Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 5/6 > Medicine: Renal > Flashcards

Medicine: Renal Flashcards

1
Q

The A-F of what the kidney does

A 
Acidosis
Anaemia
Bones
Clearance
Drugs
Electrolytes
Fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the consequences of kidney failure based off it’s functions?

A 
Acidotic
Anaemic
HypoCa
High PTH
Uraemia
HyperK
Hypervolaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nephrotic Syndrome

A

Proteinuria
Low Albumin
Oedema
Dyslipidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nephritic Syndrome

A

Haematuria
HTN
AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which hyperparathyroidism do you get?

A

Secondary: dec Ca + inc Pi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the clearance rate of the kidneys?

A

100mL/min = 144L/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you measure clearance?

A

Urea - made by liver in response to nitrogen clearance

Creatinine - made by muscle in response to turnover

We use CKD-EPI and Cockcroft Gault calcs to find the eGFR from the creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If you see someone w a high creatinine and you’re not sure why, what can you do?

A

Check for diabetes and HTN -> failing this see a nephrologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hx + Exam

A

Hx: CKD Sx? DM? IHD? SLE? Childhood UTIs? Stones? Drug Hx? FHx? Travel Hx?

Exam: BP, urinalysis, bloods, imaging, biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are causes of false pos haematuria?

A

Myoglobin + Beetroot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you quantify proteinuria?

A

Protein:Creatinine Ratio has now surpassed the 24h urine collection

Significant >100mg/mmol (1g/day)

Nephrotic >300mg/mmol (3g/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be seen in urine microscopy?

A

Crystals: ca oxalate, struvite, urate

Casts: red (GN), white (PN), muddy (ATN)

+ RBCs, WBCs, Bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the indications for kidney biopsy? (3)

A

Unexplained injury w normal size

Histology likely to influence tx or offer prognostic info

Info concerning activity and potential reversibility of a prev identified lesion would be useful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of an AKI?

A

Pre-Renal: red blood flow ?sepsis ?shock

Intrinsic: nephrotic + nephritic ?IgA ?lupus

Obstruction: urological ?stones ?malignancy ?prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a crescent a sign off?

A

V aggressive nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Obs to assess fluid balance

A

Overload: raised JVP, pulm oedema, sacral/peripheral oedema

Deplete: dry mucous membranes, red skin turgor, sunken eyes, inc CRT, tachycardic, hypotensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CKD Stage v GFR

A

1: >90
2: 60-89
3a: 45-59
3b: 30-44
4: 15-29
5: <15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the target BP for CKD pts?

A

If no proteinuria <130/80

If w proteinuria <125/75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When do you start getting sx of renal disease? And what are those sx?

A

Stage 5

Sx: pericardial effusion, N+V, weakness, lethargy, confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mx of CKD

A

Slow Progress: ACEi/ARB, glycaemic control, lifestyle

Tx Comps: bicarbonate, iron, EPO, vit D sups if deficient or analogue if inc PTH, dietary restriction of 3P’s (potassium, phosphate, protein)

ESRF: dialysis w CVD risk measures + transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the general functions of each part of the nephron?

A

PCT - electrolytes

Ascending Limb - fluid concentration

DCT - fine tuning both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What/Where/Why does the kidney secrete?

A

EPO, interstitial fibroblasts, dec oxygen delivery

1α-hydroxylase, PCT, low plasma calcium

Renin, juxtaglomerular cells, low blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What condition should you NOT use ACEi in?

A

Renal Artery Stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How has synthetic EPO revolutionised renal care?

A

Before we were reliant on transfusions which inc risk of HIV/Hep C + sensitise for future transplants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Why do we get acidotic?
Production of ammonia +/or dec production or loss of bicarbonate
26
Which ion tends to be elevated in acidosis?
Potassium
27
OsmolaLity vs OsmolaRity
If they don’t equal there’s an osmolar gap OsmolaLity: measured ie 275-295 mOsmol/kg OsmolaRity: calculated ie 2(Na+K) + Urea + Glucose
28
Mx of HyperK
Recognise it’s a medical emerg >5.5mM so A-E approach You want a baseline ECG, cardiac monitor, senior support STAT You give 10mL 10% IV calcium gluconate, 50mL 50% dextrose w 10U insulin infusion, consider dialysis Liaise w ICU + then once stable ix possible causes: drug chart, U+Es, short synacthen test
29
What is the long term mx for hyperK?
Tbc
30
Workup for an AKI
Tbc
31
What are the important considerations when starting a drug?
?Nephrotoxic ?Renally Excreted ?Correct Dose
32
Who can support you if you’re unsure about a drug?
Check BNF + liaise w pharmacist, senior nurse, reg
33
What is the best stain for overall assessment of glomerular structure?
Periodic Acid Schiff: stains mesangial matrix and basement membranes
34
What is the definition of oliguria?
<0.5mL/kg/hr
35
What are the secondary causes of nephrotic syndrome?
``` DM SLE Amyloid Myeloma PET ```
36
What does the histology show in nephrotic syndrome caused by DM?
1. Diffuse glomerular basement membrane thickening 2. Kimmelstiel Wilson Nodules 3. Advanced Glomerulosclerosis
37
What are the most common causes of AKI?
STOP: sepsis/dehydration, toxins, obstruction, parenchymal kidney disease - blood cultures, hydration status, review drug chat and OTC hx, US, if all neg discuss biopsy w renal
38
What are the most common causes of CKD?
1. Diabetic 2. IgA 3. Reno-Vascular 4. Glomerulonephritides
39
What are the endocrine functions of the kidneys?
Erythropoietin 1α-OHase Renin
40
Sx of CKD
``` Acidotic - Nausea + Vomiting Anaemic - Pale, SOB, Tired HypoCa - Spasms + Numb Uraemic - Jaundice + Pruritis HyperK - Palps + Cardiac Arrest Oedema - Pulm, Pedal, Ascites ```
41
What are the indications for emergency dialysis?
Work through all the vowels: acidosis (pH<7.1), electrolyte imbalance (K+>6.5), intoxication, overload refractory to diuretics, uraemic pericarditis or encephalopathy
42
What dietary recommendations should you advise in a pt attending low clearance clinics?
Low PO4/K/NaCl + Fluid Restrict
43
What reduces the incidence of contrast nephropathy in CKD pts due to receive IV contrast?
1. Volume expansion w 0.9% sodium chloride infusion at 1mL/kg 2. Oral acetylcysteine although trial data is lacking
44
What would you expect the CK to be in rhabdomyolysis?
>10,000
45
IgA Nephropathy vs Post-Strep Glomerulonephritis
Timing: IgA nephropathy develops days after URTI vs weeks for PSGN which is also a/w low complement
46
HyperPTH: 2° vs 3°
2°: Dec Ca + Inc PO4 3°: Inc Ca + Dec PO4
47
HyperK ECG
1 - Absent P waves, peaked T waves, tachycardia 2 - Wide QRS complexes 3 - Ventricular arrhythmias
48
HypoK ECG
Prolonged PR, depressed ST, small flattened T waves, prominent U waves
49
WPW
The AV node is bypassed by an aberrant conducting pathway and characterised by a short PR interval and a delta wave
50
What is delta wave?
A slurred upstroke to the R wave
51
How much of each electrolyte does Hartmann’s solution contain per litre?
Na+ 131 mmol, K+ 5 mmol, Ca2+ 2 mmol, HCO3- 29 mmol, Cl- 111 mmol
52
Factors that warrant urgent dialysis
HyperK resistant to medical tx, uncontrolled met acidosis, pulmonary oedema w oliguria, uraemic encephalopathy
53
HyperCa ECG
Short QT
54
HypoCa ECG
Prolonged QT
55
Brugada Syndrome
RBBB w ST elevation in V1-V3
56
How do you calculate the anion gap?
(Na+K) - (Cl+HCO3)
57
What is the anion gap normal range?
10-18mmol/L
58
What are causes of met acidosis w normal anion gap? (4)
``` HARD: Hypoaldosteronism Acetazolamide Renal Tubular Acidosis Diarrhoea ```
59
What are causes of met acidosis w raised anion gap? (4)
``` KULT ACEGIFTS: Ketoacidosis Uraemia Lactate Toxins ``` ``` Aminoglycosides Carbon Monoxide mEthanol Glycols Isoniazid Ferrous Theophyllines Salicylates ``` CAT MUDPILES: Carbon Monoxide Aminoglycosides Theophyllines ``` Methanol Uraemia DKA Paracetamol Propylene Glycol Isoniazid Iron Lactate Ethanol Ethylene Glycol Salicylates ```
60
What are the two types of lactic acidosis?
A: sepsis, shock, hypoxia B: metformin + NO hypo
61
What are causes of met alkalosis? (4)
Hyperaldosteronism Diuretics HypoK Vomiting
62
What are biochem problems in CKD?
Dec phosphate excretion + 1α hydroxylation The high phosphate leads to low calcium and thus osteomalacia The high PO4, low Ca, low vit D leads to 2° hyperPTH
63
What are the mx principles of CKD?
Aim to reduce the PO4/PTH and inc the Ca/vit D: dietary, phosphate binders, calcitriol
64
What is 1° + 3° hyperPTH?
Both have high Ca and low PO4 1°: parathyroid adenoma a/w MEN syndrome 3°: autonomous PTH secretion post renal transplant
65
What leads to tubular cell apoptosis? (2)
Aminoglycosides + Radiological Contrast Media
66
What leads to tubular cell necrosis? (2)
Myoglobinuria + Haemolysis
67
How do the different tx for hyperK work?
Stabilises the cardiac membrane: 10mL 10% IV calcium gluconate Shifts K extra-intracellular: 50mL 50% dextrose w 10U insulin infusion or 5mg salbutamol nebs Removes K from the body: calcium resonium enema>oral, loop diuretics, dialysis
68
What is spironolactone switched to following troublesome gynaecomastia?
Eplerenone
69
Give two phosphate binders used in CKD mx
Calcium Acetate: calcium based ie sx of hyperCa bones stones groans moans Sevelamer: non-calcium based ie just sx of GI discomfort
70
How do pts w rhabdomyolysis typically px?
Had a fall or prolonged epileptic seizure and found w acute kidney injury on admission Ddx UTI, dehydration, biliary obstrc, renal cell carcinoma
71
What are the clinical findings if rhabdomyolysis?
AKI w disproportionately raised creatinine, elevated CK, myoglobinuria, low Ca, high PO4, high K, met acidosis
72
What is McArdle’s syndrome?
Def of muscle phosphorylase needed for glycogen breakdown
73
Why do pts w rhabdomyolysis have low Ca and high PO4?
The myoglobin binds to calcium and the myocytes release phosphate
74
Comps of haemodialysis
Infection and stenosis at site, endocarditis, arrhythmia, hypotension, air embolus, anaphylaxis, disequilibration syndrome
75
Comps of peritoneal dialysis
Infection and blockage of catheter, peritonitis, constipation, fluid retention, hyperglycaemia, hernia, back pain
76
Tx Rhabdo -> AKI
Rehydrate w normal saline until the JVP is seen but if still anuric ?dialysis ?US ?catheter
77
What are the indications for dialysis? (4)
HyperK >6.1 Acidosis <7.35 Pulmonary Oedema Uraemic Pericarditis Too much: potassium, acid, fluid, urea
78
Which drugs are usually safe to continue in AKI? (6)
Paracetamol, low dose aspirin, clopidogrel, warfarin, beta blockers, statins
79
Which drugs should be stopped in AKI as may worsen renal function? (5)
NSAIDs, ACEi, ARBs, diuretics, aminoglycosides
80
Which drugs may have to be stopped in AKI as inc risk of toxicity? (3)
Metformin, lithium, digoxin
81
What is the most common extra-renal manifestation of ADPKD?
Liver Cysts
82
What ix excludes diabetes insipidus?
Urine osmolality of >700 mOsm/kg
83
Which hereditary condition can cause cranial DI?
Haemochromatosis
84
Which psych drug can cause nephrogenic DI?
Lithium
85
HUS
Preceding diarrhoea then the triad of AKI, MAHA and thrombocytopenia
86
TTP
Px w neuro signs
87
What is the relative importance of the HLA antigens when matching for a renal transplant?
DR > B > A
88
Which infection can cause acute graft failure post kidney transplant?
CMV
89
Timeframe of acute + chronic graft failures
> 6mnths
90
Why can you get an aortic flow murmur in anaemia?
The hyperdynamic circulation causes turbulent flow
91
What do you need to monitor when pts are on long term immunosuppression? (3)
CVS, Renals, Malignancy
92
What are the criteria for dx AKI?
1. Riss in Cr of >=26 over 48hrs 2. Rise in Cr by >=50% over 7d 3. Fall in UO to <0.5ml/kg/hr for 6hrs adults and 8hrs children 4. Fall in eGFR by >=25% over 7d
93
Anti-GBM: DISGAPMMSSP
A rare type of small-vessel vasculitis a/w both pulm haemorrhage and rapidly progressive glomerulonephritis Twice as common in males w a bimodal age distribution of 20-30 and 60-70 a/w HLA DR2 The abs are against type IV collagen and linear IgG deposits can be seen along the basement membrane on renal biopsy Tx w plasmapheresis, steroids, cyclophosphamide
94
At what eGFR do you refer to the nephrologist? (3)
Anytime <30, <15 in a year, <25% and change in category
95
What should be checked before starting EPO in CKD pts?
Iron Studies
96
When does the anaemia in CKD become apparent?
GFR <35
97
When should other causes of anaemia be considered aside from ACD in CKD?
GFR >60
98
How long do AV fistulae take to develop?
2m
99
What flow rates can AV fistulae stand?
500mL/min
100
McArdle Disease: Inheritance + Deficiency
AR + Muscle Phosphorylase
101
Comp of CAPD
Peritonitis w staph epidermidis
102
Addison’s Disease Na + K
Low Na + High K
103
Def of persistent non-visible haematuria
Pos urine dip 2/3 samples tested 2/3 wks apart
104
When do you urgently refer haematuria to urology?
>=45 AND unexplained visible w/o UTI >=60 AND unexplained non-visible w either dysuria or raised WCC

Year 5/6 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions