Nephrology Flashcards
What are the causes of rhabdomyolysis?
Fall and long lie
Prolonged seizure
Ecstasy
What are the deranged blood tests in rhabdomyolysis?
CK will be at least 5 times ULN (i.e. out of keeping with AKI)
AKI
High K
High Ph
Low Ca (released myoglobin binds to Ca)
Management of minimal change disease (causing nephrotic syndrome)?
Oral Prednisolone
(if no response to steroids, renal biopsy)
NB// you also need to investigate cause of minimal change disease - idiopathic vs leukaemia/lymphoma vs drugs (NSAIDs, Abx)
Management of ADPCKD?
Tolvaptan (ADH antagonist)
- slows down cyst growth
What are the complications of immunosuppression after renal transplant?
1) increased malignancy risk (specifically Squamous cell carcinoma)
2) CVD and impaired glucose tolerance
3) Immunosuppressive agents cyclosporin and tacrolimus are nephrotoxic
Most common cause of renal AKI?
Acute tubular necrosis
(other more rare causes include glomerulonephritis and interstitial nephritis)
Difference between pre-renal and renal AKI?
Pre-renal responds well to fluids, renal won’t
In pre-renal, kidneys are able to work to retain sodium and water - causing low Urinary Na and high urine osmolality
Whereas in renal AKI, kidneys lose ability to retain Na - high urinary Na and low urine osmolality.
Urine may also have brown cast cells.
What timeframe does contrast induced AKI occur and how to prevent it?
Occurs 2-5 days after contrast
Prevent by giving IV fluids 12 hours pre- and post-scan
at a rate of 1ml/kg/hr
What is HUS? Symptoms?
Triad of MAHA, thrombocytopenia and AKI
Caused by Enterotoxagenic E.coli (0157:07)
Pale due to Coombs negative haemolytic anaemia
petechiae due to low platelets
may have oedema due to AKI
Management of HUS?
Supportive with fluids
Abx not indicated
How long can you not drive for after first unprovoked/isolated seizure?
6 months (as long as no structural brain pathology identified and no abnormality if EEG was done)
(this extends to 12 if not)
Can you drive if you’re epileptic?
Can apply for license if you’ve been seizure free for 12 months
Which opioid is safe in renal impairment?
Buprenorphine
What are the type of renal transplant rejections?
Hyperacute - within hours
(treat by removing transplant)
would be caused by pre-made antibodies against the organ (due to HLA or ABO incompatibility
acute < 6 months
(again due to HLA or ABO, but antibodies weren’t pre-made, instead this is T cell mediated)
chronic >6 months
(mixture of antibody and T cell mediated reaction, causing fibrosis of transplant)
What’s order of HLA type importance?
DR > B > A
