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Finals (HV) > Nephrology > Flashcards

Nephrology Flashcards

1
Q

List 3 RF for an AKI?

A

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

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2
Q

List 3 pre-renal causes of an AKI?

A

Hypovolaemia secondary to D+V
Renal Artery stenosis
Sepsis

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3
Q

List 3 intrinsic causes of an AKI?

A

Glomerulonephritis
Acute tubular necrosis
Rhabdomyolysis
Tumour lysis syndrome

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4
Q

List 3 post-renal causes of an AKI?

A

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

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5
Q

What are the features of an AKI?

A

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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6
Q

What is the criteria for an AKI to be diagnosed?

A

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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7
Q

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

A

U&Es
Urinalysis

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8
Q

What medications are safe to continue in AKI?

A

Warfarin
Aspirin 75mg
Beta Blockers
Paracetamol
Clopidogrel
Statin

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9
Q

What medications are not safe to continue in AKI?

A

NSAIDs
ACEI
ARBS
Aminoglycosides
Diuretics

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10
Q

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

A

Metformin
Digoxin
Lithium

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11
Q

What is the triad associated with nephrotic syndrome?

A

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

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12
Q

List 4 causes of nephrotic syndrome?

A

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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13
Q

What Ix would you carry out for diagnosing nephrotic syndrome?

A

Urine dipstick
MSU
Protein:creatinine ratio

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14
Q

What are the ECG findings in hyperkalaemia?

A

Tall Tented T waves
Loss of P wave
Broad QRS

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15
Q

What is the short term mx of hyperkalaemia?

A

Combined Insulin/dextrose infusion
Nebulised Salbutamol

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16
Q

What is the long term mx of hyperkalaemia?

A

Calcium Resonium (via enema or Po)
loop diuretics
Dialysis

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17
Q

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

A

Tachycardia
Hypotension
Oliguria
Sunken eyes and reduced skin turgor

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18
Q

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

A

Elevated JVP
Cackles
Ascites
Tachypnoea

19
Q

What is the mx of minimal change disease?

A

Oral steroids (prednisolone)

20
Q

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

A

Cyclophosphamide

21
Q

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

A

Normal glomeruli on light microscopy

Electron microscopy shows fusion of podocytes and effacement of foot processes

22
Q

What is the staging criteria for AKI?

A

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

23
Q

What are the most common causes of acte interstitial nephritis?

A

DRUGS
*NSAIDs
Penicillin
Rifampicin
Allopurinol
Furosemide

24
Q

What are the features for acute interstitial nephritis?

A

fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension

25
Q

What are the features of HUS?

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI

26
Q

What is the most common causative organism of HUS?

A

Shigella prodiucing E-coli (STEC)

27
Q

What acid base balance would be seen i diarrhoea?

A

Metabolic acidosis with Normal anion gap

28
Q

List 3 complications of nephrotic syndrome?

A

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

29
Q

What are the side effects of EPO?

A

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

30
Q

List the features of ADPKD?

A

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

31
Q

What tests should be done before commencing EPO?

A

Iron status

32
Q

What is he preferred method of access for haemodialysis?

A

Arteriovenous fistula

33
Q

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

A

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

34
Q

What is the mx of goodpastures syndrome?

A

plasma exchange (plasmapheresis)
steroids
cyclophosphamide

35
Q

What is goodpastures?

A

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

36
Q

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

A

Bilateral enlarged/normal kindneys

37
Q

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

A

bilateral small kidneys

38
Q

What additional medication should patients with CKD be prescribed?

A

a statin for the primary or secondary prevention of cardiovascular disease

39
Q

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

A

blood pressure and urinalysis due to risk of renal failure

40
Q

What is henoch-scholein purpura?

A

IgA mediated small vessel vasculitis

41
Q

What are the features of HSP?

A

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

42
Q

What is the mx of HSP?

A

analgesia for arthralgia
treatment of nephropathy is generally supportive.

43
Q

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

A

Staphylococcus epidermidis

Finals (HV) (19 decks)

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