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Renal Flashcards

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1
Q

What is glomerulonephritis?

A

Immune mediated disease of the kidneys affecting the glomeruli with secondary tubo-interstitial damage

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2
Q

What mediates glomerulonephritis?

A

Antibody mediated - T cells, inflammatory cells, mediators, complement

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3
Q

What is the commonest cause of end stage kidney disease?

A

Diabetes

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4
Q

How does nephrotic syndrome present?

A

Proteinuria, oedema, hypoalbulinaemia, lipiduria

NON-PROLIFERATIVE

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5
Q

How does nephritic syndrome present?

A

Haematuria, hypertension, oedema, renal failure

PROLIFERATIVE

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6
Q

How is glomerulonephritis diagnosed?

A

Clinical presentation
Bloods
Urinalysis, microscopy, urine protein
Kidney biopsy

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7
Q

What are some causes of nephrotic syndrome?

A

Minimal change nephropathy
Focal segmental glomerulonephritis
Membranous glomerulonephritis

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8
Q

Whats the commonest cause of nephrotic syndrome in kids?

A

Minimal change nephropathy

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9
Q

What is the commonest cause of nephrotic syndrome in adults?

A

Focal segmental glomerulonephritis

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10
Q

‘Foot process fusion on EM’

A

Minimal change nephropathy

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11
Q

How do you treat minimal change nephropathy?

A

Steroids - should go into complete remission

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12
Q

Does minimal change nephropathy progress to renal failure?

A

No

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13
Q

What can cause focal segmental glomerulonephritis in adults?

A

Can be primary or secondary to HIV, heroin use and obesity

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14
Q

Does focal segmental glomerulonephritis progress to renal failure?

A

Yes - 50% have end stage kidney disease in 10 years

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15
Q

‘Focal segmental glomerulonephritis on LM’

A

Focal segmental glomerulonephritis

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16
Q

How is focal segmental glomerulonephritis treated?

A

Steroids

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17
Q

What causes membranous glomerulonephritis?

A

Can be primary or secondary to SLE, infection, malignancy, rheumatoid drugs (gold/penicillamine)

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18
Q

Can membranous glomerulonephritis progress to renal failure?

A

Yes

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19
Q

‘Thickened basement membrane on silver stain’

A

Membranous glomerulonephritis

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20
Q

How is membranous glomerulonephritis treated?

A

Steroids, alkylysing agents, monoclonal antibodies

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21
Q

What are causes of nephritic syndrome?

A

IgA nephropathy

Rapidly progressive glomerulonephritis

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22
Q

What is the commonest glomerulonephritis worldwide?

A

IgA nephropathy

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23
Q

‘Macroscopic haematuria 1-2 days following infection’

A

IgA nephropathy

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24
Q

‘Mesangial IgA proliferation’

A

IgA nephropathy

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25
What condition does IgA nephropathy have some overlap with?
Henoch-Schonlein Purpura
26
How is IgA nephropathy treated?
Blood pressure control if needed
27
What is rapidly progressive glomerulonephritis?
A treatable cause of acute kidney failure that rapidly progresses over days to weeks
28
What are some ANCA +ve causes of rapidly progressive glomerulonephritis?
Vasculitis, Wegners, Churg-Strauss
29
What are some ANCA -ve causes of rapidly progressive glomerulonephritis?
Goodpastures, Henoch-Schonlein Purpura, SLE
30
What other organ does Goodpastures disease affect?
Lungs - haemoptysis, cough, SOB
31
What antibody is seen in Goodpastures?
Anti-GBM
32
'Glomerular cresents seen'
Rapidly progressive glomerulonephritis
33
How is rapidly progressive glomerulonephritis treated?
Strong immunosuppressants +/- dialysis
34
What glomerulonephritis' will give a mixed nephrotic and nephritic picture?
Membranoproliferative | Post-infective
35
What causes membranoproliferative GN?
Cryoglobulinaemia, HepC
36
'Subendothelial IgG deposits'
Membranoproliferative GN
37
'Tram track appearance of basement membrane'
Membranoproliferative GN
38
How is membranoproliferative GN treated?
Steroids
39
'A child has a sore throat. 7-14 days later he has haematuria'
Post infective/Diffuse Proliferative GN
40
'Coca cola urine'
Post infective/diffuse proliferative GN
41
'Proliferation of mesangial cells, neutrophils and monocytes'
Post infective/diffuse proliferative GN
42
What is the criteria for AKI?
Rise of serum creatinine to >26 in 48hrs OR Rise of serum creatinine to >50% of last 7 days OR Fall in urine output to <0.5ml/kg/hr for more than 6hrs
43
What are pre-renal causes of AKI?
Lack of blood supply to kidneys - hypovolaemia, hypotension, drugs (NSAIDs, COX-2, ACEis, ARBs)
44
What are renal causes of AKI?
Vasculitis, IV contrast, toxins, glomerulonephritis, acute intersitital nephritis, rhabdomyolysis
45
What are post-renal causes of AKI?
Obstruction of urine outflow causing backpressure (e.g. stones, BPH, strictures, tumours)
46
What are risk factors for developing AKI?
CKD, Age over 65, diabetes, heart failure, liver failure, history of AKI, nephrotoxins
47
How do you prevent AKI?
Minimise risk factors
48
What are some signs and symptoms of AKI?
Can be asymptomatic | Reduced urine output, pulmonary and peripheral oedema, arrythmias, uraemic features (pericarditis, encephalopathy)
49
What investigations are important in AKI?
Bloods - FBC, U&Es, Clotting Urinalysis - check for haemoproteinuria Renal USS - within 24hrs to check for cause
50
What management is important in pre-renal AKI?
Fluids - 0.9% sodium chloride bolus then infusion
51
How should fluid status be assessed?
JVP, HR, BP, cap refil, urine output
52
What is a complication of untreated pre-renal AKI?
Acute tubular necrosis
53
What is acute tubular necrosis?
Death of renal tubular epithelial cells
54
'Muddy brown casts'
Acute tubular necrosis
55
What is an important investigation to carry out in intrinsic AKI?
Renal biopsy - assess for glomerulonephritis
56
What is the specific management of post-renal AKI?
Catheter/nephrostomy/stent
57
What medications should be stopped in AKI?
NSAIDs, aminoglycosides, ACEis, ARBs, diuretics
58
What metabolic complication may occur in AKI?
Hyperkalaemia
59
What ECG changes does hyperkalaemia cause?
Tall tented T waves
60
How is hyperkalaemia treated?
Calcium gluconate 10mls of 10% IV Nebulised salbutamol Insulin/Dextrose continuous infusion Calcium resonium/dialysis
61
What may be considered in AKI if medical management does not get an adequate response?
Haemodialysis
62
What are complications of AKI?
Increased length of hospital stay Increased mortality and morbidity Increased risk of CKD
63
What is CKD?
Reduced eGFR and/or evidence of kidney damage that is chronic
64
What equation is used to work out eGFR?
MDRD4
65
What variables does the MDRD4 counteract?
Creatinine, race, sex, age
66
What is classified as stage I CKD?
eGFR >90ml/min AND evidence of kidney damage
67
What is classified as stage II CKD?
eGFR 60-90ml/min AND evidence of kidney damage
68
What is classified as stage IIIA CKD?
eGFR 45-59ml/min
69
What is classified as stage IIIB CKD?
eGFR 30-44ml/min
70
What is classified as stage IV CKD?
eGFR 15-29 ml/min
71
What is classified as stage V CKD?
eGFR <15ml/min
72
What are causes of CKD?
Diabetes, hypertension, vascular disease, glomerulonephritis, PCKD, unknown
73
What are symptoms of CKD?
Usually non-specific - tiredness, poor appetite, itch, sleep disturbance
74
Which patients are more likely to progress in CKD?
Patients with proteinuria, younger patients
75
How is cardiovascular risk reduced in patients with CKD?
Stop smoking, lose weight, healthy diet | Statin and Aspirin
76
What management can slow the progression of CKD?
By decreasing proteinuria by controlling BP | Use ACEis and ARBs
77
What is the target blood pressure in CKD?
140/90 or 130/80 in diabetics
78
What kind of anaemia do patients with CKD get?
Normocytic normochromic anaemia
79
Why do patients with CKD become anaemia?
Decrease in erythropoetin
80
How is anaemia treated in CKD?
Correct any deficiencies | Give erythropoeitin injections
81
How should bones be protected in CKD?
Phosphate binders, calcium and vitamin D
82
How should oedema be treated in CKD?
Loop diuretics
83
When is dialysis considered in CKD?
End stage kidney disease - when eGFR <20
84
What must be formed in order to carry out haemodialysis?
Arteriovenous fistula
85
Why is an arteriovenous fistula needed?
Means there is not continuous cannulation of small veins that may eventually collapse Allows for faster blood flow
86
How long after formation of an AV fistula will it be functional?
6 weeks
87
What is dialysed out of a patient?
Urea, creatinine, potassium, toxins
88
What is dialysed into a patient?
Water, sodium, potassium, bicarbonate, glucose
89
What is the minimum amount of time dialysis should be done?
At least 4 hours 3 times a week
90
What restrictions are put on a patient on haemodialysis?
1L fluid per day, low salt diet, low potassium diet, low phosphate diet
91
How does peritoneal dialysis work?
Solute removed by diffusion across the peritoneal membrane
92
What are some complications of peritoneal dialysis?
Infection, membrane failure, hernias
93
When can a patient with CKD be put on the transplant list?
When they are within 6 months of starting dialysis
94
What can cause an increase in urea?
Dehydration, GI bleed, increased protein breakdown (infection, malignancy), drugs, high protein diet
95
What may cause a low urea?
Malnutrition, liver disease, pregnancy
96
What does a rise in both urea and creatinine suggest?
Renal dysfunction
97
What is the likely cause of haematuria in a patient just back from a holiday to India/Malawi?
Schistosomiasis
98
What are some renal features of autosomal dominant kidney disease?
Hypertension, recurrent UTI, abdominal pain, renal stones, haematuria, renal stones
99
What are some extra renal features of ADPKD?
Liver cysts, berry aneurysms
100
What is Alports Syndrome?
Genetic syndrome caused by a defect in type IV collagen
101
How is Alports syndrome inherited?
X-linked dominant
102
What symptoms and signs do you get in Alports syndrome?
``` Microscopic haematuria Progressive renal failure Bilateral sensorineural deafnes Lenticonus - anterior lens dislocation Retinitis Pigmentosa ```
103
What are 'eosinophilic casts' in the urine found in?
Chronic pyelonephritis
104
In pre-renal AKI, what is the urinary osmolality and urinary sodium like?
Urinary osmolality HIGH | Urinary sodium LOW
105
In renal AKI, what is the urinary osmolality and urinary sodium like?
Urinary osmolality LOW | Urinary sodium HIGH
106
What is the best investigation for hydronephrosis?
Ultrasound

Finals Revision (22 decks)

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