Nephrology (Week 14) Flashcards
Name three functions of the kidney
- Waste excretion
- Control solutes and fluid status
- Endocrine function
What kidney function test is commonly done in diabetes patients?
Albumin: creatinine ratio
What eGFR defines stage 2 kidney disease?
60-89
What stage of kidney disease does an eGFR of 15-29 represent?
Stage 4
What eGFR is related to stage 5 renal disease
eGFR <15
What kind of kidney disease is eGFR measurement not suitable in?
Acute Kidney Injury
What is urea?
A tissue breakdown product
What % of GFR has to be lost before serum creatinine drops?
50%
What is the function of mesangial cells?
Control the matrix between capillaries
In a kidney biopsy, what site is a sample taken from?
The cortex of the left kidney
Name 3 symptoms of glomerulonephritis
- Visible haematuria
- Nephrotic syndrome
- Nephritic syndrome
Name the three main features of nephrotic syndrome
- 3.5 proteinuria per 24hr
- Serum albumin <30
- Oedema
Name the three main features of nephritic syndrome
- Hypertension
- Blood and protein in urine
- Declining kidney function
Define IgA nephropathy
Deposition of IgA in mesangial cells which disrupts the filtration barrier
Which antibody is present in 70% of patients with membranous glomerulonephritis?
Anti-phospholipase A2 receptor antibody
What anatomical change happens in the nephron in type I minimal change disease?
Podocytes fuse together
What is the treatment for type II minimal change disease?
High dose steroid
Name three types of management for renovascular disease
- BP control (NOT ACEI/ARB)
- Statin
- Angioplasty (if rapidly deteriorating renal failure)
What does blood and protein in the urine indicate?
That the pathology is probably of glomerular origin
What is vesico-ureteric reflux?
Retrograde passage of urine from bladder to upper urinary tract
Name three common causative organisms in pyelonephritis
E coli
Klebsiella
Pseudomonas
Name three symptoms of Upper UTIs
Rigors
Vomiting
Abdominal pain
Name three symptoms of lower UTIs
Dysuria
Frequency
Haematuria
Which two genetic mutations can be seen in adult polycystic kidney disease?
PKD 1 (85% of cases) PKD 2 (15% of cases)
Briefly describe the pathophysiology of ADPKD
Cysts gradually enlarge in the kidneys and normal tissue is replaced
What is the diagnostic criteria for a 30-59 for polycystic kidney disease?
2 cysts in each kidney
Define AKI
Decline in renal excretory function over hours of days with rise in serum urea and creatinine
What urine output is classed as oliguria?
<400ml or 500ml per 24hr in adults
Name 2 pre-renal causes of AKI
Hypovolaemia
Diarrhoea
Name 2 renal causes of AKI
GN
Drugs
Name 1 post-renal cause of AKI
Kidney stones
How do NSAIDs affect the afferent arteriole of the glomerulus?
They inhibit prostaglandins which normally dilate the afferent arteriole
What level of potassium is classed as a medical emergency?
K >6.5
What treatments would be given to correct hyperkalemia?
Calcium Resonium (decrease gut absorption)
Insulin + dextrose (encourage K+ to move into cells)
Name three causes of CKD
Diabetic nephropathy
Renovascular disease
ADPKD
Name 2 signs of advanced CKD
Pericardial rub
Peripheral oedema
Name the 5 indications for RRT
- Medically resistant hyperkalaemia
- Medically resistant pulmonary oedema
- Medically resistant acidosis
- Uraemic pericarditis
- Uraemic encephalopathy
What is the average eGFR when dialysis would be commenced?
7ml/min
How would you treat a UTI in pregnancy?
7-10 days of Amoxicillin and Cefalexin
What organisms typically cause epididymitis?
Gram negatives e.g. enterococci and staphylococci
What is Fournier’s gangrene?
A form of necrotising fasciitis affecting the external genitalia
Which three points in the ureters are narrower than the rest?
Ureteropelvic junction
Crossing iliac artery
Ureterovesical junction
Which type of kidney stones are produced in patients who have an inherited predisposition to excrete certain amino acids?
Cysteine stones
Why are females less likely to develop kidney stones?
Because they have higher levels of citrate which are inhibitory of stone formation
List the ‘Sepsis 6’
TAKE:
- blood cultures
- measure lactate
- measure urine output
GIVE:
- O2 to keep sats >94%
- Fluid challenge
- IV antibiotics
What are staghorn calculi?
Branched stones in the renal pelvis
What is active surveillance in prostate cancer?
Patient’s fit to be cured with a life expectancy over 10 years
List three risks of bladder cancer
Smoking
Male
Caucasian
What does TURBT mean?
Transurethral resection of bladder tumour
What is the classical triad of renal cancer?
Mass
Pain
Haematuria
Name 3 useful tumour markers in testicular cancer
Alpha-fetoprotein
Beta hCG
LDH
Which 3 types of HPV virus have been implicated in penile cancer?
HPV 16, 18, 21
What is diurnal urinary frequency?
Tubular function affected so most urine is passed at night
What test is the best measure of kidney function in the acute setting?
Urine volume
Which three tests are the most important in renal disease patients in general?
Urine dipstick
U and E’s
Kidney ultrasound
Name 3 features of hyperkalaemia on ECG
Tall tented T waves
P wave absence
Abnormal QRS complex
