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Finals > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is the presentation of lower UTI?

A

*Dysuria
*Suprapubic pain
*Frequency
*Urgency
*Incontinence
*Confusion

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2
Q

What is the presentation of pyelonephritis?

A

*Fever
*Loin, suprapubic or back pain
*Vomiting
*ANorexia
*Haematuria
*Renal angle tenderness

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3
Q

What investigations should be carried out in suspected UTI?

A

*Urine dipstick
*Mid stream urine sample for culture

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4
Q

What will urinalysis show in UTI

A

*Positive for nitrates if gram negative bacteria
*Leukocytes

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5
Q

Name 3 causes of UTI

A

*E.Coli ( gram neg anaerobic rod)
*Kelbsiella pneumoniae (gram neg. anaerobic rod)
*enterococcus

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6
Q

Name a fungal cause of UTI

A

Candida albicans

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7
Q

What is the management for UTI

A

*3 days for simple lower UTI in women
*5-10 for women who are immunocompromised, have abnormal anatomy or impaired kidney function
*7 days for men, pregnant women or catheter associated UTI
*Trimethoprim or nitrofuratoin

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8
Q

When should you avoid using trimethoprim?

A

In the 1st trimester

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9
Q

What is the treatment of pyelonephritis?

A

Cefalexin, trimethoprim or co-amoxiclav for 7-10 days

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10
Q

Diagnosis of AKI

A

*urine output of <0.5ml/kg/hour for >6 hours
*Creatinine rise of ≥26mmol/l within 48 hours
*Creatinine rise to ≥1.5 times the baseline within the past 7 days

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11
Q

What investigations should be carried out in suspected AKI?

A

*Metabolic profile
*UEs
*LFTs
*FBC
*CRP
*Urine dip
*Urine output monitoring

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12
Q

What are the pre renal causes of AKI?

A

*Dehydration
*Hypotension
*Heart failure
Lead to inadequate perfusion of the kidney

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13
Q

What are the renal causes of AKI?

A

-Glomerulonephritis
- Interstitial disease
-Acute tubular necrosis

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14
Q

What are the post renal causes of AKI?

A

-Kidney stones
-Masses
-Ureter or ureteral strictures
-Enlarged prostate or prostate cancer

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15
Q

What is the management of AKI?

A

*IV fluid if pre renal cause
*Stop nephrotoxic medications
*Relieve obstruction if post renal - insert a catheter
*Treat the underlying cause

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16
Q

What are the complications of AKI?

A

*Hyperkalaemia
*Fluid overload, heart failure, pulmonary oedema
*Metabolic acidosis
*Uraemia -> encephalopathy or pericarditis

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17
Q

What are the nephrotoxic drugs?

A

*ACEi
*ARBs
*NSAIDs
*aminoglycosides
*Cyclosporin
*Tacrolimus
*amphotericin B
*Cisplatin
*Acyclovir
*Ampicillin

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18
Q

What are the causes of chronic kidney disease?

A

*Diabetes
*Hypertension
*Age related decline
*Glomerulonephritis
*Polycystic kidney disease
*NSAIDs, PPIs, Lithium

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19
Q

What are the risks for chronic kidney disease?

A

*Age
*Hypertension
*Diabetes
*Smoking

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20
Q

What is the presentation of chronic kidney disease?

A

*Often asymptomatic until the late stages
*Fatigue
*Oedema
*Nausea and/or vomiting
*Pruritis due to build up of waste
*Restless legs (uraemia)
*Anorexia

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21
Q

What investigations should be carried out in suspected chronic kidney disease?

A

*UEs + eGFR
*Serum glucose
*Urinalysis
*Urinary albumin: AER (albumin excretion rate) or ACR (albumin to creatinine ratio)
*Renal ultrasound

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22
Q

What is needed to confirm the diagnosis of chronic kidney disease?

A

eGFR 2 tests 3 months apart

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23
Q

Explain albumin categories of chronic kidney disease

A

A1: AER<30 or ACR <3

A2: AER 30-300 or ACR 3-30

A3: AER >300 or ACR >30

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24
Q

Explain the GFR category of chronic kidney disease

A

G1: GFR>90 + pathological diagnosis or haem/proteinuria or radiological abnormality

G2: GFR 60-89

G3: GFR 45-59

G3b: 30-44

G4: 15-29

G5 <15

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25
Q

What are the complications of CKD?

A
  • anaemia
  • renal bone disease
  • cardiovascular disease
  • peripheral neuropathy
  • dialysis related problems
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26
Q

What is the managment of CKD?

A

*ACEi, dapagliflozin, statin
*If hypertension is not controlled consider addign another agent
*monitor K+
*Iron supplements and erythropoietin
*vitamin D, low phosphate diet and bisphosphonates if osteoporosis

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27
Q

What are the indications of RRT?

A

*Medically resistant hyperkalaemia
*medically resistant fluid overload
*Medically resistant acidosis
*Uraemic pericarditis
*Uraemic encephalopathy
*Dialysable toxins (aspirin, lithium, toxic alcohol)

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28
Q

How often does haemodialysis take place

A

4 hours 3 times a week

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29
Q

What are the complications of haemodialysis?

A

*Acute hypotension
*Access problems
*Cramps due to sodium flux
*Fatigue
*Hypokalaemia
*Blood loss
*Air embolism
*Dialysis disequilibrium

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30
Q

What are the complications of peritoneal dialysis?

A

*Infection- peritonitis
*Glucose load - development or worsening of diabetes
*Hypoalbuminaemia
*Peritoneal membrane failure
*Mechanical: hernia, diaphragmatic leak, dislodged catheter
*Encapsulating peritoneal sclerosis

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31
Q

What are the pros of renal transplant?

A

*No dialysis
*Improved fertility
*Better renal funciton
*More independent
*Better life expectency
*Cost

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32
Q

What are the cons of renal transplant?

A

*Immunosuppression
*higher cardiovascular risk
*Higher infection risk
*Post transplant diabetes
*Skin malignancy

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33
Q

Nephrotic syndrome

A
  • 3.5g proteinuria for 24 hours (urine PCR>300)
  • serum albumin<30
  • oedema
  • ± hyperlipidaemia
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34
Q

Nephritic syndrome

A
  • Hypertension
  • Blood and protein in the urine
  • Declining kidney function
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35
Q

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

A

Minimal change disease

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36
Q

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

A

Focal segmental glomerulosclerosis

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37
Q

Presentation of minimal change disease

A
  • nephrotic
  • acute presentation
  • idiopathic or secondary to malignancy
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38
Q

Treatment of minimal change

A

High dose prednisolone

39
Q

Presentation of IgA nephropathy

A
  • peak in age 20s
  • Nephritic syndrome
  • most common cause of primary glomerulonephritis
  • following sore throat 1-2 days
40
Q

Histology of Ig A nephropathy

A

IgA deposits and glomerular mesangial proliferation

41
Q

Presentation of membranous glomerulonephritis

A
  • peak in 20s and 60s
  • majority are idiopathic
  • nephrotic syndrome
42
Q

Histology of membranous glomerulonephritis

A

IgG and complement deposits on the basement membrane

43
Q

Presentation of post streptococcal glomerulonephritis

A
  • 1-3 weeks post strep infection
  • Nephritic syndrome
  • usually a full recovery
44
Q

Presentation of Goodpasture syndrome

A

Glomerulonephritis and pulmonary haemorrhage causing AKI and haemoptysis

45
Q

Diagnosis of adult polycystic kidney disease

A

Renal ultrasound scan:
- Age 15-30: 2 cysts and a family history
- Age 30-59: 3 cysts in each kidney and a family history
- >60: 4 cysts in each kidney and a family history
- if no family history then 10+ cysts

46
Q

What is Alport’s?

A

X linked condition affecting collagen.

Causes sensorineuro deafness and renal failure. Can affect other organs including the eyes

47
Q

What is Fabry’s disease?

A

X linked storage disorder. REsults in end stage renal failure and proteinuria.

Causes neuropathy, cardiac problems and skin changes

48
Q

What is the pathophysiology of diabetic nephropathy?

A

hyperglycaemia -> osmotic load -> volume expansion -> intra glomerular HTN -> hyperfiltration -> proteinuria -> HTN and renal failure

49
Q

What is the presentation of diabetic nephropathy?

A
  • protienuria
  • usually with other diabetic complications
  • happens after around 20 years of diabetes
50
Q

Presentation of renal artery sclerosis

A
  • hypertension (rapid, resistant to treatment)
  • CKD
  • flash oedema
  • AKI after administration of ACEi/ARB
51
Q

What is amyloidosis?

A

Deposition of insoluble protienous material in extracellular space

52
Q

What is the presentation of amyloidosis?

A
  • nephrotic syndrome (oedema)
  • fatigue, weight loss, dyspnoea
  • periorbital purpura/eyelid petechiae
53
Q

Investigation for amyloidosis

A
  • congo red staining: apple green birefringence
  • serum/urine immunofixation
54
Q

Causes of nephrotic syndrome

A
  • amyloidosis
  • membranous glomerulonephritis
  • focal segmental glomerulosclerosis
  • minimal change
55
Q

Causes of nephritic syndrome

A

-IgA
- post streptococcal glomerulonephritis

56
Q

What are the indications for circumcision?

A
  • phimosis
  • recurrent balanitis
  • paraphimosis
57
Q

What must be excluded before circumcision?

A

hypospadias

58
Q

risk factors for erectile dysfunction

A
  • beta blockers
  • SSRI
  • alcohol
  • all CVD risk factors
59
Q

What are the causes of a unilateral hydronephrosis?

A
  • pelvic ureteric obstruction
  • aberrant renal vessels
  • calculi
  • tumour
60
Q

What are the causes of bilateral hydronephrosis

A
  • stenosis of the urethra
  • urethral valve
  • prostatic enlargement
  • extensive bladder tumour
  • retro peritoneal fibrosis
61
Q

Hydronephrosis investigation

62
Q

hydronephrosis acute upper urinary tract

A

nephrostomy

63
Q

chronic upper tract. obstruction hydronephrosis

A

ureteric stent/pyeloplasty

64
Q

Investigation prostate cancer

A

multiparametric MRI

65
Q

Renal stones imaging

A

non contrast CT-KUB

66
Q

renal stone 5-10mm

A

shock wave

67
Q

renal stone 10-20mm

A

shock or ureteroscopy

68
Q

renal stone >20mm

A

percutaneous nephrolithotomy

69
Q

ureteric stone

A

shockwaves lithotripsy ± alpha blockers

70
Q

BPH medication to start first

A

alpha 1 blocker

71
Q

hyperacute renal transplant

A
  • minutes to hours
  • type II
  • have to remove
72
Q

acute renal transplant reaction

A
  • less than 6 months
  • mismatched HLA
  • asymptomatic, increased creatinine, pyuria and proetinuria
  • steroids and immunosuppression
73
Q

Acute interstitial glomerulonephritis

A
  • urine WCC and eosinophils
  • impaired renal function
  • fever, rash, arthralgia
74
Q

Henoch schonlein purpura

A
  • abdo pain
  • arthritis
  • haematuria
  • purpuric rash
75
Q

Monitoring in henoch schonlein

A

BP and urinalysis

76
Q

why does nephrotic syndrome result in a pro thrombotic state?

A

Loss of antithrombin III

77
Q

Causes of acute interstitial necrosis

A
  • penicillin
  • rifampicin
  • NSAIDs
  • allopurinol
  • furosemide
78
Q

Symtpoms of acute interstitial necrosis

A
  • fever
  • rash
  • eosinophilia
  • HTN
  • mild renal impairment
79
Q

ADPKD type 1 chromosome

80
Q

inheritance of alports

A

X linked dominant

81
Q

management of anti flomerular basement membrane

A
  • plasma exchange
  • steroids
82
Q

symptoms of anti glomerular basement membrane

A

pulmonary haemorrhage and rapidly prgressing glomerulonephritis

83
Q

When should you start an ACEi in diabetic nephropathy?

A

When the ACR is ≥3

84
Q

features of haemolytic uraemic syndrome

A

AKI + thrombocytopenia + microangiopathic haemolytic anaemia

85
Q

peritonitis peritoneal dialysis

A

staphylococcus epidermidis

86
Q

treatment of peritonitis peritoneal dialysis

A

vanc and ceftazidime

87
Q

jaundice in gilberts

A

rise in unconjugated bilirubin

88
Q

what HBA1c is diagnostic?

89
Q

Asymptomatic bacteruria in catheterised patients

A

dont treat

90
Q

variance

A

square of the standard deviation

91
Q

what does VSD increase the risk of?

A

Endocarditis

92
Q

Osteomalacia presentation

A
  • bone pain
  • tenderness
  • proximal myopathy

Finals (37 decks)

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