Renal Flashcards
1
Q
What is the normal anion gap?
A
8-12mmol/l
2
Q
Give 3 symptoms of HYPERnatraemia
A
Thirst
Irritability
Weakness
3
Q
Give two causes of HYPOvolaemic HYPERnatraemia
A
Loop Diuresis (Renal Loss) Burns (Non Renal Loss)
4
Q
Give two causes of EUvolaemic HYPERnatraemia
A
Diabetes Insipidus
Hypodipsia
5
Q
Give two causes of HYPERvolaemic HYPERnatraemia
A
Hypertonic Dialysis
Cushings
6
Q
What is the triad of Diabetes Insipidus?
A
Polydipsia, Polyuria, Dilute Urine
7
Q
Give two causes of Central DI
A
TB
Sarcoidosis
8
Q
Give two causes of Nephrogenic DI
A
Congenital
Drugs (Lithium, Amphoterecin, Demeclocycline)
9
Q
What three investigation results would prove DI
A
Serum Osmolality>295
Urine Osmolality<300
Water Deprivation test causes weight loss
10
Q
Using the mnemonic SALT LOSS, what are the features of HYPOnatraemia?
A
Stupor, Anorexia, Lethargy, Tendon reflexes decreased, Limp muscles, Orthostatic hypotension, Seizures, Stomach cramping
11
Q
What are two causes of HYPOvolaemic HYPOnatraemia? How would you differentiate between them?
A
Addisons (renal)
Burns (non renal)
Differentiated by urinary sodium
12
Q
What are two causes of EUvolaemic HYPOnatraemia?
A
Primary Polydipsia
SIADH
Differentiated by urinary concentration
13
Q
What are two causes of HYPERvolaemic HYPOnatraemia
A
CCF
Liver Failure
14
Q
Name three drugs you could use to treat SIADH (by inducing DI)?
A
Lithium
Amphoterecin
Demeclocycline
15
Q
How would you treat HYPER and HYPOvolaemic HYPOnatraemia respectively?
A
HYPO- IV 0.9% saline
HYPER - Fluid restrict and consider furosemide
16
Q
Give 4 causes of HYPERkalaemia
A
CKD
Rhabdomyolysis
Addisons
Drugs
Emergency if K+>7mmol/l
OR
K+>5.3mmol/l with ECG changes
17
Q
Using the mnemonic THANKS CYCLE, what drugs contribute to HYPERkalaemia?
A
Trimethoprim Heparin ACEI NSAIDs K+ Sparing DIuretics Succinyl Choline Cyclosporine
18
Q
What is Type 4 RTA?
A
Occurs when there is low aldosterone activity
May be Hypertensive, Hyperkalaemic, Hyperchloraemic
19
Q
Give 4 possible ECG changes for HYPERkalaemia
A
Flattened P waves
Tented T waves
Prolonged QRS complex
Asystole
20
Q
What are three possible presentations of HYPERkalaemia?
A
Fatigue
Paraesthesia
Chest Pain
21
Q
Give a four step management plan for HYPERkalaemia
A
1) 10mls 10% Calcium Gluconate over 10 mins
2) Actrapid+IV dextrose/glucose solution
3) Nebulised Salbutamol
4) Calcium Resonium
22
Q
What are three possible presentations of HYPOkalaemia?
A
Fatigue
Constipation
Proximal Muscle Weakness
23
Q
Give three drugs which could cause HYPOkalaemia
A
Doxazosin
Salbutamol
Insulin
24
Q
Apart from drugs and N and V, give 3 other causes of HYPOkalaemia
A
Refeeding Syndrome
Conns Syndrome
Liquorice
25
Give 3 ECG changes of HYPOkalaemia
Low T waves
High U waves
Prolonged PR interval
26
Apart from replacing Potassium in HYPOkalaemia, what other electrolyte would you consider replacing?
Magnesium
27
Define AKI
Reduced renal function occurring over hours to days
| A rise in creatinine more than 50% in the last 7 days
28
Give two broad causes of PRE RENAL AKI
Reduced cardiac output
| Reduced circulating volume
29
Give a tubular, glomerular and vascular cause of INTRARENAL AKI
Glomerular - Acute Glomerulonephritis
Tubular - Toxins (endo - myoglobin, exo - aminoglycosides)
Vascular - Vasculitis
30
Give two causes of POSTRENAL AKI
BPH
| Bladder Outflow Obstruction
31
If you thought the AKI might be due due to Post Streptococcal Glomerulonephritis, what investigation would you do?
Anti Streptolysins Titre
32
Name 4 Investigations for AKI
Urine Dipstick
Daily Bloods (Inc CK- Rhabdomyolysis, LFTs - Hepatorenal)
Urine PCR, M, C, S
USS KUB
33
How do you calculate IV flow rate?
IV Flow Rate = (drop factor * vol)/time
34
What Nephrotoxic agents should you discontinue in an AKI? Give 4
Aminoglycosides
Vancomycin
Acyclovir
NSAIDs
35
Give 3 indications for Renal Replacement Therapy in an AKI
Refractory Hyperkalaemia
Uraemic Encephalopathy
Uraemic Pericarditis
36
What are the four characteristics of Nephrotic Syndrome?
Oedema
Proteinuria (>3.5g in 24 hours) (Frothy Urine)
Hypoalbuminaemia (<30)
Hypercholesterolaemia
37
Give the four main causes of Nephrotic Syndrome
Minimal Change Disease
Membranous Nephropathy
Focal Segmental GlomeruloSclerosis
Diabetes
38
Give the four main presenting features of Nephritic Syndrome
Haematuria
Hypertension
Hardly any urine
Proteinuria
39
Describe the pathophysiology of Post Streptococcal GN
Occurs weeks after Group A/B Strep Infection
1-2 weeks post tonsillitis
3-4 weeks post impetigo/cellulitis
Normally affects children aged 3-12
40
What would a serum sample of Post Streptococcal GN show?
Low C3
| Anti Strep Antibodies
41
How would you manage Post Streptococcal GN?
Self Limiting
| ACEI/ARB for proteinuria
42
Describe the pathophysiology of IgA Nephropathy
Haematuria after an URTI, GI Infection
| Peak incidence in 20-30 y/o
43
Describe the findings in a serum/urine/biopsy of IgA Nephropathy
Serum - High IgA, Normal C3/C4
Urine - Asymptomatic microhaematuria with intermittent visible
Biopsy - Mesangial Immune Complexes
44
State the three different types of ANCA/Small Vessel Vasculitis
Granulomatosis with Polyangitis
Microscopic Polangitis
Churg Strauss
45
Describe the features of Granulomatosis with Polyangitis
C-ANCA
| Pulmonary and Nasopharyngeal involvement (haemoptysis and nasal polyps)
46
Describe the features of Microscopic Polyangitis
P-ANCA
| Mild Respiratory Symptoms
47
Describe the features of Churg Strauss
P-ANCA
| Asthma, Allergic Rhinitis, Peripheral Neuropathy
48
Describe the pathophysiology of Anti GBM disease
Antibodies against type 4 collagen
| Type 4 collagen also lies in Respiratory System therefore haemoptysis
49
What would serum sample/CXR/biopsy of Anti GBM show?
Serum - Anti GBM Antibodies
CXR - Pulmonary Infiltrates
Biopsy - Deposition of IgG along basement membrane
50
How would you treat Anti GBM disease?
Plasma Exchange and Immunosupression
51
Describe the pathophysiology of Thin Basement Membrane Disease
Hereditary Abnormalities of Type 4 collagen cauisng microscopic haematuria
Biopsy shows diffuse thinning of GBM
52
What is Alport Syndrome?
X linked abnormalities in Type 4 collagen, also causing hearing loss and eye abnormalities
53
How does the biopsy of Alport and Thin Basement Membrane disease differ
Thin Basement Membrane - Diffuse thinning
| Alport - Alternate thinning and thickening
54
Why should you give LMWH prophylactically in Nephrotic Syndrome?
Low albumin increases VTE risk
| It is an acute phase reactant normally with anticoag properties
55
Define CKD
Presence of kidney damage with abnormal albumin excretion/decreased function, persisting more than 3 months
56
Describe the classifications of CKD in term of GFR, from G1-G5
```
G1 - >90
G2 - 60-89
G3a - 45-59
G3b - 30 - 44
G4 - 15-29
G5 - <15
```
57
How could you classify the Albumin Creatinine Ratio in CKD?
A1 - <3
A2 - 3-30
A3 - >30
58
What drug could cause hypertrophy of the gums? What would this indicate?
Cyclosporin
| Renal Transplant
59
Give four complications of CKD
Anaemia of Chronic Disease
Mineral Bone Disease
Hyperparathyroidism
Hypertension
60
What is the link between Hypertension and CKD?
Chronic raised BP causes Nephrosclerosis
| Renal Artery Stenosis causes Hypertension (investigate with Magnetic Resonant Angiogram)
61
Describe the genetics of APCKD
```
Autosomal Dominant
Type 1 (85%) - Mutation on Chromosome 16
Type 2 (15%) - Mutation on Chromosome 4, slower course, reaches end stage renal failure sooner
```
62
Give 4 clinical presentations of APCKD
Loin Pain
Visible Haematuria
Renal Calculi
High BP
63
Name three disease associations of APCKD
Mitral Valve Prolapse
Ovarian Cysts
SAH
64
How would you diagnose APCKD?
Family History and USS (although cysts aren't usually visible until after the age of 30)
65
How would you treat APCKD?
```
Controlling BP (NOT with CCB though)
Tolvaptan (ADH antagonist) may slow growth
```
66
Describe four reasons why someone may have Anaemia of Chronic Disease in CKD
Reduced Erythropoietin production
Absolute Iron Deficiency (Malnutrition)
Functional Iron Deficiency (Inflammation)
Bone Marrow Supression from Uraemia
67
How would you manage ACD in CKD?
```
Replace any Haematinics that need replacing
Give ESA (Erythropoietin Stimulating Agent)
```
68
Give two causes of CKD Mineral Bone Disease with LOW turnover
Osteomalacia (Vit D Deficiency)
| Adynamic Bone Disease (low osteoclasts and osteoblasts)
69
Give one cause of CKD Mineral Bone Disease with HIGH turnover
Osteitis FIbrosa (complication of hyperparathyroidism - soft areas of bone with no calcium)
70
Give a brief description of Vit D Metabolism
Cholecalciferol is converted to calcidiol in the liver
Calcidiol is converted to Calcitriol by 1a Hydroxylase in Kidneys
1a Hydroxylase is upregulated by PTH
71
What is Tertiary Hyperparathyroidism?
Persistent high PTH despite high calcium
72
Give two advantage and two disadvantages to Peritoneal Dialysis
Advantages - Good QoL, More individualised
| Disadvantages - Risk of Infection, Unsuitable for previous abdo surgeries
73
Give three complications of Peritoneal Dialysis
Peritonitis
Hernia
Leak
74
What are the three subtypes of Peritoneal Dialysis?
Automated - overnight exchange 10-12L over 8-10 hours leaving daytime free
Continuous Ambulatory - 4-5 exchanges throughout the day at regular intervals
Assisted Automated
75
Give 4 disadvantages of Haemodialysis
Bacteraemia
Haemodynamic Instability
Cramps
SVCO
76
What is AV Fistula Steal Syndrome?
Reduced oxygenation of tissue distal to the fistula due ot mixing of oxygenated and deoxygenated blood
77
What is Active Conservative Management, and who recieves it?
When Renal Replacement Therapy offers no survival benefit
| If over 80 or if WHO Performance Score>3
78
When is Renal Transplant contraindicated?
Active infection/malignancy
Severe heart/lung disease
Uncontrolled substance abuse
Psychiatric Illness
79
Living related donor is the best option for transplant, what are the four types of Living UNrelated donor?
```
Living Donor Paired Exchange
Living Donor Deceased Exchange
Live Donor Chain
Altruisic Donation (donated into pool)
```
80
What is the Induction treatment for a Kidney Transplant?
Methylprednisolone usually in combination with Rituximab
81
What is the Maintenance treatment for a Kidney Transplant?
Prednisolone
Calcineurin Inhibitors - Tacrolimus/Cyclosporine
Rapamycin Inhibitors - Everolimus
82
What is Polyomavirus?
Childhood infection of flu like symptoms which stay latent forever
Can become reactivated post transplant, causing renal infection and rejection
Look out for changes in vision/urination
83
What is Myeloma?
Abnormal proliferation of single clone of Plasma Cells leading to secretion of Immunoglobulins
84
Give 3 systemic complications of Myeloma
Osteolytic Bone Lesions (Backache)
Hypercalcaemia (myeloma cells increase signalling of osteoclasts)
Recurrent bacterial infection
85
How does Myeloma affect the Kidneys?
Deposition of IgG/Light Chains in glomerulus causing Tubular Obsttruction/Proteinuria
86
What is Radiocontrast Nephropathy and how can you prevent it?
AKI 48-72 hours after IV contrast
Prevented with pre hydration with IV Crystalloid and the discontinuation of Nephrotoxic drugs 24h pre and post procedure
87
What is Urate Nephropathy?
Uric acid crystals precipitate in the tubule interstitium
| Decreases GFR and causes inflammation
88
How would Urate Nephropathy present?
Mild Proteinuria
| Slight increase in serum creatinine
89
How would you manage Urate Nephropathy?
Tumour Lysis - Excessive Hydration
| Allopurinol/Febuxostat
90
What is a Phakomatose?
Neurocutaneous syndromes arising from embryonic ectoderm causing systemic hamartomas
An example is Tuberous Sclerosis - can cause Renal Angiomyolipomas
91
Name the two types of Phakomatoses affecting the Kidney
Tuberous Sclerosis Complex (Pringle's Disease)
| Vin Hippel Lindau Syndrome
92
What is the main complication of Von Hippel Lindau Syndrome?
Renal Cysts and Clear Cell Renal Carcinoma by the age of 40
93
What are the three types of Membranoproliferative Syndrome? How would it appear microscopically?
Type 1 - Hep C
Type 2 - Caused by persistent activation of compliment pathway, low circulating levels of C3
Type 3 - Hep B and Hep C
'Tram Tracks'
94
What are the two types of Nodular Glomeulonephritis? How would you differentiate between them?
Diabetic and Amyloid Nephropathy
Diabetic - Congo red negative
Amyloid - Congo positive and apple green bifringence
95
Name 3 ANCA -ve small vessel vasculitis
HSP (Henoch-Schonlein purpura)
Behcets
Goodpastures
96
What glomerulonephropathies will ONLY present as crescenteric/RPGN?
ANCA +ve
| Goodpastures
97
If the cause of the nephropathy is Drug Induced Lupus, what is the drug?
TNF Inhibitor such as Infliximab
98
It can be hard to differentiate between Post IgA nephropathy and Post Strep Nephropathy, what is the difference in timescales of renal manifestations?
```
IgA = 2-3 days
Strep = 2-3 weeks
```
99
Give 3 causes of Membranous Nephropathy
Lupus
Malignancy (Lung, Colon, Haematological)
Hep B/C
100
Give two secondary causes of FSGS
Heroin
| HIV
101
Describe the stages of AKI in terms of Serum Creatinine
Stage 1: 1.5-1.9 x baseline
Stage 2: 2-2.9 x baseline
Stage 3: 3 x baseline
102
Describe the stages of AKI in terms of Urine Output
Stage 1: <0.5ml/kg/h for 6-12hrs
Stage 2: <0.5ml/kg/h for atleast 12hrs
Stage 3: <0.3ml/kg/h for atleast 24hrs
103
Using the STOP mnemonic, how would you acutely manage an AKI?
Sepsis - Appropriate Abx
Toxins - Stop any nephrotoxic medications
Optimising Fluids - Likely to be dehydrated
Prevent Harm
104
Name five drugs that are safe to continue in an AKI
Paracetamol, Warfarin, Statins, Beta Agonists, Asparin
