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CP3 Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Classify the different stages of AKI

A

Stage 1:
• Creatinine ↑ >26umol/dL in 48hrs
• Creatinine ↑ x1.5–2 in 7d
• Urine output <0.5ml/kg/hr 6–12hrs

Stage 2:
• Creatinine ↑ x2–3 in 7d
• Urine output <0.5ml/kg/hr ≥12hrs

Stage 3: 
• Creatinine ↑ >3x in 7d
• Urine output <0.3ml/kg/hr in 24hrs
• Anuria for ≥12hrs
• New need for renal replacement
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2
Q

What are some sx of severe AKI (3)

A

Sx of complications:
Uraemia (vom/pruritis/pericarditis/encephalitis)
Hyperkal
Pulm Oedema (fluid overload – unless was pre-renal cause)

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3
Q

List some causes of renovascular obstrn in Pre-Renal AKI (3)

A

Renal aa stenosis ± thrombosis
Embolus
Ao dissection

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4
Q

What would the urine osmolality/Na be in:
Early Pre-Renal AKI
Late

A

Early: High osmolality / Low Na (kidneys can still conc)

Late (ATN): Low osmolality / High Na (lost ability to conc)

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5
Q

What are the renal causes of AKI (3)

A 
Acute tubular necrosis (85%)
Interstitial Nephritis (10%)
Glomerular disease (5%)
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6
Q

List some causes of ATN (1;3;3)

A

Prolonged Pre-Renal cause (prolonged poor perfusion)

Drugs:
Aminoglycosides / Cephalos
NSAIDs
Contrast

Toxins:
HUS
Myoglobinuria
Heavy metals

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7
Q

What Ix are done into CKD?

A

Bloods:
FBC/UEs/LFTs/Glucose
Ca/Phos/PTH

Urinary:
Dip + MCS
24hr urinary protein/CrCl

Imaging:
Renal USS (?Obstructive)
CXR (?Pulm Oedema)
DTPA scan (nuclear)
Bone imaging (renal bone diease screen)

Invasive: Renal biopsy

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8
Q

Outline the management steps of CKD

A

1st line: Control BP/DM
ACEis / Statins / Low-dose aspirin

2nd line: Control complications
EPO recombinant / Ca+VitD supps / K restriction

3rd line: Renal replacement therapy (symp CKD5)

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9
Q

Describe the effects on Vit D / Ca / PTH in CKD

A

Vit D ↓ = Ca↓ / Phos↑ = Osteomalacia

Osteomalacia = PTH↑ (2º + 3º long-term)
3º HyperPTH = ↑Ca (Hypercalcaemia)

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10
Q

How is renal bone disease treated? (3)

A

Restrict dietary phosphate
Phosphate binders (CalciChew)
VitD/Ca supps (AdCal)

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11
Q

What are the features of renal aa stenosis? (3)

A

Resistant HTN
Worsening renal func after ACEis (if bilat)
Acute pulm oedema

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12
Q

How is renal aa stenosis managed?

A

Medical:
Aspirin
Statins
Antiplatelets

Surgical:
Angioplasty / stenting

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13
Q

List the causes of AKI

A

Pre-Renal:
Shock
Renovascular obstrn

Renal:
ATN
Interstitial nephritis
Glomerular disease

Post-Renal:
Ureteric obstrn

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14
Q

Outline the steps of management for hyperkalaemia (7)

A
  1. ECG
  2. Ca gluconate
  3. 10Units Actrarapid IV + 50% 50ml glucose
  4. Salbutamol neb
  5. Ca resonium
  6. Bicarb
  7. Dialysis

ALSO loop diuretics
STOP Nephrotoxics
TREAT CAUSE

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15
Q

List the features of hyperkalaemia (MURDER)

A 
Mm weakness
Urine: oligo/anuria
Resp distress
Decreased cardiac contractility
ECG changes
Reflexes - hypo/areflexia
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16
Q

List the DDx causes of hyperkalaemia (MACHINE)

A 
Medications
A
Cellular destrn (haemolysis, tumour lysis, burns, trauma)
Hypoaldosteronism
Intake excess (inc. IV fluids)
Nephrons – renal failure
Excretion impaired
17
Q

What tests should be included when assessing a pt for renal transplant?

A

Blood Grp
HLA matching
Virology/TB status (immunosupp)

18
Q

What are the complications of renal transplant?

A 
Operative: bleeding/thrombosis/infection  /urine leak
Rejection
Ciclo/tacrolimus toxicity
Infection
Malignancy (skin/anal/lymphoma)
19
Q

What are the haematological effects of uraemia?

A

Platelet dysfunc
Haemolysis
Marrow suppression

20
Q

What are the (2º) causes of glomerulonephritis (NSAID HSP)

A 
Neoplasm
SLE
Amyloid
Infection
Diabetes
HSP
21
Q

What further Ix can be done into UTIs?

A

USS (hydronephrosis)

CT/IV Urography (exclude structural abns)

22
Q

List some causes of sterile pyuria (5)

A

Recently treated UTI
Bladder cancer

Appendicitis
TB
Chlamydia

23
Q

What advice can be given for UTIs (5)

A 
Plenty fluids
Frequent voiding (esp post-sex)
Avoid spermicides
Avoid constipation

CP3 Medicine (7 decks)

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