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MBBS Y5 > Medicine - Renal > Flashcards

Medicine - Renal Flashcards

1
Q

what is an acute kidney injury (AKI)? how is it measured?

A
  • an acute drop in kidney function| - serum creatinine
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2
Q

NICE criteria to diagnose an AKI?

A
  • rise in creatinine of 20 micromol/L or more in 2 days (48 hours)- rise in creatinine of 50% or more in 7 days- urine output of less than 0.5ml/kg/h for over 6 hours
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3
Q

what is normal urine output?

A

0.5ml per kg per hour

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4
Q

risk factors for developing an AKI?

A
  • chronic disease: CKD, HF, DM, liver disease- old age (>65)- cognitive impairment - drugs (NSAIDs, ACE-i)- contrast used in CT scans
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5
Q

how can the causes of AKI be classified? which is most common?

A

NAME?

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6
Q

examples of pre-renal causes of AKI?

A

NAME?

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7
Q

describe the pathophysiology of pre-renal AKI

A
  • pathology causing reduced blood flow to the kidneys| - less blood gets filtered through them
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8
Q

describe the pathophysiology of renal AKI

A
  • intrinsic disease of the kidney| - makes it less able to filter blood
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9
Q

examples of renal causes of AKI?

A

NAME?

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10
Q

describe the pathophysiology of post-renal AKI

A

an obstruction to outflow causes urine to build up in the kidney and reduce kidney function

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11
Q

examples of post-renal causes of AKI?

A

NAME?

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12
Q

investigations in AKI?

A
  • urinalysis| - USS of urinary tract (?obstruction)
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13
Q

what might urinalysis show in AKI?

A

depends on underlying cause:- leukocytes and nitrites (infection)- protein and blood (acute tubular necrosis, infection)- glucose (diabetes)

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14
Q

how can AKI be prevented?

A
  • avoid nephrotoxic meds where possible| - ensure adequate fluids are given
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15
Q

management of AKI?

A

treat underlying cause:- fluid rehydration (IV)- stop NSAIDs / antihypertensives - relieve obstruction (e.g. catheter to get past an enlarged prostate)if severe without clear cause, refer to renal

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16
Q

complications of AKI?

A

NAME?

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17
Q

which 2 complications could uraemia (secondary to AKI) cause?

A
  • pericarditis| - encephalopathy
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18
Q

what is CKD?

A

permanent and progressive reduction in kidney function

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19
Q

causes / risk factors of CKD?

A

NAME?

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20
Q

drug causes of CKD?

A

NAME?

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21
Q

presentation of CKD?

A

NAME?

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22
Q

investigations for CKD?

A

NAME?

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23
Q

how must eGFR be done in order to diagnose CKD?

A

2 tests done 3m apart

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24
Q

what is a significant urine ACR reading in CKD? what does this mean?

A
  • 3mg/mmol or more| - indicates proteinuria
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25
Q

what might urine dipstick show in CKD? why is this important?

A
  • haematuria| - could be bladder Ca, investigate!!!!
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26
Q

which CKD patients should be offered renal USS?

A

NAME?

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27
Q

how is CKD staged?

A

G score for each eGFR:- G1 = >90- G2 = 60-89- G3a = 45-59- G3b = 30-44- G4 = 15-29- G5 = <15 (end-stage renal failure)

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28
Q

what is A score in CKD?

A

score based on the albumin : creatinine ratio

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29
Q

how is CKD diagnosed?

A

at LEAST eGFR <60, OR proteinuria

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30
Q

complications of CKD?

A

NAME?

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31
Q

when does a CKD patient need a renal referral?

A
  • eGFR <30- ACR 70mg/mmol or more - accelerated disease- uncontrolled HTN despite 4 or more any-hypertensives
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32
Q

in CKD, what is classed as “accelerated disease”?

A 
one of the following:- eGFR drops by 15- eGFR drops by 20%- eGFR drops by 15ml/minall within 1 year
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33
Q

how can the progression of CKD be slowed?

A
  • optimise DM and HTN control| - treat glomerulonephritis
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34
Q

how can complications be reduced in CKD?

A
  • exercise to maintain healthy weight- stop smoking - special dietary advice on phosphate, sodium, potassium and water intake - atorvastatin 20mg for CVD prevention
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35
Q

how are complications in CKD treated?

A

NAME?

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36
Q

first line drug for HTN in CKD? target BP?

A
  • ACE-i| - <140/90
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37
Q

which electrolyte needs to be monitored closely in someone with CKD and on an ACE-i?

A
  • serum K+| - hyperkalaemia can result from both of these
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38
Q

how does CKD cause anaemia?

A

healthy kidney cells should produce erythropoietin but they don’t in CKD

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39
Q

How should the iron deficiency in CKD be treated?

A
  • erythropoietin| - IV iron used in dialysis patients
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40
Q

which bone diseases can arise from CKD?

A

NAME?

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41
Q

X-ray changes seen in CKD bone disease?

A

VALUE!

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42
Q

how does CKD cause secondary hyperparathyroidism?

A

the parathyroid glands respond to the low Ca by secreting more PTH

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43
Q

management of renal bone disease in CKD?

A

NAME?

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44
Q

AEIOU: indications for acute dialysis in AKI patients

A

NAME?

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45
Q

features of uraemia indicating dialysis?

A
  • seizures| - reduced consciousness
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46
Q

2 indications for long-term dialysis?

A
  • ESRF (CKD stage 5)| - any acute indications continuing long-term
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47
Q

what are the 3 main types of dialysis?

A

NAME?

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48
Q

which factors are taken into account when choosing a method for dialysis?

A

NAME?

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49
Q

which factors are taken into account when choosing a method for dialysis?

A

NAME?

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50
Q

complications of peritoneal dialysis?

A

NAME?

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51
Q

which 2 methods are there to access blood flow in order to carry out haemodialysis?

A
  • tunnelled cuff catheter| - AV fistula
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52
Q

complications of an AV fistula?

A

NAME?

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53
Q

what is STEAL syndrome?

A

inadequate blood flow to limb distal to AV fistula (it literally STEALS the blood rip)

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54
Q

describe the scar left by a renal transplant

A

hockey stick scar over ipsilateral iliac fossa

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55
Q

describe the scar left by a renal transplant

A

hockey stick scar over ipsilateral iliac fossa

56
Q

what is the immunosuppressant regime used after a kidney transplant? hint: there are 3

A

NAME?

57
Q

how long is the immunosuppressant regime continued for after a renal transplant?

A

lifelong

58
Q

complications of a renal transplant?

A

NAME?

59
Q

features of nephritic syndrome?

A

NAME?

60
Q

features of nephrotic syndrome?

A
  • peripheral oedema- proteinuria (>3g/day)- frothy urine- low serum albumin- hypercholesterolaemia
61
Q

define glomerulonephritis

A

an umbrella term used to describe any condition which causes inflammation of the glomerulus

62
Q

define interstitial nephritis. what are the 2 main diagnoses?

A

NAME?

63
Q

define glomerulosclerosis

A

NAME?

64
Q

list 3 causes of glomerulosclerosis

A

NAME?

65
Q

management of glomerulonephritis?

A
  • steroids| - ACE-i / ARB
66
Q

complications of untreated nephrotic syndrome?

A

NAME?

67
Q

most common cause of nephrotic syndrome in children?

A

minimal change disease

68
Q

most common cause of nephrotic syndrome in adults?

A

focal segmental glomerulosclerosis

69
Q

what is IgA nephropathy?

A
  • Berger’s disease| - most common cause of primary glomerulonephritis
70
Q

when does IgA nephropathy typically present?

A

in 20s

71
Q

what is seen on histology in IgA nephropathy?

A
  • IgA deposits| - glomerular mesangial proliferation
72
Q

what is the most common type of glomerulonephritis overall?

A

membranous glomerulonephritis

73
Q

how does post-strep GN present?

A
  • patient <30 years old- weeks after a strep infection - nephritic syndrome presentation- full recovery
74
Q

which streptococcal infections could be followed by post-strep GN?

A
  • tonsillitis| - impetigo
75
Q

key feature of diabetic nephropathy?

A

proteinuria

76
Q

how is diabetic nephropathy prevented?

A

it is screened for using albumin:creatinine ratio (ACR) and UEs

77
Q

management of diabetic nephropathy?

A

NAME?

78
Q

how does acute interstitial nephritis present?

A

delayed onset, 2-40 days after drug trigger:- AKI- HTN- rash- fever- eosinophilia- transient arthralgia in some

79
Q

causes of acute interstitial nephritis?

A

infection but mostly drugs:- ABx- NSAIDs- diuretics- rifampicin - allopurinol- PPIs

80
Q

management of acute interstitial nephritis?

A
  • remove underlying cause| - steroids
81
Q

pathophysiology of acute tubular necrosis?

A

ischaemia / toxins causing death of epithelial cells of the renal tubules

82
Q

causes of acute tubular necrosis? (hint: split into ischaemic and nephrotoxic)

A

ischaemic:- shock- sepsis- dehydration nephrotoxic:- radiology contrast dye- gentamicin- NSAIDs - lithium - statins- ACE-i, ARBs- heroin

83
Q

investigation and findings in acute tubular necrosis?

A

urinalysis shows “muddy brown casts”

84
Q

management of acute tubular necrosis? hint: same as other AKIs

A

NAME?

85
Q

pathophysiology of type 1 renal tubular acidosis?

A

NAME?

86
Q

causes of type 1 renal tubular acidosis?

A
  • genetic - SLE- sjogren’s syndrome- PBC- hyperthyroidism - sickle cell anaemia - marfan syndrome
87
Q

how does type 1 renal tubular acidosis present?

A

NAME?

88
Q

investigation findings in renal tubular acidosis (type 1 and type 2)?

A
  • low K+- metabolic acidosis- urinary pH >6 (high)
89
Q

management of renal tubular acidosis (types 1 and 2)?

A

PO bicarbonate

90
Q

pathophysiology of type 2 renal tubular acidosis?

A

pathology of proximal tubule making it unable to reabsorb bicarbonate

91
Q

main cause of type 2 renal tubular acidosis?

A

fanconi syndrome

92
Q

which group of people is fanconi syndrome most associated with?

A

Ashkenazi Jews

93
Q

features of fanconi syndrome?

A

NAME?

94
Q

what causes type 4 renal tubular acidosis?

A

low aldosterone

95
Q

investigation findings in type 4 renal tubular acidosis?

A

NAME?

96
Q

most common type of renal tubular acidosis?

A

type 4

97
Q

causes of type 4 renal tubular acidosis? hint: these all lower aldosterone levels

A

NAME?

98
Q

management of type 4 renal tubular acidosis?

A
  • fludrocortisone (mineralocorticoid, so mimics aldosterone) - sodium bicarbonate - treat hyperkalaemia (IV insulin w/ glucose + calcium gluconate)
99
Q

what is haemolytic uraemic syndrome (HUS)? what causes this?

A
  • thrombosis in all the small vessels around the body| - caused by shiga toxin
100
Q

features of HUS? hint: classic triad

A

NAME?

101
Q

where does the shiga toxin come from?

A

either E. coli or shigella infection

102
Q

presentation of HUS?

A

NAME?

103
Q

management of HUS?

A
  • medical emergency!- anti-hypertensives- blood transfusions- dialysis
104
Q

prognosis of HUS?

A
  • 10% mortality rate| - approx 75% make a full recovery
105
Q

what do muscle cells release when they die? (features of rhabdomyolysis)

A

NAME?

106
Q

complication of potassium release from rhabdomylosis?

A

NAME?

107
Q

causes of rhabdomyolysis?

A

NAME?

108
Q

presentation of rhabdomyolysis?

A

NAME?

109
Q

investigations and findings in rhabdomyolysis?

A
  • CK (raised, remains high for 1-3 days) - urine dipstick (positive for blood due to myoglobin)- UEs (AKI, hyperkalaemia)- ECG (hyperkalemia changes)
110
Q

management of rhabdomyolysis?

A

NAME?

111
Q

main complication of hyperkalaemia?

A
  • arrhythmias| - particularly VF
112
Q

causes of hyperkalaemia?

A

NAME?

113
Q

drug causes of hyperkalaemia?

A

NAME?

114
Q

what can cause a falsely raised potassium in a blood test?

A

haemolysis of the sample

115
Q

ECG signs in hyperkalaemia?

A

NAME?

116
Q

management of acute hyperkalaemia?

A

NAME?

117
Q

management of less urgent hyperkalaemia?

A

NAME?

118
Q

at what level of K+ does hyperkalaemia need to be managed urgently?

A
  • > 6mmol/L with ECG changes, OR:| - >6.5 mmol/L regardless of ECG
119
Q

what is polycystic kidney disease (PKD)? what does it cause?

A

genetic condition where the kidneys develop fluid-filled cysts

120
Q

which other organs can have cysts in them in PKD?

A

NAME?

121
Q

extrarenal findings in ADPKD?

A

NAME?

122
Q

what is the mode of inheritance of PKD?

A
  • there are both autosomal dominant and recessive forms| - autosomal dominant (ADPKD) is more common
123
Q

how is PKD diagnosed?

A
  • USS of kidneys| - genetic testing
124
Q

which genes are associated with autosomal dominant PKD?

A
  • PKD-1 (chrom 16), majority| - PKD-2 (chrom 4)
125
Q

complications of PKD?

A
  • chronic loin pain- HTN- CVD- gross haematuria- renal stones- ESRF aged 50
126
Q

management of PKD?

A

NAME?

127
Q

what is haemolytic uraemic syndrome (HUS)? what causes this?

A
  • thrombosis in all the small vessels throughout the body| - caused by shiga toxin
128
Q

how does autosomal recessive PKD (ARPKD) present?

A

NAME?

129
Q

renal features of ADPKD?

A

NAME?

130
Q

most common complication of dialysis?

A

dialysis-induced hypotension

131
Q

criteria for stage 1 AKI?

A

either:- Cr >1.5x baseline- UO <0.5ml/kg/hr for 6h

132
Q

criteria for stage 2 AKI?

A

either: - Cr >2x baseline- UO <0.5ml/kg/hr for 12h

133
Q

criteria for stage 3 AKI?

A

any of these:- Cr >3x baseline- Cr >354- UO <0.3ml/kg/hr for 24h- anuria for 12h

134
Q

which other conditions are associated with focal segmental glomerular sclerosis?

A
  • IgA nephropathy (berger’s disease)- HIV- sickle cell disease
135
Q

first line renal replacement therapy in ESRF? why is this preferred?

A

NAME?

136
Q

which variables are taken into account to calculate eGFR?

A

NAME?

MBBS Y5 (27 decks)

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