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Renal > Renal > Flashcards

Renal Flashcards

0
Q

Myeloma kidney types/causes

A

SEVERITY OF RENAL DYSFUNCTION CORRELATES WITH PATIENT SURVIVAL

Myeloma cast nephropathy (tubular)
Amyloidosis (glomerular)
Monoclonal immunoglobulin deposition disease (glomerular)
Also plasma cell infiltration (interstitial)

Renal failure also from hypercalcaemia, hyperuricaemia, drugs

Isolated tubular dysfunction often in light chain disease-proximal mostly- giving RTA and maybe acquired Fanconi syndrome
Also interstitial nephritis (interstitial)

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1
Q

Why would you do an abdominal fat pad aspirate?

A

If you are thinking AL Amyloidosis

  • nephrotic range proteinuria
  • peripheral sensorimotor neuropathy
  • autonomic neuropathy
  • carpal tunnel
  • peri orbital purpura
  • diarrhoea and malabsorption
  • macroglossia
  • heart failure
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2
Q

Type of renal dysfunction associated with pamindronate

A

Focal segmental glomerulosclerosis

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3
Q

4 induction drugs

A

Steroids
Cyclophosphamide
MMF
rituximab- refractory

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4
Q

Side effects cyclophosphamide

A 
Gonadal toxicity
Major infection
HZV
bladder toxicity
Malignancy 
Bone marrow suppression
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5
Q

Mechanism of probenecid increasing plasma concentration of drugs like penicillin and oseltamivir

A

Inhibits organic anion excretion in proximal tubule

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6
Q

Mechanism of increased creatinine in trimethoprim and cimetidine

A

Atp dependent transporter called P glycoprotein on brush border membranes secretes lots of drugs as well as creatinine and neurotransmitters. No change in actual gfr, the creatinine is just not being secreted

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7
Q

Abx choice in infected cyst in PCKD

A

Good pathogen cover AND good cyst penetrance
Cipro
Differentiate between ruptured cyst which has mild fever, some flank pain but usually no white cell count

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8
Q

Rasburicase mechanism in tumour lysis

A

Breaks down Uric acid and minimises xanthine accumulation

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9
Q

FSGS - what do you see in the urine.

A

Microscopic haematuria, hypertension, kidney insufficiency

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10
Q

IgA nephropathy - secondary causes include

A

Chronic liver disease
Coeliac
HIV
IBD

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11
Q

Effects of anaemia in Ckd

A

LVH
REDUCED QOL
cv complications

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12
Q

Causes of distal RTA

A

Autoimmune disorders
Lithium or amphotericin
Hypercalciuria
Hyperglobulinaemia

Also see nephrocalcinosis and urine PH over 6 in type 1

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13
Q

Gitleman syndrome

A 
Looks like thiazide effect on kidney
Autosomal recessive
Hypokalaemic metabolic alkalosis
BP low
Low mg 
Inactivating mutation in sodium chloride cotransporter in DCT
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14
Q

Cyclosporine A toxicity renal mech

A

Constrict adherent and efferent arterioles
Hypertension with high levels
HUS class effect
Chronic toxicity irreversible
Path changes- arteriolar hyalinosis, glomerulosclerosis, interstitial fibrosis, “striped fibrosis” TGF beta and Ang II mediated
Also risk hyperkalaemia, hyperuricaemia, metabolic acidosis, low mg, low phosphate

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15
Q

Name some interstitial nephritis drugs

A

NSAIDs - even after months exposure. Due to leukotriene increase. Can cause minimal change picture
Aminoglycosides- saturable tubular uptake so single large doses therefore better
Lithium
Amphotericin
Gentamicin
Antivirals- use entecavir over indinavir in HAART if CKD 3 or above. Causes ATN also, low phosphate, low my, increase creatinine, glycosuria
Ppi

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16
Q

Fanconi syndrome

A

Disease of proximal renal tubules.
Loss glucose, amino acids, Uric acid, phosphate, bicarb in urine
Type 2 RTA
LOSS PHOSPHATE leads to Ricketts
Clinical features polyuria, polydipsia, acidosis, growth failure, low K, high Cl
Inherited- cystinosis, Wilsons, glycogen storage diseases
Acquired- tenofovir, lead poisoning, expired tetracycline, mm or MGUS

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17
Q

Cisplatin and toxicity mech

A

Renal tubular toxin from free radical formation And CKs
Mg wasting
HUS

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18
Q

Time frame interstitial nephritis and PPI

A

Usually three months

Sometimes up to nine months

19
Q

Penicillamine renal side effect

A

Membranous

20
Q

Renal effect with VEGF inhibitors…. What is it?

A

Podocyte damage- see thickened BM with podocyte effacement
Need to monitor for proteinuria
Eg bevacizumab

21
Q

Hydralazine renal side effect

A

Drug induced lupus

22
Q

Trimethoprim effect on potassium

A

Increase- even in normal renal function

23
Q

Risk of gadolinium in renal failure

A

Contraindicated if GFR less than 30 due to risk of nephrogenic systemic fibrosis. Dialyse soon after if possible. 2-75 days from exposure, median 25. Most cases with gadodiamide- less risk with gadobenate

24
Q

minimal change disease drug and secondary causes

A

Drug: NSAIDs and bisphosphonates
malignancy: usually primary haematological - resolution with control of malignancy

25
Q

Tests in RPGN

A 
Anca
ANA and dsDNA 
Complement
IgA 
Phospholipase A2 receptor ab 
HCV HBV
anti GBM ab
Anti DNase B, ASOT
Cryoglobulins
26
Q

High anion gap METABOLIC ACIDOSIS

A

GOLD MARK
glycols- propylene and glycolene
Oxolene- paracetamol in malnourished ladies chronic
L- lactate- infusion metabolism phenobarbotone or lorazepam when solute propylene glycol
d lactate- short gut syndrome

Methanol
Aspirin
Renal failure
Ketoacidosis

27
Q

Normal anion gap MA

8-13

A

Loss bicarb- diarrhoea, CA Inhibitors, type 2 RTA, pancreatic ileostomy, pancreatic or biliary or intestinal fistula

Exogenous admin HCl or ammonium chloride

Decreased renal acid excretion- type 1 and 4 RTA, renal failure.

Hyperkalaemia
Recovery fromDKA

28
Q

Urine anion gap use

A

Differentiate between renal and gut causes of hyperchloraemic MA

GUT uag will be neGUTive
Renal distal accidification problem will be positive
Normal is zero or neg

This is because AG estimates loss of Cl as marker of ammonium in urine. If renal problem cannot do this so positive gap

29
Q

Distal RTA

A 
Autoimmune
HyperPT, vit D toxicity
Thyroid disorders
Hypergammaglobulinaemia
Amphotericin, lithium, ifosfamide, PPI, NSAIDs 
Chronic hep
Obstructive uropathy
Sickle cell
Renal Tx
30
Q

Type 2 RTA

A 
Often assoc Fanconi 
MM
contrast agents
Adenovir, tenofovir
Aminoglycosides 
Rhabdo
Heavy metals 
Amyloid
Interstitial nephritis
31
Q

Causes type 4 RTA

A

Acquired: decreased renin from diabetic nephropathy, NSAIDs, interstitial nephritis

Acquired: normal renin reduced aldosterone in ACE ARB heparin

Acquired: decreased response aldosterone in K sparing diuretics, trimethoprim, tac, pentamidine, tubulointerstitial disease- sickle cell, SLE, amyloid, DM

32
Q

Warfarin in AF and esrf?

A

High rates GI bleeding in these patients.

Retrospective cohort in Circulation 2014 Jan- suggested higher rate haemorrhagic stroke and other bleeds, need RCT

33
Q

Consider formation vascular access when…

A

Patient likely to live more than one year and gfr less than 20

34
Q

Benefits of PD over HD

A 
Preserve RRF
cheaper
Less inflammation
Less infection
Independence and employment
Even volume and BP control
Increase in early graft function post Tx 
Reduce EPO/ iron 
Preserve vascular access
35
Q

FIVE MAIN EFFECTS OF RENAL BONE DISEASE

A 
Bone
Anaemia
Fluid
Electrolytes
Waste retention
36
Q

Degree of RAS needed to induce Renal ischaemia and activate RAAS

A

Over 75 percent

37
Q

Three drugs most well known for drug induced lupus

A

Hydralazine
Procainamide
Isoniazid

… Arthralgia and arthralgia, pericarditis and pleuritic, ANTI HISTONE AB IN 95%

38
Q

Why do you give amiloride in nephrogenic diabetes insipidus caused by lithium

A

Directly blocks ENaC and decrease tubular uptake of lithium leading to reduced long term damage

39
Q

Differential metabolic acidosis plus resp alkalosis combined

A

Liver disease
Sepsis
Salicylate toxicity

40
Q

Indications for dialysis

A

Uraemic symptoms
Acidosis refractory to medical therapy
Fluid overload refractory
Electrolyte disturbance not easily managed with medications
Progressive deterioration in nutritional status refractory to dietary intervention
Also: refractory bp control and cognitive impairment

41
Q

How is urine pH important in urine infection suspicion

A

If over 7 suggest urease splitting organism like proteus or pseudomonas

Also highly alkaline urine can cause false positive dipstick

42
Q

ABO incompatibility- is it a contraindication to transplantation

A

No - do just as well!

43
Q

Benefits of transplantation

A

improved long term survival comp dialysis- if fit for it
QOL- independence from dialysis and fluid restriction, work, feel better
Cheaper after 1st year

44
Q

Complications of ADPCKD

A

UTI risk- GIVE CIPRO
Renal cyst rupture –>pain or haematuria
Hypertension and proteinuria and compl of CKD
ESKD- 50s for PCK-1 and 70s for PCK-2
Thoracic aortic dissection, cervico-cephalic, coronary artery aneurysms
MV prolapse and AI
IC aneurysms- screen with MRA if family history, neuro sx, or high risk like pilot.

45
Q

What is the most significant cause of renal anaemia?

A

reduced EPO synthesis

Renal (19 decks)

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