Renal Flashcards by Jessica McVeigh

How does gentamicin cause nephrotoxicity?

Acute tubular necrosis

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What medication can be used to reduce renal stones in a patient with hypercalciuria?

Thiazide diuretics e.g indapamide

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What is the most common organism that causes peritonitis secondary to peritoneal dialysis?

Staphylococcus epidermidis

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How is ADH synthesised?

Synthesised by magnocellular neurons in supraoptic and paraventricular nuclei in hypothalamus. Stored in posterior pituitary.

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What is cranial diabetes insipidus?

ADH deficiency

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What is nephrogenic diabetes insipidus?

ADH insensitivity

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A patient presents with polyuria and polydypsia. Their plasma osmolality is 300 and urina osmolality is 200. What is the likely diagnosis?

Diabetes Insipidus

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What are the causes of cranial diabetes insipidus?

Idiopathic
Craniopharyngioma
Pituitary surgery
Head Injury
Infiltrative: histiocytosis X, sarcoidosis

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What is Wolfram’s syndrome?

DIDMOAD
Diabetes insipidus
Diabetes mellitus
Optic Atrophy
Deafness

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What are the causes of nephrogenic diabetes insipidus?

Genetic - vasopressin receptor most common, aquaporin 2 less common

Electrolytes - hypercalcaemia, hypokalaemia

Lithium - desensitises kidney’s ability to respond to ADH in collecting ducts

Demeclocycline

Tubulo-interstitial disease

Haemochromatosis

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What test can you use to differentiate between nephrogenic and cranial DI?

Desmopressin test - urine osmolality increases in cranial

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What is the treatment of DI?

Nephrogenic - thiazides, low salt/protein diet

Cranial - desmopressin

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What are the two types of ADPKD?

PKD 1 and 2 - code for polycystin 1 and 2

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What is the difference between ADPKD 1 + 2?

1 - 85% of cases. Chromosome 16. Presents with renal failure earlier

2 - 15% of cases. Chromosome 4.

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What is the USS diagnostic criteria for APKD?

Age <30 - two cysts, unilateral or bilateral

Age 30-59 - Two cysts in both

Age >60 - Four cysts in both

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What does the mnemonic CYSTS stand for in ADPKD?

Cysts
Young onset HTN
Screen family
Tolvaptan (V2 receptor antagonist)
SAH risk (berry aneurysm)

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What are the features of ADPKD?

HTN
Haematuria
CKD
Flank pain/mass
Recurrent UTI/stones
Cysts in liver, pancreas, ovaries

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What are the associations with ADPKD?

Berry aneurysms
Hepatic cysts
MV prolapse
Diverticula

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A 35-year-old man presents with hypertension and recurrent flank pain. His father died of a subarachnoid hemorrhage at the age of 40. On examination, both kidneys are palpable. What is the most likely diagnosis?

Autosomal Dominant Polycystic Kidney Disease

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What are the features of minimal change disease?

Nephrotic syndrome
Proteinuria - selective, mainly albumin and transferrin
Hypoalbuminaemia
Normotensive
Normal renal function
Oedema
Hyperlipidaemia

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What are the causes of minimal change disease?

Most idiopathic
10-20% have a cause:
Drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
Infectious mononucleosis

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What is the pathophysiology of minimal change disease?

T cell and cytokine mediated damage to the GBM - > polyanion loss
Increased glomerular permeability to albumin

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Renal biopsy shows the following:
Normal glomeruli on light microscopy
Electron microscopy shows fusion of podocytes and effacement of foot processes

What is the cause?

Minimal change disease

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What is the management of minimal change disease?

1) Oral corticosteroids
2) Cyclophosphamide if steroid-resistant

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A renal biopsy electron microscopy shows thickened basement membrane with subepithelial electron dense deposits. There is a spike and dome appearance. What is the cause?

Membranous glomerulonephritis

What are the causes of membranous glomerulonephritis?

Idiopathic - anti-phospholipase A2 antibodies Infections - Hepatitis B, malaria, syphilis Malignancy - prostate, lung, lymphoma, leukaemia Drugs - gold, penicillamine, NSAIDs Autoimmune - SLE, RA, thyroiditis

What is the management of membranous glomerulonephritis?

1) All should receive ACE or ARB 2) Immunosuppression if severe or progressive: corticosteroid and cyclophosphamide or rituximab 3) Anticoag if high risk of renal vein thrombus

A 45-year-old man presents with progressive ankle swelling. Urine dipstick: protein 4+, blood trace. Serum albumin 20 g/L, cholesterol 8.5 mmol/L. He is positive for hepatitis B surface antigen. What is the most likely renal diagnosis?

Membranous glomerulonephritis

A 50-year-old woman presents with oedema and frothy urine. Bloods: albumin 18 g/L, cholesterol 9 mmol/L. Renal biopsy shows diffuse thickening of the glomerular basement membrane with subepithelial deposits on electron microscopy. What is the most likely diagnosis?

Membranous glomerulonephritis

A 60-year-old man presents with oedema. He is a heavy smoker and has recently been diagnosed with lung cancer. Urine: heavy proteinuria. Biopsy: subepithelial “spike and dome” appearance on silver stain. What is the most likely diagnosis?

Membranous glomerulonephritis

What is the most common cause of nephrotic syndrome in HIV?

Focal Segmental Glomerulosclerosis

A 44-year-old man with newly diagnosed HIV presents with a 2-week history of leg swelling. On examination, you note pitting oedema to the mid calves. Observations are as follows: heart rate 85 beats per minute, blood pressure 125/75 mmHg, respiratory rate 16 breaths per minute, temperature 37.4ºC, and SpO2 98% (on air). Blood results are as follows: Hb 130 g/L Male: (135-180) Female: (115 - 160) Platelets 240 * 109/L (150 - 400) WBC 6.2 * 109/L (4.0 - 11.0) Na+ 132 mmol/L (135 - 145) K+ 4.2 mmol/L (3.5 - 5.0) Urea 14.2 mmol/L (2.0 - 7.0) Creatinine 168 µmol/L (55 - 120) CRP 2 mg/L (< 5) Urinary protein in 24 hours 4.8g (<0.15) What is the most likely diagnosis?

Focal segmental glomerulosclerosis

What is the treatment of HIV-nephropathy?

Antiretroviral treatment

What are the 5 key features of HIV-nephropathy?

1) Massive proteinuria -> nephrotic syndrome 2) FSGS 3) Normotension 4) Raised urea and creatinine 5) Normal/large kidneys

What equation is used to estimate eGFR and what variables does it take into account?

Modification of Diet in Renal Disease (MDRD) - Creatinine - Age - Gender - Ethnicity

Define Stage 1 CKD

eGFR >90 and evidence of kidney damage

Define Stage 2 CKD

eGFR 60-90 and evidence of kidney damage

Define Stage 3a CKD

eGFR 45-59 and moderate reduction in kidney function

Define Stage 3b CKD

eGFR 30-44 and moderate reduction in kidney function

Define Stage 4 CKD

eGFR 15-29 and severe reduction in kidney function

Define Stage 5 CKD

eGFR <15 and established kidney failure

A 55-year-old male is being evaluated for persistent proteinuria. He has a past medical history of multiple myeloma that has recently relapsed. He undergoes renal biopsy. Light microscopy with Congo red stain reveals apple-green birefringence under polarised light. What is the most likely diagnosis?

Amyloidosis

How is Alport's syndrome inherited?

X linked dominant

What is defective in Alport's syndrome?

Type IV collagen

What would you see on electron microscopy in Alport's syndrome?

Basket weave appearance

What are the features of Alport's syndrome?

Sensorineural deafness, retinopathy, cataracts and lens dislocation, glomerulonephritis

What is the management of anaemia in CKD?

1) Target Hb 10-12 2) Replace iron before starting EPO

What does anaemia in CKD predispose to?

LVH

What are the features of HUS?

AKI, Microangiopathic Haemolytic Anaemia, Thrombocytopenia

What are the causes of anaemia in CKD?

1) EPO deficiency 2) Poor iron absorption secondary to raised hepcidin levels 3) Reduced erythropoiesis secondary to uraemia on bone marrow 4) Anorexia/nausea secondary to uraemia 5) Blood loss secondary to capillary fragility and poor platelet function 6) Ulceration secondary to stress

What would investigations of HUS show?

Blood film - coombs negative haemolysis, schistocytes Anaemia Thrombocytopenia AKI Stool - STEC and shiga toxin

What are the causes of HUS?

Most secondary: - STEC (Shiga toxin-producing E.Coli 0157:H7 - Pneumococcal infection - HIV - Rare: SLE, drugs, cancer Primary atypical - complement dysregulation

A 2-year-old boy is brought to the emergency department with a 3-day history of diarrhoea. His mother reports that the diarrhoea is watery initially but became bloody yesterday. He has had vomiting and appears tired. On examination, he is pale, has mild periorbital oedema, and a blood pressure of 110/70 mmHg. Laboratory investigations show: Haemoglobin: 7.5 g/dL (normal 11.5–15.5 g/dL) Platelets: 45 ×10⁹/L (normal 150–400 ×10⁹/L) White cell count: 12 ×10⁹/L (normal 4–11 ×10⁹/L) Creatinine: 180 μmol/L (normal 30–90 μmol/L) Blood film: schistocytes present LDH: elevated Urinalysis shows haematuria and mild proteinuria. What is the diagnosis?

Haemolytic Uraemic Syndrome

What is the management of HUS?

Supportive Plasma exchange if severe and no diarrhoea Eculizumab (C5 inhibitor) greater efficiency in adult atypical

A 56-year-old woman presents to her GP with a 2-day history of fever and worsening joint pains. She has been taking naproxen regularly over the past week for a musculoskeletal injury. On examination, she has a maculopapular rash over her torso. Her bloods show an eosinophilia. What is the most likely diagnosis?

Acute Interstitial Nephritis

What are the features of acute interstitial nephritis?

Fever, rash, arthralgia, eosinophilia, mild renal impairment, HTN

What is the difference between prerenal uraemia and acute tubular necrosis?

Prerenal uraemia: Urina Na <20, high urine osm, good fluid response, raised serum urea:creat ratio, urine normal/bland sedmient ATN: Urine Na >40, low urine osm, poor fluid responsiveness, normal serum urea:creat ratio, urine brown granular cysts

Which glomerulonephritides cause a nephritic syndrome?

Rapidly progressive IgA nephropathy

Which glomerulonephritides cause a mixed nephritic/nephrotic syndrome?

Diffuse proliferative Mebranoproliferative

Which glomerulonephritides cause a nephrotic syndrome?

Minimal change disease Membranous Focal segmented

What causes rapidly progressive glomerulonephritis?

Goodpasture's, ANCA vasculitis

A young adult presents with haematuria after an URTI. What is the cause?

IgA nephropathy

What causes post-streptococcus glomerulonephritis in children and is the renal disease in SLE?

Diffuse proliferative glomerulonephritis

What causes membranoproliferative glomerulonephritis?

Type 1: cryoglobulinaemia, hep C Type 2: partial lipodystrophy

A child presents with nephrotic syndrome. What is the cause?

Minimal change disease

What causes membranous glomerulonephritis?

Rheum drugs, infection, malignancy

What glomerulonephritis is typical in HIV or heroin?

Focal segmented

Which chemotherapy is typically used in prostate cancer?

Docetaxel

What is goserelin?

GnRH agonist

What is bicalutamide?

Non-steroidal anti-androgen

What is abiraterone?

Androgen synthesis inhibitor

A 65-year-old man presents with lower urinary tract symptoms. For the past few months, he has had problems with urinary urgency and has had several episodes of incontinence when he could not reach the toilet in time. He describes good urinary flow with no hesitancy or straining. Urinalysis and prostate examination are unremarkable. What management is most appropriate?

Antimuscarinic e.g oxybutynin

What is the management of void symptoms in males?

1) Pelvic floor and bladder training 2) Mod - severe symptoms = alpha blocker e.g tamsulosin 3) Enlarged prostate and risk of progression = 5-alpha reductase inhibitor e.g finasteride 4) Mod - severe and enlarged prostate = alpha and 5-alpha reductase blockers 5) Mixed void and storage problems and alpha blockers not helping = antimuscarinic

What is the management of overactive bladder symptoms in men?

1) Conservative and bladder training 2) Antimuscarinic e.g oxybutynin 3) Mirabegron if first line fails

What is the management of nocturia in men?

1) Moderate fluid intake at night 2) Furosemide 40mg late afternoon 3) Desmopressin

Renal Flashcards

(75 cards)