Exam (Year 4) Flashcards
Why is Hartmann’s solution best avoided for fluid resus in pre-renal AKI?
Contains potassium; hyperkalaemia is a risk in AKI
What are the common complications of acute kidney injury? (4)
Hyperkalaemia
Sepsis
Metabolic acidosis
Pulmonary oedema
How are pre-renal AKI and acute tubular necrosis (renal AKI) best distinguished?
In pre-renal, kidney acts to retain sodium, therefore urinary Na is low. In renal, kidney’s cannot retain sodium, therefore urinary sodium is high.
What are the commonest causes of acute tubular necrosis? (3)
Ischaemia, drugs, toxins
Triad of acute renal failure + haemolytic anaemia + thrombocytopenia
Haemolytic uraemic syndrome
Management of HUS?
Supportive- fluids, blood transfusion and dialysis if required
ECG changes in hyperkalaemia? (4)
Small P waves
Tall tented T waves
PR prolongation
Widened QRS
What is the main reason that CKD patients develop anaemia?
Loss of EPO secretion
Commonest causes of CKD?
Hypertension and diabetes
Which anti-diabetic drug drug should be discontinued for 48 hrs following contrast CT?
Metformin
What variables does the MDRD equation for eGFR use? (4)
Age
Serum creatinine
Ethnicity
Gender
What is the commonest cause of peritonitis in peritoneal dialysis patients?
Staph epidermidis
What accounts for around 80% of cases of nephrotic syndrome? What accounts for most of the remaining 20%?
Primary glomerulonephritis
The rest: Systemic disease e.g. DM, SLE, amyloidosis
Proteinuria + hypoalbuminaemia + oedema + hypercholesterolaemia
Nephrotic syndrome
What are the typical examination findings in nephrotic syndrome? (2)
Oedema- perioribital, peripheral
Ascites
Why do the following complications occur in nephrotic syndrome?
a) renal failure
b) susceptibility to infection
c) VTE (4)
a) hypovolaemia
b) loss of immunoglobulins
c) loss of antithrombin, proteins C and S, increased fibrinogen production
Management of hypertension in CKS?
ACE inhibitors
Furosemide
What is the added benefit of using furosemide in CKD, other than BP control?
Lowers serum potassium
What change in renal function might be expected in a CKD patient on an ACE inhibitor? When would this be considered abnormal and what might be the underlying cause?
Reduction in eGFR and rise in creatinine
Abnormal if eGFR goes down 25%, or creatinine goes up 30%- might indicate renal artery stenosis
Most important infection to consider in solid organ transplant patients?
Cytomegalovirus
Factors which might affect eGFR calculation? (3)
Pregnancy
Extremes of muscle mass (high- underestimates, low- over-estimates)
Eating red meat 12 hours prior to sample
Fall/seizure + acute renal failure + raised CK
? rhabdomyolysis
Purpuric rash + abdominal pain + polyarthritis + haematuria in a child
Henoch-Schonlein purpura + IgA nepropathy
What proportion of children with HSP/IgA nephropathy have a relapse?
Around 1/3rd
