Nephrology Flashcards
creatinine and urine output for the three stages of AKI
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
DAMN AKI pneumonic
Diuretics / Digoxin
ACEi / ARB
Metformin / Methotrexate
NSAIDs
which medication should you avoid in transplant patients as it is nephrotoxic
NSAIDs
metformin and AKI
does not worsen AKI but increases the risk of metformin toxicity
marker for AKI induced rhabdomyolysis
creatine kinase
how to manage metformin in patients at risk of contrast induced nephropathy
withhold for 48 hours and only restart when kidney function is normal
5 stages of eGFR for CKD
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
4 variables measured in CKD
creatine
age
gender
ethnicity
eGFR in bodybuilders
disproportionally low
does hypocalcaemia indicate chronic or acute kidney disease
chronic
eGFR below 30 or eGFR which falls more than 15 in one year
refer
how would you correct phosphate levels in CKD mineral bone disease
correct with diet
then a phosphate binder e.g. sevelamer
pathophysiology of osteomalacia in CKD
high phosphate drags calcium from bones
management of CKD induced anaemia
correct iron deficiency THEN EPO stimulating agents
side effects of EPO
bone aches, flu sx, HTN, rashes, pure red cell aplasia, encephalopathy
medication to start in all CKD pts
statin
liver cysts and subarachnoid haemorrhages with berry aneurysms are found in what condition
polycystic kidney disease
inheritance of polycystic kidney disease
autosomal dominant
scan to screen for polycystic kidney disease
USS
first indicator of diabetic nephropathy
microalbuminuria
what do diabetics need annual screening for and why
albumin:creatinine ratio (ACR)
more than 3 then start ACEi/ARB
size of kidneys in diabetic nephropathy compared to CKD
diabetic: large or normal sized
CKD: small
ABG in DKA and sepsis
raised anion gap metabolic acidosis
ABG in addisons and diarrhoea
normal anion gap metabolic acidosis
(high K in addisons, low K in diarrhoea)
does vomiting cause acidosis or alkalosis
alkalosis
too much 0.9% NaCl on ABG
metabolic acidosis
calculation of an anion gap
(+) - (-)
maintenance fluid in children
100 ml/kg for the first 10 kg
50 ml/kg for the next 10 kg
20 ml/kg for every 1kg after that
contraindication for peritoneal dialysis
crohns
most common organism in peritoneal peritonitis
staph epidermidis
maturation time for AV fistula
6-8w
rare but serious complication of haemodialysis
dialysis equilibration syndrome
most likely cause of death in patient with CKD on dialysis
IHD
pulmonary oedema with AKI and uraemia causing encephalopathy or pericarditis are indications for what
haemodialysis
transplant rejection in minutes to hours due to pre-existing antibodies against ABO/HLA
hyperacute reaction
which type of hypersensitivity reaction is a hyperacute reaction
2
management of a hyperacute reaction
removal due to thrombosis of vessels causing ischaemia and necrosis of the kidney
transplant rejection in under 6m due to mismatched HLA
often presents asymptomatically with raised creatinine, urea and protein in urine
acute graft failure
most common infection in solid organ transplant recipients which can predispose acute graft failure
cytomegalovirus infection
management of acute graft failure
can be reversible in some cases with steroids and immunosuppressants
type of immune response in acute graft failure
cell mediated with cytotoxic t cells
antibody and cell mediated response causing fibrosis of the kidney in over 6m
chronic graft failure
which cancer does renal transplant predispose and why
SCC of the skin
immunosuppressants
blood on urine dipstick
exercise
haematuria in endometriosis
cyclical haematuria
which infection can cause haematuria
TB
haematuria, loin pain and abdominal mass
can present with pyrexia of unknown origin or with a varicocele
renal cell carcinoma
paraneoplastic syndromes in renal cell carcinoma
polycythaemia (raised EPO), hypercalcaemia (raised PTH)
children under 5 present with unilateral abdominal mass, flank pain, painless haematuria, fever and anorexia
wilms tumour
most common metastases for wilms tumour
lung
histology of bladder cancer
transitional cell
when would you do a 2ww referral for cystoscopy for bladder cancer
2 episodes of painless frank haematuria
4 causes of pre-renal disease
dehydration, haemorrhage, heart failure, sepsis
all cause reduced perfusion to the kidney
urine osmolarity and serum sodium in pre renal
increased urine osmolarity and reduced Na as kidneys concentrate urine and retain sodium
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
acute tubular necrosis
urine osmolarity and serum sodium in acute tubular necrosis (renal)
reduced urine osmolarity and increased sodium as kidneys cannot concentrate urine or retain sodium
which type of renal disease can compartment syndrome cause
acute tubular necrosis due to myoglobin
ABG in renal tubular acidosis
normal anion gap acidosis
most common nephrotic syndrome in paeds causing foot processes and podocyte fusion on renal biopsy
minimal change disease
management of minimal change disease
prednisolone
which virus can cause focal segmental glomerulosclerosis
HIV
haematuria, proteinuria, oliguria and htn presenting 1-2 WEEKS after URTI
post strep glomerulonephritis
1-2 DAYS after URTI
IgA nephropathy
oedema, increased protein, thick basement membrane and sub epithelial spikes associated with malignancy and positive PLA2
membranous glomerulonephritis
3 causes of rapidly progressive glomerulonephritis
goodpasture
SLE
wegeners
haemoptysis + AKI/proteinuria/haematuria
anti-GBM disease
systemic lupus erythematosus and proteinuria
lupus nephritis
impaired renal function with an allergic picture of high WCC, IgE and eosinophils in urine
acute interstitial nephritis
cause of acute interstitial nephritis
ABX (and other drugs)
cause and presentation of post renal
obstruction of urinary tract causing hydronephrosis on USS
x linked disease causing haematuria, bilateral sensorineural deafness and eye problems with splitting of the lamina densa on biopsy
alport syndrome
cause and management of haemolytic uraemic syndrome
E. Coli
supportive therapy
abdominal pain, arthritis, haematuria and purpuric rash over buttocks and extensor surfaces of the arms and legs in children after an UTI
henoch schonlein purpura
investigation for diabetes insipidus
water deprivation test
cause and treatment for nephrogenic diabetes insipidus
lithium
thiazides, low salt and protein diet
cause and treatment for cranial diabetes insipidus
hereditary hemochromatosis
desmopressin
MOA of desmopressin
V2 receptor agonist
max rate of potassium infusion before cardiac monitoring
10
two medications for hyperkalaemia and roles
calcium gluconate: shifts potassium to stabilise the myocardium
calcium resonium: removes potassium
young female with AKI after ACEi with the renal atereis showing a string of beads
fibromuscular dysplasia
medical management of ascites
spironolactone - aldosterone antagonist
how does alcohol cause polyuria
reduces ADH in posterior pituitary
hyaline casts
loop diuretics
how does nephrotic syndrome predispose VTE
management
loss of antithrombin III
give prophylactic LMWH
