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Renal > Exam (Year 4) > Flashcards

Exam (Year 4) Flashcards

1
Q

Why is Hartmann’s solution best avoided for fluid resus in pre-renal AKI?

A

Contains potassium; hyperkalaemia is a risk in AKI

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2
Q

What are the common complications of acute kidney injury? (4)

A

Hyperkalaemia
Sepsis
Metabolic acidosis
Pulmonary oedema

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3
Q

How are pre-renal AKI and acute tubular necrosis (renal AKI) best distinguished?

A

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.

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4
Q

What are the commonest causes of acute tubular necrosis? (3)

A

Ischaemia, drugs, toxins

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5
Q

Triad of acute renal failure + haemolytic anaemia + thrombocytopenia

A

Haemolytic uraemic syndrome

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6
Q

Management of HUS?

A

Supportive- fluids, blood transfusion and dialysis if required

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7
Q

ECG changes in hyperkalaemia? (4)

A

Small P waves
Tall tented T waves
PR prolongation
Widened QRS

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8
Q

What is the main reason that CKD patients develop anaemia?

A

Loss of EPO secretion

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9
Q

Commonest causes of CKD?

A

Hypertension and diabetes

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10
Q

Which anti-diabetic drug drug should be discontinued for 48 hrs following contrast CT?

A

Metformin

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11
Q

What variables does the MDRD equation for eGFR use? (4)

A

Age
Serum creatinine
Ethnicity
Gender

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12
Q

What is the commonest cause of peritonitis in peritoneal dialysis patients?

A

Staph epidermidis

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13
Q

What accounts for around 80% of cases of nephrotic syndrome? What accounts for most of the remaining 20%?

A

Primary glomerulonephritis

The rest: Systemic disease e.g. DM, SLE, amyloidosis

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14
Q

Proteinuria + hypoalbuminaemia + oedema + hypercholesterolaemia

A

Nephrotic syndrome

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15
Q

What are the typical examination findings in nephrotic syndrome? (2)

A

Oedema- perioribital, peripheral

Ascites

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16
Q

Why do the following complications occur in nephrotic syndrome?

a) renal failure
b) susceptibility to infection
c) VTE (4)

A

a) hypovolaemia
b) loss of immunoglobulins
c) loss of antithrombin, proteins C and S, increased fibrinogen production

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17
Q

Management of hypertension in CKS?

A

ACE inhibitors

Furosemide

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18
Q

What is the added benefit of using furosemide in CKD, other than BP control?

A

Lowers serum potassium

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19
Q

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?

A

Reduction in eGFR and rise in creatinine

Abnormal if eGFR goes down 25%, or creatinine goes up 30%- might indicate renal artery stenosis

20
Q

Most important infection to consider in solid organ transplant patients?

A

Cytomegalovirus

21
Q

Factors which might affect eGFR calculation? (3)

A

Pregnancy
Extremes of muscle mass (high- underestimates, low- over-estimates)
Eating red meat 12 hours prior to sample

22
Q

Fall/seizure + acute renal failure + raised CK

A

? rhabdomyolysis

23
Q

Purpuric rash + abdominal pain + polyarthritis + haematuria in a child

A

Henoch-Schonlein purpura + IgA nepropathy

24
Q

What proportion of children with HSP/IgA nephropathy have a relapse?

A

Around 1/3rd

25
Q

Management of hypokalaemia

a) mild to moderate
b) severe

A

a) oral potassium

b) IV potassium with cardiac monitoring

26
Q

Symptoms of hypokalaemia?

A

Muscle weakness, hypotonia, palpitations

27
Q

Screening test for polycystic kidney disease?

A

Abdominal ultrasound

28
Q

How is the risk of contrast media nephrotoxicity reduced?

A

Pre and post procedure IV NaCl

29
Q

How is minimal change disease treated? (2)

A

Steroids

Cyclophosphamide in steroid resistant cases

30
Q

Commonest causes of hypokalaemia with hypertension? (2)

A

Cushing’s syndrome

Conn’s syndrome

31
Q

Commonest causes of hypokalaemia without hypertension? (2)

A

Diuretics

GI loss

32
Q

What does raised anion gap suggest?

Examples? (4)

A

Increased acid production/reduced acid excretion e.g. lactic acid (sepsis, ischaemia), uric acid (renal failure), ketones (DKA), drugs/toxins (salicylates)

33
Q

What does normal anion gap acidosis suggest?

A

Loss of bicarbonate or accumulation of H+ ions

34
Q

Causes of normal anion gap metabolic acidosis? (3)

A

Renal tubular acidosis
Diarrhoea
Addisons disease

35
Q

85% of adult polycystic kidney disease is due to mutations in which gene? What is the mode of inheritance?

A

PKD1. Autosomal dominant

36
Q

Extra-renal manifestations of polycystic kidney disease? (4)

A

Berry aneurysm
Hepatic/pancreatic cysts
Diverticulosis
Mitral valve prolapse

37
Q

Renal papillary necrosis is classically associated with…

A

Sickle cell anaemia

38
Q

Drug-induced nephritis is associated with what abnormality of blood count?

A

Eosinophilia

39
Q

What is hyperacute graft rejection caused by?

A

Preformed antibodies against ABO blood group

40
Q

Pulmonary haemorrhage + rapidly progressive glomerulonephritis

A

Goodpasture syndrome

41
Q

What is Goodpasture syndrome caused by?

A

Anti-GBM antibodies against type IV collagen

42
Q

How does Goodpasture syndrome manifest as a renal conditition?

A

Nephritic syndrome- proteinuria, haematuria and hypertension

43
Q

Immunofluorescence in Goodpasture syndrome shows…

A

Linear deposition of IgG along the basement membrane

44
Q

Immune complex deposition is seen in which glomerulonephritis?

A

IgA nephropathy

45
Q

Renail impairment + haemoptysis + positive c-ANCA

A

Granulomatosis with polyangiitis

46
Q

Indications for emergency dialysis?

A

Persistent hyperkalaemia
Fluid overload
Acidosis
Pericarditis (uraemic)

47
Q

Acute renal failure in a myeloma patient

A

Light-chain deposition

Renal (32 decks)

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