Passmed renal Flashcards
How does muscle breakdown cause renal failure (eg after long time on floor after fall)
Rhabdomyolysis -Myoglobinuria -> tubular cell necrosis
How do drugs cause renal faulure
induce apoptosis
Maintenance fluids for adult ?
Maintenance K?
25-30ml/kg/day
1mmol/kg/day
Organism for HUS ?
Name 1 non infectivee cause
E coli
tumours
pregnancy
ciclosporin, the Pill
systemic lupus erythematosu
HUS triad
acute renal failure
microangiopathic haemolytic anaemia
thrombocytopenia
What if
renal failure, sensorineural hearing loss and ocular abnormalities develop in a child
Alport syndrome
What will exam q often give if need to calculate anion gap?
how do you do it?
Cl
=(Na + K) - (Cl + HCO3)
Acidosis with normal anion gap =? name 2 causes
= hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
young female patients who develop AKI after the initiation of an ACE inhibitor?
Seen on imaging?
fibromuscular dysplasia
string of beads’ appearance.
Most common virus in organ transplant
cytomegalovirus
3 comps post renal transplant
Ca - due to immune supression Esp Basal / squamous skin Ca
Renal failure - ciclosporin/graft rejection/recurrenc
Cardiovascular disease - due to meds
Name 2 differences between IgA nephropathy and post strep glomerulonephritis
IgA - 1-2days after URTI
Can get frank haematuria
Pos t stret - 1-2 weeks
proteinuria
Usual screening for PKD
USS
name 2 parts of Mx hyper k
Stabilisation of the cardiac membrane
intravenous calcium gluconate
Short-term shift in potassium from extracellular to intracellular fluid compartment
combined insulin/dextrose infusion
nebulised salbutamol
Removal of potassium from the body
calcium resonium (orally or enema)
loop diuretics
dialysis
Basics of cranial vs nephrogenic DI
Cranial - dont produce enough vasopressin
neph - kidneys dont respond to vassopressin
Mx nephrogenic DI
thiazide like diuretic
Mx HUS
Supportive - e.g. Fluids, blood transfusion and dialysis if required
DI plasma vs urine osmolality
high plasma osmolality
and a low urine osmolality
Dx of DI
water deprivation test
Ix for diabetic nephropathy
albumin:creatinine ratio (ACR) in early morning
55-year-old man presenting with progressive weakness and dyspnoea, hepatomegaly, proteinuria and worsening renal function.
amyloidosis
Stain for amyloid?
congo red staining - apple -green birefringence
urea / creatinine in dehydration
urea that is proportionally higher than the rise in creatinine
Persistent pyuria and negative urine culture
Renal TB
Mx of hyperK
IV calcium gluconate
Indication that renal disease is chronic and not acute?
hypocalcaemia
[Due to reduced synthesis of vit D -> less Ca reabsorption]
Bilat small kidneys on USS
Signs of drug induced nephritis
Raised urinary WCC/IgE/Eosiniphils
Fever
Rash
Arthralgia
Seen on biopsy of wegners / good pastures / SLE …[Rapid progressive glomerulonephritis]
Crescentic glomerulonephritis
Pre/intra/post renal if dip has protein
only Intra
Acute interstitial nephritis vs Acute tubular necrosis on dip
nephritis is inflammatory process -> higher white cell content in the urine
A 55-year-old man presents with a one month history of fever, arthralgia and lethargy. He also recently developed haemoptysis and dyspnoea. Investigations show that he has an acute kidney injury. ANCA (anti-neutrophil cytoplasmic antibody) is negative.
Que es?
anti gbm
tachycardia, fatigue, pallor and an aortic flow murmur in CKD
anaemia
Why does nephrotic syndrome predispose to thrombus
Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels
How to differentiate kidneys not getting enough blood (pre-renal) and Acute tubular necrosis?
The job of the kidneys is to take blood, remove all the shite from it and make concentrated urine.
So if the urine osmolality = plasma osmolality then you know that the kidneys are knackered.
But if the urine osmolality > plasma, then you know the kidneys themselves are fine but they’re just not getting enough blood.
A 4-year-old boy with recurrent urinary tract infections is referred to the paediatric team due to worries over reflux nephropathy.
Key Ix?
micturating cystography
drug causing rhabdomyolysis?
statin
Urinary sodium in pre-renal vs intra renal
pre renal is low Urinary as kidneys try and hold onto sodium to increase blood volume
