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P4 > renal > Flashcards

renal Flashcards

1
Q

causes of CKD

A 
HTN
Diabetes Melitius
Glomeronephritis
Pylonephritis
Obstructive nephropathy
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2
Q

explain process of haemodialysis

A

AV fistula made –> 2 months

vein: cephalic / basilic
artery: brachial

  1. blood filtered against a semi-permable membrane
  2. toxic concentrations filter across
  3. blood becomes more like the dialsis fluid
  4. filtered back
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3
Q

complications of dialysis

A

bacterial peritonitis
sclerosing peritonitis
constipation

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4
Q

what time period determines whether the organ rejection is acute or chronic?

A

6 months

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5
Q

if on immunosuppressants - what are you concerned about?

A

Squamous cell carcinoma

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6
Q

what is the term called for bone disease in patients with renal failure

A

renal osteodystropy

also known as uraemic osteopathy

  • osteomalacia / rickets
  • hyperparathyroidism
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7
Q

action of PTH

A
  1. increases osteoclast activity –> Ca / Phos
  2. vitamin D hydroxylation - liver + kidneys
  3. Ca / Phos reabsorption via kidneys
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8
Q

How does teritary hyperPTH develop?

A

due to untreated secondary hyperparathyroidism

results in parathyroid gland to act autonomously / undergo hyperplastic change

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9
Q

complications of CKD

A

anaemia - due to reduced EPO responsible for RBC production

renal osteodystrophy - elevated PTH

cardiovascular disease

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10
Q

pre-renal causes of AKI

A

hypovolaemia (sepsis, liver cirrhosis)
renal artery stenosis (ACE-i)
congestive heart failure

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11
Q

renal causes of AKI

A 
acute tubular necrosis
nephrotoxic (rhabdomyolysis, contrast)
glomerulonephritis
malignant HTN
vasculitis
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12
Q

post-renal causes of AKI

A

renal calculi
BPH
strictures / ureteric tumours
prostate cancer

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13
Q

indications for dialysis

A 
chronic hyperkalaemia 
metabolic acidosis
intractable fluid overload
uraemic pericarditis
uraemic encephalopathy
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14
Q

in rhabdomyolysis what is the urinary test?

what is seen in it?

A

urinary myoblobin

muddy brown/granular clasts

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15
Q

other than prolonged immobility - what else causes rhabdo?

A 
excessive exercise
burns
epilepsy
neuroepiletic malignant syndrome
drugs (statins, ecstasy, heroin)
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16
Q

define nephrotic syndrome

A

oedema
hypoalbuminia
proteinuria

hyperlipidimia

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17
Q

complications of nephrotic syndrome + their Mx

A

hyperlipidaemia - statin
thromboembolism - anticoagulation
infections - pneumococcal vac

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18
Q

dietary requirements for nephrotic syndrome

A

low salt intake

normal protein intake

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19
Q

concerns of correcting sodium too quickly

hypo / hyper

A

hyper - cerebral oedema

hypo - central pontine myelinolysis

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20
Q

Pathology of SIADH

Ix / Mx

A

oversecretion of ADH from posterior pituitary

ADH acts on aqua-porin 2 channels to reabsorb water molecules

Serum / urine osmolaity

  1. fluid restriction
  2. furosemide
  3. hypertonic saline
  4. conivapton / tolvapton - vasopressin receptor antagonist - competes at the collecting ducts
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21
Q

conivapton / tolvapton - class of drug

A

vasopression receptor antagonist

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22
Q

name 2 markers of infection urine

A

nitrates

leucocyte esterases

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23
Q

things to reduce risk of developing UTI in females

A

well hydrated
post-coital voiding
wipe front to back
avoid spermcide

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24
Q

types of renal replacement therapy

A

haemodialysis

  • filtering of blood via AV fistula
  • 3 to 5 hour sessions

perioneal dialysis

  • flitration occurs inside the patient’s abdomen
  • high dextrose concentration draws waste products out
  • several hours of ‘dwelling time’

renal transplant

  • donor kidney connected to external iliac vessels
  • 10-12 year
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25
Q

what is diagnostic criteria for in diabetic nephropathy?

A

albumin: creatinine ratio (ACR)
- early morning sample

ACR > 2.5 microalbuminuria
BP aim <130/80

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26
Q

what is henoch-schonlein purpura?

A

IgA mediated small vessel vascultitis
- commonly seen in children after infection

(slight overlap with IgA nephropathy - Berger’s Disease)

palpable purpuric rash
abdo pain
polyarthritis
renal failure - IgA

Prognosis

  • self-limiting, good outcome
  • especially in children w/o renal involvement
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27
Q

what qualifies for urgent referral regarding haematuria?

A
  1. aged 45 +
  2. unexplained haematuria (no UTI)
  3. visible haematuria that persists after treatment
  4. aged 60 +
  5. unexplained non-visible haematuria + raised WCC / dysuria
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28
Q

define triad for haemolytic uraemic syndrome

A
  1. acute kidney injury
  2. microangiopathic haemolytic anaemia
  3. thrombocytopenia
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29
Q

what is haemolytic uraemia syndrome classfied into?

A

primary - atypical

complement dysregulation

secondary - following infection

E.coli
Pneumococcal infection
HIV

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30
Q

what is desmopressin?

A

synthetic ADH

used to treat cranial diabetes insipidus

NOT nephrogenic DI

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31
Q

what is chlorothiazide?

A

thiazide
- allows sodium to be released into the urine –> hence lowering the serum osmolarity

used to treat nephrogenic DI

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32
Q

what is the acceptable amount of glucose for a patient to be given daily?

A

50-100g irrespective of weight

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33
Q

how do you detemine between pre/renal/post causes of AKI?

A

presence of protein in urine dip - confirms renal cause

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34
Q

after 2 episodes of painless frank haematuria - what is the investigation?

A

cystoscopy

gold standard for bladder cancer

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35
Q

what is the mechanism of renal failure by rhabdomyelosis?

A

myoglobinuria causes renal failure by tubular cell necrosis

–> toxicity of myoglobin on the tubular cells

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36
Q

patients on haemodialysis for CKD –> what are they most likely to die from? Why

A

ischaemic heart disease

due to increased calcification in dialysis

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37
Q

why is the hypercoagulopathy in nephrotic syndrome?

A

loss of anti-thrombin 3 via the kidneys

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38
Q

what is the screenin test for adult polycystic kidney disease?

A

Abdo USS

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39
Q

what would you find on a membranous glomerulonephritis renal biopsy?

A
  • thickened basement membrane
  • subepithelial spikes on silver stain
  • PLA2
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40
Q

on abdominal USS - what difference would you see between diabetic nephropathy + CKD?

A

Chronic diabetic nephropathy
- bilateral enlarged kidneys / normal

CKD - bilateral small kidneys

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41
Q

causes of renal artery stenosis

A 
atherosclerosis (90%)
fibromusclar dysplasia (10%)
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42
Q

why would you choose to use contrast on a CT ?

A

if checking for malignancy - look for blood supply

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43
Q

indications for NIV? (4)

A
  1. COPD with resp acidosis (pH 7.25-7.35)
  2. Cardiogenic pulmonary oedema unresponsive to CPAP
  3. T2RF with chest wall deformity / obstructive sleep apnoea
  4. weaning off tracheal intubation
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44
Q

when investigating a pleural effusion - how do you determine the cause

A

fluid / serum protein ratio

if >0.5 exudate

if <0.5 transudate

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45
Q

define ARDS

A

increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli

  • acute onset
  • bilateral pulmonary oedema
  • non-cardiogenic
  • low oxygen sat (in site of high ox)
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46
Q

what are to 2 management outcomes of CURB65?

A

moderate / outpatient
- amox (macrolide if pen allergic)

severe / admit
- amox + macrolide

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47
Q

explain the biochem of conn’s

A

high aldosterone secretion

acts on Na/k channels - resulting NA reabsorption + K excretion

H ions are also in competition with K ions
As H ions are excreted HCO3 is being reabsorbed with Na –> high HCO3 –> metabolic alkalosis

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48
Q

what does urine potassium >20 mmol/l in the presence of hypokalaemia tell you?

A

pathology is a renal cause

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49
Q

drugs influencing renin/aldosterone measures

A

spironolactone
ostrogens
ACE-i

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50
Q

how do you work out anion gap?

what is normal value?

A

(Na + K) - (HCO3 + Cl)

8-14 mmol/L

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51
Q

causes of hypercalcaemia

A

bone mets
thiazide diuretics - reduced calcium reabsorb (stimulate sodium/calcium exchange intracellularly)
1 + 3 hyperPTH
PTHrP - squamous cell

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52
Q

difference on imaging between acute renal failure vs CKD?

A

CKD - bilateral small kidneys

HIV-related nephropathy - bilateral large kidneys

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53
Q

what class of diuretic is used to prevent reaccumulation os ascites?

A

aldosterone antagonist - spironolactone

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54
Q

extra-renal manifestations of ADPKD

A

liver cysts - hepatomegaly (most common)

berry aneurysms - SAH

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55
Q

iatrogenic cause for nephrogenic diabetes inspidus

A

lithium

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56
Q

what does a greater increase in urea over creatinine signify?

and vice versa?

A

urea > creatinine = dehydration

creatinine > urea = AKI

57
Q

What are the features of diabeteic nephropathy?

A

microalbuminuria - 1st indicator

urinary albumin:creatinine ratio (ACR) used for screening
ACR > 2.5 = microalbuminuria

58
Q

Mx of diabetic nephropathy

A
  1. dietary protein restriction
  2. tight glycaemic control
  3. BP control
  4. ACE -I & ARB
  5. statins
59
Q

electrolyte imbalance seen in adrenal insuffiiency

A

hyperkalaemia metabolic acidosis

  • loss of adrenal function
  • low aldosterone = low sodium / high pot
  • sodium excretion = Hion retention
60
Q

what are the variables used to calculate eGFR?

A

Creatinine
Age
Gender
Ethinicity

61
Q

what is henoch schonlein purpura

A

IgA mediated small vessel vasculitis

overlap with IgA nephropathy (berger’s disease)

HSP - children usually get this after infection

62
Q

Features of HSP

A

abdo pain
polyarthritis
haematuria
palpable purpuric rash

63
Q

Mx for HSP

A

supportive - disease is self-limiting

analgesia

64
Q

what do eosinophillic cast seen in urine signfiy?

A

tubulointerstitial nephritis

reaction to penicillin

65
Q

when is EPO secreted?

A

in response to cellular hypoxia

used to treat anaemia associated with CKD

66
Q

how to determine between renal artery stenosis + bilateral adrenal hyperplasia?

why?

A

RAS - high renin levels, signifiying a secondary cause

BAH - low renin levels

in RAS - kidney thinks BP is low so triggers RAAS = high renin

in BAH - high BP due to water retention, kidneys trying to lower it hence low renin produced

67
Q

what is haemolytic uraemic syndrome?

A

disease of endothelial injury, classified by:

  • classically after e.coli releasing toxin (90% cases)
  • pneunococal
  • HIV
  1. AKI
  2. microangiopathic haematuria
  3. thrombocytopenia

Mx - supportive, abx have no role

68
Q

post-catheterising care

A
  1. sample
  2. document residual volume
  3. retract foreskin over glans penis
69
Q

causes of acute urinary retention

A

UTI
constipation
BPH
Pelvic nerve damage

Meds - anti-cholinergics / opioids

70
Q

how to determine if retention is acute or chronic ?

A

acute:
- smaller volumes drained

chronic:
- larger volume + painless
- incontinence due to overload pressure

71
Q

draining urinary retention - what is the patient at risk from?

A

post-obstructive diuresis

  • triggered by acute drainage
  • at risk of dehydration

generally self-limiting to 24 hrs

72
Q

Mx for BPH

A

alpha 1 receptor antagonist

  • tamulosin
  • doxazosin

5-alpha reductase
- finesteride

PDE-5 inhibitor
- sidenifil

Anti-cholinergics
- oxybutynin

73
Q

risk factors for bladder ca

A 
smoking
aromatic amine exposure
males
schistosomiasis
chronic cysitis
74
Q

investigations for macroscopic haematuria

A

renal USS
flexible cystoscopy
x-ray KUB

75
Q

most common type of bladder ca

other types;

A

transitional

squamous
adeno

76
Q

Mx bladder Cancer

A

trans-urethral resection of bladder tumour (TURBT)

77
Q

bladder cancer mets (3 - systems)

A

local:
- pelvic structures (uterus, rectum)

lymphatic:
- iliac + paraaortic LN

haematological:
- liver
- lung
- bone

78
Q

why is abx cover given for prostate biopsy?

A

minimise infection associated with transrectal biopsy

moving flora into the prostate

79
Q

what score is used to grade prostate cancer?

A

gleason’s

80
Q

causes for testicular pain

A 
testicular torsion
epididymo-orchitis
testicular tumour
varicocele
hydrococele
inguino-scrotal hernia
81
Q

clinical signs of testicular torsion

A
  • swollen hot testis
  • high lying transverse
  • unilateral pain

loss of cremasteric reflex
prehn’s sign - pain does not ease

82
Q

renal tumour for:

55yr old:

5yr old:

A

renal cell carcinoma

wilm’s tumour / nephroblastoma

83
Q

common complication of renal tumour in males + pathophysiology?

A
  1. renal mass causing compression of L renal vein
  2. resulting in testicular vein compression
  3. resulting in variocele (bag of worms)
84
Q

RF for renal cell carcinoma

A 
age
smoking
male
obesity
hereditary papillary RCC
long term dialysis
85
Q

what are you concerned about administering vancomycin ?

A

too fast - red man syndrome

redness / pruritus / burning sensation
- upper body

patho - excess release of histamine from mast cells

86
Q

what drugs should be stopped in AKI

A 
NSAIDs
aminoglycosides
ACE-i 
ARBs
Diuretics
metformin
87
Q

what rate should fluids be prescribed?

A

30ml/kg/24hr

88
Q

bedside test for renal colic?

following investigation

A

urinanalysis

CT KUB

89
Q

Why is there referred pain to the groin in renal colic?

A

visceral nerve supply to the ureters + kidneys follow the same somatic pathway as the gonads and the flank

–> ureteric pain is referred to these regions

90
Q

why is there pain in renal colic?

A

peristalisis attempting to push the stone and relieve obstruction

  • results in local ischaemia and hence pain
91
Q

locations of stone obstuction (3)

A
  • pelvic-ureteric junction
  • crosses the bifuraction of the common iliac artery
  • vesico-ureteric junction
92
Q

what is contraindicated in a patient w/ renal colic with infection

A

retrograde ureterogram + stent insertion

  • don’t put foreign body in an KNOWN infected space
93
Q

Ix for patient admitted with renal colic

Analgesia

A

CT KUB within 14 hrs

NSAID - diclofenac

94
Q

Mx of renal stones

A

<5mm pass spontaneously

> 5mm:;
- lithtripsy = high energy shock waves, crushing stones into smaller pieces

  • nephrolithotomy / tripsy = used if there is infection / irregular stones / post lithotripsy

–> enter kidney at the back either taken out via tube (-tomy) or crushed and vaccumed up (-tripsy)

> 2cm:
ureteroscopy

  • -> involves a flexible telescope, to looking into the ureter
  • -> outpatient procedure with or w/o a tent inserted
95
Q

where does a hydrocele arise from?

A

accumulation of fluid in the tunica vaginalis

96
Q

how is a varicocele described?

A

abnormal enlargement of the testicular veins

‘bag of worms’

associated with RCC
- renal tumour obstructs the L testicular vein

97
Q

what is a triple diagnosis ?

A

Adopt a holistic approach:

  • physical
  • psychological
  • social
98
Q

types of hydrocele

A

communicating
- channel from the peritoneum into the tunica vaginalis
- patent process vaginalis
(common in new borns)

non-communicating
- caused by excessive fluid production in the tunica vaginalis

99
Q

pathophysiology of TURP syndrome

A
  1. irrigation fluid (glycine - hypo-osmolar) enters via the prostate bed/sinuses
  2. fluid enters the intravascular space – resulting in expansion
  3. A state of fluid overload develops
    - hyponatraemia
    - fluid overload
  4. Glycine is metbolised by the liver –> producing ammonia –> visual disturbances
100
Q

list general operation risks

A 
infection
bleeding
atelectasis
VTE
MI
Reaction to anaesthia
101
Q

what is TURP?

op risks

A

transurethral resection of the prostate
- removing portion of the prostate to improve urinary symptoms

impotence
retrograde ejaculation
bladder wall injury
clot retention
bladder neck stenosis
TURP syndrome
102
Q

spinal > GA

A
  • short post op recovery time
  • lower risk of resp infections
  • reduced risk of atelactasis
  • decreased bleeding (less vasodilation)
103
Q

describe stress incon

A

rise in intra-abdominal pressure overwhelms the pelvic floor and pelvic fascia

–> forces urine out of the urethral closure

laughing / coughing

104
Q

describe urge incon

A

overactive innveration of the detrusor activity

sudden urge to micturate

105
Q

RFs for stress incon

A

child birth
surgery to pelvic floor
chronic cough
obesity

106
Q

Mx for urge

A

1 - bladder retraining
2 - antimuscuarinics (oxybutylin - avoid in old frail ladies)
3 - mirabegron (a beta-3 agonist - use for old ladies)

107
Q

anti-cholingeric SE

A 
dry mouth
urinary retention
constipation
blurred vision
dizziness / drowiness
acute closed angle glaucoma
hyperthermia
confusion
108
Q

Mx for stress incon

A
  1. pelvis floor exercises

2. surgery - retropubic mid-urethral tape procedures

109
Q

common bacteria in UTI

A 
E.coli
klebsiella
proteus
enterococuss
staph. saprophyitucs
110
Q

causes of ureathral stricture

A

foreign body insertion (catheter)
gonnhorra / chlamydia
pelvic trauma

111
Q

causes of recurrante UTI in men

A

bladder overflow obstruction

  • BPH
  • indwelling catheter
  • ureathral stricture

neuropathic bladder
uretheral tract surgery

112
Q

what is bladder diverticulum?

A

outpouching of the bladder (congenital / acquired)

acquired - increased intravesicular pressure, forcing the mucosa through the muscle layer

113
Q

what bacteria can colonise bladder diverticulum?

A

pseudomonas

e.coli

114
Q

what is nephritic syndrome

A

hypertension

haematuria

115
Q

types of renal stone

A

calcium oxalate - 85%
calcium phosphate - 10%
struvite (magnesium) - 2-20%

116
Q

triad for TURP

A

hyponatriaemia - dilution
fluid overload
glycine toxicity - confusion / hallucinations

117
Q

stag horn calculi seen on AXR - what does this signify?

A

struvite composition

  • develops in alkaline
  • proteus infection potentiate this environemnt
  • convert urea to ammonia
118
Q

voiding symptoms

A

SH-EDF

straining
hestitancy

emptying
dribble
flow (poor)

119
Q

causes of a raised PSA

A 
rigorous exercise 
recent ejaculation
BPH
prostate cancer
prostate exam
120
Q

erectile dysfunction Ix

A
  1. QRISK - cvd risk
  2. morning testosterone test
    - -> if low / borderline = check FSH/LH
121
Q

difference between acute interstitial nephritis vs acute tubular nephritis

A

acute interstitial nephritis - commonly after abx/amino use

triad:

  1. rash
  2. fever
  3. eosinphillia

acute tubular necrosis

2 main causes:

  • ischaemia (shock, sepsis)
  • nephrotoxins (rhab, contrast, aminoglycosides)
  • muddy brown clasts / unresolving renal dysfunction
122
Q

varicocele Mx

A

asymptomatic

  • no action
  • semen analysis every 1-2 yrs

symptomatic
- surgery

123
Q

what is priapism

A

persistent penile erecton > 4hrs

not associated with sexual stimulation

  1. ischaemic
  2. non-ischaemic
124
Q

hydronephrosis causes

A

unilateral:

  • Pelvic-ureteric obstruction
  • Abberant renal artery (supplies both superior/inferior pole of kidney)
  • Calculi
  • Tumours of the renal pelvis

bilateral:

  • Stenosis of urethra
  • Urethral valve
  • Prostatic enlargement
  • Extensive bladder tumour
  • Retro-perioneal fibrosis
125
Q

hydronephrosis

Ix / Mx

A
  1. USS - identify presence of hydronephrosis

Mx
if small stone (<10mm) - let it pass

if large obstruction (>10mm)

  • Remove obstruction
  • stent

acute - nephrostomy tube
chronic - ureteric stent / pl

126
Q

when to urgently refer after prostate exam

A

felt hard
irregular

PSA doesnt always have to be elevated

127
Q

if renal stones suspected - what specific test would you request?

A

calcium
urate
oxlate

in blood + urine

128
Q

abx used to treat UTIs in community

A

trimethoprim
nitrofuratoin
amoxicillin

129
Q

female advice forn UTI reoccurance

A

post coital voiding
front to back wiping
stay hydrated
drink cranberry juice

130
Q

LUTS

A 
VOIDING
straining
hesitancy
emptying
dribbling
flow
STORAGE
nocturia
urgency
incontinence
frequency
131
Q

polcystic kidney disease genetic trait?

pathophysio

A

autosomal dominant / PKD1 - 85%

  • development of renal cysts w/ chronic kidney disease
  • kidney enlargement
  • compression of renal vasculature / interstital fibrosis
132
Q

ADPKD screening

+ diagnostic criteria

A

USS abdo
CT / MRI

2 cysts in pt < 30yrs
2 cysts, both kidneys in pt 30-59yrs
4 cysts, both kidneys in pt >60yrs

133
Q

ADPKD Mx

A

vasopressin receptor antagonist (same as SIADH)

- act on aquaporins to prevent water absorption

134
Q

Location of other cysts

A

mainly liver cysts (70%)

cardiovascular disease (10%)

  • left ventricular hypertrophy
  • mitral value prolapse / regurg
135
Q

ADPKD complications

A

renal carcinoma

ovarian cysts

136
Q

minimal change disease pathophysiology

A
  1. damage to basement membrane - by t cell / cytokine
  2. glomerular permability to serum albumin –> hence hypoalbumin

doesn’t cause end-stage renal failure

137
Q

minimal change disease - what is seen on microscopy?

A

light microscopy - normal

electron microscopy - podcyte fusion + effacement of foot processes

138
Q

minimal change disease Mx

A

steroids (resolves 80% of the time)
immunosuppressants

small portion have recurrant episodes

P4 (11 decks)

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