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Medicine Finals: HARD STUFF ONLY > Nephrology > Flashcards

Nephrology Flashcards

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?

A

More than 6 = ECG

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

22
Q

Screening test for PKD?

A

Abdominal ultrasound

23
Q

AKI + proteinuria - what does this mean?

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?

A

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

25
Q

What are signs of CKD that you may see on examination?

A 
Pallor
Uraemic tinge
Brsiing
Peripheral oedema
Hypertension
AV fistula
26
Q

What are complications peritoneal dialysis?

A 
Peritonitis
Catheter infection
Catheter blockage 
Constipation 
Fluid retention 
Hyperglycaemia 
Hernia 
Back pain 
Malnutrition
27
Q

What are complications of haemodialysis?

A 
Site infection
Endocarditis
Cardiac arrhythmia 
Air embolus 
Anaphylactic reaction 
Amyloidosis 
Hypertension 
Disequilibration syndrome (Acute cerebral oedema - headache+drowsy)
28
Q

What is dialysis disequilibrium syndrome?

A

Complication of haemodialysis

Acute cerebral oedema due to rapid excretion

29
Q

What is the most common organism which causes peritonitis due to peritoneal dialysis?

How can we prevent peritonitis from peritoneal dialysis?

A

Staph epidermis

Add antibiotics to the dialysis fluid

30
Q

What are physical signs of haemolytic uraemic syndrome?

A

Jaundice (due to haemolysis)
Bruising(due to low platelets)
Abdominal tenderness

31
Q

What is the main complication of nephrotic syndrome?

What are other complications?

A

Increased risk of VTE due to loss of Antithrombin III

AKI, CKD, end stage renal disease

32
Q

How does membranous glomerulonephitis present and how is it seen on renal biopsy?

A

Nephrotic syndrome
Renal biopsy - thickened basement membrane, igG and complement deposits on basement membrane –> “Spike and dome appearance”

33
Q

What is seen on renal biopsy in anti-GBM disease?

A

Linear IgG deposits on basement membrane
Epithelial crescents
(Same as what is seen in rapidly progressive glomerulonephritis)

34
Q

How is diabetic nephropathy diagnosed?

A

Monitor early morning albumin:creatinine ratio

If abnormal - conduct 1st pass urine for Proteinuria

35
Q

What are the two types of ADPKD?

A

PKD1 - chromosome 4

PKD2 - chromosome 16

36
Q

What are causes of metabolic ALKALOSIS?

A 
Vomiting
Diuretics
Hypokalaemia
Primary hyperaldosteronism
Cushing’s
37
Q

What is Alport’s syndrome?

A 
X-linked recessive condition
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Protrusion of lens surface
Retinitis pigmentosa
38
Q

What is seen on renal biopsy in Alport’s syndrome?

A

Longitudinal splitting of the lamina densa

Basket-weave appearance

39
Q

What is the NICE criteria for AKI?

A

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
Q

What is type 4 renal tubular acidosis? What are causes?

A

Reduced aldosterone which leads to reduced ammonium excretion by the proximal tubule

Due to...
Adrenal insufficiency
ACEi
Spironolactone
SLE
HIV
41
Q

What is sterile pyuria and what are causes?

A 
Raised white cells in urine but Negative urine culture
Renal tuberculosis 
Partially treated UTI 
Acute interstitial nephritis 
Urinary tract stones
42
Q

What is seen on electron microscopy in minimal change disease?

A

Effacement of foot processes

Fusion of podocytes

43
Q

What is the gold standard diagnostic investigation for renal artery stenosis?

A

Renal angiography

Also renal ultrasound (first line)

44
Q

What are complications of renal transplant?

A 
DVT/PE
Opportunistic infection
Malignanies - lymphoma/skin cancer 
Bone marrow suppression 
Urinary tract obstruction 
CVD 
Graft rejection
45
Q

What can cause metabolic acidosis in someone who has received too much NaCl?

A

Hypercholeraemic metabolic acidosis

Due to Cl in sodum chloride

46
Q

What is dialysis disequilibrium syndrome?

A

Rare complication after haemodialysis

Causes cerebral oedema - drowsiness and headache

47
Q

What is the serum urea:creatinine ratio in pre-renal AKI?

A

Raised

48
Q

How does lupus nephritis present?

A

Proteinuria
Can become focal segmental proliferative glomerulonephritis
Electron microscopy = endothelial and mesangial proliferation

49
Q

How is lupus nephritis managed?

A

Treat HTN

Prednisolone + Mycophenolate/Cyclophosphamide

50
Q

How does lupus nephritis present?

A

Proteinuria
Can become focal segmental proliferative glomerulonephritis
Electron microscopy = endothelial and mesangial proliferation

51
Q

How is lupus nephritis managed?

A

Treat HTN

Prednisolone + Mycophenolate/Cyclophosphamide

Medicine Finals: HARD STUFF ONLY (23 decks)

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