Nephrology Flashcards by Humairaa Asmal

List 3 RF for an AKI?

Drugs- ACEI/ARB/NSAIDs etc
Iodinated contrast agents w/in past week
CKD + other end organ failure
65+

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List 3 pre-renal causes of an AKI?

Hypovolaemia secondary to D+V
Renal Artery stenosis
Sepsis

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List 3 intrinsic causes of an AKI?

Glomerulonephritis
Acute tubular necrosis
Rhabdomyolysis
Tumour lysis syndrome

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List 3 post-renal causes of an AKI?

BPH
Kidney stone in urethra or bladder
External compression of the urethra

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What are the features of an AKI?

Reduced urine output (<0.5ml/kg/hour)
Pulmonary/peripheral oedema
Arrhythmias (electrolyte imbalances)
Features of uraemia (for example, pericarditis or encephalopathy)

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What is the criteria for an AKI to be diagnosed?

Rise in serum creatinine of 26mmol/L or greater within 48 hours

A 50% increase in creatinine within 7 days

Fall in urine output <0.5ml/kg/hour greater than 6 hours

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What 1st line Ix would you do in someone with suspected AKI?

U&Es
Urinalysis

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What medications are safe to continue in AKI?

Warfarin
Aspirin 75mg
Beta Blockers
Paracetamol
Clopidogrel
Statin

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What medications are not safe to continue in AKI?

NSAIDs
ACEI
ARBS
Aminoglycosides
Diuretics

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What medications may need to be stopped due to an increased risk of toxicity (but doesn’t usually worsen AKI itself) ?

Metformin
Digoxin
Lithium

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What is the triad associated with nephrotic syndrome?

Proteinuria (>3g/24hr)
Hypoalbuminaemia (>30g/L)
Oedema

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List 4 causes of nephrotic syndrome?

Idiopathic

Primary causes:
Minimal Change disease
Focal Segmental Glomerulosclerosis (FSGS)
Membranous nephropathy

Secondary causes:
Diabetes mellitus
SLE
Amyloidosis
Drugs (Gold and NSAIDS)

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What Ix would you carry out for diagnosing nephrotic syndrome?

Urine dipstick
MSU
Protein:creatinine ratio

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What are the ECG findings in hyperkalaemia?

Tall Tented T waves
Loss of P wave
Broad QRS

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What is the short term mx of hyperkalaemia?

Combined Insulin/dextrose infusion
Nebulised Salbutamol

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What is the long term mx of hyperkalaemia?

Calcium Resonium (via enema or Po)
loop diuretics
Dialysis

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What are the possible sx in a -ve fluid balance patient?

Tachycardia
Hypotension
Oliguria
Sunken eyes and reduced skin turgor

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What are the possible sx in a +ve fluid balance patient?

Elevated JVP
Cackles
Ascites
Tachypnoea

What is the mx of minimal change disease?

Oral steroids (prednisolone)

What is the mx of minimal change disease in a patient who is unresponsive to steroids?

Cyclophosphamide

What would a renal biopsy in a patient with minimal change in disease show?

Normal glomeruli on light microscopy

Electron microscopy shows fusion of podocytes and effacement of foot processes

What is the staging criteria for AKI?

Stage 1:
*Rise in creatine 1.5-1.9 times baseline
*Reduction in urine output <0.5ml/kg/hour for >=6 hours

Stage 2:
*Rise in creatinine 2-2.9 times baseline
* Reduction in urine output <0.5ml/kg/hour >=12 hours

Stage 3:
* Increase in creatinine >=3
*Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours

What are the most common causes of acte interstitial nephritis?

DRUGS
*NSAIDs
Penicillin
Rifampicin
Allopurinol
Furosemide

What are the features for acute interstitial nephritis?

fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension

What are the features of HUS?

Microangiopathic haemolytic anaemia Thrombocytopenia AKI

What is the most common causative organism of HUS?

Shigella prodiucing E-coli (STEC)

What acid base balance would be seen i diarrhoea?

Metabolic acidosis with Normal anion gap

List 3 complications of nephrotic syndrome?

*increased risk of thromboembolism related to loss of antithrombin III and plasminogen in the urine *Hyperlipidaemia *CKD *Hypocalcaemia

What are the side effects of EPO?

*Accelerated hypertension potentially leading to encephalopathy and seizures *Bone aches *Flu like sx *Skin rash, urticaria

List the features of ADPKD?

Hypertension recurrent UTIs flank pain haematuria palpable kidneys renal impairment renal stones *Liver cyst*- most common extra-renal manifestation that causes hepatomegaly *Berry Aneurysms Mitral valve prolapse

What tests should be done before commencing EPO?

Iron status

What is he preferred method of access for haemodialysis?

Arteriovenous fistula

What are the features of goodpastures syndrome(Anti GBM)?

*Pulmonary haemorrhage *Rapidly progressive glomerulonephritis this typically results in a rapid onset acute kidney injury nephritis → proteinuria + haematuria

What is the mx of goodpastures syndrome?

plasma exchange (plasmapheresis) steroids cyclophosphamide

What is goodpastures?

rare type of small-vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis

What is seen in on USS of kidneys in a diabetic nephropathy patient?

Bilateral enlarged/normal kindneys

What is seen in on USS of kidneys in a CKD patient?

bilateral small kidneys

What additional medication should patients with CKD be prescribed?

a statin for the primary or secondary prevention of cardiovascular disease

What monitoring is required in a patient with Henoch-scholein purpura

blood pressure and urinalysis due to risk of renal failure

What is henoch-scholein purpura?

IgA mediated small vessel vasculitis

What are the features of HSP?

Palpable purpuric rash over buttocks and extensor surfaces Abdominal pain Polyarthritis Haematuria/renal failure

What is the mx of HSP?

analgesia for arthralgia treatment of nephropathy is generally supportive.

What is the most common causative organism for peritonitis secondary to peritoneal dialysis?

Staphylococcus epidermidis