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Renal & Urology > PassMedicine > Flashcards

PassMedicine Flashcards

1
Q

def of acute kidney injury

A

AKA acute renal failure

reduction in renal function

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2
Q

what is the inpatient mortality of AKI in the UK

A

25%

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3
Q

what are the causes of AKI divided into

A

1 prerenal
2 intrinsic
3 post renal

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4
Q

what are the prerenal causes of AKI

A

lack of blood flow to kidnets
1 hypovolaemia (secondary to D/V)
2 renal artery stenosis

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5
Q

what are the intrinsic causes of AKI

A 
damage to kidney itself
1 glomerulonephritis
2 acute tubular necrosis
3 acute interstitial nephritis
4 rhabdomyolysis
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6
Q

what are the postrenal causes of AKI

A

obstruction causing urine to ‘back-up’
1 kidney stones in ureter or bladder
2 benign prostatic hyperplasia
3 external compression of ureter

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7
Q

risk factors of AKI

A

1 chronic kidney disease
2 heart failure/DM
3 history of AKI
4 nephrotoxic drugs

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8
Q

what drugs have nephrotoxic potential

A

NSAIDs
aminoglyclosides (gentamicin, streptomycin)
ACE inhibitors + ARBs
diuretics

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9
Q

symptoms and signs of AKI

A

reduced urine output
pulmonary/peripheral oedema
arrythmias (due to change in potassium)

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10
Q

how is AKI detected

A

1 rise in serum creatinine >26micromol/l in 48h
2 >50% rise in serum creatinine in last 7 days
3 a fall in urine output to <0.5ml/kg/hr for >6hrs

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11
Q

what drugs are used in hyperkalaemia treatment

A 
1 IV calcium gluconate
2 combined insulin/dextrose infusion
3 nebulised salbutamol
4 calcium resonium
5 loop diuretics
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12
Q

how does combined insulin/dextrose infusion and nebulised salbutamol work against hyperkalaemia

A

causes short-term shift of K form extracellular to intracellular

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13
Q

how do calcium resonium and loop diuretics work against hyperkalaemia

A

removal of K from body

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14
Q

what must be stopped in AKI which due to increased risk of toxicity (but doesnt usually worsen AKI itself)

A

metformin
lithium
digoxin

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15
Q

what happens to H+ levels as K+ rises

A

hyperkalaemia is associated with acidosis because as potassium levels rise, fewer H+ ions enter the cells

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16
Q

what are causes of hypokalaemia with alkalosis

A

vomiting
diuretics
Cushings + Conns

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17
Q

A 35-year-old man presents with severe, episodic loin pain which radiates round to the front. He has blood+++, leucocytes ++ on the urine dipstick

A

renal colic

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18
Q

what is usually safe to continue in AKI

A 
paracetamol
warfarin
statins
aspirin
clopidogrel
BBs
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19
Q

what is primary hyperaldosteronism associated with

A

hypokalaemia

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20
Q

what stimulates ADH release

A

angiotensin II

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21
Q

what increases Na reabsorption in the renal distal tubule

A

aldosterone

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22
Q

what increases proximal tubule Na/H activity

A

angiotensin II

23
Q

what is Granular appearance on immunofluorescence associated with

A

post-streptococcal glomerulonephritis
SLE nephropathy (class IV)
membranous glomerulonephritis

24
Q

what can blood in the urine be split up into

A

microscopic

macroscopic

25
Q

what does blood throughout voiding the bladder indicate

A

bleeding from bladder

26
Q

what does blood at the end of voiding indicate

A

bleeding from terminal bladder or prostatitis

27
Q

what are the two main causes of glomerulonephritis

A

IgA nephropathy

beurgers disease

28
Q

what would you see in bloods with addisons

A

low Na

high Ka

29
Q

what is the main cause of acute tubulointerstitial nephritis

A

drug hypersensitivity due to penicillin or NSAIDs

30
Q

what are the symptoms of acute tubulointerstitial nephritis

A

fever
rash
painful joints

31
Q

what would you expect urine output to be like with renal failure

A

oliguria ( decreased urine output)

32
Q

what is the triad of nephrotic syndrome

A

proteinuria
low serum albumin
oedema

33
Q

what is the 1st line treatment for nephrotic syndrome

A

low Na diet

diuretics

34
Q

what is characteristic of nephritic syndrome

A

haematuria
proteinuria
HTN
oedema

35
Q

what does TB of the kidney present with

A

haematuria
polyuria
nocturia

36
Q

what would you expect to see in the urine with diabetic nephropathy

A

proteinuria

not haematuria

37
Q

what is the triad of renal cell cancer

A

haematuria
flank pain
abdominal/flank mass

38
Q

what is renal cell cancer also called

A

von grawitz tumour

39
Q

what are symptoms of hypercalcaemia

A

increased urinary frequency, nocturia, constipation, polydipsia

40
Q

what does bleeding throughout voiding indicate

A

lesion in bladder or above

41
Q

what does bleeding at end of voiding indicate

A

terminal bladder or prostate lesion

42
Q

what does bleeding at start of voiding indicate

A

urethral lesion

43
Q

what causes tubulointerstitial nephritis

A

hypersensitivity reactions to drugs such as penicillin or NSAIDs

44
Q

what is the first line imaging for renal stones

A

KUB USS

45
Q

what is the gold standard for renal stones

A

CT

46
Q

what drugs are safe to use in pregnancy

A

penicillins + cephalosporins

47
Q

what are features of tubulointerstitial nephritis

A

anaemia
UTI
haematoma

48
Q

what is the gold standard investigation for renovascular disease

A

renal arteriography

49
Q

what is associated with Wegeners

A

cANCA

50
Q

what is the most appropriate investigation for detecting EARLY renal impairment

A

microalbuminuria

51
Q

how does renal failure cause secondary hyperparathyroidism

A

renal failure causes decreased Ca resorption and decreased PO4 excretion, this leads to low Ca and high PO4
low Ca causes a increase in PTH (secondary hyperparathyroidism) to compensate for the low Ca
PTH causes resorption which increases Ca to normal and increases PO4 causing hyperphosphataemia

52
Q

what causes acute tubular necrosis

A

ischaema or nephrotoxins

53
Q

what are features of acute tubular necrosis

A

will cause renal impairment and low urine output

later on it will recover and then increase urine output to greater than normal for a transient period

Renal & Urology (18 decks)

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