Pathophysiology for diabetes insipidus in patients taking lithium
Desensitisation of kidney to respond to ADH
What is used for vitamin D therapy in CKD
Early CKD - cholecalciferol (D3) - require some activation by liver and kidneys
Advanced CKD - alfacalcifol or calcitriol (active vitamin D analogues) - do not require renal activation. Used to suppress PTH in secondary hyperparathyroidism
Management of PKD
Tolvaptan (vasopressin receptor 2 antagonist) can slow progression of disease. Recommended if
- have CKD stage 2 or 3 at start of treatment
- evidence of rapidly progressing disease
Electrolyte disturbances causing nephrogenic DI
Hypercalcaemia (calcium kills)
Hypokalaemia (potassium protects - less K+ = renal damage)
Most common causative organism for peritonitis secondary to peritoneal dialysis
Coagulase-negative staphylococcus ( S. epidermidis, S. saprophyticus)
Interpretation of ACR ratio
3-70 mg/mmol - needs confirming with early morning sample
>70 mg/mmol - does not need repeating
>3 confirmed = clinically important proteinuria
Treatment of HUS
IV fluids
plasma exchange in severe cases that are not associated with diarrhoea
Eculizumab - better than plasma exchange alone in adult atypical HUS (primary HUS)
Primary vs Secondary haemolytic uraemia syndrome (HUS)
Primary ‘atypical’ - due to complement dysregulation
Secondary ‘typical’ - due to shiga toxin -producing e.coli, pneumococcal infection or HIV.
Ix for renal artery stenosis
MR angiography of renal vessels
Kidney biopsy showing: Congo red staining: apple-green birefringence =
Amyloidosis
Gentamicin therapy causes what type of AKI, on urinalysis?
Intrinsic AKI
proteinuria on urinalysis = sign of intrinsic AKI
Epididymo-orchitis abx
If STD suspected : Ceftriaxone 500mg IM Stat + Doxycycline 100mg
If enteric source likely : Ciprofloxacin / ofloxacin for 14 days
ABCD - achy balls = cef + doxy
Most common causes of nephrotic and nephritic syndrome in SLE
NephrOTIC syndrome in SLE - Membranous GN
NephrITIC syndrome in SLE - Diffuse Proliferative GN
affected only membrane: nephrotic.
diffusely proliferated it! now it will bleed: NEPHRITIC
Abx for prostatitis
Ciprofloxacin for 14 days
Which investigation is useful for determining acute tubular necrosis from acute interstitial nephritis in AKI
Urinalysis
- interstitial nephritis = inflammatory - leucocytes in urine
- acute tubular necrosis - no leucocytes
Both have proteinuria as intrinsic causes of AKI
What needs to be co-prescribed with goserelin
Anti-androgen treatment e.g cyproterone acetate to prevent tumour flare
Treatment of membranous glomerulonephritis
Ace-i/ARB - reduced proteinuria and improves prognosis
steroids + cyclophosphamide for severe disease
useful Ix to determine pre-renal uraemia from acute tubular necrosis
urine sodium
<20mmol in pre-renal uraemia (trying to hold onto Na)
>40mmol in acute tubular necrosis
cystic lesion containing heterogeneous solid echoes within the left testicle =
Teratoma
Genetic cause of recurrent renal calculi
Cystinuria - autosomal recessive disorder. high amount of cystine in urine.
ureterosigmoidostomy causes what acid/base disturbance
Metabolic acidosis with normal anion gap
What is sodium zirconium cyclosilicate used for? MOA?
Newer agent in hyperkalaemia mx
Uses gastrointestinal cation exchange to remove K+ from body
Effect of alcohol bingeing on ADH and urine output
Can lead to ADH suppression in posterior pituitary leading to polyuria
Diagnosis of CKD 1 and 2
Needs to be abnormality in U+Es +/- proteinuria not just decreased eGFR
