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ICSM Year 6 > Medicine - Renal > Flashcards

Medicine - Renal Flashcards

1
Q

What are the 2 main types of dialysis?

A

Haemodialysis

Peritoneal dialysis

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2
Q

What is required for haemodialysis?

A
  • Dialysis machine (patient’s blood is pumped OUTSIDE the body and through this machine)
  • Vascular access is required via an AV fistula (longterm), or a temporary CVC
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3
Q

What happens inside a haemodialysis machine (broadly)?

A

Blood flows through tiny semi-permeable tubes surrounded by a dialysis solution (dialysate)
Filtration occurs via osmosis and diffusion - dialysis fluid contains solutes at a similar level to the level they would be in a healthy patient’s blood
Can add bicarbonate (to combat acidosis), EPO and drugs if needed
Heparin always added

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4
Q

How often should haemodialysis be performed?

A

4 hour treatment 3 times per week

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5
Q

What are the 3 main possible complications of dialysis

A
  • Blood infection (more common in peritoneal dialysis)
  • Thrombosis
  • Internal bleeding (due to added heparin)
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6
Q

What is peritoneal dialysis?

A

Dialysis fluid is introduced into the patient’s abdominal cavity for several hours, and the peritoneum serves as the natural filter
Can be done automatically at night during sleep

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7
Q

Recall some pros of peritoneal dilaysis

A
  • Offers more flexibility (can be done overnight)
  • Is better tolerated by patients
  • Less expensive
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8
Q

What is a tesio line?

A
  • Tunneled dual lumen central line
  • Used as a ‘bridge’ before an AV fistula can be put in
  • One lumen enters the right atrium, the other
    sits outside the RA in the vena cava
  • Both lumens exit the body (with a central line, only 1 lumen enters the skin)
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9
Q

Why is a normal vein unsuitable for haemodialysis, and why is an AV fistula used?

A

Normal vein would easily collapse/ thrombose with recurrent venepuncture
Vein in an AV fistula hypertrophies in response to turbulent flow of blood from artery and so can withstand repeated venepuncture

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10
Q

Recall some contra-indications to renal biopsy in acute renal failure

A
  • Obvious pre or post renal cause (these are contra-indications)
  • Significant coagulopathy
  • Infection at the site
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11
Q

What group of diseases is the most common cause of nephritic syndrome?

A

Proliferative glomerulonephritis

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12
Q

Recall 5 causes of the nephrotic syndrome

A 
Amyloidosis 
Diabetes
Focal segmental glomerulosclerosis 
Membranous glomerulonephritis 
Minimal change disease
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13
Q

What are the most common causes of AKI?

A

Remember STOP:

  • Sepsis/dehydration
  • Toxins (NSAIDs, nephrotoxic drugs),
  • Obstruction in the urinary tract
  • Parenchymal kidney disease
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14
Q

What are the most common causes of CKD?

A

Diabetic nephropathy

Hypertensive nephropathy

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15
Q

What are the primary functions of the kidney?

A

Balance:

  • Water
  • Electrolyte
  • Acid-base

Endocrine:

  • erythropoietin
  • vit D activation
  • renin-angiotensin system
  • BP control

Excretion:

  • Waste
  • Metabolites
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16
Q

What symptoms might you expect from someone with CKD?

A

Fluid overload (pedal oedema, pleural effusion, ascites, tiredness)

Anaemia (SOB, tiredness, LoC, headcaches)

Hyperkalaemia (palpitations, cardiac arrest, asymptomatic)

Uremia (pruritis, confusion, pericarditis, encephalopathy)

Acidosis (nausea, vomiting,
tiredness)

Increased drug action (e.g. opioid side effects)

Reduced urine output

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17
Q

What diet should be followed in patients with very low creatinine clearance?

A 
Low phosphate
(eg. avoid chocolate, shellfish, nuts)

Low potassium (avoiding chocolate, bananas etc)

Fluid restricted (avoiding alcohol, avoid too much tea/coffee)

Low salt (avoiding processed foods)

Can take phosphate binders if diet restriction alone doesn’t succeed

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18
Q

Recall a mnemonic that can be used to remember the most common indications for emergency dialysis

A

A – acidosis
E – electrolyte imbalance (K+ of 6.5+ and refractory to
medical management)
I – intoxication (certain drugs require dialysis to
clear the blood)
O – overload of fluid (refractory to diuretic treatment)
U – uraemic encephalopathy & pericarditis

BLAST mnemonic for drugs that can be dialysed out - 
Barbiturates
Lithium
Alcohol
Salicylates
Theophylline
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19
Q

What can be used as an alternative to calcium gluconate in hyperkalaemia as a cardioprotective infusion?

A

Calcium chloride

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20
Q

How might a chest x ray appear in Goodpasture’s syndrome?

A

Bilateral widespread airspace opacities

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21
Q

Which diagnosis classically has the symptoms of haematuria and haemoptysis in a young person?

A

Goodpasture’s

22
Q

What is the likelihood of complete recovery of kidney function following an AKI if there is no pre-existing CKD?

A

80%

23
Q

Recall 3 ECG changes in hyperkalaemia

A

Tented T waves
Widening QRS complex
Small p waves

24
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous glomerulonephritis

25
Q

What are the components of the annual review for patients with type 2 diabetes?

A 
Retinopathy screening
Foot assessment for both sensation and doppler testing of vascular supply
Albumin:creatinie ratio
U+E
Serum cholesterol
HBa1c 
Review of any glucose monitoring
Weight assessment
Smoking status assessment
26
Q

What are the indications for dialysis?

A 
Refractory hyperkalaemia 
Refractory fluid overload 
Metabolic acidosis 
Uraemia symptoms 
CKD stage 5
27
Q

What will the urinary sodium be in pre-renal vs intrinsic renal ARF?

A

Pre-renal: urinary sodium low

Intrinsic renal: urinary sodium high

28
Q

Recall the symptoms of HUS vs TTP

A

HUS: MAHA, thrombocytopaenia, AKI

TTP: MAHA, thrombocytopaenia, AKI, neurological impairment and fever

29
Q

Recall some key nephrotoxic drugs that should be stopped in AKI

A 
stop the DAMN drugs 
Diuretics 
ACEi and ARBs 
Metformin 
NSAIDs
30
Q

At what GFR would you do a routine nephrology referral?

A

Either at GFR <30 or a reduction in GFR over 12 months of >25% >15mL/min/1.73m^2

31
Q

How can CKD be managed by diet?

A
  1. Reduce dietary phosphate, sodium, potassium, fluids
  2. Sevelamar (phosphate binder) - reduces uric acid and lipid levels
  3. Vitamin D
32
Q

Recall 4 features of adult polycystic kidney disease

A

Liver cysts
Berry aneurysms
Mitral valve prolapse
Renal failure signs

33
Q

What is the medical management of adult polycystic kidney disease?

A

Tolvaptan

34
Q

Does IgA nephropathy cause nephrotic or nephritic syndrome?

A

Nephritic (rarely nephrotic)

35
Q

Recall some signs and symptoms of IgA nephropathy

A

Purpuric rash (100%)
Arthralgia (60-80%)
Abdominal pain (60%)
Glomerulonephritis (20-60%)

36
Q

How should IgA nephropathy be managed?

A

Most cases will resolve spontaneously in 4w
Joint pain –> NSAIDs

Scrotal involvement/severe oedema/ severe abdominal pain –> oral prednisolone

Renal involvement –> IV corticosteroids

37
Q

What type of cancer is left varicocele most associated with?

A

Renal cell carcinoma

38
Q

What is the most common form of renal tumour?

A

Clear cell carcinoma

39
Q

Which urological cancer is most associated with painless haematuria?

A

Transistional cell carcinoma

40
Q

In patients with CKD, what should be done before any scan that uses contrast?

A

Give IV saline –> volume expansion –> reduced chance of cast nephropathy

41
Q

What are the variables in the Modification of Diet in Renal Disease equation, that affect eGFR?

A 
CAGE: 
Creatinine 
Age 
Gender 
Ethnicity
42
Q

What medication should be started in patients with CKD who have an ACR of >30?

A

ACE inhibitor

43
Q

How long does it take for an AV fistula to develop

A

6-8 weeks

44
Q

How does the size of kidneys differ in chronic diabetic nephropathy vs ckd of another cause?

A

Chronic diabetic nephropathy = large/normal kidneys

CKD = small kidneys

45
Q

In what circumstance would ACEi not be indicated in renal disease?

A

RAS

46
Q

What scar is typically seen in renal transplant patients?

A

Rutherford-Morrison

47
Q

What would bilateral iliac fossae scars suggest?

A

Kidney and pancreas transplant (usually seen in T1 diabetics)

48
Q

What are the indications for dialysis?

A

AEIOU

A - acidosis (pH<7.1, refractory to medical Mx)
E - electrolyte abnormalities (refractory hyperkalaemia)
I - ingestion of toxic substances
O - overload (fluid)
U - uraemia

OR end-stage renal disease

49
Q

What are some causes of unilateral kidney enlargement?

A
  • RCC
  • PKD
  • Simple cysts
  • Hydronephrosis - due to ureteric obstruction on one side
50
Q

What are some causes of bilateral kidney enlargement?

A
  • RCC (rare, only seen in ~5% cases)
  • Bilateral hydronephrosis - due to bladder obstruction affecting both ureters
  • PKD
  • Amyloidosis
  • Tuberous sclerosis

ICSM Year 6 (21 decks)

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