MRCP 1 PASSMED > NEPHROLOGY > Flashcards

NEPHROLOGY Flashcards

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1
Q

What immunoglobulin is involved in hyperacute kidney graft rejection?

A

IgG (couple minutes to hours) than IgM later
due to pre-existing antibodies against ABO or HLA - type II hypersensitivity - leads to widespread thrombosis in vessels and necrosis- no treatment besides removing organ

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2
Q

What’s the mechanism of acute graft failure? (<6 months)

A

Due to mismatched HLA (cell-mediated by cytotoxic T-cells) - other causes include CMV
reversible with steroids and immunosupressants

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3
Q

Causes of chronic graft failure (>6 months)?

A
  • Both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy)
  • Recurrence of original renal disease (MCGN > IgA > FSGS)
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4
Q

Renal cell carcinoma + cholestatic picture/RUQ pain =

A

Paraneoplastic hepatic dysfunction syndrome (PHDs) aka Stauffer’s syndrome = high GGT, ALP, platelets and prothrombin time - NO JAUNDICE NO LIVER METASTASIS

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5
Q

Eosinophilia + fever, rash, arthralgia + mild renal impairment + hypertension =

A

Acute interstitial nephritis (usually secondary to drugs like penicillin, rifampicin, NSAIDs, allopurinol, furosemide)

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6
Q

Which tumour is more commonly associated to a rise in B-HCG?

A

Seminomas (Choriocarcinomas as well but much rarer)

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7
Q

Side effects of erythropoietin therapy?

A

Urticaria, bone aches, pure red cell aplasia, hypertension (due to hypercoagulability state)

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8
Q

Extra renal features of ADPKD?

A

-Hepatic cysts (hepatomegaly)
-Ovary cysts
-Diverticulosis
-Berry aneurysms

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9
Q

Management of predominantly voiding problems?

A

Conservative measures first : Pelvic floor muscle training, fluid intake management, bladder training and containment products.
- If moderate or severe symptoms: offer alpha blockers
- If prostate is enlarged, offer 5-alpha reductase inhibitor
- if moderate/severe Sx + BPH = offer alpha blocker AND 5-alpha reductase inhibitor
-If mixed symptoms of storage+voiding = Add antimuscarinic to alpha blocker

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10
Q

Management of predominantly overactive bladder?

A

Conservative measures first (fluid management)
-Bladder retraining should be offered
-if Sx persist = offer antimuscarinic (oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation))
-If first-line drugs fail = offer MIRABEGRON

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11
Q

What is Bicalutamide?

A

Androgen receptor blocker (for prostate cancer)

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12
Q

What is Abiraterone?

A

Androgen synthesis inhibitor (for prostate cancer)

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13
Q

What is Goserelin (Zoladex)?

A

GnRH agonist (After causing an initial phase of stimulation, it then causes a down-regulation of gonadotrophin-releasing hormone receptors, thus reducing the release of gonadotrophins (follicle-stimulating hormone and luteinizing hormone) which in turn leads to inhibition of androgen production.)

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14
Q

How does lithium cause nephrogenic diabetes insipidus?

A

By reducing the kidneys’ sensitivity to ADH in the collecting ducts

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15
Q

Papillary necrosis is caused by?

A

(PTSD A) acute Pyelonephritis -Tuberculosis - Sickle cell disease - Diabetes mellitus - Analgesic use

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16
Q

How does alcohol bingeing cause diabetes insipidus?

A

By supressing ADH production in the posterior pituitary gland leading to polyuria.

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17
Q

Management of Haemolytic uraemic syndrome?

A

Supportive measures : Fluids, blood transfusion and dialysis if required
- If Typical HUS with no diarrheoa = plasma exchange can be considered
- In Atypical HUS, eculizumab (C5 inhibitor monoclonal antibody) has show superior to plasma exchange alone

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18
Q

Most common cause of death in patients with CKD?

A

Ischaemic heart disease

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19
Q

What is the most common cancer in patients who got renal transplant?

A

Non-melanoma skin cancers (NMSC) followed by Squamous cell carcinoma (SCC) of the skin and Basal Cell Carcinoma (BCC) due to long-term use of immunosupressants (Ciclosporin)

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20
Q

What nephropathy is caused by heroin use?

A

Focal segmental glomerulosclerosis

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21
Q

What precaution to take in diabetics post-contrast intervention e.g (PCI or CT)

A

Withhold Metformin for at least 48h until renal function gets back to normal

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22
Q

When does contrast-induced nephropathy manifest?

A

2-5 days post contrast use

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23
Q

What glomerulonephrities have low complement levels?

A

Post-streptococcal glomerulonephritis
Subacute bacterial endocarditis
Systemic lupus erythematosus
Mesangiocapillary glomerulonephritis

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24
Q

What is the treatment of membranous glomerulonephritis?

A
  • ACEi or ARB (corticosteroids not effective) and immunosupressants in moderate to severe disease.
  • Reminder (MG is due to anti-phospholipase A2 antibodies, it can be caused by malignancy, infection like malaria, syphilis and hep B; drugs like NSAIDs, gold and penicillamine; and autoimmune diseases like RA; thryoiditis, SLE class V)
    Renal biopsy demonstrates:
    electron microscopy: the basement membrane is thickened with subepithelial electron dense deposits. This creates a ‘spike and dome’ appearance
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25
How to differentiate between AIN and ATN?
AIN has leucocyturia while ATN does not, ATN has blood instead.
26
How to treat vitamin D deficiency in CKD?
Alfacalcidiol (already hydroxylised and ready to be absorbed)
27
What are the parameters required by the Modification of Diet in Renal Disease (MDRD) equation to estimate eGFR?
CAGE = Creatinine - Age - Gender - Ethnicity
28
Which renal pathology is associated with coeliac disease?
IgA nephropathy Berger's disease - recurrent macroscopic haematuria following URTI or without a trigger
29
What class of medication is Sumariptan?
Specific 5 HT-1 agonist
30
Mode of inheritance of facioscapulohumeral muscular dystrophy?
Autosomal dominant
31
Most important test in Restless leg syndrome?
Ferritin
32
What diseases are positive on a cyanide-nitroprusside test?
Cystinuria (NOT CYSTINOSIS) Homocystinuria
33
Genetic defect in cystinuria?
- Chromosome 2: SLC3A1 gene - Chromosome 19: SLC7A9 gene
34
Which genetic defect causes autosomal recessive polycystic kidney disease?
Chromosome 6: PKHD1 gene (Chromosome 16: ADPKD)
35
Biopsy findings of ARPKD?
Cylindrical lesion at a right angle to the cortical surface
36
Cardiac condition associated with ADPKD?
- MVP - Mitral valve prolapse - Most common - Mitral/tricuspid insufficiency - Aortic root dilatation - Aortic dissection
37
Management of peritonitis secondary to peritoneal dialysis?
- Vancomycin or teicoplanin + ceftazidime in dialysis fluid OR - Vancomycin in dialysis fluid + ciprofloxacin by mouth
38
Most common causative organism of peritonitis in peritoneal dialysis?
Staph. epidermidis +++ Staph aureus ++
39
Drugs to stop in AKI?
Metformin => risk of lactic acidosis ACE inhibitors => precipitates ESRF Diuretics => ATN by reducing capillary blood NSAIDs => vasoconstriction/nephrotoxic
40
Which NSAID can be used in AKI?
Aspirin at cardio-protective dose
41
How long does it take for an arteriovenous fistula to become usable for dialysis?
6-8 weeks
42
Causes of nephrogenic diabetes insipidus?
- Genetics: abnormalityADH receptor-encoding gene - Electrolytes: Hypokalaemia - hypercalcaemia - Lithium: desensitizes kidney to ADH - Demeclocycline - Obstruction, sickle cell, pyelonephritis, haemochromatosis
43
What medication is used to reduce size of renal cell cancer?
Alpha-interferon and interleukin-2
44
MDRD criteria to calculate eGFR?
- Gender - Ethnicity - Age - Serum creatinine
45
Wilm's tumour association?
Beckwith-Wiedemann syndrome
46
Wilm's tumour gene defect?
Loss of mutation in the WT1 gene on chromosome 11
47
Children with enlarged abdominal mass?
Possible Wilm's tumour - refer to paediatrics within 48 hours
48
Features of Wilm's tumour?
- Painless haematuria - Abdominal mass - Flank pain - Unilateral in 95% of cases - Metastasis found in 20% (lung)
49
Management of Haemolytic Uraemic Syndrome?
-Supportive with fluids, blood transfusions and dialysis if required - Plasma exchange in some severe cases with no diarrhoea - Eclizumab (C5 inhibitor monoclonal antibody) has greater effect than plasma exchange in adults
50
Diagnosis of HUS?
Blood film: Anaemia -
51
Management of older patients on warfarin who present microscopic haematuria?
Refer to urology for cystoscopy as risk of microscopic haematuria is the same as in the general population and should be investigated the same way
52
MOA of abiraterone in relapsing prostate cancer?
Selective androgen synthesis inhibitor that works by blocking cytochrome P450 17 alpha-hydroxylase
53
How to assess for anaemia in CKD patients?
Ferritin + either Transferrin saturation or percentage hypochromic red cells
54
What are the target ferritin, haemoglobin and transferrin saturation in CKD?
- Hb: 105-125 - Transferrin saturation >20% - Ferritin 100ug/L> in pre-dialysis and peritoneal dialysis 200ug/L> in haemodialysis
55
What impairs the efficacy of Erythropoietin?
Aluminium toxicity - Folate deficiency - Infection - Hyperkalaemia
56
What is the normal anion gap?
8-16 mmol/L
57
How to reduce the risk of Hepatorenal syndrome?
Albumin + Antibiotics (Piperacillin-Tazobactam)
58
What is the urine sodium osmolality in SIADH?
>= 20mmol/L (usually >40 in practice)
59
What is the urine sodium osmolality in ATN?
>40 mmol/L (usually >60 in practice)
60
Management of SIADH?
Initial management = Fluid restriction Second step = Demeclocycline (NOT DESMOPRESSIN)
61
Definitive diagnosis of AIN?
Biopsy showing oedema of the interstitium with infiltration of mononuclear cells with acute tubular necrosis and variable tubular dilatation
62
Management of Acute Interstitial Nephritis?
Cessation of offending drug High-dose prednisolone in some cases to hasten recovery Dialysis in severe cases
63
Most common side-effect of Erythropoietin used in CKD patients?
Hypertension (that may induce seizures)
64
Most common side-effect of Ciclosporin?
Nephrotoxicity
65
Initial investigation of choice in HUS?
Blood film which shows fragmented red cells
66
Management of Granulomatosis with polyangiitis?
Methylprednisolone given immediately, followed by Cyclophosphamide and dialysis
67
Signs of Microscopic polyangiitis?
Worsening renal function + Haemoptysis + purpuric rash in lower limbs
68
Management of Goodpasture's syndrome?
First line: Plasmapheresis (therapeutic plasma exchange) Second line: Corticosteroids + cyclophosphamide
69
What organisms are associated with Henoch-Schönlein purpura?
Streptococcus A and Mycoplasma
70
Management of Henoch-Schönlein Purpura?
ACE inhibitor
71
First line investigation for myeloma?
Plasma protein electrophoresis
72
What is the protein/creatinin ratio in nephrotic syndrome?
300-350 mg/mmol
73
Management of nephrotic syndrome caused by membranous nephropathy?
Immunosuppression by alternating steroids and cyclophosphamide
74
What calcium supplement to give in CKD depending on stage?
CKD 1-3: Ergocalciferol (Vit D2) and Cholecalciferol (Vit D3) CKD 4-5: Alfacalcidiol or Calcitriol (already activated form)
75
Phosphate management in CKD?
- If patient has normal or low calcium => Calcium-based binder - If patient is already hypercalcaemic or high risk of vascular calcification => Non-Calcium-based binder: SEVELAMER (has the advantage of lowering uric acid and cholesterol too)
76
Management of acute prostatitis?
Quinolone (Ciprofloxacin) for 14 days
77
In patients with 5-10 years of dialysis for CKD, presenting with shoulder/hip/wrist pain and bilateral carpal tunnel syndrome, what is the underlying cause?
Beta-2 Microglobulin Amyloidosis (B2 Microglobulin, a component of MHC class I molecules, accumulates in the blood because it is not efficiently cleared by standard dialysis membranes)
78
What are the types and causes of Amyloidosis?
AL Amyloidosis - Myeloma, Waldenström, MGUS AA Amyloidosis - Bronchiectasis, RA, Tuberculosis B2-Microglobulin Amyloidosis - 5-10 years dialysis
79
Nephrotic syndrome + anti-PLA2R antibodies (phospholipase A2 receptor) = what condition?
Idiopathic Membranous Nephropathy (Most common cause of Nephrotic Syndrome in Caucasian adults - Spike and dome appearance on electron microscopy - Prognosis follow the Rule of Thirds)
80
Management of epididymo-orchitis in low STI-risk individual?
Quinolones (ciprofloxacin or ofloxacin) for 2 weeks (same management as prostatitis, as the most likely organism is E.coli and not STI)
81
Mangement of epididymo-orchitis in high-risk STI individuals?
IM ceftriaxone + 14 days oral doxycycline
82
Management of SBP?
Vancomycin (or Teicoplanin) + Ceftazidime in dialysis fluid OR Vancomycin in dialysis fluid + PO Ciprofloxacin
83
How to reduce incidence of Oxalate stones?
- Cholestyramine - Pyridoxine
84
How to reduce incidence of Urate stones?
- Allopurinol - Urinary alkalinisation: ORAL BICARBONATE
85
What is Abiraterone acetate and what is its MOA?
It's a selective androgen synthesis inhibitor that works by blocking cytochrome P450 17 alpha-hydroxylase
86
MRCP 1 PASSMED
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