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what is the presentation of renal vein thrombosis?
- loin/flank pain
- deterioration in renal function
- proteinuria/haematuria
- palpable kidney
- PE
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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
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how is renal vein thrombosis diagnosed?
- renal angiography in venous phase
- also do doppler US, CT, MRI
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what is the treatment of renal vein thrombosis?
- anticoagulant with warfarin for 3-6 months
- INR 2-3
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what are the advantages of indapamide over bendroflumethiazide?
- less hypoNa
- no effect on insulin resistance so can use better in DM
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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
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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
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what is the commonest type of GN in the world?
IgA nephropathy (Berger's disease)
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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
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what does renal biopsy of IgA nephropathy show?
- mesangial proliferation
- IF: IgA and C3 deposits
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if patients with IgA nephropathy have HTN, what is Rx?
ACEi
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what is medullary sponge kidney characterised by?
- dilatation of collecting ducts in papillae
- so stasis or urine
-
what is the appearance of medullary sponge kidney on AXR?
- multiple pre-calyceal calcifications affecting both kidneys
- bunch of grapes appearance
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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
-
how is medullary sponge kidney diagnosed?
excretion urography
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what is the management of medullary sponge kidney?
prevent complications - so increase fluid intake if get recurrent UTI/stones
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if an IVDU has systemic vasculitis and cryoglobulins in blood. what is the likely cause
hep C
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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
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What are the signs of cholesterol emboli?
- livedo reticularis
- gangrene
- GI bleed
- renal failure
- inflam response: fever, myalgia, high eosinophils
-
what are the risk factors for cholesterol emboli?
- atheroma
- high cholesterol
- AAA
- thrombolysis
- arterial catheterisation
-
if a patient has renal failure, raised CK and raised K+ and been immobile what is diagnosis?
rhabdomyolysis
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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
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what are the causes of rhabdomyolysis?
- prolonged immobilisation after faul
- burns
- crush injury
- excessive exercise
- uncontrolled seizures
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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
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which drug needs to be given in SAH to prevent a severe complication?
- nimodipine - CCB
- prevent vasospasm
-
why do you get polycythaemia in PKD?
increased EPO
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why are ACEi useful in nephrotic syndrome?
antiproteinuric effects
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what defines oliguria?
< 400ml urine/day
-
what are the 3 main biochem/urine features of ARK?
- inc creatinine (>130)
- inc urea (> 6.7)
- oliguria (<400ml/day)
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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
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what are the signs/symptoms of hypoNa?
- oedema (heavy legs)
- weakness
- cramping
- confusion
- seizures
- hypertension
- cardiac failure
- nausea
-
what are the signs/symptoms of hyperNa?
- thirst
- confusion
- coma
- fits
- signs of dehydration: dry skin, reduced skin turgor, post hypo, oliguria
-
what is the treatment of uraemia pericarditis/enceph?
dialysis
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what are the symptoms of raised ICP?
- vomit
- headache
- seizure
- behavioural change
-
what is the treatment for raised ICP? and its SE?
-
name 2 types of loop diuretics
-
what is nephritic syndrome?
-
what are the associated features of nephritic syndrome?
- HTN
- proteinuria
- haematuria
- oliguria
-
what is the main cause of nephritic syndrome?
immune response leading to glomerular inflammation
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name 5 causes of nephritic syndrome
- Berger's (IgA nephropathy)
- Wegener's granulomatosis
- Goodpasture's
- Alport's
- post strep GN
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middle aged patient, oedema, HTN, 2 sinus drainage this yr. whats the diagnosis?
Wegener's
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pt < 20yo, URTI, frank haematuria. whats the diagnosis?
Berger's disease IgA nephropathy
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age < 40, deafness, cataracts, kidney probs. whats the diagnosis?
Alport's syndrome
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20yo, haemoptysis, hypertension, oedema (kidney probs). whats the diagnosis?
Goodpastures (haemoptysis is central feature) - young male
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young man, after sore throat/skin infection get nephritic. whats the diagnosis?
Post strep GN
-
what increases the risk of goodpastures?
smoking, young male
-
what is the treatment of wegener's?
- prednisolone
- immunosuppressant
-
what is the treatment of goodpastures?
- cyclophosphamide
- plasmapheresis - remove autoAb
-
what are the features of alports on biopsy?
- focal segmental glomerulosclerosis
- thickened and split BM
- IgM C3 deposits in affected (focal) areas
-
what type of GN do Wegeners and goodpastures cause?
rapidly progressive GN
-
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
-
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
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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
-
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
-
-
which anti complement Ab is specific for SLE?
anti C1q
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