day for 4 weeks

33
Q

Describe minal change disease

A

Fuckery of the podocyte on the parietal epithelial cells of the basement membrane

34
Q

What is the treatment for nephrotic syndrome?

A

prednisolone (60 mg/m2/day for four weeks followed by 40 mg/m2/day) for at least another four weeks.
Penicillin prophylaxis

35
Q

What are the chickenpox rules for nephrotic syndrome?

A

should receive varicella zoster immunoglobulin within 96 hours of exposure to chickenpox. If a child with nephrotic syndrome develops chickenpox, they should receive treatment with intravenous aciclovir.

36
Q

What are the types of immune-complex mediated glomerulonephritis?

A

Post-infectious, usually post streptococcal
Other post-infectious causes – bacterial, viruses, rickettsiae, fungal, parasites
Henoch–Schönlein purpura (HSP)/IgA vasculitis
Systemic lupus erythematosus (SLE)
IgA nephropathy (IgAN)
Membranoproliferative glomerulonephritis (MPGN)/C3 glomerulopathy

37
Q

What type of glomerulonephritis is commonest? And what is it associated with?

A

post group A haemolytic strep
Low C3

38
Q

How does IgA nephritis normally present?

A

Macroscopic haematuria following URTI/ upper GI illness. Occurs 1-2 days after rather than a week seen in post-strep

39
Q

subepithelial immune deposits or humps are seen in what?

A

post-strep glomerulonephritis

40
Q

mesangial deposits are a feature of what ?

A

IgA nephritis

41
Q

Subendothelial depostis are a feature of what?

A

Membranoproliferative glomerulonephritis AND in class III +IV lupus

42
Q

Diffuse thinning and splitting of glomerular basement membrane/ lamina densa is a feature of what?

A

Alport syndrome

43
Q

What are the features of Alport syndrome

A

haematuria 1-2 days post URTI + bilateral sensorinueral hearing loss and anterior lenticonus

TAS (18 decks)

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