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2010-06-09 15:35:57

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  1. what is the presentation of renal vein thrombosis?
    • loin/flank pain
    • deterioration in renal function
    • proteinuria/haematuria
    • palpable kidney
    • PE
  2. what are the causes/RF for renal vein thrombosis?
    • extrinsic compression by tumour
    • invasion by tumour e.g. renal cell carcinoma
    • nephrotic syndrome - hypercoagulable state
  3. how is renal vein thrombosis diagnosed?
    • renal angiography in venous phase
    • also do doppler US, CT, MRI
  4. what is the treatment of renal vein thrombosis?
    • anticoagulant with warfarin for 3-6 months
    • INR 2-3
  5. what are the advantages of indapamide over bendroflumethiazide?
    • less hypoNa
    • no effect on insulin resistance so can use better in DM
  6. why is PTH high in CRF?
    • 1. low calcium as low active vitD as less 1alpha hydrox
    • 2. high phosphate levels as kidneys fail to excrete
    • 3. low 1.25(OH)2vitD3
  7. how is hyperPTH in CRF managed?
    • give calcium carbonate with meals
    • alpha calcidiol (active vitD analogue)
    • calcichew - phosphate binders in gut
    • normally start on vitamin D supplement alone and this may normalise PTH alone
  8. what is the commonest type of GN in the world?
    IgA nephropathy (Berger's disease)
  9. how does Berger's disease typically present?
    • young man
    • episodic macro/microscopic haematuria
    • few days after URTI - pharyngitis
    • recovery is rapid between attacks
    • overproduction of IgA forms immune complex and deposits in mesangial cells
  10. what does renal biopsy of IgA nephropathy show?
    • mesangial proliferation
    • IF: IgA and C3 deposits
  11. if patients with IgA nephropathy have HTN, what is Rx?
  12. what is medullary sponge kidney characterised by?
    • dilatation of collecting ducts in papillae
    • so stasis or urine
  13. what is the appearance of medullary sponge kidney on AXR?
    • multiple pre-calyceal calcifications affecting both kidneys
    • bunch of grapes appearance
  14. what are the clinical features of medullary sponge kidney?
    • asymptomatic
    • haematuria
    • intermittent colic - renal stones: costovertabral angle pain
    • UTI
    • hypercalciuria
    • unlike PKD - cysts are not seen elsewhere in the body and renal failure is uncommon
    • metabolic acidosis due to RTA
  15. how is medullary sponge kidney diagnosed?
    excretion urography
  16. what is the management of medullary sponge kidney?
    prevent complications - so increase fluid intake if get recurrent UTI/stones
  17. if an IVDU has systemic vasculitis and cryoglobulins in blood. what is the likely cause
    hep C
  18. where do cholesterol emboli usually come from and where do they lodge?
    • from: atheromatous plaques in aorta
    • lodge: distal microcirculation e.g. renal vessels, peripheral circulation, GIT to cause ischaemia
  19. What are the signs of cholesterol emboli?
    • livedo reticularis
    • gangrene
    • GI bleed
    • renal failure
    • inflam response: fever, myalgia, high eosinophils
  20. what are the risk factors for cholesterol emboli?
    • atheroma
    • high cholesterol
    • AAA
    • thrombolysis
    • arterial catheterisation
  21. if a patient has renal failure, raised CK and raised K+ and been immobile what is diagnosis?
  22. why do you get renal failure in rhabdomyolysis?
    skeletal muscle breakdown release myoglobin which is filtered by glomeruli and precipitates and therefore obstructs renal tubules
  23. what are the causes of rhabdomyolysis?
    • prolonged immobilisation after faul
    • burns
    • crush injury
    • excessive exercise
    • uncontrolled seizures
  24. in renal artery stenosis, which drug (antiHTN) is specifically CI and why?
    • ACEi as angiotensin II is required for vasoconstriction of efferent arteriole to maintain GFR especially in states of reduced renal perfusion such as RAS.
    • without angiotensinII, get decrease in GFR
  25. which drug needs to be given in SAH to prevent a severe complication?
    • nimodipine - CCB
    • prevent vasospasm
  26. why do you get polycythaemia in PKD?
    increased EPO
  27. why are ACEi useful in nephrotic syndrome?
    antiproteinuric effects
  28. what defines oliguria?
    < 400ml urine/day
  29. what are the 3 main biochem/urine features of ARK?
    • inc creatinine (>130)
    • inc urea (> 6.7)
    • oliguria (<400ml/day)
  30. what are the symptoms of ARF? (categorise)
    • Oliguria
    • Cardiopulmonary: SOB due to pulm oedema and anaemia, uraemic pericarditis - pericardial effusion and tamponade, palpitations, arrhythmia (inc K+)
    • Systemic metabolic acidosis: Kussmaul's respiration
    • Neuro: uraemic encephalopathy, weak, faituge, mental confusion, seizure, coma
    • Skin: pallor (anaemia), pruritis, pigmentation, bruising (plt func down)
    • GI: N+V, anorexia
    • Haem: anaemia. impaired platelet function - bruise and GI bleed, frank haematuria, prolonged nosebleeds, purpura
  31. what are the signs/symptoms of hypoNa?
    • oedema (heavy legs)
    • weakness
    • cramping
    • confusion
    • seizures
    • hypertension
    • cardiac failure
    • nausea
  32. what are the signs/symptoms of hyperNa?
    • thirst
    • confusion
    • coma
    • fits
    • signs of dehydration: dry skin, reduced skin turgor, post hypo, oliguria
  33. what is the treatment of uraemia pericarditis/enceph?
  34. what are the symptoms of raised ICP?
    • vomit
    • headache
    • seizure
    • behavioural change
  35. what is the treatment for raised ICP? and its SE?
    • mannitol
    • SE: fever
  36. name 2 types of loop diuretics
    • frusemide
    • bumetanide
  37. what is nephritic syndrome?
    • haematuria
    • RBC casts
  38. what are the associated features of nephritic syndrome?
    • HTN
    • proteinuria
    • haematuria
    • oliguria
  39. what is the main cause of nephritic syndrome?
    immune response leading to glomerular inflammation
  40. name 5 causes of nephritic syndrome
    • Berger's (IgA nephropathy)
    • Wegener's granulomatosis
    • Goodpasture's
    • Alport's
    • post strep GN
  41. middle aged patient, oedema, HTN, 2 sinus drainage this yr. whats the diagnosis?
  42. pt < 20yo, URTI, frank haematuria. whats the diagnosis?
    Berger's disease IgA nephropathy
  43. age < 40, deafness, cataracts, kidney probs. whats the diagnosis?
    Alport's syndrome
  44. 20yo, haemoptysis, hypertension, oedema (kidney probs). whats the diagnosis?
    Goodpastures (haemoptysis is central feature) - young male
  45. young man, after sore throat/skin infection get nephritic. whats the diagnosis?
    Post strep GN
  46. what increases the risk of goodpastures?
    smoking, young male
  47. what is the treatment of wegener's?
    • prednisolone
    • immunosuppressant
  48. what is the treatment of goodpastures?
    • cyclophosphamide
    • plasmapheresis - remove autoAb
  49. what are the features of alports on biopsy?
    • focal segmental glomerulosclerosis
    • thickened and split BM
    • IgM C3 deposits in affected (focal) areas
  50. what type of GN do Wegeners and goodpastures cause?
    rapidly progressive GN
  51. what is the main cause of proliferative GN and how does it present?
    • post strep GN (after sore throat or skin infec - e.g. impetigo)
    • presents as nephritic syndrome
  52. middle aged man, oedema, periorbital darkness, haematuria. whats the diagnosis?
    • membranous nephropathy
    • (most common cause of nephrotic syndrome in adults)
    • biopsy: thick BM, IgG, C3 deposits
  53. what are the complications of nephrotic syndrome, why? how Rx?
    • loss of proteins - albumin and Ig so
    • 1. more infections - abx prophylaxis
    • 2. liver compensates and makes more lipoproteins - more chol and TG - statins
    • 3. liver makes more clotting factors - DVT, PE
    • 4. renal vein thrombosis - prophylactic heparin and early mobilisation
  54. which Ix need to be done in nephrotic syndrome?
    • urinalysis
    • 24 hour urine collection to determine protein loss
    • then biopsy after assessment of possible causes
  55. who is SLE common in?
    • afrocaribbeans
    • asians
  56. which anti complement Ab is specific for SLE?
    anti C1q