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Renal Flashcards

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1
Q

Contrast nephrectomy

A

occurs 2-5 days after administration

RF:

  • Known CKD
  • AGE
  • Dehydration
  • Hfx
  • NEphrotoxicss
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2
Q

ACEI - ?renal A stenosis

A

Fall in eGDR of 25% or rise in Cr of 30%

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3
Q

Gosrelin MOA

A

GnRH Agonist –> neg feedback to ant pituitary

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4
Q

persistent non-visible haematuria def

A

Blood + 2/3 samples taken 2-3 weeks apart

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5
Q

Post tranplant infection

A

CMV - CMV PCR

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6
Q

Testicular Ca - types

A

95% germ cell –> divided into seminoma and non seminomas

Non germ cell = Leydig and sarcomas.

peak incidence for teratoma = 25 yrs

peak incidence for seminoma = 35 yrs

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7
Q

Testicular Ca - RF

A 
Infertility 
cryptorchidism 
Fhx
Klinefelter's
mumps orchitis
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8
Q

Testicula Ca features

A

Painless lump
Hydrocele
gynaecomastia

Seminoma - hCG

AFP/LDH elevated in most

Diagnosis = US

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9
Q

TEsticular Ca Mx

A

Orchidectomy

chemo/RT

Semioma 5yr survivval >teratoma

95%:85%

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10
Q

Site of action of diuretics

A

Loop:

  • Furosemide - TAL - NA-K+-Cl
  • Bumetande

Thiazide:
- Distal tubule - Na-CL

Aldostenerone angtag:

  • Spironolactone
  • Distal tubule/Collectinf duct - Na/K+
  • ANP = anti aldisteribe
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11
Q

Proteinuria

A

microalbuminuria = 30-250 of Alb or UACR >5mg

non renal causes of high protein:

  • Temp
  • Ex
  • Skin dz
  • LUTI

Orthostatic proteinuria:
- Raised protein after standing for long time - disappears afte recumbence - early a.m. = N

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12
Q

Renal angiography complicaion

A

Nephrogenic systemic fibrosis = similar to scleroderma

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13
Q

Renal tubular acidosis

A

Type 1:

  • Distal
  • Poor H+ excretion
  • URinary pH >5.3 - alkaline
  • HYPOKALAEMIA
  • Complication: Nephrocalcinosis/Renal stines
  • Causes: idiopathic/SLE/Sjrogrens/amphoterecin/analgesic neohropathy
Type 2:
- Proximal 
- NaHCO3- rabs fx 
 Urine pH normal
- HYPOKALAEMIA 
- Causes: idiopathic/fanconi syndrome/ Wilsons's dx/cystinosis/tetracycline/carbonic anhydrase inhib

Typ 4:

  • Low aldosterone –> Dont form NH3+
  • HYPERKALAEMIA
  • Causes: Hpoaldosteronism/DB
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14
Q

Fanconi syndrome

A

General reabsorptive disporder of procimal tubule
Rype 2 RTA

glycosuria, Amino-aciduria, polyuria, phsphateuria

Causes:

  • Cystinosis
  • Sjrogrens
  • MM
  • Wilson’s
  • Nephrotic syndrome
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15
Q

Hypokalaemia causes

A

w/HTN

  • Cushings
  • Conns
  • Liddles
  • 11-beta-hydroxyas deficiency

w/o HTN

  • Diuretics
  • GI loss
  • RTA
  • Barters
  • Giltemanns
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16
Q

Liddles/barters/gitelman - what are they

A

Liddle:

  • Xs Na Reabs
  • These NA channels = amiloride sensitice
  • HTN + Hypokalaemia
  • Mx: Na restrict/ K+ replace/ Amiloride

Barters:

  • A.D.
  • Defect in Cl- channel of NA- K - CL transporter
  • low BP/hyper reninuria
  • Tx = K+ replace +/- NSADS

Gitelmans:

  • Similar to BArters
  • A.R.
  • Px later in life:
  • Low K+/ Mg/ H+/ Ca
  • Mx: Mg + K replace
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17
Q

AKI KDIGO Classification

A

Satge 1:

  • Cr - >26 mmol or rise of =/> 1.5-1.9x BL
  • UO - <0.5 ml/kg/6hr

Stage 2:

  • Cr: >2 - 2.9x
  • UO: <0.5 ml/kg/>24hr

Stage 3:

  • Cr: >3x or >354 mmol
  • On RRT
  • UO <0.3/kg/24hr or Anuria for/12 hrs
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18
Q

Drugs to stop in AKI

A

Stop as worsens AKI

  • NSAIDS
  • ACEI/ARBS
  • aminoglycloside
  • Diuretics

Stop as increase toxic:

  • metformin
  • Dig
  • Li
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19
Q

ATN

A

Causes

  • Renal ischaemia
  • Toxins - Aminoglycloside/Myoglobin (Rhabdomyolysis)

Ft

  • High urea/cr/K+
  • MUDDY BROW CASTS

Histopathology

  • Tubular epithelial necrosis
  • these necrotic cells can block tubules
  • thos can cause tubular dilation

Phases

  • Oliguric
  • Polyuric
  • Recovery
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20
Q

ATN Vs Pre-renal uraemia

A

Think about pre-renal ureamia - HOLDING on to Na + urea

Urinary NA:

  • ATN>30
  • PU - <20

Na Secretion:

  • ATN >%
  • PU <1%

Urea excretion:
- ATN >35%
PU <35%

URine:plasma OSm:
- PU >1.5
ATN <1.1

Urine:

  • ATN - muddy brown cast
  • PU - bland sediment
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21
Q

Indications for emergecy dialyss

A
  • Hyperkalia > 6.5
  • URaemia - pericarditis/encephalopathy
  • pH <7.1
  • Resistant fluid overload
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22
Q

Rhadbomyolysis

A

Causes:

  • Seizure
  • Long lie
  • Traumatic –> IVDU
  • Ecstasy
  • Crush injury
  • McArdles
  • Statins - combo with clarithromycin

Mx:

  • IVI
  • URinary alkalinisation
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23
Q

RF for Contrast nephropathy

A

RF:

  • high contrast lad
  • multiple doses
  • Age
  • CKD
  • Hypovolaemia
  • Dehydration
  • Myeloma
  • hyper Ca
  • Hyperuricaemia
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24
Q

CKD

A

Stage 1 - eGF>90
- Req abnoral U+E or proteinuria

Stage 2: 60-90:
req abnormal U+E  or proteinuria
- no anaemia
- no MBD
- may have HTN

Stage 3a = 45-59 and 3b = 30-44

  • Most commonly have HTN]
  • largest group
  • 3b –> anaemia/MBD

Stage 4: 15-30:

  • HTN +++
  • PO4-

Stage 5: <15
- RRT

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25
Anaemia of CKD - causes
dmaged kidney produce less EPO URaemia + Toxin build up --> decrease EPO production Nausea/anorexia Decreased Fe absorption BLood loss - fragile capillaries - GI Reduced RBC survival
26
anaemia - CKD MX
EPO stimulating agents: - EPO/darbopoeitin - target = 10 - 12 g/l - Ensure Fe Replac - only use when deemed likely to benefit from QOL and physical fn Resistance to EPO: - Low Fe - Occult GI blood loss - Al toxicity - hyper PTH - sepsis/chronic inflamm - pure red cell aplasia S.e: - Accelerated HTN/Encephalopathy - Flu-like - Bone aches - thrombosis - Pure red cell aplasia = Ab vs exog/endo EP
27
CKD HTN
ACEI + ARB = 1st line eGFR <30-45 consider furosemide
28
CKD - PRoteinuria
UACR used : Early am spot test 3-7 --> rpt --> >3 --> confirms >70 - doesnt need repeat Freq monitoring - per yr - SEE NOTES Referral to nephrologist: - UACR >70 - UACR >30 + persistent haematuria (xcl UTI) - UACR >3 + persistent haematuria + 2 other R F(renal fn/CVD)
29
CKD - MBD - Histological findings at bone biopsy
OSteomalacia = low vit D Hyper PTH bone dx = OSteoperosis + OSteitis fibrosa cystia ( Subperiosrteal eroisons in radial border of phalanges) OSteoperosis = malnurised + high PTH Osteosclerosis - RUGGER JERSE SPINE Adynamic bone dx --> low urnober Aluminium bone dx - rre now as AL agents not used
30
CKD - MBD mx:
1) low dietary PO4- 2) PO4- Binders - Sevelamer - Non Ca based --> decreases uric Acid + improves lipids - Ca based --> S.e. hyper Ca + vascular calc - Al based - no longer used 3) Vit D replace - alpha -calcidol.calcitriol 4) PTH-ectomy
31
HD vs PD - When to choose HD
- recent abdo surgery - recurrent peritnitis - severe recurrent illness - resp dx - stenting - frail - peritoneal mebrane/ ultrafiltration faiure - too poor renal fn - sev malnutrition --> lots of protein lost in efluent..
32
PD complications
BActerial peritonitis - Staph epidermis - most common ---> Staph A/G- - rpt episodes --> HD Ultrafiltration fx Pt = high transporter of glucose Encapsulating peritoneal scelrosis: - Recurrent peritonitis or LT PD _-> Peritoneum thickens and encases bowel --> UF/ Bowel obstruct / Malnutritiom
33
Haemodialysis
usually vasc access via elective fistula can use tunelled catheter in emergencies: - Late px w/sev uraemia - Fistula complication - higher infection risk - OBstruction risk
34
Lt complications
IHD LVH/dilated cardiomyopaty vacular calcification calvular dx pyrophosphate arthropathy --> pseudogout/gout
35
Contraindications to Renal transplant
Recurrent/ malignancy (<2yrs) | Severe comorbidity
36
Graft rejection
Hyperacute: - Mins - hrs - mottled dusky skin - preformed Ab vs Donor HLA class 1 - Types 2 hypersensitivity - mx = remove graft Acute graft rejection: - <6/12 - T cell mediated - mismatch HLA or CMV - Mx - Steroid/IS Chronic graft rejection: - >6/12 - Ab & Cell mediated --> fibrosis - Recurrence of original dx - MCGN>IgA>FSGN
37
Acute graft dysfn causes
ATN of graft Stenosis: - Uncontrolled HTN --> angioplasty thrombosis - if arterial --> sudden anuria --> immed surgery - Venous --> pain + swelling + oliguria --> graft loss. urine leakage - Decreased UP / high Cr/ fever --> US revision infection/lymphocele --> drain
38
chronic graft dysfn
Chronic renal allograft nephropathy: - immunological and non-immune cuases - Develop --> proteinuria + graft dysfn - Mx - controlled HTN/low proteinuria --> ACEI / ARB Recurrence of primary dx polyomavirus infection: - BK/JC virus - Decrease MMF
39
Renla transplant I.S - example regimes
initial: Ciclosporin/Tacrolimus w/Mab Maintenance: Ciclosporin/tacrolimus w/ MMF or sirolimus + steroid if >1 steroid responsive acute rejection
40
Renal transplant I.S. - medicaqtions
Ciclosporin - Calcineurin Inhibitor Tacrolimus - Stop B/T cell - s.e. - GI/BM supression Sirolimus: - IL-2 inhib --> stop T cell prolif - s.e. Hyperlipidsaemia Mab: - Il-2 inhibitors Monitoring: - CV dx - Renal Fx - Malignancy
41
Nephritic
- Rapidly progressive GN - IgA Nephropathy - Alports I= eye = things you can see - H's: - HTN - HAematuria - HArdly pee - Oliguria
42
Nephrotic syndromes nephr-O-tic
- minimal changed - Minimal Age - membranous GN - Suck some dick to become a MEMBER of the club - FSGS - FSG - HIV - Amyloidosis - DB nepropathy -O-: pr-O-teinuria hyp-O-albuminaemia Fat chick with big belly - hyperlipidaemia
43
Mixed nephrotic/nephritic
Triad: 1) Proteinuria - >3g/day 2) Hypoalbuminaemia - <30g/L 3) Oedema - Diffuse prolif GN - Membranoproliferaive GN - Proliferative = fast - post-strep GN
44
Rapidly progressive GN - Rapidly "crescenteric" GN
Crescents = look like loops = LUPUS or DIFFLUPUS (Diffuse prolif) - Loop wire lesions Rapid onset --> AKI HTN Histology - glomeruli full of crescent cells. Mx: - plasma exchange - Steroid/IS
45
Goodpasteures - Goodpasteures = 2 pasteures The 2s and the Gs
Type 2 hypersensitivity Affects 2 organs - lung + Kidney Ab vs (type 2 x type 2) = Type 4 collagen anti-GBM - Vs Collagen type 4 - pulmonary/glomerular BM Px: - Pulmonary haemorrhage - young smoker - Biopsy - IgG deposits in linear patterns - Increased transfer factor RF: - smoking - LRTI - pulm oedema - inhaled hydrocarbons - young male
46
IgA Nephropathy - IgA = deposits
AKA - Bergers Dx/Mesangioprolif Most common Histology: - Mesangial hypercellularity w/ +ve immunofluroensce IgA/C3 FOLOWS URTI - 1-2/7 Px: - young male, follows URTI 1-2/7, recurrent macroscopic haematuria. Good prognosis: - Frank haematuria Poor prognosis: - Male - Smoking - HTN - proteinuria - high lipids - ACE
47
Post-streptocoocal GN PSG = THREE
3 weeks post URTI Low C3 Lump3 - Bump3 - immune complex deposits Type 3 hypersensitivoty Immune complex deposition of IgM/IgG/C3 Ft: - young child gen unweel - LOW C3 - proteinuria - ASO TITRE Biopsy features: - Acute GN - Endothelial prolif w/neutrophils - electron microscopy --> subendothelial umps = immune complex deposits - immunofluorescence = STARRY SKY = GRANULAR
48
Alports syndrome Alports = Alfort = Al-4
Same as goodpasteures (2 organs) + can't see or hear (2 more) - Lungs + Kidney + eyes + Ears remember dodgy landing X wing video on pixorize. X - Linked dominant Collagen type 4 defect Eyes - cataracts/lenticonus/lens dislocation/retinopathy - Ears - sensorineural deafness - Kidneys - GN/haematuria Renal biopsy - S[litting of lamina densa = basket weaves.
49
Minimal change dx - THE MINIMALS
Affects kids - Minimal age Foot = minimal body part = foot process effacement Nepjrotic syndrome affects CHILDREN Causes: - idiopathic - Drugs - NSAID/Rifampicin - Hodgkins lymphoma.thymoma - infectious mononucleosis Pathophysiology: - T cell mediated damage to BM --> Anion loss --> electrostatic charge --> more permeable to Albumin Ft: - Nephrotic syndrome - Normotension - Selective protein loss Inc: - Light microscopy no change - e- microscopy - effacement of foot processes + fusion ofpodocytes. Mx: STEROIDS --> fx --> Cyclophoisphamade Prognosis: - 1/3 recover 1/3 infreq episodes 1/3 freq episodes --> stop b4 adulthood
50
FSGS FSG = HIV
Px - Young adults w/ nephrotic syndrome Causes: - idiopathic - secondary to IgAA/Reflux nephropathy - HIV - Heroin - Alports - SCD - recureence risk in transplant Biopsy finding: - Light microscopy - focal + segmental sclerosis - e- microscopy - foot effacement process. Mx: - Steroid + IS
51
Membranoproliferative GN Proliferative = Fast
``` Prolif = fast = TRAM TRACK Px = Mixed ] ``` Type 1: - majority - causes = cryoglobulinameia/hep C - Renal biopsy - TRAM TRACK Type 2: - dense deposit dx - Causes = lipodystrophy/factor H deficiency - Ft = low complement - C3 - Biopsy = DENSE DEPOSITS - immune complex
52
DB Nepropathy
Pathophysiology: - Raised glomerualar capillary pressure --> non-enzymatic glycosylation of BM Histology: - BM thickening - Capillary obliteration - Mesangial thickening - KW nodules Stages: 1) Hyperfiltration - raised eGFR 2) Silent phase - no microalbuminuria 3) Incipient nephropathy microalbumin - 30 -300 4) Over nephropathy: - alb excretion >300/HTN/ KW nodules 5) ESRF
53
APKD
Most common inherited kidney dx. ADPKD - Chromosome 16 APKD type 1 - 85% - Polycystin 1 - Px earlier APKD type 2 - 15% - polycystin 2 Px: - Abdo pain - HTN - UTI - Aneurysmal dx +FHx --> SCREEN Mx: Tolvaptan - vasopressin 2 US diagnostic criteria: - 2 cysts unilat - <30 yrs - 2 cysts B/l - 30-60yrs - 4 cysts B/L - >60yrs NB: These adults tend not to be EPO Defficient --> Inflamm or mlaignancy --> suddem fall in Hb in prev stable pt as --> increase inhibition of recombinant EPO
54
Thin BM disease
Inherited - type 4 collagen 3 of: - persistent haematuria - No renal fx - + FHx - haematuria w/o renal fx.
55
Acute interstitial nephritis.
accounts for 25% of drug induced AKI Causes: - Penicillin - Rifampicin - NSAIDS - Allopurinol - Furosemide - systems - sjrogrens/SLE/Sarcoid infectious: - Hanta virus/staph Ft: - Temp/Rash/Arthralgia - ESR - mild renal impairment - HTN Inx: - Sterile pyuria - white casts Histology: - increased oedema + infiltrate of CT between renal tubule Mx: - Cesation +/- Steroids
56
Chronic interstitial nephritis.
Many causes - systemic and local Px: CKD/ ESRF/RTA. DB1/ Salt wasting
57
Renal papillary necrosis
Coagulative necrosis of renal papillae Causes: - severe acute pyelonephritis - DB Nephropathy - Obstructive nehropathy - Analgesic nephropathy - Phenacetin/NSAIDS - Sickle cell anaemia Ft: - Visable haematuria - loin pain - proteinuria Q STEM - pt with chronic pain px with loin pain + CKD = Haematuria.
58
Reflux nephropathy
most common cause of ESKD in children Scarring in 1st 5 years of life Strong GENETIC component - therefore if siblings affected --> Screen Grade 1 - 4 with increasing reflux All children UTI - investigate - VUR Inx - micturition cystography Px: - UTI in child - Renal scar --> HTN - Proteinuria Mx: GRade 1-3 self resolve Grade >4 - surgery Prophylactic abx if >grade 2
59
UTI in pregnancy
symptomatic: - 7/7 abx - avoid Nitro if near term - urine culture Asx + bacteruria: - 7/7 - urine culture - 2nd urine culture after completeion.
60
Renal Stones Types
Ca Oxalate Cystine - Metabollic - semi opaque Uric Acid - Assoc with GOUT CaPO4- Struvite - Recurrent UTI - P.mirabilis
61
Diffuse proliferative GN
Post strep - in child - Nephritix syndrome and AKI - SLE
62
Goodpasteures - REMEMBER THE G
IgG anti-GBM
63
AV fistula - ?time taken to develop
6-8 weeks
64
Cystinuria
A.R. - Chromsome 2 - defect in transport of cysteine, orthinine lysine arginine (COLA) Recurrent renal stones = yellow + crystalline = semiopaque Inx - cyanide - nitroprusside test Mx: - Hydralazine - penicillamine - urina alkalinisation
65
Membranous GN - Need to suck some dick to become a MEMBER
Dome = street for sucking dick = Spike + Dome apperance Who sucks dick int he street - IVDU looking to score = HEPATITIS Most common type of GN in adults: e- microscopy --> spike and dome appearance = thick BM + electron dense deposits Causes: - Idiopathic - anti-phospholipase A2 - Infection - Hep B, malaria and symphillis - malignance - lung Ca, lymphoma, leukaemia - Drugs - Gold, penicillamine, NSAIDs - AI - SLE, thyroiditis, RA Mx - ACEI + ARB - I.S. - if high risk 0---> anticoah Prognossi s= rule of 1/3 - 1/3 recover - 1/3 persistent proteimuria - 1/3 ESRF
66
HIV + renal involvement
``` Large kidneys FSGS Proteinuria/nephrotic syndrome Elevated urea + creatinine normotesnion ```
67
retroperitoneal fibrosis
``` Reidels thyroiditis inflamm AAA Sarcoidosis RT Drugs - methysergide ```
68
eGFR variables
CAGE Cr Age Gendor Ethnicity
69
Renal stones types
Ca Oxalate: - pH 6 - Radio-opaque - High calcium - low oxalate in ureine Cystine stones: - Cystinuria / metabolic - SEMI-OPAQUE - URate stones: - Produc of pirine synthesis - pH low - GOUT / ileostomy - Can be caused by malignancy - Radio-opazue CaPO4-: - RTA - pH>5.5 - RTA - type 1 + Type 2 - Radio-LUCENT ``` Struvite: pH<7.2 -Staghorn calculi - stones of Mg, NH3, Po4 - assoc w/ CHRONIC INFECTION ```
70
RF for stones
``` ehydration hyper Ca/PO4 high oxalate RTA Medullary sponge kidney Cadmium.berillyium ``` RF for urate stones: - gout - ileostomy ``` Drugs: - Loop diuretics steroids acetazolamide theophylline ```
71
Mx of renal stones general
NSAID - diclofenac for renal colic Non contrast CT KUB <5 mm - pass by itself >5 mm: - SWL - CI Pregnancy - <2cm+ not preg - Ureteroscopy - <2cm + preg - Percut - complex staghorn Obstruction + infection --> SURGICAL EMERGENCY
72
Mx of renal stones specific
Calcium: - low protein + salt diet - Fluid - Thiazides Oxalate: - cholecystyramine - Pyrodixine Uric Acid: - Allopurinol - Urinary alkalinisation
73
Acute urinary retention
Pain Px --> anuria/AKI Inx - US Mx: If bladder outflow obstruct --> catheter if vesico-ureteric and above --> stent or drainage - percut post mx -- > massive diurese = temporary nephrogenic DI
74
Chronic urinary retention
Painless px --> CKD/ESRF Common complication - Na wasting/metabolic acidosis Inx: - US --> retrograde pyelography if no obstruction identified ( VUR/post obstruct atrophy) Causes: Luminal = calc/clot/tumour/papillary necrosis. Wall = neuromuscular - neuropathic bladder External compression = multiple cause
75
Neuropathic bladder
Childhood most common cause: Px: - Upper tract dilatation --> US - no obstruction - incontinence/reflux/infection - assoc bowel dysfn. Mx: - anticholinergic intermittent self cath ileal conduit
76
Post urethral valces
Px: - male infants - px in 1st year of life w/ - poor stream/bladder dysfunction/failure to thrve. Inx --> ANC US Tx - self cath
77
Renal Cell Ca
Most common cell type = Clx cell Assox: - middle aged male - smoking - VHL - Tuberous Sclerosis Ft - Triad of: 1) Loin pain 2) Haematuria 3) Abdo mass Other ft - Left varicocele - Enocrine - high PTH/high EPO. Renin/ ACTH - 25% metastatic - Stauffer syndrome = paraneoplastic hepatic dysfn Mx: - Confined - SURGERY - High size/METS - TKI (Sonafenib)/INF-alpha/ IL-2
78
Wilm's Tumour
Childhood Px - <5yrs Ft: - Abdo mass - Flank pain - Haematuria 95% = Unilat 20% Mets = lung Assoc. - Beckswith wiedenaan --> overgrowth syndrome - big tongue + open abdo - WAGR - Wilms/Aniridia/ G-U/ Retardation Mx: Nephrectomy/cryo/RT Good prognosis - 80% cure rate
79
Uroethelial tumours
majority = transitional cell Ca others - Squamous cell ``` RF: - Smoking - Alanine - Analgesic nephropathy -Rubber -Schistomiasis - renal cystiv dx - Renal stones (VHL) - ```
80
Bladder Ca RF
Transitional: - Smoking - ALANINE - Rubber - Cyclophosphamide Sq Cell Ca: - Smoking - Schistomiasis
81
Amyloidosis of renal tract - Inx
Inx - CONGO RED STAINING - APPLE GREEN BIFRINGENCE - SAP Scan - serum amyloid precursor - Rectal tissue biopsy
82
Amyloidosis of renal tract types
AL: - Most common - Light chain - Ig - Ft - nephrotic syndrome/cardiac/neuro - Mx = Mephalan --> BM transplant ``` AA: - Amyloid A precursor = acute phase ractant - seen in CHRONIC INFECTION - High renal dx = Tx = txunderlying ``` Beta-2 microglobulin - Part og MHC - assoc w/ pt on renal dialysis
83
Renal A stenosis
cokmmon causes: Old = athersclorosis Young female = Fibromyscylar dysplace - US = Assymetric kidneys - Angiography =string of beads Px: - HTN - CKD/AKI - Flash pulm oedema - Above exac by ACEI/ARB
84
SLE and the Kidney
SLE --> Lupus nephritis --> Therefore req REGULAR SCREENING ``` WHO CLassification: - Class 1 = Normal Class 2 = Mesangial GN Type 3 = FSGN Class 4 = Diffuse prolif GN Type 5 = Diffuse membranous GN Type 6 = Sclerosing GN ``` Inx = Renal Biopsu - WIRE LOOPING = endothelial/Mesangial expansio - E- micro - Subendothelial immune deposits - IF --> GRanular appearance MX: - ACEI/ARB - Active dx --> Steroids/IS
85
H.U.S
see in young child - Triad of: - AKI - Miicroangiopathic anaemia - Thrombocytopaenia Causative agent - E.COLI other causes: - Pneumococcal - HIV- SLE/Drugs/Ca Inx: - FBC - U+E - Stool culture tx = supportive - V.Sev ecoli infec --> Plasma exchnge
86
TTP
Abnormally large sticky multimers of vWF --> clumo Ft: - Triad as for HUS - these patients have FLUCTUATING neuro signs = microemboli. ``` CauseS: - infection -preg - Drugs - ciclosporin/OCP/pemmocollin/Clopi - Tumours SLE - HIV ``` Mx: - PLASMA EXCHANGE - Steroid/IS
87
Multiple Myeloma Mnemonics: Ecidence of end organ damage - CRAB M.Y.E.L.O.M.A
NEoplasm of BM CRAB: - Ca >11/ RFx / Anaemia / Bone dx (lytic lesion/rain drop skull) M.Y.E.L.O.M.A - M spike - You better check Ca + lYtic lesion - ESR - Light chain/bence jones - Ouch my bones - myeloma nephrosis/ marrow plasmocytosis >10% - Anaemia Inx: - BM biopsy --> >10% plasma cells - IgA + IgG + Bence jones - Skull XRAY - Raindrop skull - MRI - radiculopathy Diagnostic criteria 1 maj + 1 minor or 3 minor: MAjor: - Plasmocytoma - >30% plasma celss - v.high M protein Minor: - 10-30% plasma cells - minor M protein - Osteolytic lesions - minor level Ab
88
VAsculitis in Renal
Small vesse vasculitis - NO HTN : - WG - cANCA - Saddle nose - Churg strauss - pANCA - Astham/nasal polyp/eosinophillia - MPA - pANCA - Histology for all above = Necrotising GN = CRESCENT OR FOCAL PROLIF Poly arteritis Nodosa - HTN: - med vassel - ANCA neg HSP - IgA cross over Kawasaki Dx - Child - CRASH & BURN - Conjunctivitis - non purulent - Rash - adenopathy - Strawberry togue - HAnds + feet - erythema - Burn = temp ``` Takaysau: - Lrg vessel vasculitis - claudication RAS - arotid bruit ``` GCS
89
Renal sarcoid
Px as AKI due to AIN --> HYPER CA AND HEPATO-SPLENOMEGALU Px as CKD - due to HyperCa or CIN Mx - steroids - monitor serum ACE
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Nephrotoxic drugs
Decrease BF: - NSAID - ACEI - ARB - Tacrolimus - Ciclosporin Direct toxic - Aminoglycloside - Amphotericin - Cisplatin GN: - gold - penicillamine Li --> interstitial fibrosis
91
Most common infectign organism of PD?
Staph epididermis !!!!! Followed by: - stah A - enterococcus
92
Rapidly progressive haematuria HAemoptysis URTI signs - what is it
Granulamotosis with polyangitis
93
Plasma exchange wjhat electrolyte is low
Hypocalcaemia Plasma exchange is used to remove and filter a patients blood. Citrate is used as an anticoagulant, which can bind to calcium --> hypocalcaemia
94
bph MX - medical
1) - alpha-1 antag - Tamsulosin - causes postural hypotension, dry mouth, depression - decreas SM tone dizziness 2) 5-alpha reductase inhibitor - Finasteride - stops T --> DHT - reduces volume of prostate --> slow progression - take sup to 6/12 to work - E.D./decreased libido/ejac problems.
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Drug induced AIN
Commonky allopurinol and NSAIDs Allopurinol -, eosinophika Note NSAIDs no eosinophiks Mx: A Withdrasl of drug (no proof for steroids, may be use din very severe)
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Following Transplant immunosupression what is a common side effet
Increase in DB Steroids heavily used in I.S.
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Renal involvement in Myeloma
Cast nephropathy: - severe renal insufficiency - ABSENT ALBUMIN (or bery small amounts) - Bence jones AL. Amyloidosis: - nephrotic syndrome - mild. Renal. Insufficiency - LAMBDA LIGHT CHAIN Cryoglobunaemic glomerulonephritis: - mild. To. Severe nephrotic sybdroe - HAEMATURIA Light chain deposition diseass: - MILD disease - KAPPA ligt chain
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Amyloidosis
seen on MYELOMA AND MGUS Other csuses: Familal Mediterranean fever Secondary (RA) Apple green bifringence on congonred staining Renal. Amyloidosis recurrs after. Transplant Affects liver kidneys and heart Cardiac involcemenr is the most common causs of sudden. Death
99
AA vs AL amyloid question features
Both are apple. Green bifringencd AA - related to RHEUMATOID - chronic inflamm diseass AL - severe disease
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Acute vs chrinic graft rejection
Acute <2 weeks: - acute rejextion - ATN - CNI Toxicity - thrombosis - surgicla comlkciatuon Chronic reject - >2 weekz - chronic rejection - chronic CNI toxicity - obstruxt - R. A. S - Bk/JC virus - recurrenc of primary dx
101
Acute vs chrinic graft rejection
Acute <2 weeks: - acute rejextion - ATN - CNI Toxicity - thrombosis - surgicla comlkciatuon Chronic reject - >2 weekz - chronic rejection - chronic CNI toxicity - obstruxt - R. A. S - Bk/JC virus - recurrenc of primary dx
102
HyperPTH vs familial hypocalciuric hypercalcaemia
Both have high serum Ca FHH has LOW URINARY CA
103
Which glomerulonephritis is assoc with cance
Membranous neohritid - lung cancer
104
Wegners we-C-ners
cANCA C on stick man - effects nasopharync + lungs + kidneys Biopsy: - Segmental -C-rescentic necrotising GN Poor prognosis - Renal dx
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most common side effect of LT dialysis
Carpal tunnel syndrome
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medullary sponge kdiney
increase risk of renal stones in pregnancy
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Oain in drinking alcohol and renal. Dx
Minimal change disease
108
Hb aim. In CKD
110-120 g/DL
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Nephritic Syndromes: PIG ARM
Post strep GN IgA Nephropathy Goodpastuers Alports RPGN Membrano-prolif
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Partial lipodystrophy - renal involvement
mesangiocapillary with C3 nephritic factor therefore get low C3 and normal C4
111
Normal Anion Gap
12-18
112
Which vasculitis is assoc with wegners
R PGN
MRCP
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