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PLAB 1 August 2024 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What are the features of AKI?

A

➜ Acutely raised creatinine with reduced urine output

  • ⬆︎ creatinine of ≥ 26.5µmol/L from baseline within 48h;

OR

  • ⬆︎ creatinine of ≥ 50% from baseline within 7 days;

OR

  • ⬇︎ in urine output < 0.5ml/Kg/h for 6h.
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2
Q

What are the drugs that cause renal failure?

A

DAMN
- Diuretics
- ACEi/ARBs
- Metformin
- NSAIDs

Metformin: not nephrotoxic, just needs to be reduced in renal failure.

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3
Q

What are the features of CKD?

A

➜ Chronically ↓ eGFR and/or proteinuria.

Minimum of 3 months:
- eGFR < 60
- Proteinuria (ACR) > 3mg/mmol

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4
Q

Describe what is Goodpasture syndrome?

A
  • Autoimmune disease;

Characterized by:
➔ Glomerulonephritis
➔ Pulmonary alveolar haemorrhage

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5
Q

What are the symptoms of Goodpasture syndrome?

A
  • Haematuria
  • Hemoptysis
  • Impaired renal function tests
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6
Q

What are the investigations done in Goodpasture syndrome?

A

Most initial:
- anti-GBM antibodies

Most definitive:
- Lung biopsy
- Kidney biopsy

Others:
- Chest x-ray
- Chest CT scan

Anti-glomerular basement membrane antibodies

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7
Q

In rhabdomyolysis what are the components released (from the muscles) into the bloodstream?

A
  • Myoglobin
  • Potassium
  • Creatine kinase
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8
Q

What are the symptoms of rhabdomyolysis?

A
  • Myoglubinuria (dipstick would pick up blood with no red cells)
  • Hyperkalaemia
  • AKI (acute tubular injury)
  • ⬆︎ creatine kinase
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9
Q

What are the causes of rhabdomyolysis?

A

➔ Prolonged immobilisation
- Muscle ischaemia ➝ rhabdomyolysis

➔ Trauma
➔ Severe exhertion or dehydration (marathon runner)

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10
Q

What are the causes of acute tubular necrosis?

A

1. Ischaemic
➜ Decreased renal perfusion
- Shock (haemorrhagic, septic, cardiogenic);
- Hypotension

2. Nephrotoxic
- Aminoglycosides
- Radiocontrast media
- Myoglobin
- Cisplatin

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11
Q

What is the Rx of acute tubular necrosis?

A

Treat the cause
Shock
- Fluids
- Fluid balance management

Nephrotoxic
- Stop the causative drug

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12
Q

What is the cause of acute interstitial nephritis?

A

Immune-mediated tubulointerstitial injury initiated by:
- Drugs
- Infection

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13
Q

What are the features of acute interstitial nephritis?

A

➔ Acute kidney injury in a euvolaemic patient.

  • Mild eosonophilia
  • Urine dipstick: bland/normal
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14
Q

What are the drugs that can cause acute interstitial nephritis?

A
  • NSAIDs
  • Antibiotics (penicillins, cephalosporim, rifampicin)
  • Proton pump inhibitors
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15
Q

How is the diagnosis of acute interstitial nephritis made?

A

Definitive Dx: renal biopsy

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16
Q

What is the Rx of acute interstitial nephritis?

A

Oral prednisolone.

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17
Q

Describe the Vit D deficiency in chronic kidney disease.

A
  • 2nd hydroxylation in kidney doesn't occur
  • No formation of 1,25-dihydroxycholecalciferol (activacted Vit D/ calcitriol)
18
Q

What are the causes of pyelonephritis?

A
  • Pregnancy
  • Vesico-ureteric reflux
  • DM
  • Stone
19
Q

What are the symptoms of pyelonephritis?

A

Acute:
- Fever
- Rigors
- Loin pain

Chronic
- Hypertension
- Repeated UTI (renal scarring)
- No active infection

20
Q

What is the investigation done for pyelonephritis?

A
  • Urinalysis
  • Urine culture and sensitivity
21
Q

What is the Rx of pyelonephritis?

A

➜ E.coli (most common cause)

  • Co-amoxiclav
  • Cefalexin

7 days.

22
Q

What is the Rx for UTI in men and non-pregnant women?

A

Women:
- Trimethrophin
- Nitrofurantoin
- 3 days

Men:
- Trimethrophin
- Nitrofurantoin
- 7 days

23
Q

What is the management of proteiunuria?

A
  1. If no symptoms and health:
    - Repeat test
  2. If still ⬆︎
    - 24h urine collection
    - Urinary albumin/creatine ratio and/or cretine/protein ratio
24
Q

DDx of common cause of nephrotic syndrome:
- Children
- Adults

A

Children
- Minimal change nephrophaty

Adults
- Membranous glomerulonephritis

25
Q

What are the types of glomerulonephritis?

A

1. Presented with nephritic syndrome
- Haematuria
- Hypertension

2. Presented with nephrotic syndrome
- Oedema
- Proteinuria

26
Q

What are the types of glomerulonephritis:
- Presented with nephritic syndrome?

A
  • Crescentic / rapid progressive glomerulonephritis
  • IgA nephropathy / Berger’s disease
  • MPGN (membranoproliferative glomerulonephritis)
27
Q

What are the types of glomerulonephritis:
- Presented with nephrotic syndrome

A
  • Minimal change diseases
  • Membranous glomerulonephritis
  • Focal segmental glomerulosclerosis
28
Q

When to suspect CKD?

A
  • Anaemia
  • Hypocalcaemia
  • Hyperphosphatemia
  • Small kidney on ultrasound < 9 cm
29
Q

When should a patient be reffered to nephrology?

A
  • eGFR < 30
    OR
  • ACR ≥ 70 (unless diabetic)
    OR
  • eGFR ⬇︎ > 15 within 1 year.
30
Q

What are the symptoms of polycystic kidney disease?

A
  • Haematuria
  • Hypertension
  • Loin or flank pain
  • Enlarged and palpable kidneys on examination
    ➜ Associated with intracranial aneurysm
31
Q

What are the investigationd done in polycystic kidney disease?

A

Ultrasound.

32
Q

DDx between:
- Haemolytic uremic syndrome
- Thrombotic thrombocytopenic purpura

A

HUS
- Haemolytic anaemia
- Uraemia
- Thrombocytopenia

TTP
- Fever
- Neurological symptoms
- Haemolytic anaemia
- Uraemia
- Thrombocytopenia

33
Q

DDx between:
- IgA nephropathy
- Post-streptococcal glomerulonephritis

A

IgA nephropathy / Berger’s disease
- 1-2 days after URTI
- Haematuria

Post-streptococcal glomerulonephritis
- 1-2 weeks after URTI
- Proteinuria

Both caused by streptococcus pyogenes.

34
Q

What is the management of IgA nephropathy / Berger’s disease?

A
  • Annual BP measurements
  • Renal function
  • Urinalysis

If high risk of progression
- ACEi/ARBs
- Prednisolone

35
Q

What are the causes of small kidneys?

A
  • Hypertensive renal diseases
  • Bilateral/unilateral renal stenosis
  • Chronic pylenophritis
  • Chronic glomerulonephritis
36
Q

What are the causes of large kidneys?

A
  • Autossomal dominant polycystic kidney diseases
  • Obstructive uropathy
37
Q

What are the indications of haemodialysis?

A
  • Persistent ⬆︎K⁺
  • Acidosis
  • Pulmonary oedema
  • Fluid overload with anuria
38
Q

Describe what is adynamic bone disease?

A
  • Disease due to low bone turnover;
39
Q

What is the cause of adynamic bone disease?

A

➜ Oversuppression of PTH (overreplacement of Ca²⁺ and Vit D).

40
Q

What are the symptoms of adynamic bone disease?

A

In the context of end stage renal disease:
- Normal PTH
- Normal / high Ca²⁺
- Normal / high phosphate
- Normal / low ALP
- Bone pain

41
Q

What is the management of renal obstruction / renal stones done?

A

➜ Urgent decompression:
- Percutaneous nephrostomy;
- Ureteric stent;

➜ Stones < 5 mm
- Increase fluid intake, likely to pass on its own;

➜ Stone 5 -10 mm + distal location
- Alpha-blockers (tamsulosin)

➜ Stone 5-10 mm + upper ureter or kidney
- Extracorporeal shock wave lithotripsy

➜ Stone 5-20 mm
- Uterescopy with stenting

➜ Stone > 20 mm
- Percutaneous nephrolithotomy

PLAB 1 August 2024 (32 decks)

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