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MRCP 1 > Renal > Flashcards

Renal Flashcards

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1
Q

Nephrotic syndrome causes

A

Primary glomerulonepbritis
Systemic disease - DM, SLE, amyloidosis
Drugs - gold, penicillamine
Congenital
Neoplasia
Infection - endocarditis, hepatitis B, malaria

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2
Q

Nephrotic syndrome complications

A

Increased risk of VTE due to loss of antithrombin III and plasminogen in urine

Hyperlipidaemia
CKD
Increased risk of infection
Hypocalcaemia

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3
Q

What is amyloidosis

A

Term to describe the extra cellular deposition of amyloid from precursor proteins
Accumulation of amyloid leads to tissue/organ dysfunction

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4
Q

Diagnosis of amyloidosis

A

Congo red staining : apple green birefringance
Serum amyloid precursor scan
Biopsy of skin- rectal mucosa- abdo fat

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5
Q

ADPKD treatment

A

Tolvaptan - vasopressin receptor 2 antagonist only if -
- ckd 2/3
- rapidly progressive disease
- needs discount from company

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6
Q

Hyperkalaemia management

A

Stabilise cardiac membrane - IV calcium gluconate (doesn’t remove K)

Short term shift - insulin/dextrose infusion & salbutamol Neb

Removal of potassium from body - calcium resonium, loop diuretics, dialysis

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7
Q

What causes focal segmental glomerulosclerosis?

A

Idiopathic
Other renal pathology
HIV
Heroin
Alport’s
Sickle-cell

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8
Q

Investigation of focal segmental glomerulosclerosis

A

Renal biopsy - focal and segmental sclerosis and hyalinosis on light microscopy
Effacement of foot processes on electron microscopy

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9
Q

What’s the management of focal segmental glomerulosclerosis

A

Steroids +/- immunosuppressants

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10
Q

Spironolactone - when to use

A

Ascites- patients with cirrhosis develop secondary hyperaldosteronism
HTN
HF
Nephrotic syndrome
Conn’s

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11
Q

Adverse effects of spironolactone

A

Hyperkalaemia
Gynaecomastia

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12
Q

Features of autosomal dominant PKD

A

HTN
Recurrent UTI’s
Flank pain
Haematuria
Palpable kidneys
Renal impairment
Renal stones

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13
Q

Extra renal manifestations of ADPKD

A

Liver cysts - may cause hepatomegaly
Berry aneurysm
Cardiovascular - mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
Cysts in other organs - pancreas, spleen

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14
Q

Conditions associated with Bergers

A

Alcoholic cirrhosis
Coeliac/dermatitis herpetiformis
Henoch-Schonlein purpura

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15
Q

Pathophysiology of Bergers

A

Deposition of IgA immune complexes
Positive immunofluorescence for IgA & C3

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16
Q

Presentations of Berger’s

A

Young male, recurrent macroscopic haematuria
Recurrent chest infections
Renal failure is unusual

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17
Q

Post-strep glomerulonephritis features

A

Develops 1-2 weeks after URTI
Proteinuria
Low complement

Can have haematuria but not as common

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18
Q

Management of Berger’s

A

Nothing needed unless persistent proteinuria (>500mg) - first line is ACE

Active disease or not responding to ACE - steroids

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19
Q

Investigations for renal stones

A

Urine dip and culture
Serum creat and electrolytes
FBC/CRP - look for infection
Calcium/urate - look for underlying cause
Cultures if Pyrexic
Clotting

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20
Q

Management of renal stones

A

Watch and wait if <5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20mm shockwave or ureteroscopy
>20mm percutaneous nephrolithotomy

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21
Q

Uretic stones management

A

Shockwave lithotripsy +/- alpha blockers

10-20mm ureteroscopy

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22
Q

Prevention of calcium stones

A

High fluid intake
Add lemon juice to water
Avoid carbonated drinks
Limit salt
Potassium citrate
Thiazide diuretics

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23
Q

Prevention of oxalate stones

Study These Flashcards
A

Cholestyramine reduces urinary oxalate secretion
Pyridoxine reduces urinary oxalate secretion

24
Q

Prevention of uric acid stones

Study These Flashcards
A

Allopurinol
Urinary alkalinization (oral bicarbonate)

25
What’s calciphylaxis
Rare complication of end-stage renal failure Deposition of calcium in arterioles causing occlusion and necrosis Presents as painful necrotic skin lesions
26
Causes of minimal change disease
Idiopathic Drugs - NSAID’s, rifampicin Hodgkin’s lymphoma, thymoma Infectious mono
27
Pathophysiology of minimal change disease
T-Cell and cytokine-mediated damage to glomerular basement membrane leads to polyanion loss Reduction in electrostatic charge leads to increased glomerular permeability to serum albumin
28
Features of minimal change disease
Nephrotic syndrome Normotension Highly selective proteinuria (albumin & transferrin) Renal biopsy - normal glomeruli on light microscopy, electron microscopy shows fusion of podocytes and effacement of foot processes
29
Management of minimal change disease
Oral steroids Cyclophosphamide
30
Goodpastures features
Pulmonary haemorrhage Rapidly progressive glomerulonephritis
31
Goodpastures investigations
Renal biopsy - linear IgG deposits along basement membrane Raised transfer factor due to pulmonary haemorrhage
32
Management of Goodpastures
Plasma exchange - plasmapheresis Steroids Cyclophosphamide
33
Causes of anaemia in renal failure
Reduced erythropoietin levels Reduced absorption of iron Reduced erythropoiesis due to toxic effects of uraemia on bone marrow Anorexia/nausea due to uraemia Reduced red cell survival Blood loss due to capillary fragility Stress ulceration leading to chronic blood loss
34
Renal transplant post op problems
ATN of graft Vascular thrombosis Urine leakage UTI
35
Important HLA antigens when matching for renal transplant
DR > B > A
36
How is Alport’s inherited
X-linked dominant
37
What is Alport’s due to a defect in?
Type IV collagen
38
What is the favourite Alport’s question?
Alport patient with failing renal transplant caused by presence of anti-GBM antibodies leading to a Goodpastures type syndrome
39
Alport’s features
Microscopic haematuria Progressive renal failure Bilateral sensorineural deafness Lenticonus Retinitis pigmentosa Renal biopsy - splitting of lamina densa seen on electron microscopy
40
Diagnosing Alport’s
Molecular genetic testing Renal biopsy - longitudinal splitting of lamina densa of GBM, basket weave appearance
41
Types of testicular cancer
95% are germ cell - seminomas & non-seminomas (embryonal, yolk sac, teratoma, choriocarcinoma) Rest are non-germ cell - Leydig cells and sarcomas
42
Risk factors for testicular cancer
Infertility Cryptorchidism Family history Klinefelter’s Mumps
43
Features of testicular cancer
Painless lump Hydrocele Gynaecomastia
44
Tumour markers in testicular cancer
Seminomas - hcg may be elevated Non seminomas - AFP LDH is raised in 40% of germ cell tumours
45
Management of testicular cancer
Orchidectomy Chemo/radio
46
Features of fibromuscuar dysplasia
HTN CKD Flash pulmonary oedema
47
What is Fanconi syndrome
A generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule
48
Features of Fanconi syndrome
type 2 (proximal) renal tubular acidosis Polyuria Aminoaciduria Glycosuria Phosphaturia Osteomalacia
49
Causes of Fanconi
Cystinosis Sjogren’s Multiple myeloma Nephrotic syndrome Wilson’s
50
Idiopathic membranous glomerulonephritis is due to what?
Anti-phospholipase A2 antibodies
51
What triad does haemolytic uraemic syndrome cause
AKI Microangiopathic haemolytic anaemia Thrombocytopenia
52
Causes of secondary haemolytic uraemic syndrome (typical HUS)
Shiga toxin - E Coli Pneumococcal infection HIV Rare - SLE, drugs, cancer
53
Investigation results for primary HUS (atypical)
FBC - Hb <80, negative Coombs, thrombocytopenia, fragmented blood film - schistocytes, helmet cells U&E - AKI Stool culture -STEC infection, pcr for shiga
54
Causes of normal anion gap
GI bicarbonate loss - prolonged diarrhoea, fistula, ureterosigmoidostomy Renal tubular acidosis Drugs - acetazolamide Ammonium chloride injection Addisons
55
Causes of raised anion gap
Lactate - shock, sepsis, hypoxia Ketones - DKA, alcohol Urate - renal failure Acid poisoning - salicylates, methanol Metformin.
56
Investigations for Bergers
Urinalysis - erythrocytes, proteinuria Urine microscopy & culture - erythrocytes C3 & C4 levels normal Renal uss - normal CT - normal Biopsy - diffuse mesangial IgA deposition

MRCP 1 (14 decks)

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