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RenalJaz > Clinical > Flashcards

Clinical Flashcards

1
Q

5 affects uraemia can have on the body

A 
pericarditis
encephalopathy
neuropathy
asterixis
gastritis
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2
Q

consequences renal dysfunction has: (8)

A 
nephrotic
oedema
hyperK+
uraemia
metabolic acidosis
drug toxicity
anaemia
renal bone disease
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3
Q

definition of hbp

A

> 140/90

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4
Q

accelerated hbp has a dbp of

A

> 120

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5
Q

normal amount for a 24hr urine protein collection

A

<150mg

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6
Q

stage 1 CKD by GFR

A

> =90ml/min/1.73m^2 AND EVIDENCE OF KIDNEY DAMAGE

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7
Q

stage 2 CKD by GFR

A

60-89ml/min/1.73m^2 AND EVIDENCE OF KIDNEY DAMAGE

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8
Q

stage 3 CKD by GFR

A

30-59ml/min/1.73m^2

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9
Q

stage 4 CKD by GFR

A

15-29ml/min/1.73m^2

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10
Q

stage 5 CKD by GFR

A

<15ml/min/1.73m^2
OR
on dialysis

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11
Q 
proteinuria >3g/24hr
hypoalbuminaemia
oedema
hypercholesteraemia
normal renal function usually =
A

nephrotic syndrome

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12
Q 
AKI
oliguria
hbp
active urinary sediment
some proteinuria =
A

nephritic syndrome

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13
Q

CKD defintion =

A

chronic reduced GFR +/ evidence of kidney damage

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14
Q

used to calculate eGFR =

A

serum creatinine

MDRD4 equation

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15
Q

eGFR is accurate if __

A

<60 GFR

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16
Q

if muscle mass is low then eGFR ___ GFR

A

overestimates

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17
Q

control of bp and proteinaemia in CKD

A

ACEI/ARB

sprionolactone

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18
Q

in CKD must check ++_ when anaemic
Rx =
target Hb =

A

folate + vit B12 + Fe
IV Fe / Epo - uses up Fe stores so need topped up too
10.5-12.5g/dl

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19
Q

treatment for renal bone disease

A

alfacalcidol (hydroxylated vit D)
decrease phosphate intake
phosphate binders - calcium carbonate/acetate , sevelamer

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20
Q

bone disease in CKD is caused by

A

decreased vit D hydroxylation => decreased Ca2+ abs => 2ndry hyper PT = high calcium and phosphate => vascular and valvular calcification

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21
Q

start educating ptnt on dialysis when GFR =

A

20 - or before if rapidly progressing

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22
Q

best form of vascular access for haemodialysis =

takes __ to mature

A

arteriovenous fistula

6wks

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23
Q

refer to vascular surgeon for AV fistula when GFR =

A

15

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24
Q

can use peritoneal dialysis catheter ___ after insertion

A

1-2wks

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25
Q

can be put on kidney transplant list when within __ of dialysis

A

6months

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26
Q

conservative management of ESRF (often chosen by elderly/comorbidities)

A

Epo and sympt control

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27
Q

confounders of serum creatinine levels =

A 
muscle mass (increases Cr)
age
sex
ethnicity
protein diet
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28
Q

if it is essential to get an accurate measurement of GFR then ___ is the reference standard

A

^51Cr-EDTA clearance

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29
Q

2 ways to quantify proteinuria

A

24hr urine collection

spot sample PCR

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30
Q

4 types of proteinuria

A

overflow
tubular
secreted
glomerular

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31
Q

1st expression of diabetic nephropathy

A

microalbuminuria

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32
Q

microalbuminuria is undetectable on __

A

dipstick

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33
Q

to assess tubular function compare __ to __

A

urine osmolarity to serum osmolarity
normal if very different
abnormal if similar

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34
Q

Abx that can be used to treat asympt bacteriuria in 1st/2nd trimester =

A

nitrofurantoin

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35
Q

Abx that can be used to treat asympt bacteriuria in 3rd trimester

A

trimethoprim

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36
Q

treatment of pyelonephritis in 6th month of pregnancy

A

co-amoxiclav

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37
Q

bladder wall components inside -> out

A 
lamina propria (epithelium, CT with nerves and vessels)
detrusor muscle (inner longitudinal, circular, outer longitudinal)
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38
Q

__ in brain controls micturition

A

Pons

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39
Q

complications of bladder outflow obstruction = (9)

A 
overflow incontinence
stones
haematuria
recurrent UTI
retention
diverticulae/saccules in bladder
trabeculation
atonic bladder
hydronephrosis
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40
Q

treatment of bladder outflow obstruction

A

IV fluids for renal function

catheterise to relieve

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41
Q

Rx options for BPH

A

alpha blocker
finasteride
TURP/laser

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42
Q

mutations implicated in ADPKD

protein they encode

A

PKD1 gene on chromosome 16
PKD2 gene on chromosome 4
make polycystin 1 +2

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43
Q

PKD1/2 for ADPKD develop ESRD earlier

A

PKD1

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44
Q

pathological features of ADPKD

A

massive cyst enlarged kidneys
epithelial lined cysts arise from small no of renal tubules
benign adenomas in 25% of kidneys

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45
Q

renal features of ADPKD

A 
decreased urine concentrating ability
chronic pain
hbp - early age
haematuria
cyst infection
renal failure
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46
Q

extra renal features of ADPKD

A

Berry aneurysms and subarachnoid haemorrhages
hepatic cysts (10y after renal ones, no function loss)
mitral/aortic valve prolapse
diverticular disease
herniae

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47
Q

US of ADPKD findings =

A

multiple bilateral cysts

renal enlargement

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48
Q

scan at __ if FH of ADPKD

A

30yo

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49
Q

in kids a ___ in high risk ptnts is enough for a ADPKD diagnosis

A

single cyst

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50
Q

___ are rare in kids with ADPKD but renal signs are the same as in adults

A

cerebral aneurysms

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51
Q

on US ___ suggest ARPKD rather than ADPKD

A

congenital hepatic fibrosis

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52
Q

Rx for ADPKD

A 
hbp control
hydrate
decrease proteinuria
tolvaptan - decreases cyst vol and progression
dialysis and transplant if failure
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53
Q

genetic mutation in ARPKD

A

PKDH1 gene on chromosome 6

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54
Q

ARPKD cysts arise from

A

collecting ducts

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55
Q

X linked disorder of type 4 collagen that affects kidneys =

A

Alport’s syndrome / hereditary nephritis

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56
Q

gene in Alport’s syndrome

A

COL4A5

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57
Q

presentation of Alport’s syndrome

A 
haematuria
proteinuria
sensorineural deafness
anterior lenticonus
leiomyomatosis of oesophagus/genitals
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58
Q

haematuria + deafness =

test you should order =

A

Alport’s syndrome

renal biopsy

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59
Q

thickened GBM and lamina propria splitting is seen in renal biopsy of

A

Alport’s syndrome

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60
Q

alpha-galactosidase A deficiency - an Xlinked lysosomal storage disease =

A

Anderson-Fabrys disease

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61
Q

Fabrys affects +++

A

liver, kidneys, lungs and erythrocytes

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62
Q

features of Fabrys disease =

A 
renal failure
angiokeratomas (dark red to blue telangiectasia in umbilical region)
cardiomyopathy
valve disease
stroke
acroparaesthesia
pyschiatric
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63
Q

diagnosis of Fabrys is by

A

alphaGAL activity in plasma/leukocyte
skin biopsy
renal biopsy - concentric lamellar inclusions in lysosomes

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64
Q

treatment of Fabrys

A

fabrysyme (enzyme replacement of alpha-galactosidase A)

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65
Q

auto dom condition with cysts in corticomedullary junction/medulla => abnormal tubules and fibrosis = normal/small kidneys =

A

Medullary cystic kidney

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66
Q

diagnose medullary cystic kidney by __+__
on average presents age ___
treatment =

A

FH and CT
28yo
renal transplant

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67
Q

medullary sponge kidney = dilation of ___

cysts have ___ and these are seen on ___

A

collecting ducts
calculi
excretion urography

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68
Q

Rx for a ptnt with CKD and proteinuria/ DM with microalbuminuria

A

ACEI/ARB

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69
Q

post micturition dribbling in BPH is due to

A

pooling in bulbar urethra

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70
Q

can be an indicator for prostate volume

A

PSA

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71
Q

if high PSA and BPH then these ptnts gain the most from ___ treatment

A

5 alpha reductase inhibitors

finasteride and dutsasteride

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72
Q

Ix for BPH that indicates those with a non diminished peak flow that are more likely to have an overactive bladder and so don’t need Sx

A

uroflowmetry

73
Q

Ix for incontinence =

A

3 day bladder diary
dipstick
bladder scan

74
Q

Rx for stress incontinence in F

A

wt loss

pelvic floor 3 month trial

75
Q

Rx for urge incontinence F

A

6 wk bladder retrain
antimusc if ineffective - oxybutynin / darifenacin/solifenacin/tolterodine/trospium chloride
intravaginal oestrogen if atrophy

76
Q

antimuscarinics eg. oxybutynin are contraindicated in

A

acute closed angle glaucoma

77
Q

treatment of post micturition dribbling in M

A

urethral milking and pelvic floor exercises

78
Q

treatment of post prostatectomy incontinence in M

A

pelvic floor exercises

may => Sx/urethral bulking agents

79
Q

Rx of stress/urge incontinence in M

A

bladder retrain and pelvic floor
oxybutynin
alpha blocker (alfuzosin) +/ finasteride

80
Q

patients at high risk of CKD who are screened =

A

DM
hbp
CVD
structural renal tract disease
multisystem disease with potential renal involvement
FH of hereditary kidney disease/ stage 5 CKD
on long term NSAIDS

81
Q

features more suggestive of AKI rather than CKD =

A

unwell ptnt + >=1 of:
50% rise in Cr over hrs/days
decreased eGFR by > 25%
oliguria

82
Q

to diagnose CKD need at least ___ eGFRs over __

A

3

90days

83
Q

target bp for CKD =

if have proteinuria as well =

A

<130/90

<120/80

84
Q 
stop ACEI if potassium \_\_\_
initial fall (but not >\_\_% = \_\_\_) in GFR is good as it suggests \_\_
A

> 6mmol
25% - renal artery stenosis
preferential relaxation of efferent glomerular vessels

85
Q

causes of pre renal AKI

A 
haemorrhage
hypovolaemia, severe diarrhoea
severe sepsis
lbp
MI
NSAIDs
86
Q

treatment of hyperK+

A

calcium gluconate 10% 10ml IV
10U actrapid insulin + 50ml glucose 50% IV
2,5mg nebulised salbutamol
will need haemodialysis as these effects on serum K+ are temporary

87
Q

screening for CKD involves __+__

A

serum creatinine and urinalysis

88
Q

contraindications for a renal biopsy

A 
moderate-severe thrombocytopaenia
coagulation defects
small kidneys
hbp
untreated UTI
relative = 1 kidney
89
Q

glomerulonephritis definition =

A

immune mediated disease affecting glomeruli with 2ndry tubulointerstitial damage

90
Q

glomerular barrier repels ___ charged molecules

A

-vely

91
Q

damage to endothelial / mesangial cells => __ lesion = + released, __ attracted and ___

A

proliferative
Ang2 (hbp), chemokines
inflammatiory cells
vasculitis

92
Q

damage to podocytes => ___ > ___ lesion

A

atrophy

non-proliferative

93
Q

In GN haematuria is usually __/__

A

asympt microscopic/painless macroscopic

94
Q

heavy proteinuria =

A

1-3g/day

95
Q

microalbuminuria =

A

30-300mg albumin/day

96
Q

asympt proteinuria =

A

<1g/day

97
Q

nephritic syndrome is caused by a __ process on ___ cells =>

A 
proliferative
endothelial
AKI
oliguria
oedema
hbp
active urinary sediment - RBCs and RBC+granular casts
98
Q

complications of nephrotic syndrome

A 
infections (lose opsonising Igs)
renal vein thrombosis
PE
volume depletion
vit D deficiency
subclinical hypothyroid
99
Q

non IS Rx used for GN

A

ACEI/ARB, diuretics, statins, anticoag possibly, omega 3/ fish oils

100
Q

IS drugs used for GN

A

steroids
azathioprine
alkylating agents - cyclophosphamide/chlorambucil
calcineurin inhibitors - cyclosporin/tacrolimus
mycophenolate mofetil (MMF)

101
Q

IS last line for GN

A

plasmaphoresis
IV Ig
monoclonal T/B cell Igs

102
Q

Rx of nephrotic syndrome =

A 
fluid and salt restrict
diuretics
ACEI/ARB
maybe anticoag
IV albumin - if other ineffective and vol deplete
IS
103
Q

complete remission =
partial remission =
of nephrotic disease

A

<300mg/day

<3g/day proteinuria

104
Q

commonest cause of nephrotic syndrome in kids =

A

minimal change GN

105
Q

foot process fusion in electron microscopy but nothing on other imagings =

A

minimal change GN

106
Q

Rx for minimal change GN =

A

steroids (94% remission)

2nd line - cyclophosphamide / CSA

107
Q

commonest cause of nephrotic syndrome in adults =

A

focal segmental GN

108
Q

2ndry causes of FSGN

A

obesity
HIV
heroin
reflux nephropathy

109
Q

parietal epithelial cells migrate to help podocytes => sclerosis =

A

FSGN

110
Q

2ndry causes of membranous GN =

A

hep B / parasites
SLE
carcinoma/lymphoma
gold/penicillamine

111
Q

subepithelial immune complex deposition in spike and dome in GBM which is thickened

A

membranous GN

112
Q

Rx for membrnaous GN

A

steroid/ alkylating agents / B cell monoclonal Ig

113
Q

Ig implicated in >70% of membranous GN

A

anti PLA2r Ig

114
Q

commonest GN in world =

A

IgA GN

115
Q

asympt microhaematuria +/- non-nephrotic range proteinuria - macrohaematuria after URTI/GI infection =

A

IgA GN

116
Q

GN ass with HSP

A

IgA

117
Q

results of renal biopsy on IgA GN

A

mesangial proliferation and expansion on light microscopy

IgA deposits in mesangium on immunofluorescence

118
Q

Rx for IgA GN

A

fish oils, bp, ACEI/ARB

119
Q

crescent formation = __ in capillary wall and GBM => __ into Bowman’s capsule => __ formation and + deposited => ___ proliferate

A 
holes
coagulation factors
fibrin
monocytes and lymphocytes
parietal epithelial cells proliferate
120
Q

Goodpastures attacks ___

A

type IV collagen

121
Q

nodular glomerulosclerosis aka

is a feature of

A

Kimmelstiel Wilson lesions

nodular glomerulosclerosis

122
Q

renal lesions that complicated DM =

A

widespread ischaemic atrophy 2ndry to atheroma of renal arteries
arteriolar hyalinosis and lumenal narrowing
thickening of capillary BM
diffuse glomerulosclerosis
Kimmelstiel Wilson lesions
severe acute pyleonephritis with renal papillary necrosis

123
Q

BPH mainly involves which lobes of the prostate

A

lateral and median

124
Q

Prostate cancer mainly involves which lobes of the prostate

A

posterior

125
Q

microscopic features of BPH

A

glandulocystic
fibromuscular
hyperplasia

126
Q

mesangial matrix expansion aka

seen in __

A

diffuse glomerulosclerosis

DM kidney disease

127
Q

apple green birefringence on congo red =

A

amyloid

128
Q

seminoma tens to spread lymphatically to __

A

para-aortic lymph nodes

129
Q

hbp medication if have renal artery stenosis

A

CCB - amlodipine

130
Q

dont give ____ in bilateral renal artery stenosis

WHY?

A

ACEI/ARB

dilates efferent which is needed to maintain glomeruli P and so GFR drops drastically.

131
Q

investigation for renal artery stenosis

A

MR angiogram with gadolinium contrast

132
Q

Factors to reduce the risk of AKI after contrast exposure

A

hydrate
use as little as possible
use LMW contrast

133
Q

do you biopsy a typical presentation of diabetes nephropathy?

A

no

134
Q

treatment for diabetic nephropathy?

A

ACEI

135
Q

features of pre diabetic nephropathy

A

GFR increases 25-50% (hyperfiltration)

renal hypertrophy

136
Q

what causes the increased GFR in pre diabetic nephropathy

A

haemodynamic changes - constricted efferent => afferent dilates by vasoactive mediators => hyperfiltration.

137
Q

features of incipient diabetic nephropathy

A

microalbuminuria, hbp, GFR stable at 100
mesangial expansion (glucose acts as GF)
GBM thickens
arteriolar hyalinosis

138
Q

features of overt diabetic nephropathy

A 
decreased GFR
proteinuria
nephrotic syndrome
Kimmelstiel-Wilson nodules
tubulointerstitial fibrosis
139
Q

be wary of ____ dialysis in diabetic nephropathy as it contains ___

A

peritoneal

dextrose

140
Q

Ischaemic nephropathy causes a drop in GFR because

A

renal blood flow drops below the level of autoreg compensation

141
Q

causes of ischaemic nephropathy

A

renal artery stenosis

fibromuscular dysplasia

142
Q

presentation of renal artery stenosis

A 
hbp
AKI after start ACEI
CKD in elderly vasculopaths
flash pulm oedema
abdo bruit
one kidney small and scarred
143
Q

imaging for renal artery stenosis

A

US (kidney size)

MR angriography

144
Q

in fibromuscular dysplasia see ___ on angriography

age and gender

A

beading

15-50yo F

145
Q

treatment of fibromuscular dysplasia

A

stent renal artery

146
Q

fanconi syndrome =

may be caused by

A

inadequate reabsorption in prox tubule

myeloma

147
Q

gold standard treatment for myeloma

A

stem cell transplant

148
Q

Ix for vasculitis causing nephropathy

A

urinalysis
bloods
Igs
renal biopsy

149
Q

Rx for vasculitis nephropathy

A

steroid and cyclophosphamide (if sig renal involvement)
plasma exchange
supportive = dialysis and ventilate

150
Q

Rx for SLE nephropathy

A

all on HCQ

steroids + maybe cyclophosphamide/MMF/azathioprine

151
Q

definition of AKI

A

abrupt (<48hrs) reduction in kidney function => increased serum creatinine by >26.4micromol/l or>50% or reduced urine output.
Only applied after fluid resus and exclusion of obstruction

152
Q

KDIGO stage 1 AKI =

A

urine output <0.5ml/kg/hr for >6hrs

serum Cr increase >26micromol/l or >=1-5-1.9xreferenceCr

153
Q

KDIGO stage 2 AKI =

A

urine output <0.5ml/kg/hr for >12hrs

serum Cr increase >=2-2.9xreferenceCr

154
Q

KDIGO stage 3 AKI =

A

urine output <0.3ml/kg/hr for >24hrs/anuric for >12hrs

serum Cr increase >3xreferenceCr/ >354 / need RRT

155
Q

untreated pre-renal AKI can lead to

A

ATN

156
Q

Rx for pre-renal AKI

A

assess hydration
hypovol = fluid resus - if >1000ml = seek help
dont use dextrose as dont stay intravascular

157
Q

Renal causes of AKI

A

vasculitis, renovascular disease
GN
interstitial nephritis - NSAID, PPI, Abx, infection
tubular injury - ischaemia, gentamicin, contrast, rhabdomyolysis

158
Q

Ix for renal causes of AKI

A 
urinalysis
look at drug chart
FBC
U+E
US
Bence Jones (everyone >50yo)
159
Q

urgent indications for dialysis

A 
>7/6.5 unresponsive hyperK+
<7.15pH severe acidosis
severe uraemia >40
uraemic pericardial effusion
fluid overload - pulmonary oedema
160
Q

Treatment of post renal causes of AKI

A

catheter/nephrostomy

161
Q

hyperK+ =

life threatening =

A

> 5.5

>6.5

162
Q

ECG signs of hyperK+

A

peaked Ts > flattened P, prolonged PR, depressed ST > atrial standstill, prolonged QRS, increased T peaking > sine wave

163
Q

Rx of hyperK+

A

10ml 10% calcium gluconate
actrapid insulin 10units + 50ml 50% dextrose
nebulised salbutamol
later for chronic = calcium resonium

164
Q

if suspect pyelonephritis/ gynae path mimicking renal colic imaging =

A

US

165
Q

if pregnant and have renal colic Ix =

A

US/MRI

166
Q

gold standard Ix for renal colic

A

CT - lots of radiation so must have high clinical suspicion

non-contrast “stone-search” = definitive for calculi

167
Q

to distinguish calculi from phleboliths Ix =

A

Contrast CT

168
Q

Ix for >50yo with macroscopic haematuria

A

CTU + cystoscopy

may then do uteroscopy if want to confirm / ablate ca that is unfit for nephrouterectomy

169
Q

Ix for <50yo with macroscopic haematuria

A

US
cytoscopy
only CTU is both are normal and haematuria persists

170
Q

If CTU is contraindicated in a ptnt with macroscopic haematuria the Ix =

A

MR urography

eg. contrast allergy, renal impairment, pregnancy

171
Q

Ix for renal masses

A

CT - size and stage ca
MR - with contrast for preg
US - for simple cysts

172
Q

Ix for pre renal failure

A

MR angiography

173
Q

Ix for renal causes of renal failure

A

US biopsy

174
Q

Ix for post-renal causes of renal failure

A

US (exclude obstruction) CT for definitive cause

175
Q

Ix for scrotum =

A

US

176
Q

varicocele =

A

dilaed scrotal venous plexus
Usually the left side
>2mm diameter tortuous veins on US

177
Q

`Renal trauma Ix =

A

CT

178
Q

bladder trauma Ix =

A

cystography/ CT cystography

179
Q

if long term urethral stricture suspected Ix =

A

urethrography

RenalJaz (10 decks)

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