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ISCE > Kidney > Flashcards

Kidney Flashcards

1
Q

How do you manage CKD?

A

fluid restriction, dietary protein restriction, ACEi

Treat complciations - hypertension - antihypertensives
- oedema - fluid restriction +/- furosemide
anaemia - erythropoietin +/- iron supplementation
secondary hyperparathyroidism - active vit D therapy
- dietary phsophate restriction +/- phosphate binders , calcium tablets if low
- acidosis - bicarb
- hyperlipidaemia - statin
- hyperkalaemia - dietary potassium
Dialysis

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2
Q

what ix should you do in hyponatraemia

A 
plasma osmolality - to determine if pseudohyponatraemia
- urinary sodium and osmolality 
Specific tests - e.g. addisons disease
SIADH 
Hypothryoidism
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3
Q

how do you manage hyponatraemia

A

treat the cause

  • sodium correction
  • seizures/coma = consider 3% hypertonic saline with ICU input
  • hypovolaemic - replace with saline of hartmans
  • euvolaemic - coorect cuase
  • if SIADH or odematous = fluid restriction 1 litre/day
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4
Q

what are the sx of hyponatraemia

A 
nausea/vomiting 
headache 
confusion 
seizures 
reduced consciousness
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5
Q

hypernatreamia sx

A

thirst, confusion, muscle twitching/spasms

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6
Q

how do you tx hypernatraemia

A

treat cause
sodium correction
- most patients - 5% dextrose slowly if chronic
- signs of volume depletion - replace fluid with 0.9% saline/hartmans

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7
Q

what are the sx of hypokalaemia

A

arrhythmias, tremor, muscle weakness/cramps and constipation

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8
Q

what is the tx of hypokalaemia

A

> 2.5 potassium supplements or 20-40mmol in each litre of IV fluids
<2.5 40 mmol/l in saline over 4-6 hours
treat cuase
never correct too quickly

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9
Q

what are the sx of hyperkalaemia

A

arrhythmias, lethargy, muscle weakness

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10
Q

what is the acute management of hyperkalaemia

A

ecg and 3 lead cardiac monitoring
calcium gluconate - 10 ml 10% IV over 10 minutes
actrapid - 10 units in 250 ml 10% dextrose IV over 30 mins
calcium resonium -
consider haemodialysis and treat cause

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11
Q

what are the sx of hypocalcaemia

A 
CATS go numb 
Convulsions 
Arrhythmias 
Tetany 
Numbness
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12
Q

what is the management of hypocalcaemia

A

if severe <1.9 - calcium gluconate 10 ml 10% over 10 minutes
mild = calcium supplements
treat cause - e.g. severe Vit D deficiency load with colecalciferol

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13
Q

what is the management of hypercalcaemia

A

treat cause
replace fluid defiicit and keep pt well hydrated
if severe = bisphonate

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14
Q

what are the sx of hypomagneaemia

A

lethargy muscle weakness/cramps and tremors

arrhythmias and seizures

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15
Q

what is the management of hypomagnesium

A

PO - magnesium asparate 1 sachet 10 mmol BD
IV 5 mg magnesium in 500 ml 0.9% saline over 5 hrs
correct hypomagnesaemia before concurrent hypok and hypoca

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16
Q

what investigations should you do in acute pyelonephritis

A 
urinalysis, urine MC/S
FBC, ESR, CRP, U/E, creaitnine, blood cultures 
consider renal US 
contrast enhanced CT 
MRI
17
Q

what are the mx acute pyelonephritis?

A

could this be sepsis
empirical abx based on the severity and micro results
self care advice - fluids anaglesia and safety netting
if complicated IV abx - co-amox
in men tx with fluroquinolone e.g. ciproflox due to the prostatitis cover switch to oral when possible
treat men for minimum 14 days
reassess and admit if complicated
if reccurent may require repeat urine cultures to censure cure
follow up in pregnant ladies = important

18
Q

what are the risk factors fo rrenal colic

A

dehydration, diet ,obesity and medicines

19
Q

what are the ix for renal colic

A

acute urgent low dose non-contrast CT
renal US if pregnant or child
urinalysis, FBC, U/Es and urine pregnancy test

20
Q

what are the differentials in kidney stones

A

acute appendicitis, ectopic, ovarian cyst, diverticulitis, bowel obstruction, pylonephritis

21
Q

what is the management of kidney stones

A

urgent urological assessment if stone is in ureter/kidney with signs of infection or obstruction
diclofenac - NSAID analgesia
IV fluids
If stone is less than 5mm or asymptomatic can use watchful waiting
if uteric stone <10mm use alpha blockade
for stones >10mm or if they remain despite conservative tx
= shock wave lithotripsy if <10mm
= uteroscopy if 10-20
- percutaneous nephrolithotomy >20 or staghorn
If pregnant uteroscopy
Advise to drink 2.5-3 L per day, healthy lifestyle and low sodium

22
Q

what icx do you do in testicular torsion

A

US - whirlpool sign, urinalysis, FBC, U/E, CRP, scintigraphy

23
Q

what are the differentials for testicular torsion

A 
testicluar appendix torsion (blue dot sign) 
epidiymitis 
hydrocele 
varicocele 
testicular cancer 
acute appendicitis
24
Q

mx of testicualr torsion

A

immediate urological consultation for emergency scrotal exploration
suuportive care = pain relief, anti-emetic
cosmetic saline implant for resticle at later date

fixation of contralateral testis
orchidectomy or orchidoplexy
if over 6 hours can use manual detorsion while surgery is being prepared

educate on possibliity of recurrent torsion, hormonal tx if loss of both testes
monitor for post op complciaitons - infection, testicular atrophy and infertility

25
Q

what is the management of urosepsis

A

haemodynamic support - IV fluids, vasopressors
resp support
metabolic support - blood glucose, DVT prophylaxis, monitor for signs of DIC, nutritional supplementation
abx - ciprofloxacin
DM pts at high risk counsel

26
Q

what are the differentials for BPH

A

urinalysis, PSA, international prostate symptom score - determines severity of sc, global bother score, volume charting, US may be considered, CT abdo/pelvis
urodynamic studies
cytoscopy

27
Q

what is the mx of BPH

A

watchful waiting if non bothersome
behavioural mx programme e.g. limitation of fluids, bladder training, timed voiding, tx of constipation
if no indication for surgery use -
alpha blocker, 5alpha reductase inhibitor, phosphodiesterase 5 inhibitors, anticholinergic agent e.g. tolteradine
Surgery e.g. transurethral incision of prostate
or open proctatectomy
council pt on ses
monitor and prostate cancer screening PSA and PR

28
Q

what are the unilateral causes of hydronephrosis

A

pelvic uteric obstruction
aberrant renal vessles
calculi
tumours of the renal pelvis

29
Q

what are the bilateral cuases of hydronephrosis

A 
stenosis of the ureters 
urethral valve 
prostatic enlargement 
extensice bladder tumours 
retroperitoneal fibrosis
30
Q

what are the ix for hydronephrosis

A

us, urine dip, U/es, fbc, non-contrast CT KUB and PSA

31
Q

what are the mx of hydronephrosis

A

unilateral or bilaeral with signs of infection = urgent nephrostomy or ureteric stent
ABx - ceftriaxime
if due to BPH - alpah blockers, 5alpha reductase inhibitors
urethral catheterisation
Tx underlying cuase
risk of severe sepsis and CV collapse

32
Q

what ix do you do in AKI

A

urine dip, bloods, FBC, UE, CRP, Ca, PO4, PTH, VBG, accurate fluid balance charts
stopping renally excreted drugs

33
Q

what is teh STOP AKI mneumonic

A

sepsis - urgent spetic screen
Toxins - idnetify and stop
Optimise volume status and BP
Prevent harm - identify and tx cause, manage life-treatening complications and modify meds

Low threshold for haemodialysis
Quantify type using KDIGO criteria

ISCE (10 decks)

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