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MRCP part 2 > Renal > Flashcards

Renal Flashcards

(52 cards)

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1
Q

Granulomatosis with polyangiitis features

A
  • pulmonary haemaorrhage / epistaxis
  • sinusitis, nasal crusting
  • dyspnoea
  • saddle nose deformity
  • vasculitic rash
  • mononeuritis multiplex
  • renal failure

cANCA +ve

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2
Q

Granulomatosis with polyangiitis mx

A
  • steroids + cyclophosphamide

- PLEX

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3
Q

Post streptococcal glomerulonephritis ix

A
  • ASOT positive
  • low C3
  • immune complex deposition

Renal biopsy

  • Diffuse proliferative glomerulonephritis
  • starry sky appearance EM
  • subepithelial humps
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4
Q

Post streptococcal glomerulonephritis mx

A
  • supportive, good prognosis
    Oedema & hypertension?
    1) loop diuretics
    2) ACEi / CCBs
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5
Q

Liddle’s

A 
AD inheritance
High ENaC (mimics hyperaldosteronism)
BUT low renin and aldosterone
HypoK, metabolic alkalosis
HTN

Mx: amiloride

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6
Q

GPA vs anti-GBM differentiation

A
  • p-ANCA vs anti-GBM

- raised ESR in GPA, normal in anti-GBM

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7
Q

Bartter syndrome features and mx

A

NaK2Cl co-transporter mutation (AR) - analogous to loop diuretics

  • hypokalaemia
  • metabolic alkalosis
  • hypomagnesaemia
  • normal blood pressure
  • INCREASED urinary calcium
  • high renin, hyperaldosteronism

Mx: K / Mg supplementation, NSAIDs, ACEi

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8
Q

Gitelman syndrome features and mx

A

NaCl transporter mutation DCT - analogous to thiazide use

  • hypokalaemia
  • metabolic alkalosis
  • normotension
  • high renin, hyperaldosteronism
  • DECREASED urinary calcium
  • presents later vs Bartter’s

Mx: K / Mg supplementation, NSAIDs, ACEi

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9
Q

Liddle’s syndrome

A

AD condition -> high ENaC - mimics hyperaldosteronism

  • hypokalaemia
  • metabolic alkalosis
  • hypertension
  • low renin and aldosterone

Mx: amiloride

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10
Q

Type 1 (distal) renal tubular acidosis causes

A
  • idiopathic
  • rheumatological conditions
  • amphotericin B
  • analgesic nephropathy
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11
Q

Type 2 (proximal) renal tubular acidosis causes

A
  • idiopathic
  • Fanconi sydrome (losing all electrolytes?)
  • Wilson’s
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12
Q

Type 4 renal tubular acidosis causes

A
  • most common
  • aldosterone deficiency is usually cause
  • hypoaldosteronism
  • ACEi / ARB / spiro
  • NSAIDs
  • diabetes
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13
Q

Cast nephropathy

A

Myeloma with renal involvement as cause
Mx: chemotherapy
- mephalan + corticosteroids
- OR bortezomib + thalidomide + steroids if younger patient

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14
Q

Time-frame for EPO-induced epilepsy

A

90 days

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15
Q

Isograft

A

From genetically identical source (identical twin)

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16
Q

Allograft

A

Genetically different source but same species

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17
Q

Autograft

A

Same individual is donor and recipient

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18
Q

Heterotopic graft

A

Graft into different anatomical locations

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19
Q

Orthotopic graft

A

Graft into same anatomical location

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20
Q

Xenograft

A

Graft from different species

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21
Q

Fibromuscular dysplasia affecting renal artery

Study These Flashcards
A

Angio: string of beads appearance
Mx: angioplasty > medical therapy. NB: no role for renal artery re-implantation

22
Q

Renal artery stenosis

Study These Flashcards
A
  • raised renin and aldosterone (mech to preserve blood flow to kidney)
    Mx: medical management of hypertension is as effective as angioplasty. ACE / ARB + diuretic usually used
    NB: ACE/ARB NOT contraindicated as long as U&Es closely monitored
23
Q

Minimal change disease features features, causes, management, prognosis

Study These Flashcards
A
  • nephrotic syndrome
  • EM: fusion of podocytes

Causes

  • mostly idiopathic
  • drugs: NSAIDs, rifampicin
  • Hodgkin’s lymphoma, thymoma
  • infectious mononucleosis

Mx:

1) 80% steroid responsive
2) cyclophosphamide

Prognosis
1/3 one episode
1/3 infrequent relapses
1/3 frequent relapses which stop just before adulthood

24
Q

Membranous GN features, causes, management, prognosis

Study These Flashcards
A
  • nephrotic syndrome
  • EM: thickened BM, subepithelial deposits - spike and dome

Causes

  • idiopathic
  • hep B, malaria, syphilis
  • cancers
  • drugs e.g. NSAIDs
  • AI disease e.g. SLE, RA

Mx

  • ACEi
  • corticosteroid + cylophosphamide
  • generally poorly steroid responsive as monotherapy
  • consider anticoag

Prognosis
1/3 spontaneous remission
1/3 remain proteinuric
1/3 ESRF

25
ADPCKD screening
- renal USS after age 20 | - cerebral angio only if +ve FHx cerebral bleed, previous rupture, warning symptoms
26
Haemolytic uraemic syndrome
- usually young children - bloody diarrhoea & abdo pain - acute renal failure - microvascular autoimmune haemolytic anaemia (schistocytes) - thrombocytopenia - NO RASH Causes: - O157 e coli - cancers - pregnancy - COCP - SLE - HIV Mx: supportive - ?PLEX if no diarrhoea
27
TTP
- fever - microangiopathic haemolytic anaemia (schistocytes) - thrombocytopenia - renal failure - fluctuating neuro signs Ix: ADAMTS13 low Mx - post-infection e.g. urinary, gastrointestinal pregnancy - drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel, aciclovir - tumours - SLE - HIV Mx 1) PLEX 2) Steroids 3) Rituximab
28
Mx calcium stones
- increase fluid intake - low salt diet - low animal protein diet - thiazide diuretics e.g. indapamide
29
Oxalate stones mx
- hydration - cholestyramine - pyridoxine - thiamine
30
Uric acid stones mx
- allopurinol | - bicarbonate
31
Type 1 RTA features
- acidosis - low bicarb - hypokalaemia - alkaline urine - hypercalciuria - nephrocalcinosis
32
Type 2 RTA features
- acidosis - hypokalaemia - acidic urine - high bicarb in urine - hyperchloraemia
33
Type 4 RTA
- low renin, low aldosterone | - hyperK
34
AA amyloidosis
Secondary amyloidosis e.g. rhuematological conditions
35
AL amyloidosis
Primary amyloidosis e.g. myeloma
36
Beta 2 microglobulin amyloidosis
- accumulation as unable to be filtered by cellulose dialysis machines - CTS, tenosynovitis, arthropathy, bony cysts, pathological fractures Mx: other newer dialysis machines (high flux) OR transplant
37
HIV associated nephropathy
- nephrotic range proteinuria - normotensive - normal / increased kidney size - focal segmental glomerulosclerosis - Mx: ACEi and ART
38
Von Hippel Lindau
- AD VHL tumour suppressor gene mutation - cerebellar haemangiomas - retinal haemangiomas - premalignant renal cysts (may -> high hb) - phaeo - other cysts
39
Acute interstitial nephritis
Causes: - drugs e.g. penicillins, NSAIDs, furosemide - rheumatological disease - infections e.g. staph Features - fever - rash - arthralgia - hypertension - mild renal impairment Ix - eosinophilia - sterile pyuria, white cell casts Mx - remove cause - supportive - steroids if no improvement NB: if uveitis also present -> GIVE STEROIDS
40
Alport's syndrome, features, inheritance
- X-linked dominant OR autosomal recessive Features - microscopic haematuria - prog renal failure - b/l sensorineural deafness - retinitis pigmentosa - anti-GBM disease in 5% after renal transplant -> RPGN Mx: renal transplant
41
Pseudohyponatraemia causes
Hyperlipidaemia | Very high protein
42
Primary hyperoxaluria
- recurrent calcium oxalate stones - raised urinary oxalate, calcium, urate - may progress to kidney failure - Mx: urinary acidification with citrate; may need combined liver / kidney transplant
43
Causes and effects of ciclosporin toxicity
Causes: - drugs that inhibit cytochrome p450 system e.g. erythromycin and clarithyromycin Effects - nephrotoxicity - hepatotoxicity - hypertension - gingival hyperplasia - hypertrichosis - tremor - hyperlipidaemia - impaired glucose tolerance
44
Hyperacute graft rejection
- minutes-hours - pre-existent IgG vs HLA antigens - now rare because of HLA matching
45
Acute graft rejection
- <6 months - cytotoxic T-cell mediated vs HLA - Mx: steroids, immunosuppressants
46
Chronic graft rejection
> 6 months | - fibrosis
47
CMV in renal transplantation
- disease usually 1-4 months after transplant or stopping CMV prophylaxis - prophylaxis with valganciclovir given to all patients unless both donor and recipient are CMV -ve Features - fever, myalgia, arthralgia - leukopenia - mild transaminitis - complications: acute graft failure, hepatitis, pancreatitis, colitis, pneumonitis Mx: IV ganciclovir
48
Post transplant lymphoproliferative disorder
- often EBV -> B cell proliferation / lymphoma - 1st year after transplant - fever, weight loss, fatigue, organ dysfunction - Ix: monoclonal Ig/paraprotein - Mx: reduce immunosuppression + rituximab
49
Features of ADPCKD
- progressive renal failure - hypertension - associated with mitral valve prolapse - 20% will have berry aneurysms - liver cysts may be present
50
HIV drugs and AKI
Protease inhibitors can cause intratubular crystal obstruction Mx: IV fluids
51
Urge incontinence mx
1) bladder training (6 weeks minimum) 2) anticholinergics - solifenacin / tolterodine > oxybutynin as fewer SEs including cognitive impairment in elderly 3) mirabegron - another alternative with fewer SEs
52
Stress incontinence
1) pelvic floor training (3 months minimum) 2) surgical procedures 3) duloxetine

MRCP part 2 (11 decks)

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