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Finals Revision > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Sx of ADPKD? What is the most common extra renal presentation?

A

HTN, recurrent UTIs, Haematuria, Renal stones, Renal impairment, Liver cysts, Berry aneurysms
Liver cysts are the most common extra renal presentation - suspect if hepatomegaly

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2
Q

How do we diagnose early CKD? How do we interpret this test?

A

Using albumin: creatinine ratio
ACR >70 or ACR >30 with HTN give ACEis to manage the proteinuria - this is common in diabetic nephropathy

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3
Q

How do we calculate maintenance fluids in children?

A

1st 10kg = 100ml/kg
2nd 10kg = 50ml/kg
subsequent kg = 20ml/kg

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4
Q

What is seen in nephrotic syndrome?

A

Oedema, Low serum albumin (less than 30g/L) and protein in the urine (>3g/24hrs)
There should be no blood in the urine!

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5
Q

What is the most common cause of nephrotic syndrome in adults and children respectively? How do you manage?

A

Children = minimal change disease. Mx = high dose steroids, ACEis and immunosuppressants alongside renal biopsy if steroids resistant.
Adults = Focal segmental glomerulosclerosis and Membranous glomerulonephropathy. Mx = steroids +/- immunosuppression

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6
Q

How fast can you give potassium?

A

At a max rate of 10mmol/hr via a peripheral line
Can be given up to 20mmol/hr but only if there is cardiac monitoring

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7
Q

Which metabolic abnormality is often seen in adrenal insufficiency?

A

Hyperkalaemic metabolic acidosis
Aldosterone normally excretes both K+ and H+

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8
Q

What type of anaemia is associated with CKD? How do we investigate and treat this?

A

Normocytic anaemia due to low EPO production
All other haematinic tests will be normal. If ferritin is low this implies iron deficiency which must be corrected first!
Mx = Darbepoetin alpha injections

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9
Q

Describe post-streptococcal glomerulonephritis?

A

Seen in children
Haematuria, proteinuria, oedema, HTN and oliguria
Seen 1-3 weeks following URTI or 3-6 weeks following skin infection e.g. impetigo

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10
Q

Classify CKD

A

Stage 1 = eGFR >90, must be other signs of kidney damage
Stage 2 = eGFR 60-90, must be other signs of kidney damage
Stage 3a = 45-59
Stage 3b = 30-44
Stage 4 = 15-29
Stage 5 <15, consider dialysis and transplant

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11
Q

True or false, nephrotic syndrome decreases the risk of VTE and decreases free thyroxine levels?

A

FALSE
It increases the risk of VTE - prescribe dalteparin
It also decreases the total thyroxine levels but does not affect free thyroxine

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12
Q

What is an important complication of secondary hyperparathyroidism? How should you mange this?

A

Mineral bone disease - low calcium, high phosphate and high PTH
1st line = reduce dietary phosphate
2nd line = phosphate binders e.g. calcium acetate

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13
Q

What drug should you start all patients with CKD on?

A

A statin

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14
Q

What is seen in hyperkalaemia on ECG?

A

tall tented T waves, loss of P waves, broad QRS and sinusoidal wave pattern

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15
Q

What is the most common and most important viral infection seen in solid organ transplant patients?

A

Cytomegalovirus

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16
Q

What should you do if K+ is raised but <6.5

A

ECG!

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17
Q

What has happened if a transplant is rejected in <48 hours?

A

Hyperacute transplant rejection
This is secondary to pre-existing antibodies against ABO or HLA antigens. Requires urgent return to theatre to remove the organ

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18
Q

What should you suspect in a patient with a recent history of haematuria who is now in urinary retention. How should you manage this?

A

A clot causing a bladder outlet obstruction
Mx = bladder irrigation via a 3 way urethral catheter

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19
Q

Describe stage 1 AKI?

A

Urine output <0.5ml/kg/hr for >= 6 hours
Rise in creatinine by >26 umol/L in 48 hrs or increase of 1.5-1.9 times the baseline

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20
Q

Describe stage 2 AKI

A

Urine output <0.5ml/kg/hr for >= 12 hours
Rise in creatinine by 2.0-2.9 times the baseline

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21
Q

Describe stage 3 AKI

A

Urine output <0.3ml/kg/hr for >= 24 hours
Rise in creatinine by >3 times baseline or to >=353.6umol/L

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22
Q

Describe stage 3 AKI in those who are under 18 or are initiating kidney replacement therapy?

A

eGFR <35

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23
Q

How does calcium resonium work? How can you give it?

A

It removes potassium from the body. Can be given orally or via an enema (this is the best way)

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24
Q

What is seen on renal biopsy in minimal change disease?

A

Podocyte fusion and effacement of the podocyte foot processes

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25
Q

What is Sevelamer?

A

A non-calcium based phosphate binder

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26
Q

How can you confirm the diagnosis of a recent strep infection in ?Post-Streptococcal Glomerulonephritis?

A

Raised anti-streptolysin O titres

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27
Q

What antibodies are seen in Glomerulonephritis?

A

Anti-Glomerular basement membrane antibodies

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28
Q

How do we correct vitamin D deficiency in CKD?

A

Alfacalcidol

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29
Q

How can we reduce the rate of CKD progression in ADPKD?

A

Tolvaptan

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30
Q

What are the S/Es of EPO therapy?

A

HTN leading to encephalopathy and seizures
Bone aches
Flu like symptoms
Skin rashes/urticaria
Pure red cell aplasia
Thrombosis
Iron deficiency

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31
Q

How can nephrotic syndrome precipitate a hypercoagulable state?

A

Antithrombin III is lost via the kidneys

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32
Q

Describe Haemolytic Uremic Syndrome?

A

Typically seen in children post E.coli infection (diarrhoea with or without blood)
Sx = AKI, thrombocytopenia and normocytic anaemia with fragmented RBCs
Mx = supportive

33
Q

What symptoms can be seen in patients with a negative fluid balance?

A

Tachycardia, hypotension, oliguria, sunken eyes and reduced skin turgor

34
Q

What is IgA nepropathy?

A

A nephritic syndrome which occurs after URTI

35
Q

What is membranous glomerulonephritis?

A

A nephrotic syndrome which can be caused by SLE

36
Q

What is the classic triad seen in renal cell carcinoma?

A

Flank pain, flank mass and haematuria

37
Q

What is the NICE criteria to diagnose AKI of any stage?

A

Rise in creatinine >26umol/L in 48 hours
Rise in creatinine >50% in 7 days
Drop in urine output <0.5ml/kg/hr for >6hours

38
Q

True or false, amyloidosis can cause hepatosplenomegaly?

A

True

39
Q

Name 3 factors which can affect eGFR reading?

A

Pregnancy, extremes of muscle mass and eating red meat 12 hours before the test

40
Q

What is the Alubumin:Creatinine ratio cut off for starting diabetics on an ACEi or ARB?

A

ACR >= 3, measured from a morning specimine

41
Q

Which drug can you start in patients who have experienced gynaecomastia on spiro?

A

Eplerenone

42
Q

How long do arteriovenous fistulas take to develop after being surgically formed?

A

6-8 weeks

43
Q

When should you offer haemodialysis to patients with AKI?

A

When they have complications which are not responding to normal medical treatment e.g. pulmonary oedema, acidosis or uraemia (e.g. pericarditis or encephalopathy)

44
Q

How is LDH affected in nephrotic syndrome?

A

It is raised

45
Q

What may cause transient non-visible haematuria?

A

UTI, menstruation, vigorous exercise or sexual intercourse

46
Q

How can we reduce the risk of contrast induced nephropathy?

A

Give 09% saline pre and post procedure

47
Q

What is the prognosis in minimal change disease?

A

1/3 have no relapses, 1/3 have infrequent relapses, 1/3 have frequent relapses which resolve before adulthood

48
Q

Describe Granulomatosis with Polyangiitis (Wegner’s)

A

Sx = saddle shaped nose, crusty nasal secretions, sinusitis, nose bleeds, hearing loss, cough, haemoptysis and nephritic syndrome
Ix = cANCA and crescenteric glomerulonephritis

49
Q

Which conditions is pANCA seen in?

A

Microscopic polyangiitis and Churg-Strauss Syndrome

50
Q

Describe Churg-Strauss Syndrome?

A

Sx = severe asthma presenting in late teenage years/early adulthood, lung, skin and kidney issues
Ix = raised eosinophil levels

51
Q

Describe Microscopic Polyangiitis?

A

Renal failure, SOB and haemoptysis

52
Q

How can we differentiate AKI from CKD?

A

Small kidneys on USS point to CKD.
This can not be used in PKD or early diabetic nephropathy

53
Q

Describe Fibromuscular dysplasia?

A

AKI in a young female who has recently started ACEi. HTN and oedema may be seen. The renal arteries have a string of beans appearance

54
Q

What should you suspect if a patient presents like Fibromuscular dysplasia (sting of bean appearance renal arteries, AKI, HTN and oedema) but is old?

A

Atherosclerosis of the renal arteries

55
Q

What is acute graft failure?

A

Occurs within 6 months of transplant
It is usually asymptomatic and is picked up by an increase in creatinine, pyuria and proteinuria
Mx = steroids and immunosuppressants

56
Q

What is chronic graft failure?

A

Graft failure occurring more than 6 months after the transplant

57
Q

A diabetic patient presents with new onset foamy urine and an ACR >3. What is the diagnosis and how will the kidneys appear?

A

Proteinuria secondary to early diabetic nephropathy
There will be bilateral kidney enlargement (with chronic diabetic nephropathy they will be small)

58
Q

How can timescale help you tell between IgA nephropathy and post-streptococcal glomerulonephritis?

A

IgA nephropathy occurs 1-2 days after URTI where as post-streptococcal glomerulonephritis occurs 1-2 weeks after

59
Q

What abnormality is seen on ABG/U&Es in DKA?

A

Raised anion gap metabolic acidosis

60
Q

Ix of IgA nephropathy?

A

renal biopsy which will show IgA deposition

61
Q

How can alcohol binging affect ADH ? What will this cause?

A

It can cause ADH suppression
Sx = polyuria, hypernatraemia, high serum osmolality and low urine osmolality

62
Q

How can MDMA affect ADH ? What will this cause?

A

It can cause SIADH
Sx = low serum osmolality, high urine osmolality and hyponatraemia

63
Q

How do you manage hypokalaemia?

A

If 2.5-3.4 give oral K+ replacements. If <2.5 move to an area with cardiac monitoring an give IV K+ replacement at no more than 20mmol/hr

64
Q

What drug can you consider adding if patients with minimal change disease do not respond to prednisolone?

A

Cyclophosphamide

65
Q

What is the first line RRT?

A

In mobile patients = peritoneal dialysis
If non-mobile or have UC = haemodialysis

66
Q

Describe Wilm’s Nephroblastoma?

A

Seen in children under 5. Presents with abdo mass (most common symptom), flank pain and painless haematuria.
Most commonly metastasises to the lungs

67
Q

Describe Alport’s syndrome?

A

An X-linked dominant condition associated with microscopic haematuria, bilateral sensorineural deafness, retinitis pigmentosa and progressive renal failure (or failure of a renal transplant)

68
Q

When should you refer a patient to nephrology because of their eGFR?

A

If they have an eGFR <30 or worsening by >15 per year

69
Q

What abnormality can be seen on ABG in type 1 respiratory failure?

A

Non-compensated respiratory alkalosis
T1RF leads to hyperventilation, this causes a drop in CO2

70
Q

How can you calculate the urea:creatinine ratio? How is it significant?

A

Urea / (creatinine/100)
If it is >100 this indicates a pre-renal cause of renal failure (e.g. dehydration)

71
Q

What should you suspect if there is a low GCS and uraemia?

A

Encephalopathy

72
Q

What is Dialysis Disequilibrium Syndrome?

A

Cerebral oedema leading to decreased consciousness in those who have recently started RRT

73
Q

Sx and Mx of Salicylate poisoning (e.g. aspirin)?

A

Metabolic acidosis with a raised anion gap. There may also be some respiratory alkalosis due to the tachypnoea caused by aspirin.
Tinnitus is also present
Mx = IV sodium bicarbonate

74
Q

Who should you hold metformin before giving contrast? How long should you hold it for?

A

In those with high risk of contrast nephropathy (if known renal impairment, >70 years, dehydration, HF and nephrotoxic drug use). Hold for 48 hours before contrast is to be given

75
Q

What variables affect eGFR?

A

CAGE
Creatinine, Age, Gender and Ethnicity

76
Q

What does acute transplant rejection often mimic? How do you treat?

A

Mimics infection - except creatinine will be newly raised
Mx = increase steroid dose

77
Q

What is the prefered method of access in haemodialysis?

A

A/V fistula

78
Q

Mx of benzo OD?

A

Flumenezil

Finals Revision (23 decks)

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