Renal 1 Flashcards
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)
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
In HLA testing family members for donor of renal transplant- which antigen is most important? Then 2nd and 3rd most important?
- HLA-DR
- HLA- B
- HLA- A
Diagnostic test for diabetes insipidus?
Water deprivation test
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)
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
CKD induced anaemia, give erythropoetin
SE of erythropoetin? (3)
Bone aches, flu-like symptoms and skin rashes
USS findings of chronic diabetic nephropathy vs CKD
Chronic diabetic- Bilateral large/ normal
CKD- Bilateral small kidneys
Management of post-renal AKI due to acute clot retention?
Continuous bladder irrigation via a 3-way urethral catheter
CKD anaemia management
Target Hb =
- FIRST….
Situation 1:
Situation 2:
- Give…. If….
Target Hb = 10-12g/dl
- 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
- Give ESA such as erythropoietin and darbepoetin if they’re likely to benefit from it
What does renal tubular acidosis look like on ABG?
+ electrolyte
+ electrolyte
Compared this with DKA, Salicylate and methanol and Sepsis
- Metabolic acidosis
(Acidotic low bicarb becuase its being used up, no resp change) - NORMAL ANION GAP- 6-16mmol/L
- Hypercholaemia
- Hypokalaemia
All 4 of DKA, Salicylate and methanol and Sepsis cause a raised anion gap
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?
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
Alport Syn
What is it?
Genetic pattern?
What is the classic Q/ scenario with this syn?
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.
Alport Syn
Features: Usually child (4)
Diagnosis via genetic testing and what would you see on renal biopsy/ STEM?
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
Someone on haemodialysis for CKD, what are they most likely to die from?
IHD
WHat drug raises CK and makes you think there is rhabdomyolysis when there isn’t?
Statins- induced myopathy (Usually 2-4 times the normal CK range if just started on statin).
Think Rhabdomyolysis when x5 normal range (1500/1600)
DRugs to withold in AKI
DAAAMN
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?
How do you work out anion gap?
What is a normal anion gap?
(Na+ + K+) - (Bicrab + Cl-)
Normal - 8-14mmol/L (6-16)
WHich pathogen is most common assoc. with peritonitis secondary to peritoneal dialysis
Coagulase-negative Staphylococcus (Staph Epidermis)
What variables do you look at in estimated eGFR using Modification of Diet in Renal Disease (MDRD) equation? (4)
CAGE
Creatinine (serum), Age, Gender, Ethnicity
How can anaemia present (linked to ckd)
3 classic but 1 strange
- tachycardia,
- fatigue,
- pallor
- 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.
What does diarrhoea look like on ABG
What does vom look like on ABG
Diarrhoea- normal anion gap metabolic acidosis
Vom- metabolic alkalosis (lose H+)
What type of haemorrhage are you at risk with with Adult polycystic kidney disease
Subarachnoid- ue to ruptured berry aneurysms
Management of Hyperkalaemia:
If K+ is…. Or ….
1.
2.
3.
4.
If K+ > 6.5 mmol/l or if there are ECG changes:
- Calcium gluconate 10% 10-20ml by slow IV injection titrated to ECG response
- Give 10 U Actrapid in 50 ml of 50% glucose over 10-15 minutes
- Consider correcting acid base balance with sodium bicarbonate
- Consider Salbutamol
Medications which cause acute interstitial nephritis
(5)
See what
in blood?
- Rifampicin
- penicillins
- NSAIDs
- allopurinol
- furosemide
Eosinophilia
Causes of acidosis NORMAL anion gap ( a Danny B)
A BAD D
A- Acidosis renal tubular
B- Bicarbonate loss
A- Addisons disease
D- Diarrhoea
D- Drugs? (Acetazolamide)
H-Hyperchloraemia
