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Phase 2 v2 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is nephrolithiasis?

A
  • Presence of calculi within the urinary tract.
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2
Q

What is the clinical presentation of nephrolithiasis?

A
  • Severe, acute loin to groin pain. (Renal-colic).

- Commonly associated with nausea and vomiting.

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3
Q

What are the risk factors for nephrolithiasis?

A
  • Male.
  • Dehydration.
  • High salt intake.
  • Obesity.
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4
Q

What is the most common type of renal stone?

A
  • Calcium oxalate.
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5
Q

Which renal stones are radiolucent?

A
  • Urate stones.
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6
Q

What are all 5 types of renal stone?

A
  • Calcium oxalate (most common).
  • Calcium phosphate.
  • Uric acid.
  • Cysteine.
  • Struvite.
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7
Q

What is the first line investigation for suspected kidney stones?

A
  • Non-contrast CT of KUB.
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8
Q

What is the treatment for nephrolithiasis?

A

If smaller:

  • Ibuprofen
  • Watch and wait, hope the stone passes.
If larger (>10mm):
- Shock wave lithotripsy (SWL).

If there is obstruction:
- Insert uteric stent to drain/decompress the urinary tract.

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9
Q

What is AKI?

A
  • Acute decline in kidney function.
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10
Q

What are the key diagnostic features of AKI?

A
  • Raised creatinine/urea.

- Decreased urinary output/GFR.

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11
Q

What are the 3 types of AKI? 2/3 examples of each.

A

Pre-renal:

  • Heart failure
  • Hypovolaemia (hypotension).
  • Overdiuresis (too many diuretics given).

Renal:

  • Glomerulonephritis.
  • Acute tubular necrosis.

Post-renal:

  • BPH.
  • UTI.
  • Renal stones (cholelithiasis).
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12
Q

How do arterioles in the kidney affect the GFR?

A

Afferent go towards the glomerulus. Efferent go away from the glomerulus.

  • Dilate afferent and constrict efferent to increase GFR.
  • Constrict efferent and dilate afferent to decrease GFR.
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13
Q

What are the nephrotoxic medications?

Which drug specifically is SAFE in CKD/AKI?

A

“DAMN” + gentamycin. Cause drug-induced AKI.

  • Diuretics.
  • ACEi/ARBs
  • Metformin
  • NSAIDs.
  • PARACETAMOL IS SAFE IN AKI.
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14
Q

What electrolyte changes are commonly seen in AKI?

A
  • Hyperphosphataemia.
  • Hyperkalaemia.
  • Metabolic acidosis.
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15
Q

What is the treatment for AKI?

A
  • Stop nephrotoxic drugs (DAMN + gentamycin).
  • Give fluids for hypovolaemia.
  • If there are electrolyte imbalances, RRT (renal replacement therapy/dialysis).
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16
Q

What is CKD?

A

Abnormal kidney structure/function that has been present for over 3 months.

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17
Q

How does CKD present?

A

Often asymptomatic in the early stages.

Can present with:

  • Oedema (fluid overload due to low GFR).
  • Nausea.
  • Pruritus (due to hyperphosphataemia).
  • Restless leg syndrome (anaemia due to low EPO production).
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18
Q

What is the most common cause of CKD?

A
  • Diabetes mellitus. Causes DKD (a form of CKD).
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19
Q

How is GFR classified?

A 
Stage 1: GFR>90
Stage 2: GFR 60-89
Stage 3a: GFR 45/58
Stage 3b: GFR 30-44
Stage 4: GFR 15-29
Stage 5 (Kidney failure): GFR <15.
20
Q

What are the investigations used to diagnose CKD?

A
  • Creatinine/urea. Raised
  • Estimated GFR. Low.
  • Urinalysis. Haematuria and proteinuria.
21
Q

What is the treatment for CKD?

A
  • ACEI is first line for control of hypertension (e.g. ramipril).

For renal failure (stage 5 kidney disease):

  • RRT (renal replacement therapy such as dialysis).
  • Kidney transplant.
22
Q

What is calcium gluconate used for?

A

To stabilise the cardiac membrane when the patient is hyperkalaemic.

23
Q

What is nephrotic syndrome?

A
  • Kidney disease characterised by proteinuria and hyperphosphataemia.
24
Q

What is nephritic syndrome?

A
  • Kidney disease associated with haematuria, and a raised BP.
25
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease.

26
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy.

27
Q

What is the typical clinical presentation of IgA nephropathy?

A
  • Haematuria, usually proceeded by a GI or upper respiratory tract infection.
28
Q

What is Polycystic kidney disease?

A
  • Inherited renal cystic disease, that is normally autosomal dominant.
29
Q

What is are the diagnostic factors for PKD?

A
  • +ve family history.
  • Gross haematuria.
  • Flank pain.
30
Q

What are the investigations used for PKD?

A
  • Urinalysis: haematuria and proteinuria.

- USS kidney. Reveals cysts.

31
Q

What is the treatment for PKD?

A
  • Tolvaptan.
32
Q

What is the most common form of primary kidney cancer?

A
  • Renal cell carcinoma.
33
Q

What is the presentation of a renal cell carcinoma?

A

Classic triad is:

  • Haematuria.
  • Palpable loin mass.
  • Flank pain.
34
Q

What is the imaging used for suspected kidney cancer?

A

USS kidney.

35
Q

What is the treatment for renal cell carcinoma?

A
  • Resection of the tumour.
36
Q

What is the mechanism of action of loop diuretics?

Give an example.

A
  • Inhibition of the Na/Cl/K channels in the ascending limb of the loop of Henle.
  • Furosemide is an example.
37
Q

What are the electrolyte changes seen with loop diuretic use?

A
  • Hyponatraemia.
  • Hypokalaemia.
  • Hypocalcaemia.
38
Q

What is the mechanism of action of thiazide diuretics?

Give an example.

A
  • Inhibits sodium reabsorption in the distal convoluted tubule.

Hydrochlorothiazide is an example.

39
Q

What are the electrolyte changes seen with thiazide diuretic use?

A
  • Hyponatraemia.
  • Hypokalaemia.
  • HYPERcalcaemia.
40
Q

What is the mechanism of action of potassium-sparring diuretics?

A
  • Aldosterone antagonists.

- Example is spironolactone.

41
Q

What are the electrolyte changes seen with potassium sparring diuretic use?

A
  • Hyponatraemia.
  • HYPERkalaemia.
  • Hypocalcaemia.
42
Q

What is the ECG presentation of hypocalcaemia?

A
  • QT prolongation.
43
Q

What are the two signs associated with hypocalcaemia?

A

Trosseau’s sign: Inflation of a blood pressure cuff leads to flexion of the hand/wrist.

Chvostek’s sign: Tapping of the facial nerve causes spasm of the facial muscles.

44
Q

What are the ECG changes seen in hyperkalaemia?

A

“Go, go tall, go long, go far”

  • Absent P waves.
  • Tall tented T waves.
  • Long PR interval.
  • Wide QRS complex.
45
Q

What medication is given to protect the cardiac membrane in a state of hyperkalaemia?

A
  • Calcium gluconate.
46
Q

What are the ECG changes seen in hypokalaemia?

A
  • ST depression.

- T wave flattening/inversion.

Phase 2 v2 (14 decks)

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