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Year 4 PassMed Incorrect Qs > Renal 1 > Flashcards

Renal 1 Flashcards

1
Q

Cranial diabetes insipidus vs Nephrogenic diabetes insipidus

What can you see in urine and serum osmolality?

What happens following water deprivation test?

What happens after giving desmopressin (synthetic ADH)

A

Both have low urine osmolality and high serum osmolality

Water deprivation- Both types the urine osmolality remain low.

Desmopressin (synthetic ADH)
Cranial- Causes serum osmollaity to decrease and urine osmolaity to increase

Nephrogenic will have no change in

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2
Q

In HLA testing family members for donor of renal transplant- which antigen is most important? Then 2nd and 3rd most important?

A
  1. HLA-DR
  2. HLA- B
  3. HLA- A
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3
Q

Diagnostic test for diabetes insipidus?

A

Water deprivation test

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4
Q

Nephrogenic diabetes insipidus

What medications can induce it? (2)

What electrolyte changes can cause it? (2)

Genetic causes MOA? (2)

Other rogue interstitial disease causes (3)

A

Lithium
Demeclocycline (tetracycline)

  • Hypercalcaemia
  • Hypokalaemia
  • Most are due to ADH receptor not working
  • Less common due to mutation in gene which affects aquaporin 2 channel

Other
- Sickle cell
- Pyelonephritis
- Obstruction

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5
Q

CKD induced anaemia, give erythropoetin

SE of erythropoetin? (3)

A

Bone aches, flu-like symptoms and skin rashes

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6
Q

USS findings of chronic diabetic nephropathy vs CKD

A

Chronic diabetic- Bilateral large/ normal

CKD- Bilateral small kidneys

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7
Q

Management of post-renal AKI due to acute clot retention?

A

Continuous bladder irrigation via a 3-way urethral catheter

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8
Q

CKD anaemia management
Target Hb =

  1. FIRST….

Situation 1:

Situation 2:

  1. Give…. If….
A

Target Hb = 10-12g/dl

  1. FIRST…. optimise iron status
  • If not on erythropoiesis-stimulating agents (ESA) or haemodialysis then give ORAL IRON- if not reached target in 3 months then give IV iron.
  • If on ESA or haemodialysis then give IV Iron
  1. Give ESA such as erythropoietin and darbepoetin if they’re likely to benefit from it
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9
Q

What does renal tubular acidosis look like on ABG?
+ electrolyte
+ electrolyte

Compared this with DKA, Salicylate and methanol and Sepsis

A
  1. Metabolic acidosis
    (Acidotic low bicarb becuase its being used up, no resp change)
  2. NORMAL ANION GAP- 6-16mmol/L
  3. Hypercholaemia
  4. Hypokalaemia

All 4 of DKA, Salicylate and methanol and Sepsis cause a raised anion gap

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10
Q

What should you do for someone who needs a CT contrast but who has CKD?

How much to do you give/ what rate?

What should you do if on metformin and why?

A

Need to give saline 0.9% to dilute the contrast which is nephrotoxic and can cause AKI in a CKD patient.

How much to do you give?
Rate of 1ml/kg per hour over 12 hours

Withold metformin for 48hrs and until renal function is proven normal- decrease risk of lactic acidosis

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11
Q

Alport Syn

What is it?

Genetic pattern?

What is the classic Q/ scenario with this syn?

A

Defect in gene which codes for type IV collagen- abnormal glomerular-basement membrane. The disease is more severe in males

inherited in an X-linked dominant pattern

classic Q:
an Alport’s patient with a failing renal transplant. This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture’s syndrome like picture.

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12
Q

Alport Syn

Features: Usually child (4)

Diagnosis via genetic testing and what would you see on renal biopsy/ STEM?

A

Features: Usually child
1. microscopic haematuria
2. progressive renal failure
bilateral
3. sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
4. retinitis pigmentosa

renal biopsy
electron microscopy: characteristic finding is of the longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance

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13
Q

Someone on haemodialysis for CKD, what are they most likely to die from?

A

IHD

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14
Q

WHat drug raises CK and makes you think there is rhabdomyolysis when there isn’t?

A

Statins- induced myopathy (Usually 2-4 times the normal CK range if just started on statin).

Think Rhabdomyolysis when x5 normal range (1500/1600)

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15
Q

DRugs to withold in AKI
DAAAMN

A

D- Diuretics
A- ACEi
A- Aminoglycosides (gentamicin, neomycin etc.)
A- ARB
M- Metformin
N- NSAIDs (unless Aspirin 75mg which is low and for anti-platelet CVD purposes)

SGLT-2 inhibs?
Sulphonylureas?

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16
Q

How do you work out anion gap?

What is a normal anion gap?

A

(Na+ + K+) - (Bicrab + Cl-)

Normal - 8-14mmol/L (6-16)

17
Q

WHich pathogen is most common assoc. with peritonitis secondary to peritoneal dialysis

A

Coagulase-negative Staphylococcus (Staph Epidermis)

18
Q

What variables do you look at in estimated eGFR using Modification of Diet in Renal Disease (MDRD) equation? (4)

A

CAGE
Creatinine (serum), Age, Gender, Ethnicity

19
Q

How can anaemia present (linked to ckd)

3 classic but 1 strange

A
  1. tachycardia,
  2. fatigue,
  3. pallor
  4. an aortic flow murmur- its soft and doesn’t radiate, its due to blood being thin allowing it to flow differently and thereby result in an abnormal added heart sound, particularly in the aortic region.
20
Q

What does diarrhoea look like on ABG
What does vom look like on ABG

A

Diarrhoea- normal anion gap metabolic acidosis

Vom- metabolic alkalosis (lose H+)

21
Q

What type of haemorrhage are you at risk with with Adult polycystic kidney disease

A

Subarachnoid- ue to ruptured berry aneurysms

22
Q

Management of Hyperkalaemia:

If K+ is…. Or ….
1.
2.
3.
4.

A

If K+ > 6.5 mmol/l or if there are ECG changes:

  1. Calcium gluconate 10% 10-20ml by slow IV injection titrated to ECG response
  2. Give 10 U Actrapid in 50 ml of 50% glucose over 10-15 minutes
  3. Consider correcting acid base balance with sodium bicarbonate
  4. Consider Salbutamol
23
Q

Medications which cause acute interstitial nephritis
(5)
See what
in blood?

A
  1. Rifampicin
  2. penicillins
  3. NSAIDs
  4. allopurinol
  5. furosemide

Eosinophilia

24
Q

Causes of acidosis NORMAL anion gap ( a Danny B)

A

A BAD D

A- Acidosis renal tubular
B- Bicarbonate loss
A- Addisons disease
D- Diarrhoea

D- Drugs? (Acetazolamide)
H-Hyperchloraemia

25
Q

How can you tell if it is a pre-renal AKI or renal AKI from the Cr: Urea ratio?

A

A
Pre-renal- Kidneys working fine hust not gettng the vol, therefore Urea is being reabsorbed and Cr is being extreted (Normal). Cr will be less than Urea

In renal such as Acute tubular necrosis or Acute interstitial nephritis kidneys aren’t functioning. can’t reabsorb the urea - so the value becomes low and they can’t excrete the creatinine - so the value goes up

Other way to work out Cr: Urea ratio is Divide the creatinine by 10, if the urea is higher than that then think prerenal cause.

In this case creatinine was 123 umol/L and urea was 16.1mmol/L.

16.1 > 12.3 so consider prerenal disease.

26
Q

What would you see on ABG due to severe diarrhoea and why? ie. in Crohns

A

Metabolic acidosis with hypokalaemia

Loss of bicarb from the GI tract therefore turn acidotic.

Hypokalaemia as potassium is lost through an intracellular shift

27
Q

CKD anaemia- why would someone not respond to erythropoetin therapy?

  1. 1 main!
    2.
    3.
    4.
    5.
A
  1. Iron deficiency anaemia (ed sore tongue is known as glossitis, the red dry patches at the corner of the mouth are known as angular stomatitis, the flattened thin nails koilonychia, brittle hair)
  2. Inadequate dose
    concurrent
  3. infection/inflammation
  4. hyperparathyroid bone disease
  5. aluminium toxicity
28
Q

Maintenance fluids:

What is needed for

Fluids/ water

K+
Cl-
Na+

Glucose

Therefore for an 80 kg person over 6 hours what do they need?

2 KEY POINTS WHEN USING 0.9% NaCl and Hartmanns

A

Fluids/ water- 25-30/ml/kg/day

K+- 1mmol/kg/day
Cl– 1mmol/kg/day
Na+- 1mmol/kg/day

Glucose 50-100g/day

Fluid- 80 x 25 = 2L in 24 hrs, Divide by 4 = 500ml
K+/Cl-/Na+- 80/4= 20
Glucose- 50 x 80= 400 (divide by 4 =100)

0.9% in large volumes can induce risk of hyperchloraemic metabolic acidosis

Hartmans contains K+ and should not be used if hyperkalaemic

29
Q

Someone with CKD but needs a contrast CT-what do you give and how much?

A

intravenous 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure

30
Q

What casts do you see in acute interstitial nephritis

A

Sterile pyuria and white cell casts in the setting of rash and fever should raise the suspicion of acute interstitial nephritis, which is commonly due to antibiotic therapy

31
Q

What drug can you KEEP in AKI and why?

when should metformin be stopped?

A

Aspirin at LOW DOSE!! (previous MI)

Metformin- stop if eGFR < 30
(lactic acidosis)

32
Q

What can INVALIDATE an eGFR-
Someones is low with no PM Hx or meds
1.
2.

A
  1. Eating red meat the evening before a blood test can invalidate eGFR result
  • due to creatinine in the meat.
  1. preg
  2. Muscle mass- (amputated limb, BODY BUILDER!)
33
Q

MILd hyperkalaemia (5.9) just do ECG and then repeat bloods to see
- If any abnormalities then begin to treat

A
34
Q

Patients with CKD should be started on an…. if….

A

ACEi if their ACR > 30

start a statin and alternative for naproxen

35
Q

In an ASYMPTOMATUC patient- how do you screen for CKD in a diabetic?

A
  1. ACR on spot urine sample
  2. If abnormal then do a first pass the next morning repeat
36
Q

prescibing fluids with dextrose in how much g of glucose do you give?!

A

glucose requirement is 50-100 g/day irrespective of the patient’s weight!!!!

36
Q

prescibing fluids with dextrose in how much g of glucose do you give?!

A

glucose requirement is 50-100 g/day irrespective of the patient’s weight!!!!

37
Q

when do you refer to nephrologist for CKD? (2)

A
  1. eGFR <30
    or
  2. DECREASE eGFR of > 15 in a year
  3. ACR) of 70 mg/mmol or more (not if proteinuria is known to be assoc. with D.M and approp managed)
  4. ACR of 30 mg/mmol or more together with persistent haematuria, after exclusion of a urinary tract infection (UTI).
  5. Tx resistant HTN
  6. suspect APCKD
  7. Suspect renal A stenosis
  8. suspect complication with CKD
38
Q

If you’ve had lost of diarrhoea and over the course of the day had lots of 0.9% NaCl infusions to replace, what would you see on ABG?

A

Metabolic acidosis
- high Cl- (from fluid IV)
- low K+ (lost from bowel)

Year 4 PassMed Incorrect Qs (37 decks)

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