Nephrology Flashcards by Evie Brown

What is HUS?

Typically seen in young children

Triad of AKI, microangiopathic haemolytic anaemia, thrombocytopenia

Most cases caused by E. coli 0157

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Blood results seen in HUS?

Fragmented red blood cells

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Medication may have to be stopped in AKI as increased risk of toxicity (but doesn’t usually worsen AKI itself)?

Lithium

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Anaemia in CKD - what should be corrected before starting erythropoiesis-stimulating agents?

Iron deficiency

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What is the pharmacological treament of choice for nephrogenic DI?

Chlorothiazide

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How can you differentiate between primary and secondary aldosteronism?

Look at renin levels

If renin is high then a secondary cause is more likely, i.e renal artery stenosis

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Treatment of HUS?

Supportive treatment only

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Symptoms of HSP?

The classic tetrad of symptoms includes non-thrombocytopenic palpable purpura, arthritis or arthralgia, abdominal pain and renal disease

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What is the most common cause of acute interstitial nephritis?

Drugs, particularly antibiotics

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What are the features of acute interstitial nephritis?

Fever, rash, arthralgia
Eosinophilia
Mild renal impairment
Hypertension

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What are the causes of a normal anion gap metabolic acidosis?

Gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
Renal tubular acidosis
Drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

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What are the causes of a raised anion gap metabolic acidosis?

Lactate: shock, hypoxia
Ketones: diabetic ketoacidosis, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use

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What should be monitored in HSP?

Blood pressure and urinanalysis should be monitored to detect progressive renal involvement

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Hyaline casts may be seen in the urine of patients taking what drug?

Loop diuretics

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What is the first step if a patient has a urine output of < 0.5ml/kg/hr postoperatively?

Fluid challenge

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What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?

1/3 of patients have infrequent relapses, 1/3 of patients have frequent relapses, majority (2/3) will have later recurrent episodes

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What is the maximum recommended rate of potassium infusion via a peripheral line?

10 mmol/hour

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What are the indications for dialysis in AKI?

Used when a patient is not responding to medical treatment of complications, for example hyperkalaemia, pulmonary oedema, acidosis or uraemia (e.g. pericarditis, encephalopathy)

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What are the most common extra-renal manifestations of ADPKD?

Liver cysts, cerebral berry aneurysms (which can rupture and lead to a subarachnoid haemorrhage), and cysts in other organs (such as the pancreas and spleen)

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What blood result indicates chronic kidney diease over acute?

Hypocalcaemia

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A 60-year-old man presents with visible haematuria for the past three weeks. He has an ache in the left loin but examination is unremarkable other than a left varicocele. He also notes to feeling intermittently hot and sweaty.

What is the most likely diagnosis?

Renal cell carcinoma

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How fast should maintenance fluids be prescribed?

30 ml/kg/24hr

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What are the diagnostic criteria for AKI?

↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours

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What is darbepoetin alfa?

Erythropoietin prescription for anaemia in CKD

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What drug in hyperkalaemia removes potassium from the body?

Calcium resonium

What drug in hyperkalaemia stabilises the cardiac membrane?

IV calcium gluconate

What drugs in hyperkalaemia facilitate a short-term shift in potassium from extracellular (ECF) to intracellular fluid (ICF) compartment?

* Combined insulin/dextrose * Infusion nebulised salbutamol

Describe the appearance of the kidneys on ultrasound in diabetic nephropathy vs CKD

Chronic diabetic nephropathy will have large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys

Urine osmolality high, urine sodium low indicates what type of AKI?

Pre-renal

Urine osmolality low, urine sodium high indicates what type of AKI?

Renal

What are the symptoms of an under-filled fluid balance?

* Tachycardia * Hypotension * Oliguria * Sunken eyes and reduced skin turgor

What are the side effects of erythropoietin?

Bone aches, flu-like symptoms and skin rashes

List 3 factors which can affect eGFR

* Pregnancy * Muscle mass (e.g. amputees, body-builders) * Eating red meat 12 hours prior to the sample being taken

What is the diagnostic investiagtion for DI?

Water deprivation test

How do you differentiate between AKI and dehydration?

Dehydration is characterised by a urea that is proportionally higher than the rise in creatinine

What form of glomerulonephritis is associated with malignancy?

Membranous glomerulonephritis

What is the management of aspirin overdose?

IV sodium bicarbinate

What investigation is required in all patients with AKI of unknown aetiology?

Renal tract ultrasound within 24 hours

In post-streptococcal glomerulonephritis, what test is used to confirm the diagnosis of a recent streptococcal infection?

Raised anti-streptolysin O

What urine osmolality is seen in prerenal disease?

> 500 mOsm/kg

What urine osmolality is associated with acute tubular necrosis (e.g. due to ethylene glycol)?

< 350 mOsm/kg

What is calcium acetate?

Calcium-based binder used to treat hyperphosphataemia e.g. in CKD Side effects include hypocalcaemia

What is the first line option for dialysis?

Peritoneal dialysis UNLESS conditions e.g. Crohn's where haemodialysis is safer

Severe hyperkalaemia in the context of an AKI requires?

Immediate discussion with critical care/nephrology to consider haemofiltration/haemodialysis

What are the features of Alport's syndrome?

* Microscopic haematuria * Progressive renal failure * Bilateral sensorineural deafness * Lenticonus: protrusion of the lens surface into the anterior chamber * Retinitis pigmentosa * Renal biopsy: splitting of lamina densa seen on electron microscopy

What electrolyte disturbance is seen in diarrhoea?

Hypochloraemia, hypokalaemia, and metabolic alkalosis

What electrolyte disturbance is seen in Addison's

Hyperkalaemic metabolic acidosis

When prescribing fluids, what is the potassium requirement per day?

1 mmol/kg/day

Describe the presentation of acute graft failure in renal transplant

Happens within months, is usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria

What are the most common causes of nephrotic syndrome in adults?

Focal segmental glomerulosclerosis or membranous glomerulopathy

Management of hyperphosphataemia in CKD

1. Dietary changes 2. Phosphate binder

High plasma osmolality and a low urine osmolality is seen in what condition?

How do you differentiate between cranial and nephrogenic DI?

Administration of desmopressin (synthetic antidiuretic hormone) Since cranial diabetes insipidus is caused by a lack of antidiuretic hormone, substituting it with desmopressin will cause the serum osmolarity to fall and the urine osmolarity to rise to normal levels

Describe the histology of membranous glomerulonephritis

* Basement membrane thickening on light microscopy * Subepithelial spikes on sliver stain * Positive immunohistochemistry for PLA2

How do you differentiate between exercise-induced CK elevation and rhabdo?

Elevations of CK that are 'only' 2-4 times that of normal are not supportive of a diagnosis of rhabdomyolysis and suggest another underlying pathophysiology

What diagnosis should be considered in young female patients who develop AKI after the initiation of an ACEi?

Fibromuscular dysplasia

What could have caused the abnormalities seen in this ECG?

AKI - signs of hyperkalaemia (tall tented T waves, a lack of P waves and broad QRS complexes)

An 80-year-old man presents to his general practitioner complaining of long-standing shortness of breath on exertion. He claims he has lost 4kg of weight in the past month and is constantly tired all of the time. On examination, the patient has venous jugular distension and hepatosplenomegaly. An X-ray was normal and an echocardiogram showed heart failure with a preserved ejection fraction. Blood tests are sent off and the immunoglobulin-free light chain assay comes back abnormal. What is the most likely diagnosis?

Amyloidosis

What are the causes of focal segmental glomerulosclerosis?

* Idiopathic * Secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy * HIV * Heroin * Alport's syndrome * Sickle-cell

What histology findings are seen in focal segmental glomerulosclerosis?

* Focal and segmental sclerosis and hyalinosis on light microscopy * Effacement of foot processes on electron microscopy

What is the most common cause of peritonitis secondary to peritoneal dialysis?

Coagulase-negative Staphylococcus e.g. Staphylococcus epidermidis

What drug is beneficial in proteinuric CKD, regardless of diabetic status?

SGLT-2 inhibitors

Drug of choice in ascites?

Spironolactone

What is the pathophysiology of nephrotic syndrome?

Associated with a hypercoagulable state due to loss of antithrombin III via the kidneys

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

Cytomegalovirus

How does chronic HIV-associated nephropathy present on ultrasound?

Large/normal sized kidneys on ultrasound

What histology findings are associated with IgA nephropathy?

Mesangial hypercellularity, positive immunofluorescence for IgA and C3

How does lithium cause DI?

Lithium desensitizes the kidney's ability to respond to ADH in the collecting ducts (causing nephrogenic DI)

Describe the presentation of Goodpasture's syndrome

Typically presents with haemoptysis + AKI/proteinuria/haematuria

What causes hyperacute transplant rejection?

Pre-existing antibodies against ABO or HLA antigens

Name a common cardiac manifestation of ADPKD

Mitral valve prolaspe

Describe the presentation of HSP

Abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs

Describe the presentation of IgA nephropathy

Visible haematuria following a recent URTI

What drugs cause acute interstitial nephritis?

* Penicillin * Rifampicin * NSAIDs * Allopurinol * Furosemide

What are some of the causes of an pre-renal AKI?

* Hypovolaemia secondary to diarrhoea/vomiting * Renal artery stenosis

What are some of the causes of an intrinsic AKI?

* Glomerulonephritis * Acute tubular necrosis (ATN) * Acute interstitial nephritis (AIN) * Rhabdomyolysis * Tumour lysis syndrome * Drugs e.g. gentamicin

Proteinuria is only seen in which form of AKI?

Intrinsic

How can binge dringing lead to hypernatraemia?

Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria

What is alfacalcidol?

Drug used as a vitamin D supplement in end-stage renal disease because it does not require activation in the kidneys

Describe the presentation of post-streptococcal glomerulonephritis

Haematuria, proteinuria/oedema, hypertension and oliguria

What is the screening test for adult polycystic kidney disease?

Ultrasound