Last Minute Bits Flashcards
CKD Measuring Proteinuria
> 3= Proteinuria basically in EARLY MORNING
3-70= Repeat the sample
> 70= No need to repeat
When to Refer to a Nephrologist in Proteinuria in CKD
if >70
if >30 with Haematuria
if >3 with Haematuria and CVD/ lowering eGFR
When to start the ACE, sGLT2 and Statins for Proteinuria in CKD
if ACR>70
if HTN and ACR>30
if Diabetes and ACR>3
Why might a patient not respond to EPO?
Aluminium Toxicity
Iron Deficiency (so correct Iron First/ Measure Iron Levels first)
High Parathyroid
What is Type 1 and Type 2 Renal Tubular Acidosis?
Type 1= DCT
Type 2= PCT (Fanconi Syndrome)
When should you suspect Focal Segmental Glomerulosclerosis?
Minimal Change Disease that is NOT responding to steroids
Patient has Sickle Cell/ Alports Syndrome/ HIV/ is a Drug Addict
Also Parvovirus if they have Sickle Cell
What investigations should be checked in Haematuria?
Urine Dipstick
Blood Pressure
When should Haematuria be referred? (2ww)
> 45 years old with no sign of UTI
> 60 years old with Dysuria or a raised WCC
Investigations in HUS
Stool Culture
FBC for Anaemia
Blood Film for Schistocytes
What is the pathophysiology and management of IgA Nephropathy
IgA deposition in Mesangium
Proteinuria <500= No Rx Needed
Proteinuria >500= ACE and Steroids
What is seen in Rapidly Progressive Glomerulonephritis?
Cresenteric GN
What types of Antibodies are seen in PSGN?
IgG/ IgM
What is the blood investigations for PSGN? and why may it be normal despite the patient actually having PSGN?
Anti-Streptolysin O
Normal due to HIGH CHOLESTEROL LEVES
How does Nephrotic Syndrome affect the Thyroid Levels?
It lowers the TOTAL
but not the FREE Thyroxine Levels
In cells, What comes out with Potassium out of channels, and what goes in through channels?
Potassium Out
Water Out
H+ IN
Also other way around
What are the Signs of Hypokalaemia?
Less Stools
Lots of Urine
Leg Cramps
Limp Muscles
Lethargy
What are the causes of Hypokalaemia?
GRAPHIC IDEA
GI Loss
Renal Tubular Acidosis
Aldosterone
Paralysis
Hypothermia
Insulin
Cushing’s
Intake is not enough
Diuretics
Elevated SABA use
Alkalosis
What are two things that can cause High Aldosterone?
Compensated Heart Failure
Cirrhosis
What is seen in Type 1 and Type 2 Membranoproliferative Glomerulonephritis
Type 1 activates Classic Complement
- Causes are- Cryoglobuminaemia and Hepatitis C
Type 2 activates Alternative Complement
- causes are Factor H Deficiency, Partial Lipodystrophy, Low Circulating C3
STEROIDS may be used to manage Membranoproliferative Glomeruolonephritis
What causes Membranous Glomerulonephritis (the COMMONEST Glomerulonephritis in Adults)?
A Lot of INFECTIONS, and INFLAMMATORY REACTIONS
Also MALIGNANCY
Also Gold and Penicillamine
How do you manage Membranous Glomerulonephritis?
ACE/ ARBs
If Severe- Manage as Diffuse Proliferative (Steroids and Cyclophosphamide)
Peritoneal Dialysis can cause Peritonitis due to Staph Epidermis- how do you manage this?
Vancomycin added to Dialysis Fluid
What are the 3 Nephritic Syndromes?
IgA
Alports
Rapidly Progressive
What is one of the biggest risks of Rapidly Progressive Glomerulonephritis?
Clotting due to HIGH FIBRIN LEVELS
What is the management of Rapidly Progressive Glomerulonephritis?
Anticoagulants
Plasmapharesis
ImmunoSuppressants
Dialysis
How long does it take for an AV Fistula to form?
6-8 weeks
What are the Complications of Haemodialysis?
Cardiac Arrhythmia
Hypotension
Anaphylactic Reaction
Site Infection
Endocarditis
What are the side effects of Peritoneal Dialysis?
Constipation
Peritonitis
Back Pain
Hyperglycaemia
What are the side effects of Renal Transplant?
DVT/ PE
Malignancies (Squamous Cell Carcinoma due to immunosuppressant use and Lymphoma)
Recurrence of Original Disease
Rejection
What type of reaction is Hyperacute Rejection?
Type 2
due to preexisting antibodies
What is Acute Rejection?
Type 4
Due to HLA Mismatch/ CMV Infection
Manage with Steroids and Immunosuppressants
What is Chronic Rejection?
usually due to the Recurrence of the original Disease
How is GvHD managed?
IV Steroids
What suggests Rhabdomyolysis
HIGH P’s and Low C
High Potassium and Phosphate and Low Calcium
And CK higher that 5 times the upper limit of normal
How is Rhabdomyolysis managed?
JUST Iv Fluids
and Alkalise the Urine
What are HYALINE CASTS in URINE?
Tamm-Horsfall Proteins
Seen in Exercise and Loop Diuretic Use
What is the URINE Osmolality in PRE and INTRA renal AKI?
Pre- >500 as it is trying to increase blood pressure to make up for fluid loss
Intra- <350
How is Alports managed?
ACE/ ARBs for the Proteinuria and Lens Replacement for the LENS Issues
Management of Closed Angle Glaucoma
Pilocarpine
Timolol
Apraclonidine (a2 agonist- avoid MAOIS and TCAs)
Acetazolamide
Closed and Open Angle Glaucoma vs Long and Short Sightedness
Closed- LONG SIGHTEDNESS
Open- SHORT SIGHTEDNESS
Management of Open angle Glaucoma
If IOP>24= 360 SLT
Prostaglandins
Then same management as Closed Angle
How is Blepharitis managed?
It can have Styes and Chalazions so manage it the same as those
with Hot Compresses and eyelid hygeine
Causes of CRVO
PHADO
Polycythaemia
Hyprtension
Arteriosclerosis
Diabetes
Obesity
Management of CRVO
CRVO- Conservative
Macular Oedema= Anti VEGF
Retinal Neovascularisation= Laser Photocoagulation
Management of CRAO
Treat the underlying cause and IntraArterial Thrombolysis
When is a RAPD seen?
Anything that affects the optic nerve or affects blood supply to the retina
so MS and CRAO
What is the management of Conjunctivitis in pregnant women?
Fusidic Acid
What is the 4,2,1 rule for categorising Severe Non-Proliferative Diabetic Retinopathy
Severe if:
Haemorrhages or Microaneurysms (small red dots) seen in all 4 quadrants
or
Venous beading in 2 or more quadrants
or
IRMA appears in at least 1 quadrant
What is the difference between superficial and deep haemorrhages
Superficial= Flame Haemorrhages
Deep= BLOT/ DOT
Where are Hard Exudates usually found?
In the Macular (can present as CIRCINATE pattern or MACULAR STAR pattern)
What are IRMAs?
They are small blood vessels that arise from capillaries and look like lil hairs in between the actual big vessels
These are different from NEOVASCULARISATION- where the blood vessels are NOT connected to a capillary and just form out of the blue
What defines Mild NPDR in Diabetic Retinopathy
Ther will ONLY be microaneurysms and nothing else
How is NPDR managed?
If Severe= Panretinal Laser Photocoagulation
How is Proliferative Diabetic Retinopathy managed?
Panretinal Laser Photocoagulation
AntiVEGF
Vitroretinal Surgery
What are the stages of Hypertensive Retinopathy?
Stage 1- Narrowing of Arterioles and Increased Light Reflex (makes it look like SILVER WIRES)
Stage 2- AV Nipping
Stage 3- Cotton Wool Exudates and Flame Haemorrhages
Stage 4- Papilloedema
Red EYE Classification?
Painless and Normal Vision= Conjunctivitis
Painless and Blurred Vision- Anterior Uveitis (rare)
Painful and Blurred Vision- Also Anterior Uveitis/ Keratitis/ Glaucoma
- vision is worse in uveitis than keratitis
Photophobia- Uveitis and Keratitis
Haloes- Glaucoma
Pupil= Small in Uveitis/ Big in Glaucoma
