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FINALS > NEPHROLOGY > Flashcards

NEPHROLOGY Flashcards

1
Q

What is ADPKD?

A

Inherited kidney disease

Chromosome 16 (85%) 4 (15%)

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2
Q

What are the features of ADPKD?

A

USS shows cysts, diagnostic criteria:

  • two cysts, unilateral or bilateral if <30y/o
  • two cysts in both kidneys if 30-59 y/o
  • four cysts in both kidneys if >60y/o
HTN
Recurrent UTI
Abdominal pain
Renal stones
Haematuria
CKD (can result in renal carcinoma)
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3
Q

What are the extra-renal manifestations of ADPKD?

A
  • Liver cysts
  • Berry aneurysms
  • CVS
    Mitral valve incompetence/prolapse
    Aortic root dilation and dissections
  • Cysts in other organs e.g. pancreas
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4
Q

What is ARPKD?

A

Chromosome 6

Multiple cylindrical lesions at right angles to the cortical surface

Features in the newborn
Prenatal USS or early infancy with abdominal masss
- Polyuria and polydypsia
- HTN

End stage renal failure usually by 15
Liver involvement

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5
Q

What is Renal Cell Carcinoma?

A

Arises from PCT epithelium
Circumscribed by psuedocapsule of compressed normal renal tissue

20% Multifocal
20% Calcified
20% Cystic

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6
Q

How is Renal Cell Carcinoma managed?

A

Radical nephrectomy
Resistant to R+Ch
Biologics: a-interferon

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7
Q

How is Osmolality calculayed?

A

2 (Na+K) + GLucose + Urea

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8
Q

What is Acute Kidney Injury?

A

Rapid fall in kidney function over hours to days

Rise in serum urea and creatinine

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9
Q

What are the Pre-Renal causes of AKI?

A

Hypoperfusion:

Hypotension:

  • Hypovolaemia
  • Sepsis

Renal Artery stenosis:
-ACEi

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10
Q

What are the Intra-Renal causes of AKI?

A

Interstitial:

  • Lymphoma
  • Infection
  • Tumour lysis after chemo
  • Drugs

Glomerular:

  • AI - SLE
  • Drugs
  • Infection
  • Primary Glomerulonephritides
Nephrotoxins:
- Drugs - Aminoglycosides
- Radiocontrast
- Myoglobin
- Acute Tubular Necrosis 
Myeloma and Hypercalcaemia

Vascular:

  • Vasculitis
  • Malignant HTN
  • Thrombus or Cholesterol Emboli from Angiography
  • HUS/TTP
  • Large vessel occlusion
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11
Q

What are the causes of post-renal AKI?

A

Luminal:

  • Stones
  • Clots
  • Sloughed papilale

Mural:

  • Malignancy
  • BPH
  • Strictures

Extrinsic compression:

  • Pelvic malignancy
  • Retroperitoneal fibrosis
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12
Q

What are the risk factors for AKI?

A 
>75 y/o
CKD
Heart Failure
Peripheral Vascular Disease
Chronic liver disease
Diabetes
Drugs
Sepsis
Reduced Hypovolaemia 
Other urinary issues
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13
Q

What are the features of AKI?

A

Maintain fluid balance:

  • Reduced BP
  • Non-visible JVP
  • Increased pulse

Hyperkalaemia

Uraemic Encephalopathy

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14
Q

What is KDIGO

A

1
SC: >2.6umol or >1,5x in 48 hours
UO: <0.5ml/kg/hr over 6 hours

2
SC: 2-2.9x baseline
UO: < 0.5ml/kg/hr over >12hours

3
SC: >3x baseline
UO: <0.3ml/kg >24 or 0 for 12 hours (Anuria)

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15
Q

What is Chronic Kidney Disease?

A

irreversible sometimes progressive loss of renal function over >3months to years

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16
Q

How is eGFR calculated?

A

MDRD =eGFR= 175 x Serum Creatinine x Age x 0.742 if F x 1.212 if black

175
Creatinine
Age
Gender (women get paid 0.742)
Ethnicity 1.212 (iggy azalea is black)
s

Affected by: pregnancy, muscle mass, eating red meat 12 hours prior

Also test with USS <9cm (shrink) and Biopsy

17
Q

What are the causes of Chronic Kidney Disease?

A

Diabetic Nephropathy

Chronic Glomerulonephritis (e.g. IgA)

Chronic pyelonephritis and Reflux Nephropathy

HTN (Furosemide or endovascular disease)

Adult polycystic kidney disease

Alport’s

18
Q

What are the complications of CKD?

A

Oedema

Restless legs

Acidosis

Bones
- Reduced vitamin D (OSTEOMALACIA) increased Phosphate Hypercalcaemia leading to SECONDARY HYPERPARATHYROIDISM (increased PTH) > Stage 3 - Osteitis Fibrosa Cystica -> Brown Tumour
OSTEOSCLEROSIS
OSTEOPOROSIS

Anaemia
- Reduced Erythropoetin
- Reduced iron absorption
- Reduced RBC survival especially in Haemodialysis
- Uraemia is toxic to bone: reduced erythropoesis
NORMOCHROMIC NORMOCYTIC ANAEMIA

19
Q

What are the stages of CKD?

A

1: >90ml/min + other signs of damage
2: 60-90 + other signs
3a: 45-59
3b: 30-44
4: 15-29 severe reduction
5: <15 kidney failure

<10 ml immediate dialysis
(<15 in diabetics)

20
Q

What is SIADH?

A

Hyponatraemia secondary to excessive water retention

Concentrated urine with Na+ >20mmmol/L and osmolality >100moskg

Plasma Na+ <125 and osmolality <260

In the absence of hypovolaemia, oedema or diuretics

21
Q

What can cause SIADH?

A

Malignancy:

  • Small cell lung cancer
  • Pancreas
  • Prostate

Infections:

  • TB
  • Pneumonia

Drugs:

  • SSRIs/Tricyclics
  • Carbemazapine
  • Cyclophasphamides

Neurological:

  • Stroke
  • Subaracchnoid haemorrhage
  • Subdural
  • Meningitis
  • Abscess
22
Q

How is SIADH managed?

A

Correction should be SLOW to avoid precipitating CENTRAL PONTINE MYELINOSIS

  • Fluid restriction
  • ADH receptor antagonists: DEMECLOCYCLINE
23
Q

What are the types of renal stones?

A

CALCIUM OXALATE

CYSTINE

URIC ACID

STRUVATE

CALCIUM PHOSPHATE

24
Q

Calcium Phosphate stones

A

10%
In Type 1 and 3 Renal Tubular Acidosis

High urinary pH i(>5.5) ncreases supersaturation of Calcium and Phosphate

Radio-opaque like bone

25
Q

Calcium Oxalate stones

A

85%
HYPERCALCURIA, HyperOXALURIA, HypOCITRATURIA (citrate usually complexes with Ca2+ to increase solubility)
Variable pH

Stones are radio-opaque but not as opaque as Calcium Phosphate stones

Give CHOLESTYRAMINE and PYROXIDIEN to reduce urinary OXALATE secretion

26
Q

Uric Acid stones

A

10%
Low urinary pH
PURINE METABOLISM in diseases with extensive TISSUE BREAKDOWN and children with METABOLIC DISORDERS

Radiolucent

ALLOPURINOL and URINARY ALKALISATION e.g. with BICARBONATE

27
Q

Struvite stones

A

20%
Alkaline urine >7.2
Crystals precipitate
Caused by UREASE PRODUCING BACTERIA (e.g. Chronic UTIs)

Slightly Radio opaque

Magnesium + Ammonium + Phosphate

28
Q

Cystine stones

A

1%

A.R Transmembrane cystine: reduced absorption of cystine from intestine and reanl tubus

Semi-radiodense ‘ground gladd’

Normal pH, may have lots of stones

29
Q

How are renal stones detected on imagine?

A
  • USS

- Non-contrast CTKUB (kidneys, ureters, bladder)

30
Q

How are renal stones managed?

A
  • Diclofenac for analgesia
  • a-adrenergic blockers to aid passage
  • Stones >5mm usually pass spontaneously, if not…

Shock-wave lithotripsy <2cm
Ureteroscopy <2cm in pregnancy
Percutaneous nephrolithotopy

31
Q

What are staghorn stones?

A

Struvite: complex, involve the renal pelvis and extend into > 2 calyces

FINALS (13 decks)

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