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3B + Finals > Renal > Flashcards

Renal Flashcards

1
Q

Definition of AKI

A

> 26umol/L increase in creatinine in 48hrs
<0.5mls/kg/hour of urine output
50% increase in creatinine in 7/7

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2
Q

Causes of systemic vasodilation which could cause an AKI.

A

SEPSIS

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3
Q

Causes of renal vasoconstriction in AKI

A

ACEi
ARB
hepatorenal syndrome

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4
Q

What monitoring a patient. What should you check on bloods and on examination

A

Pulmonary Oedema
K+
Sodium and urea (volume)

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5
Q

Fluid resuscitation mx for AKI

A

500mLs over 15 min of 0.9% saline

2L before specialist help.

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6
Q

Drugs to stop in AKI

A

NSAIDS
Diuretics/k+ sparing drugs
Gentamycin and aminoglycasides
ACEi and ARB

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7
Q

Most common causes of CKD

A

Diabetes and hypertensio

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8
Q

less common causes of ckd

A

glomerulonephritis
Autoimmune disease
PCKD and ADPCKD
NSAIDs and Lithium (drugs) + PPI

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9
Q

monitoring of CKD is done through

A

eGFR 90, 60, 45, 30, 15

Albumin to creatinine ratio

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10
Q

Common problems and ckd presentations

A 
low appetite 
faitgue
nausea
itching 
OEDEMA
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11
Q

5 complication in CKD

A 
cardiac failure 
anaemia 
metabolic bone disease/mineral bone disease
oedema 
Acidosis
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12
Q

Management of acidosis in CKD

A 
consider bicarbonates (sodium bicarb IV) if GFR <30
Be aware of fluid overload because of Na addition
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13
Q

Management of anaemia in CKD

A

EPO. EPO won’t work if Fe deficient so test and treat.

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14
Q

Oedema management

A

Loop Diuretics
Loop + thiazide = fucking strong
furosemide bendroflumethiazide
Fluid restriction to 1L/day and strict fluid and weight monitoring

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15
Q

Bone mineral pathology in CKD

A

Bad clearance of PO4. Low production of D3.
High PO4 and low Ca.
Causes 2ndary hyperparathyroidism. Which can then cause osteoporosis
2ndary can develop into tertiary if PT hyperplasia. Then massive PTH and normal to raised Ca

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16
Q

Management of bone mineral disease in CKD

A

If PO4 >1.5mmol/L. Give phosphate binders (calcium acetate first line)
Vitamin D supplements (colecalciferol)
Adcal d3 is always your friend.

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17
Q

A patients presents to A&E with confusion, abdominal pain and reduced urine output following 5 days of diarrhoea.

1) What is the most likely diagnosis. What 3 other signs/symptoms might you expect with initial examination and investigations.
2) What organism and toxin commonly causes this disease
3) Triad associated with this disease
4) 3 Aspects of management
5) 2 Drugs that increase the risk of this disease

A

1) Haemolytic uraemia syndrome. Haematuria, Hypertension. Bruising. lethargy, irritability
2) E. Coli - produced shiga toxin. (also produced by shigella toxin but less common.
3) Thrombocytopenia. Haemolytic anaemia. AKI
4) BP management. Blood transfusions. Dialysis
5) Broad spectrum antibiotic. Loperamide

18
Q

Patient with an AKI has a serum urea of 16 and a serum creatinine of 190 (baseline of 95).
What is the most likely cause of the AKI

A

Any pre-renal cause

Raised urea: creatinine ratio = pre-renal cause of AKI

19
Q

A patient is acidotic, with hyperkalaemia, hypochloraemia

1) Diagnosis?
2) Urine pH?
3) 2 Causes

A

1) Type 4 renal tubular acidosis
2) Low
3) Addisons disease. ACE-I

20
Q

1
a) What is the cause of type 1 renal tubular acidosis
b) What are the bloods
2
a) What is the cause of type 2 renal tubular acidosis
b) What are the bloods
3) How to manage both

A

1a) Distal tubule unable to excrete hydrogen
b) Hypokalaemia. acidosis

2a) Proximal tubule can’t reabsorb bicarb
b) Hypokalaemia. High urine pH
3) Oral bicarbonate

21
Q

4 Aspects of nephritic syndrome

A

High bp
haematuria
renal impairment
?proteinuria

22
Q

1) Causes of nephritis
2) Most common cause in children/young people
3) What should you ask a 6 yo with dark urine/haematuria

A

1) SLE, Post-strep, IgA, vasculitis, Anti-GBM
2) IgA
3) If they have had a recent throat infection

23
Q

Presentation of nephritis

A 
Haematuria 
Fluid excess - oedema and ascites 
Lethargy 
Hypertension 
Low urine output
24
Q

Management of IgA nephropathy

A

Low salt diet
ACE-I
Corticosteroids may be needed

25
Q

1) Antibodies involved in granuloma polyangitis
2) 4 general symptoms of GPA
3) Extra renal symptoms
4) a) drugs to achieve remission. b) to maintain remission

A

1) ANCA
2) Fever, weight loss, anorexia, haematruria,
3) Rhinosinusitis, earache, epistaxis, mononeuritis multiplex, purpuric rash, uveitis, conjunctivitis,
4) a) Steroids, rituximab, cyclophosphamide
b) Rituximab, azathioprine, methotrexate.

26
Q

3 main symptoms of nephrotic syndrome

A

Low albumin < 35
Proteinurea > 3.5
Oedema
(and Hyperlipidaemia)

27
Q

Complications of nephrotic syndrome

A

AKI
Recurrent infection (loss of immunoglobulins)
Loss of antithombin 3 causes increase risk of VTE

28
Q

Causes of glomerular disease

1) Primary
2) Secondary

A

1) minimal change disease, focal segmental, membranous nephropathy
2) DM. Amyloidosis, ANCA vasculitis

29
Q

1) Most common nephrotic syndrome in children and gold standard symptoms
2) Pathophysiology
3) Management

A

1) Minimal change disease, periorbital oedema
2) Podocyte malformation
3) Prednisolone

30
Q

Causes of prostate infection

A

E. coli most common.
STI rare
Catheter. Cystoscopy, prostate biopsy

31
Q

Management of prostate infection

A

14/7 Ciprofloxacin

CO-trimoxazole is second line

32
Q

Inx for prostate infection

A

Urinalysis and culture. Semen culture
NAAT for chlamydia and gonorrhoea
MRI pelvis

33
Q

Inx for BPH

A

PSA
urine dip and infection screen
Post void bladder scan

34
Q

2 drugs to manage BPH

A

Alpha blockers - Tamsulosin

5a-reductase inhibitors - finasteride

35
Q

Significant side effect of tamsulosin and when to consider this

A

Postural hypotension

Elderly males with postural drop/syncope

36
Q

Most common type of prostate cancer

A

adenocarcinoma

37
Q

Referral criteria for prostate cancer

A

Unusual DRE

PSA level above normal age range

38
Q

First line inx for Prostate cancer (i’ll give you a clue, it isnt PSA)

A

Multiparametric MRI

39
Q

2 staging scores for prostate cancer

A

Gleason score

TNM

40
Q

Management of metastatic disease of prostate cancer

A

Chemo - docetaxel

GnRH antagonists - androgen deprivation

41
Q

What disease produces muddy brown casts in urine microscopy

A

Acute tubular necrosis

3B + Finals (15 decks)

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