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Medicine Finals: HARD STUFF ONLY > Nephrology > Flashcards

Nephrology Flashcards

(51 cards)

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1
Q

How is CKD staged?

A 
Stage 1 - >90 + signs of kidney disease
Stage 2- 60-90 + signs of kidney disease
Stage 3a- 45-59
Stage 3b- 29-44
Stage 4- 15-29
Stage 5 - <15
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2
Q

How to stage AKI?

A

AKI Stage 1 = Creatinine raised 1.5x baseline, urine output less than 0.5ml/kg/hr for 6hrs
AKI Stage 2 = Creatinine raised 2x baseline urine output less than 0.5ml/kg/hr for 12 hrs
AKI Stage 3 = creatinine raised 3x baseline urine output less than 0.3ml/kg/hr for 24 hrs

Creatinine which has raised by more than 24 in 48 hours = AKI

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3
Q

Which drugs can cause acute interstitial nephritis?

A 
Nephrotoxic drugs
Penicillins
PPIs
Allopurinol
Ciprofloxacin
Rifampicin
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4
Q

What results are seen in rhabdomyolysis?

A

Raised CK
Hyperkalaemia
Hyperphosphataemia
Myoglobinaemia

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5
Q

What are acceptable changes in eGFR and creatinine after starting an ACEi? What about potassium?

A

eGFR - 25% decrease
Creatinine - 30% rise

Potassium can rise up to 5.5

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6
Q

What triad is seen in haemolytic uraemia syndrome?

A
  1. Haemolytic anaemia
  2. AKI
  3. Low platelets
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7
Q

What are extra-renal manifestations of ADPKD?

A 
Cerebral aneurysms
Hepatic/splenic/pancreatic/ovarian/prostatic cysts
Mitral regurg
Colonic diverticula
Aortic root dilation
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8
Q

What is Alport’s syndrome? How does it present?

A 
X-linked recessive
Haematuria + renal failure 
Sensorineural deafness 
Protrusion of lens surface
Retinitis pigmentosa
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9
Q

Indications for dialysis in AKI?

A

AEIOU
Acidosis (severe metabolic acidosis with pH of less than 7.20)
Electrolyte imbalance (persistent hyperkalaemia with ECG changes)
Intoxication (poisoning)
Oedema (refractory pulmonary oedema not responding to medication)
Uraemia (symptomatic uraemia - encephalopathy or pericarditis)

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10
Q

All the causes of glomerulonephritis!!!!!

A

x

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11
Q

Which infection must you consider in someone who has had a renal transplant?

A

Cytomegalovirus

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12
Q

What is seen on urinalysis in acute interstitialnephritis?

A

Sterile pyuria (raised WCC)

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13
Q

What are the two main manifestations of uraemia?

A

Uraemic pericarditis or uraemic encephalopathy

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14
Q

Management of CKD bone disease?

A
  1. Decrease phosphate in diet
  2. Phosphate binder e.g. sevelamar
  3. Vit D analogues - colecalciferol
  4. Bisphosphonates
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15
Q

Which antibiotic can cause an isolated rise in creatinine with normal urea?

A

Trimethoprim

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16
Q

What is the most common viral cause of Focal Segmental Glomerulosclerosis?

A

HIV

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17
Q

What is hyper acute graft failure?
What is the cause?
How is it managed?

A

Minutes to hours after re-vascularisation of transplanted kidneys - AKI

Reason: Pre-existing antibodies in recipients blood e.g. ABO

RF: Prev blood transfusions, prev tansplants, multiple pregnancies

Management: No treatment possible. Graft must be removed.

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18
Q

What is acute graft failure?

A

Graft failure <6 months
May be reversible with steroids and immunosuppressants

Usually asymptomatic but picked up on with raised creatinine, pyuria and proteinuria

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19
Q

What is chronic graft failure?

A

> 6 months
Due to repeated episodes of acute rejection
Results in fibrosis

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20
Q

What is amyloidosis? How does it present?

A

Extracellular deposition of amyloid

Most common presenting features = breathlessness, weakness

Often causes loss of renal function + proteinuria
Hepatomegaly

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21
Q

Management of hyperkalaemia - when to give calcium gluconate?

Study These Flashcards
A

More than 6 = ECG

More than 6.5 = straight to calcium glauconite. Do not wait for ECG

22
Q

Screening test for PKD?

Study These Flashcards
A

Abdominal ultrasound

23
Q

AKI + proteinuria - what does this mean?

Study These Flashcards
A

Has to be a renal cause. Pre-renal and post-renal would not cause proteinuria

24
Q

What is an AV fistula and how long do they take to start working?

Study These Flashcards
A

Direct connection between artery and vein - preferred method of access for haemodialysis
Takes 6-8 weeks to develop

25
What are signs of CKD that you may see on examination?
``` Pallor Uraemic tinge Brsiing Peripheral oedema Hypertension AV fistula ```
26
What are complications peritoneal dialysis?
``` Peritonitis Catheter infection Catheter blockage Constipation Fluid retention Hyperglycaemia Hernia Back pain Malnutrition ```
27
What are complications of haemodialysis?
``` Site infection Endocarditis Cardiac arrhythmia Air embolus Anaphylactic reaction Amyloidosis Hypertension Disequilibration syndrome (Acute cerebral oedema - headache+drowsy) ```
28
What is dialysis disequilibrium syndrome?
Complication of haemodialysis | Acute cerebral oedema due to rapid excretion
29
What is the most common organism which causes peritonitis due to peritoneal dialysis? How can we prevent peritonitis from peritoneal dialysis?
Staph epidermis Add antibiotics to the dialysis fluid
30
What are physical signs of haemolytic uraemic syndrome?
Jaundice (due to haemolysis) Bruising(due to low platelets) Abdominal tenderness
31
What is the main complication of nephrotic syndrome? | What are other complications?
Increased risk of VTE due to loss of Antithrombin III AKI, CKD, end stage renal disease
32
How does membranous glomerulonephitis present and how is it seen on renal biopsy?
Nephrotic syndrome Renal biopsy - thickened basement membrane, igG and complement deposits on basement membrane --> "Spike and dome appearance"
33
What is seen on renal biopsy in anti-GBM disease?
Linear IgG deposits on basement membrane Epithelial crescents (Same as what is seen in rapidly progressive glomerulonephritis)
34
How is diabetic nephropathy diagnosed?
Monitor early morning albumin:creatinine ratio | If abnormal - conduct 1st pass urine for Proteinuria
35
What are the two types of ADPKD?
PKD1 - chromosome 4 | PKD2 - chromosome 16
36
What are causes of metabolic ALKALOSIS?
``` Vomiting Diuretics Hypokalaemia Primary hyperaldosteronism  Cushing’s ```
37
What is Alport’s syndrome?
``` X-linked recessive condition Microscopic haematuria Progressive renal failure Bilateral sensorineural deafness Protrusion of lens surface Retinitis pigmentosa ```
38
What is seen on renal biopsy in Alport’s syndrome?
Longitudinal splitting of the lamina densa | Basket-weave appearance
39
What is the NICE criteria for AKI?
Rise in creatinine of ≥ 25 micromol/L in 48 hours Rise in creatinine of ≥ 50% in 7 days Urine output of < 0.5ml/kg/hour for > 6 hours
40
What is type 4 renal tubular acidosis? What are causes?
Reduced aldosterone which leads to reduced ammonium excretion by the proximal tubule ``` Due to... Adrenal insufficiency ACEi Spironolactone SLE HIV ```
41
What is sterile pyuria and what are causes?
``` Raised white cells in urine but Negative urine culture Renal tuberculosis Partially treated UTI Acute interstitial nephritis Urinary tract stones ```
42
What is seen on electron microscopy in minimal change disease?
Effacement of foot processes | Fusion of podocytes
43
What is the gold standard diagnostic investigation for renal artery stenosis?
Renal angiography | Also renal ultrasound (first line)
44
What are complications of renal transplant?
``` DVT/PE Opportunistic infection Malignanies - lymphoma/skin cancer Bone marrow suppression Urinary tract obstruction CVD Graft rejection ```
45
What can cause metabolic acidosis in someone who has received too much NaCl?
Hypercholeraemic metabolic acidosis | Due to Cl in sodum chloride
46
What is dialysis disequilibrium syndrome?
Rare complication after haemodialysis | Causes cerebral oedema - drowsiness and headache
47
What is the serum urea:creatinine ratio in pre-renal AKI?
Raised
48
How does lupus nephritis present?
Proteinuria Can become focal segmental proliferative glomerulonephritis Electron microscopy = endothelial and mesangial proliferation
49
How is lupus nephritis managed?
Treat HTN | Prednisolone + Mycophenolate/Cyclophosphamide
50
How does lupus nephritis present?
Proteinuria Can become focal segmental proliferative glomerulonephritis Electron microscopy = endothelial and mesangial proliferation
51
How is lupus nephritis managed?
Treat HTN | Prednisolone + Mycophenolate/Cyclophosphamide

Medicine Finals: HARD STUFF ONLY (23 decks)

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