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Year 2 MBChB > Renal > Flashcards

Renal Flashcards

(103 cards)

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1
Q

What antibodies are present in Good-pastures?

A

Anti-glomerular basement membrane

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2
Q

What is the presentation of Good-pastures?

A

Haemoptysis, nephritic syndrome

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3
Q

What investigations are done in Good-pastures?

A

Anti-GBM,

IgG along the basement membrane

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4
Q

What is the investigation of choice in a suspected glomerulonephritis?

A

Renal biopsy

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5
Q

What investigations are done in microscopic polyangitis?

A

p-ANCA

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6
Q

What is the presentation of nephrotic syndrome?

A

POO (proteinuria, oedema, nephrOtic)

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7
Q

What are the causes of minimal change disease?

A

Hodgkin’s, NSAIDS, assoc with atopy

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8
Q

What investigation is done in minimal change disease?

A

Electron microscopy: fused podocytes

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9
Q

Which GN is assoc with FSGS?

A

HIV

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10
Q

What is the presentation of FSGS?

A

Nephrotic syndrome - may be associated with haematuria, hypertension, poor renal function

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11
Q

How is FSGS investigated?

A

Specific segments of certain glomeruli develop sclerosed lesions

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12
Q

What is membranous GN caused by?

A

Immune complex deposition –> complement activation against glomerular basement membrane proteins

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13
Q

What can membranous GN be secondary to?

A

SLE, Hep B, penicillin amine, gold & malignancy

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14
Q

How is membranous GN investigated?

A

Thickened glomerular basement membrane, immunofluorescence: increased IgG uptake

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15
Q

What is the most common GN in adults?

A

IgA nephropathy

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16
Q

When does IgA nephropathy often appear?

A

1-2 days after URTI

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17
Q

What is the presentation of IgA nephropathy?

A

Nephritic syndrome: macroscopic haematuria, hypertension

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18
Q

What investigations are done in IgA nephropathy?

A

Microscopy: increased mesangial cells and matrix, IgA deposits in matrix

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19
Q

What is the presentation of post-strep GN?

A

Nephritic syndrome, AKI

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20
Q

When does post-strep Gn occur?

A

1-2 weeks after URTI (commonly strep pyogenes)

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21
Q

What is membranoproliferative GN caused by?

A

Subendothelial deposition of immune complexes

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22
Q

What is membranoproliferative GN associated with?

A

Decreased C3 levels

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23
Q

How is membranoproliferative GN investigated?

A

Thickened BM and mesangium, IgG deposition

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24
Q

How can the causes of AKI be split up?

A

Prerenal, intrinsic, postrenal

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25
What are some pre renal causes of AKI?
Hypovolaemia, renal artery stenosis
26
What are some intrinsic renal causes of AKI?
GN, Acute tubular necrosis, acute interstitial nephritis, rhabdomyolysis, tumour lysis syndrome
27
What are some post renal causes of AKI?
stones, BPH, external compression of ureter (tumour)
28
Define oliguria
Urine output < 0.5ml/kg/hour
29
What are the signs and symptoms of AKI?
Reduced urine output, oedema, arrhythmias (secondary to electrolyte abnormalities), features of uraemia
30
Which drugs should be stoped in AKI?
NSAIDs, ACEIs, diuretics, aminoglycosides, angiotensin II receptor antagonists
31
Which drugs may have to be stopped in AKI due to increased risk of toxicity?
Metformin, lithium, digoxin
32
When should haemodialysis be considered in AKI?
Hyperkalaemia, acidosis, uraemia
33
How is AKI managed?
Careful fluid balance, stopping drugs, finding cause (urinalysis, U&Es, renal USS), management of hyperkalaemia
34
What is the buzzword for acute tubular necrosis?
Brown granular casts
35
What is the criteria for diagnosing AKI in adults?
Rise in creatinine of 26 or more in 48 hours OR at least 50% rise in creatinine over 7 days OR oliguria for more than 6 hours
36
What is the final pathway in AKI?
Tubular cell death
37
What is the best way to differentiate between acute and chronic renal failure?
Renal ultrasound - chronic have bilateral small kidneys usually
38
Which chromosome is affected in ADPKD type 1?
Chromosome 16
39
What are the features of ADPKD?
Hypertension, recurrent UTIs, abdo pain, renal stones, haematuria, CKD
40
How is Alport's syndrome inherited?
X-linked dominant
41
What is Alport's syndrome due to?
Defect in the gene which codes for type IV collagen --> abnormal GBM
42
What are the features for Alport's?
Microscopic haematuria, progressive renal failure, bilateral SN deafness, lenticonus
43
What is amyloidosis?
Extraceullular deposition of an insoluble fibrillar protein (amyloid)
44
How is amyloidosis diagnosed?
Congo-red staining - apple green birefringence, SAP scan
45
What are common causes of CKD?
Diabetic nephropathy, chronic GN, chronic pyelonephritis, hypertension, PCKD
46
Define stage 1 CKD
eGFR > 90 with some sign of kidney damage on other tests
47
Define stage 2 CKD
eGFR 60-90 with some sign of kidney damage on other tests
48
Define stage 3a CKD
eGFR 45 - 59
49
Define stage 3b CKD
eGFR 30-44
50
Define stage 4 CKD
eGFR 15-29
51
Define stage 5 CKD
eGFR < 15
52
What factors may affect the eGFR result?
Pregnancy, muscle mass, eating red meat 12 hours prior to sample
53
Which drugs are first line in hypertension with CKD?
ACEIs
54
What eGFR change is OK with ACEIs in CKD?
eGFR decrease of up to 25%
55
What investigations are done in diabetes insipidus?
High plasma osmolality, low urine osmolality, water deprivation test
56
What is diabetes insipidus caused by?
Deficiency of ADH (cranial), or insensitivity to ADH (nephrogenic)
57
How are diabetics screened for diabetic nephropathy?
Albumin:creatinine ration in early morning specimen
58
What is used to treat anaemia associated with CKD?
EPO
59
Which renal problem is HSP associated with?
IgA nephropathy
60
What are the features of HSP?
purpuric rash peripherally, abdominal pain, polyarthritis, IgA nephropathy
61
What are the ECG changes of hypokalaemia?
U waves, small T waves, prolonged PR, ST depression
62
What does hypokalaemia predispose patients to?
Digoxin toxicity
63
When does hyper acute acute graft rejection occur?
minutes to hours
64
What is hyper acute ate graft rejection due to?
Pre-existent antibodies against donor HLA Type 1 antigens (type II hypersensitivity)
65
What is acute graft failure due to?
Usually mismatched HLA (cell-mediated), can be CMV
66
When does acute graft failure occur?
Within 6 months
67
What is chronic graft failure due to?
Both antibody and cell mediated mechanisms cause fibrosis to the transplanted kidney
68
When does chronic graft failure occur?
> 6 months
69
What is the management of rhabomyolsis?
IV fluids, sometimes urinary alkalinization
70
Where does spironolactone act?
Cortical collecting duct
71
Where do loop diuretics act?
Ascending loop of Henle
72
Where is glucose reabsorbed?
Proximal convoluted tubule
73
Where is most water reabsorbed?
proximal convoluted tubule
74
What is the management of UTI in non-pregnant women?
Trimethoprim/nitrofurantoin for three days
75
How is pyelonephritis managed?
IV amor + gent, step down to PO co-trimoxazole
76
What is the make up of the majority of renal stones?
Calcium oxalate
77
What is the first line management of renal stones?
USS
78
What is the investigation of choice in renal stones to confirm diagnosis?
Non contrast CT
79
What drugs should be given for renal colic?
Diclofenac
80
How are stones managed (< 5mm)?
Usually will pass within 4 weeks
81
How are stones managed ( >5mm)?
Lithotripsy (less than 2cm), ureteroscopy (less than 2cm pregnancy), percutaneous nephrolithotomy (complex stones + staghorn)
82
What is the most common renal malignancy?
Renal cell carcinoma
83
How are renal cancers investigated?
CT chest, abdo, pelvis
84
What decade of life do renal cancers most commonly affect?
60s
85
What are causes of bilateral hydropnephrosis?
SUPER: stenosis of urethra, urethral valve, prostate, extensive bladder tumour, retroperitoneal fibrosis
86
What are causes of unilateral hydronephrosis?
PACT: pelvic-ureteric obstruction, aberrant renal vessels, calculi, tumours of renal vessels
87
What are the investigations done in hydronephrosis?
USS, IVU
88
What does nephrotic syndrome occur due to?
Protein loss through abnormally permeable capillary basement membranes
89
What is the most common renal cell carcinoma?
Clear cell
90
What is a sarcomatous renal cancer?
Renal cell cancer that contains muscles, nerves, fat, blood vessels
91
What are the features of a WIlms' tumour?
Abdo mass, painless haematuria, flank pain
92
When does Wilms' tumour occur?
Typically under 5 years of age
93
How are Wilms' tumours treated?
Nephrectomy
94
Do Wilms' tumours metastasise?
yes - early, usually to lung
95
What are paraneoplastic features of renal cell carcinoma?
Hypertension and polycythaemia
96
What is an angiomyolipoma?
Tumour composed of blood vessels, smooth muscle, and fat
97
What are the different parts of the urethra (proximal)?
Prostatic --> membranous --> bulbous --> penile
98
What is the descending loop of henley responsible for?
Highly permeable to water, impermeable to NaCl
99
Where do thiazide diuretics act?
Distal tubule
100
Where do potassium sparing diuretics act?
Collecting tubule
101
Where do loop diuretics act?
Thick ascending loop of Henley
102
What does beading of the renal artery indicate?
Fibromuscular dysplasia
103
What does apple green birefringence on congo red stain indicate?
Amyloidosis

Year 2 MBChB (8 decks)

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