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Medicine Year 5 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

creatinine and urine output for the three stages of AKI

A

1: creatinine 1.5-1.9x & urine output 0.5ml/kg/hr for 6 hrs
2: creatinine 2-2.9x & urine output 0.5 ml/kh/hr for 12 hrs
3: creatinine 3+x & urine output 0.3 ml/kg/hr for 24 hrs

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2
Q

DAMN AKI pneumonic

A

Diuretics / Digoxin
ACEi / ARB
Metformin / Methotrexate
NSAIDs

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3
Q

which medication should you avoid in transplant patients as it is nephrotoxic

A

NSAIDs

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4
Q

metformin and AKI

A

does not worsen AKI but increases the risk of metformin toxicity

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5
Q

marker for AKI induced rhabdomyolysis

A

creatine kinase

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6
Q

how to manage metformin in patients at risk of contrast induced nephropathy

A

withhold for 48 hours and only restart when kidney function is normal

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7
Q

5 stages of eGFR for CKD

A

1: above 90 and signs of kidney damage
2: 60-90 and signs of kidney damage
3a: 45-59 and moderate reduction in function
3b: 30-44 and moderate reduction in function
4: 15-29 and severe reduction in function
5: below 15 and established kidney failure

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8
Q

4 variables measured in CKD

A

creatine
age
gender
ethnicity

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9
Q

eGFR in bodybuilders

A

disproportionally low

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10
Q

does hypocalcaemia indicate chronic or acute kidney disease

A

chronic

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11
Q

eGFR below 30 or eGFR which falls more than 15 in one year

A

refer

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12
Q

how would you correct phosphate levels in CKD mineral bone disease

A

correct with diet
then a phosphate binder e.g. sevelamer

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13
Q

pathophysiology of osteomalacia in CKD

A

high phosphate drags calcium from bones

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14
Q

management of CKD induced anaemia

A

correct iron deficiency THEN EPO stimulating agents

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15
Q

side effects of EPO

A

bone aches, flu sx, HTN, rashes, pure red cell aplasia, encephalopathy

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16
Q

medication to start in all CKD pts

A

statin

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17
Q

liver cysts and subarachnoid haemorrhages with berry aneurysms are found in what condition

A

polycystic kidney disease

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18
Q

inheritance of polycystic kidney disease

A

autosomal dominant

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19
Q

scan to screen for polycystic kidney disease

A

USS

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20
Q

first indicator of diabetic nephropathy

A

microalbuminuria

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21
Q

what do diabetics need annual screening for and why

A

albumin:creatinine ratio (ACR)

more than 3 then start ACEi/ARB

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22
Q

size of kidneys in diabetic nephropathy compared to CKD

A

diabetic: large or normal sized
CKD: small

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23
Q

ABG in DKA and sepsis

A

raised anion gap metabolic acidosis

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24
Q

ABG in addisons and diarrhoea

A

normal anion gap metabolic acidosis
(high K in addisons, low K in diarrhoea)

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25
Q

does vomiting cause acidosis or alkalosis

A

alkalosis

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26
Q

too much 0.9% NaCl on ABG

A

metabolic acidosis

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27
Q

calculation of an anion gap

A

(+) - (-)

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28
Q

maintenance fluid in children

A

100 ml/kg for the first 10 kg
50 ml/kg for the next 10 kg
20 ml/kg for every 1kg after that

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29
Q

contraindication for peritoneal dialysis

A

crohns

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30
Q

most common organism in peritoneal peritonitis

A

staph epidermidis

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31
Q

maturation time for AV fistula

A

6-8w

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32
Q

rare but serious complication of haemodialysis

A

dialysis equilibration syndrome

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33
Q

most likely cause of death in patient with CKD on dialysis

A

IHD

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34
Q

pulmonary oedema with AKI and uraemia causing encephalopathy or pericarditis are indications for what

A

haemodialysis

35
Q

transplant rejection in minutes to hours due to pre-existing antibodies against ABO/HLA

A

hyperacute reaction

36
Q

which type of hypersensitivity reaction is a hyperacute reaction

A

2

37
Q

management of a hyperacute reaction

A

removal due to thrombosis of vessels causing ischaemia and necrosis of the kidney

38
Q

transplant rejection in under 6m due to mismatched HLA
often presents asymptomatically with raised creatinine, urea and protein in urine

A

acute graft failure

39
Q

most common infection in solid organ transplant recipients which can predispose acute graft failure

A

cytomegalovirus infection

40
Q

management of acute graft failure

A

can be reversible in some cases with steroids and immunosuppressants

41
Q

type of immune response in acute graft failure

A

cell mediated with cytotoxic t cells

42
Q

antibody and cell mediated response causing fibrosis of the kidney in over 6m

A

chronic graft failure

43
Q

which cancer does renal transplant predispose and why

A

SCC of the skin
immunosuppressants

44
Q

blood on urine dipstick

A

exercise

45
Q

haematuria in endometriosis

A

cyclical haematuria

46
Q

which infection can cause haematuria

A

TB

47
Q

haematuria, loin pain and abdominal mass
can present with pyrexia of unknown origin or with a varicocele

A

renal cell carcinoma

48
Q

paraneoplastic syndromes in renal cell carcinoma

A

polycythaemia (raised EPO), hypercalcaemia (raised PTH)

49
Q

children under 5 present with unilateral abdominal mass, flank pain, painless haematuria, fever and anorexia

A

wilms tumour

50
Q

most common metastases for wilms tumour

A

lung

51
Q

histology of bladder cancer

A

transitional cell

52
Q

when would you do a 2ww referral for cystoscopy for bladder cancer

A

2 episodes of painless frank haematuria

53
Q

4 causes of pre-renal disease

A

dehydration, haemorrhage, heart failure, sepsis

all cause reduced perfusion to the kidney

54
Q

urine osmolarity and serum sodium in pre renal

A

increased urine osmolarity and reduced Na as kidneys concentrate urine and retain sodium

55
Q

most common cause of renal failure causing damage to tubular cells due to ischaemia or toxins
results in dark brown urine with muddy brown casts

A

acute tubular necrosis

56
Q

urine osmolarity and serum sodium in acute tubular necrosis (renal)

A

reduced urine osmolarity and increased sodium as kidneys cannot concentrate urine or retain sodium

57
Q

which type of renal disease can compartment syndrome cause

A

acute tubular necrosis due to myoglobin

58
Q

ABG in renal tubular acidosis

A

normal anion gap acidosis

59
Q

most common nephrotic syndrome in paeds causing foot processes and podocyte fusion on renal biopsy

A

minimal change disease

60
Q

management of minimal change disease

A

prednisolone

61
Q

which virus can cause focal segmental glomerulosclerosis

A

HIV

62
Q

haematuria, proteinuria, oliguria and htn presenting 1-2 WEEKS after URTI

A

post strep glomerulonephritis

63
Q

1-2 DAYS after URTI

A

IgA nephropathy

64
Q

oedema, increased protein, thick basement membrane and sub epithelial spikes associated with malignancy and positive PLA2

A

membranous glomerulonephritis

65
Q

3 causes of rapidly progressive glomerulonephritis

A

goodpasture
SLE
wegeners

66
Q

haemoptysis + AKI/proteinuria/haematuria

A

anti-GBM disease

67
Q

systemic lupus erythematosus and proteinuria

A

lupus nephritis

68
Q

impaired renal function with an allergic picture of high WCC, IgE and eosinophils in urine

A

acute interstitial nephritis

69
Q

cause of acute interstitial nephritis

A

ABX (and other drugs)

70
Q

cause and presentation of post renal

A

obstruction of urinary tract causing hydronephrosis on USS

71
Q

x linked disease causing haematuria, bilateral sensorineural deafness and eye problems with splitting of the lamina densa on biopsy

A

alport syndrome

72
Q

cause and management of haemolytic uraemic syndrome

A

E. Coli
supportive therapy

73
Q

abdominal pain, arthritis, haematuria and purpuric rash over buttocks and extensor surfaces of the arms and legs in children after an UTI

A

henoch schonlein purpura

74
Q

investigation for diabetes insipidus

A

water deprivation test

75
Q

cause and treatment for nephrogenic diabetes insipidus

A

lithium
thiazides, low salt and protein diet

76
Q

cause and treatment for cranial diabetes insipidus

A

hereditary hemochromatosis
desmopressin

77
Q

MOA of desmopressin

A

V2 receptor agonist

78
Q

max rate of potassium infusion before cardiac monitoring

A

10

79
Q

two medications for hyperkalaemia and roles

A

calcium gluconate: shifts potassium to stabilise the myocardium
calcium resonium: removes potassium

80
Q

young female with AKI after ACEi with the renal atereis showing a string of beads

A

fibromuscular dysplasia

81
Q

medical management of ascites

A

spironolactone - aldosterone antagonist

82
Q

how does alcohol cause polyuria

A

reduces ADH in posterior pituitary

83
Q

hyaline casts

A

loop diuretics

84
Q

how does nephrotic syndrome predispose VTE
management

A

loss of antithrombin III
give prophylactic LMWH

Medicine Year 5 (27 decks)

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