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Renal > Kidney disease > Flashcards

Kidney disease Flashcards

1
Q

What may someone present with in kidney disease?

A
  • asymptomatic
  • loin pain
  • urinary symptoms
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2
Q

What may occur if the fluid balance is off?

A
  • oedema
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3
Q

What may occur if the electrolyte balance is off?

A
  • hyperkalaemia

- cardiac arrythmias

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4
Q

If what substance is reduced in production from the kidneys may result in anaemia?

A

-erythropoietin

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5
Q

What systemic enquiry questions do you want to ask with someone with kidney injury?

A
  • appetite
  • nausea/vomiting
  • dyspnoea
  • urinary
  • skin rashes
  • changes to medications
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6
Q

What drugs may cause renal impairment?

A
  • NSAIDs
  • ACEi
  • ARB
  • Metformin
  • Gentamicin
  • PPI
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7
Q

Define accelerated hypertension?

A
  • diastolic BP > 120mmHg
  • papilloedema
  • end organ decompensation
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8
Q

Splinter haemorrhages may be indicative of what?

A
  • endocarditis

- vasculitis

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9
Q

Vasculitic skin rash may be indicative of what?

A
  • acute glomerulonephritis
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10
Q

Specific gravity on urinalysis is describing?

A
  • urine concentration
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11
Q

Red cell casts may suggest?

A
  • pathological

- nephritic syndrome

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12
Q

Leucocyte cast may suggest?

A
  • infection

- inflammation

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13
Q

Granular casts may suggest?

A
  • chronic disease
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14
Q

ECG changes in hyperkalaemia?

A
  • peaked T waves
  • QRS wide
  • loss of p waves
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15
Q

Define acute kidney injury

A
  • decline in kidney function
  • increase in serum creatinine
  • reduction in urine output
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16
Q

What is the triad associated with nephrotic syndrome?

A
  • proteinuria
  • hypoalbuminaemia
  • oedema
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17
Q

Nephrotic syndrome urine contains ___many/few___ cast cells?

A
  • few
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18
Q

Symptoms of nephrotic syndrome?

A
  • perioribtal oedema

- frothy urine

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19
Q

Nephritic syndrome differs from nephrotic syndrome how?

A
  • patient has nephritis

- active urinary sediment

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20
Q

Active urinary sediment is indicative of ___nephrotic/nephritic__ syndrome

A
  • nephritic
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21
Q

Symptoms of nephritic syndrome

A
  • oliguria
  • oedema
  • hypertension
  • blood in urine
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22
Q

Define oliguria?

A
  • less than 400ml of urine/day
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23
Q

What may cause nephritic syndrome?

A
  • post streptococcal throat
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24
Q

What classification system is used in acute kidney injury?

A
  • KDIGO staging
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25
What are the risk factors for acute kidney injury?
- older age - CKD - Diabetes - medication change - hypovolaemia
26
Pre-renal causes of acute kidney injury?
- hypovolaemia - hypotension - reduced renal perfusion
27
Complication of pre-renal cause of acute kidney injury?
- acute tubular necrosis
28
Investigations into pre renal causes of acute kidney?
- fluid status | - urinalysis
29
Describe the affect of ACEi on renal perfusion
- vasoconstriction of arterioles | - reduced perfusion
30
Causes of acute tubular necrosis?
- sepsis - severe dehydration - rhabdomyolysis - drug toxicity
31
Commonest form of AKI in hospital?
- acute tubular necrosis
32
Renal causes of AKI?
- Vasculitis - glomerulonephritis - drugs - tubular injury
33
Symptoms of a renal cause of AKI?
- Causes and vomiting - itch - oedema - oliguria
34
Treatment of a renal cause of AKI
- Fluid resuscitation | - treat underlying cause
35
Causes of a post-renal Aki?
- Obstruction
36
Treatment of a post renal AKI
- Catheter | - nephrostomy
37
Treatment of hyperkalaemia?
- 10ml of calcium gluconate - insulin + dextrose - salbutamol neb - sodium bicarbonate
38
What can be given to an acidotic patient?
- sodium bicarbonate
39
Haemodialysis must be conducted where?
- dialysis centre
40
Peritoneal dialysis differs from haemodialysis how?
- carried out at home | - every night
41
Define chronic kidney disease?
- reduction in kidney function and / or - structural damage - present for 3 months or mole
42
What are markers of CKD?
- ACR >3mg/mol - urine sediment abnormalities - tubular disorder - histological abnormalities - persistent reduction in renal function, eGFR<60ml/min
43
What are the 5 stages of CKD in relation to eGFR?
- G1 = >90 - G2 = 60-89 - G3 a = 45-49 - G3 b = 30-44 - G4 = 15-29 G5= <15
44
Stages of CKD in relation to ACR?
- A1 = <3 - A2 = 3-30 - A3 = >30
45
Define accelerated progression of CKD
- Persistent decrease of eGFR of 25% or change in stage within 12 months - persistent decrease of 15ml/min eGFR within 12 months
46
Causes of CKD
- AKI - Hypertension - diabetes - glomerular disease
47
Name some nephrotoxic drugs
- aminoglycosides - ACEi - bishosphonates - diuretics - lithium - calcinuerin inhibitor - NSAIDs
48
Name some multisystem diseases associated with CKD?-
- SLE - Vasculitis - myeloma
49
Complications of CKD
- AKI - hypertension - dyslipidaemia - CVD - renal anaemia - bone disorder
50
Treatment of CKD
- Treat underlying cause
51
Hypertension targets in CKD
- Systolic <130 | - Diastolic <90
52
Diabetes target in CKD
- HbA1c = 53 or less
53
What drug should be given in CKD to prevent CVD?
- Atorvastatin 20mg
54
Explain renal anaemia
- associated with CKD | - Inadequate erythropoeitn
55
Treatment of renal anaemia?
- IV erythropoetin infusion
56
Treatment of acidosis in CKD
- Sodium bicarbonate
57
Treatment of oedma in CKD
- Restrict fluid and sodium | - loop diuretic and thiazide
58
Treatment of bone disease in CKD
- Phosphate binder | - vitamin D supplement (alfacalcidol)
59
Most common inherited kidney disease?
- Polycysic kidney disease - autosomal dominant | - ADPKD
60
ADPKD is what mutation?
- PKD1 = Chromosome 16 (most common) | - PKD2 = chromsome 4
61
Pathology of ADPKD?
- Large kidneys | - massive cyst enlargement
62
Symptoms of ADPKD?
- Haematuria - proteinuria - hepatic cysts
63
Intracranial berry aneurysms may be associated with what kidney disease?
- autosomal dominant polycystic kidney disease
64
Treatment of ADPKD?
- Tolvaptan
65
Tolvaptan works by?
- reducing cyst volume and progression in ADPKD
66
What population is ARPKD seen more commonly?
- children
67
ARPKD is what mutation?
- PKHD1 = chromosome 6 | - codes for fibrocystin
68
symptoms of ARPKD?
- child - recurrent urinary tract infections - palpable kidneys
69
Alport's syndrome is what mode of inheritance?
- X-linked
70
Alport's syndrome is what mutation?
- COL4A5 | - IV collagen matrix
71
Sensiorneural hearing loss is associated with what kidney disease?
- Alports
72
Alport's syndrome symptoms?
- haematuria - proteinuria - sensiorneual hearing loss
73
Anderson Fabry's disease is what mode of inheritance?
- X linked
74
Andersons Fabry's disease mutation?
- a-GAL deficiency
75
Diagnosis of Andersons Fabry's disease?
- Plasma a-GAL activity
76
Treatment of Andersons Fabry's disease
- enzyme replacement of a-GAL = Fabryzyme
77
Medullary cystic kidney disease presentation?
- normal or small kidney size due to fibrosis
78
Medullary sponge kidney disease presentation?
- dilation of kidney collecting ducts | - recurrent kidney stones
79
Medullary cystic kidney disease is what mode of inheritance?
- autosomal dominant
80
Presentation of diabetic nephropathy?
- proteinuria | - raised creatine
81
Explain the pathogenesis of diabetic nephropathy?
- haemodynamic changes - inital increase in GFR - Renal hypertrophy - weakening of membrane - proteinuria
82
Suspected diabetic nephropathy, but haematuria?
- no haematuria associated with diabetic nephropathy | - should biopsy
83
Glucose target for diabetic nephropathy?
- aim for 53mmol/l
84
Blood pressure aim for diabetic nephropathy?
- less than 130/80
85
Normal ACR?
- less than 3
86
Normal PCR
- Proteinuria | - less than 50
87
Explain the mechanism of ACEi
- vasodilation of afferent arteriole - reduce pressure - reduce protein leakage
88
Define vasculitis
- inflammation of blood vessels
89
What vasculitis are associated with kidney disease?
- ANCA vasculitis - granulomatous w/polyangitis - microscopic polyangitis
90
Blood results in ANCA vasulitis?
- Raised CRP, ESR - ANCA - urinalysis - biopsy = necrotizing glomerulonephritis
91
Symptoms of nephrotic vasculitis?
- vague - weight loss - purpura
92
Purpura associated with vasculitis is present where?
- back - buttocks - legs
93
Lupus nephritis is what type of disease
- autoimmune - ANA - Anti-dsDNA
94
What are the manefistations of lupus nephritis?
- joint pain - skin - malar rash - lung involvement - renal involement
95
Diagnosis of lupus nephritis?
- ANA - Anti-dsDNA - Renal biopsy
96
Treatment of lupus nephritis?
- ACEi - ARB - immunosuppressant
97
Presentation of renovascular disease
- haematuria - hypertension - flash pulmonary oedema
98
Flash pulmonary oedema is associated with what condition?
- renovascular disease
99
Potential treatment of renovascular disease
- statin - aspirin - angioplasty +/- stent
100
Describe myeloma
- lymphoid malignancy
101
Symptoms of myeloma
- bone pain - weakness - amyloidosis - hypercalcaemia - IgG
102
Congo red staining on biopsy?
- apple green bifringent | - amyloidosis
103
Granulomatous polyangitis is what ANCA?
- cANCA
104
Microscopic polyagitis is what ANCA?
- pANCA
105
Myeloma is cancer of ____
- Plasma B cells | - overproduction of immunoglobulins
106
What are the 2 main types of amyloidosis?
- primary /light chain (AL) | - Systemic / secondary (AA)
107
Define amyloidosis?
- abnormal protein deposition due to abnormal protein folding
108
Patient with a history of IBS and presents with severe protein uria?
- secondar/systemic amyloidosis
109
Investigations for amyloidosis?
- urinalysis uPCR - Protein electropheresis - biopsy with congo red staining
110
What scan can be used to show extend of amyloidosis deposition?
- SAP scan
111
How are renal stones formed?
- due to a high concentration of precipitate in the urine
112
What is the most common precipitate of renal stones?
- calcium oxalate
113
What are the risk factors for developing renal stones?
- dehydration - males>females - elderly - hypercalcauria - hyperparathyroidism - diet high in protein and fat
114
Stones < ___ mm may pass freely
- <5mm
115
Stones >___mm may require surgical intervention
- >5mm
116
Where are the 2 constrictions the majority of renal stones get found?
- uteropelvic junction | - vesicouterine junction
117
Presentation/symptoms of renal stones
- loin to groin pain - nausea and vomiting - sepsis - fever
118
Investigations for a suspected renal stone
- urinalysis - axr - non-contrast KUB **** 1st line - USS if pregnant or child - iv urogram
119
Initial management for urinary stones?
- analgesia - a blocker - ccb
120
Invasive management for stent removal?
- endoscopic with steric stent | - shock wave lithotripsy ( outpatient)
121
What drug can be used in the prevention of kidney stones and why?
- thiazide diuretiche as they reduce ca2+ excretion

Renal (14 decks)

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