Nephr Flashcards
How does acute kidney transplant rejection present? What do you do next?
less than 6 months but not hyperacute
Pain localised to transplant
reducing function
white cells raised
need to biopsy the kidney and increase steroids to try and prevent
What is the management for goodpastures
steroids
plasma exchange
cyclophosphamide
What are the stages of AKI?
1,2,3
1 - Creatinine 1.5-1.9x baseline
2 - Creatineine 2x baseline
3 - Creatineine 3x baseline OR 354
How should renal stones be investigated
ultrasound - 50% found and 90% are correctly diagnosed
easy to identify hydronephrosis
non contrast CT to confirm
What is the treatment for renal stones?
Immediate analgesia - strong diclofenac
alpha blockers such as tamsulosin
size of the stone - >5mm need management intervention
uretoretinoscopy - distal or larger or failed SWL/ preg
sound wave lithotripsy - smaller
percutaneous nephrolithotomy - staghorn
What is the cut off for treating hyperkalaeima?
k+ 6.5
OR
Ecg changes
what causes the purpuric rash in HSP
small vessel vasculitis
not thrombocytopenia
difference between ATN and AIN
ATN - muddy brown casts - is damage related usually from drugs
AIN - hypersensitivity mediated with high IgE. present wtith AKI
When monitoring ACEi use what is the cutoff for stopping?
30 percent rise in creatine
25% fall in egfr
What is the rate that fluids should be given as maintenance?
30ml/kg/day
encourage oral intake where possible
What are the complications of haemodialysis?
most people die from IHD - events are common
How quickly can you replace potassium
20mmol per hour
severe vs mild hypokalaemia?
2.5-3.5 mild
less than 2.5 or symptomatic - leg cramps, weakness palpitations
crescenteric glomerulonephritis causes
goodpastures
wegeners(c anca)
SLE
Why do you need a nephrostomy tube
hydronephrosis
Why is an anion gap important?
to differentiate sources of metabolic acidosis
What causes a raised anion gap
increased production of or reduced excretion of fixed acids such as lactic acid - sepsis/tissue ischemia urate(renal failure) ketones(DKA) drugs(salicylates
causes of an acidosis with normal anion gap?
accumulation of H+ or loss of bicarb
addisons
diarrhoea
renal tubular acidosis
potentiol complications of AV fistulas
thrombosis
infection
stenosis
steal syndrome
polyuria polydipsia dehydration normal high sodium
diabetes insipidus
nephrogenic - lithium, hypercalcaemia, hypokalaemia
how do you investigate HUS
bloods: thrombocytopenia Haemolytic anaemia
film - red cell fragments
U and E renal failure
stool culture
