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
Management of hypokalaemia
a) mild to moderate
b) severe
a) oral potassium
b) IV potassium with cardiac monitoring
Symptoms of hypokalaemia?
Muscle weakness, hypotonia, palpitations
Screening test for polycystic kidney disease?
Abdominal ultrasound
How is the risk of contrast media nephrotoxicity reduced?
Pre and post procedure IV NaCl
How is minimal change disease treated? (2)
Steroids
Cyclophosphamide in steroid resistant cases
Commonest causes of hypokalaemia with hypertension? (2)
Cushing’s syndrome
Conn’s syndrome
Commonest causes of hypokalaemia without hypertension? (2)
Diuretics
GI loss
What does raised anion gap suggest?
Examples? (4)
Increased acid production/reduced acid excretion e.g. lactic acid (sepsis, ischaemia), uric acid (renal failure), ketones (DKA), drugs/toxins (salicylates)
What does normal anion gap acidosis suggest?
Loss of bicarbonate or accumulation of H+ ions
Causes of normal anion gap metabolic acidosis? (3)
Renal tubular acidosis
Diarrhoea
Addisons disease
85% of adult polycystic kidney disease is due to mutations in which gene? What is the mode of inheritance?
PKD1. Autosomal dominant
Extra-renal manifestations of polycystic kidney disease? (4)
Berry aneurysm
Hepatic/pancreatic cysts
Diverticulosis
Mitral valve prolapse
Renal papillary necrosis is classically associated with…
Sickle cell anaemia
Drug-induced nephritis is associated with what abnormality of blood count?
Eosinophilia
What is hyperacute graft rejection caused by?
Preformed antibodies against ABO blood group
Pulmonary haemorrhage + rapidly progressive glomerulonephritis
Goodpasture syndrome
What is Goodpasture syndrome caused by?
Anti-GBM antibodies against type IV collagen
How does Goodpasture syndrome manifest as a renal conditition?
Nephritic syndrome- proteinuria, haematuria and hypertension
Immunofluorescence in Goodpasture syndrome shows…
Linear deposition of IgG along the basement membrane
Immune complex deposition is seen in which glomerulonephritis?
IgA nephropathy
Renail impairment + haemoptysis + positive c-ANCA
Granulomatosis with polyangiitis
Indications for emergency dialysis?
Persistent hyperkalaemia
Fluid overload
Acidosis
Pericarditis (uraemic)
Acute renal failure in a myeloma patient
Light-chain deposition
