miscellaneous Flashcards
what measurement is used to assess tubular function
urine osmolality
what would indicate tubules are functioning in terms of osmolality
urine osmolality is very different to serum osmolality
what would indicate tubules aren’t functioning in terms of osmolality
if urine osmolality is exactly the same as serum osmolality
what is the earliest expression of diabetic nephropathy
microalbuminuria
what are the 2 main situations which result in significant proteinuria and which is most common
glomerular !!
overflow
what are our 2 main tools for investigating glomerular function
GFR and proteinuria
what 3 factors are estimated glomerular filtration rate based on
serum creatine, age and gender
what does eGFR estimate
the rate at which fluid is filtered from the blood into bowman’s capsule
how do we quantify proteinuria
urine albumin : creatine ratio (ACR)
how do we assess haematuria
urine dipstick or microscopy
what are the 2 things that can be identified with a renal ultrasound
obstructions and polycystic kidney disease
what is diffusion
process of movement from an area of high concentration to low concentration across a partially permeable membrane
what are the 4 main solutes that ‘move in dialysis’ and which way
K, urea and Na out
HCO3 in
what is ultrafiltration
movement of water and all solutes dissolved in it across a semi-permeable membrane in response to a pressure gradient
what is adsorption
molecules/ions/particles adhere to the surface of a solid or a liquid, rather than dissolving into it
what is the gold standard for dialysis vascular access
arteriovenous fistula
what vessel is most commonly used for a central venous catheter
internal jugular vein
what is a major complication or an AV fistula for dialysis
steal syndrome
what is steal syndrome
excessive blood flow diversion away from the distal limb, leading to ischaemia
time scale of an AV fistula for dialysis
needs 6-12 weeks before dialysis for the fistula to mature
what is the next best option for dialysis, following an AV fistula
arteriovenous graft
how does haemodialysis mainly remove solutes
diffusion
how does haemofiltration mainly remove solutes
convection
name some factors that can affective convective transport
membrane pore size, pressure difference, viscosity of fluid, molecular size and charge
what is the main difference between haemodialysis and haemofiltration
ultrapure replacement is added to compensate for fluid loss in haemofiltration
how does peritoneal dialysis mainly remove solutes
diffusion and osmosis
what is the main complication for haemodialysis
hypotension
what is the most common organism associated with a central venous catheter infection
staph aureus
management of a central venous catheter infection
vancomycin and gentamycin
line removal or exchange
what are the 2 main complications of a central venous catheter infection
endocarditis and discitis
what are the 3 main complications of peritoneal dialysis
peritonitis, peritoneal membrane failure, hernias
what are some acute indications for starting dialysis
AEIOU
acidosis, electrolyte abnormalities - severe hyperkalaemia, intoxications, overload (fluid), uraemia (severe and symptomatic)
chronic indication for starting dialysis
CKD 5
what can be a complication of building up dialysis too quickly
disequilibrium syndrome
name some restrictions for patients on dialysis
fluid restriction of 1L
low salt, potassium and phosphate diet
what is the most effective option for donor transplantation
living donor !!
what are the 3 main types of transplant rejection and what causes them
hyperacute - due to preformed antibodies - unsalvageable
acute - cellular or antibody mediated - can be treated with immunosuppression
chronic - antibody mediated, slowly progressive decline
induction treatment for a kidney transplant
prednisolone IV during operation
mab to prevent T-cell activation
what infection do we need to watch out for in the first 3 months following a kidney transplant
CMV
management of CMV infection in a patient with a transplant
IV ganciclovir
investigation for suspected CMV infection in transplant patient
IgM antibodies and PCR
what should we always suspect in patients with haematuria
malignancy
what causes joggers haematuria
vasoconstriction of blood supply to the kidneys -> hypoxia and constriction of the efferent glomerular arterioli -> increased filtration pressure
initial haematuria indicates pathology where
urethra and prostatic area
terminal haematuria indicates pathology where
bladder neck
name some drugs that can cause spurious contamination of urine
rifampicin, chloroquine, senna containing laxatives
most common scan for the bladder
ultrasound
what is used to assess the urethra in males
urethrogram
what is used to assess the urethra in females
MRI
what is used to assess tubal patency (infertility) in females
hysterosalpingogram
