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Things I don't know, but need to know, for fourth year > Renal > Flashcards

Renal Flashcards

1
Q

Type 1 Renal Tubular Acidosis

A

Cant secrete H+
Hypo k+
Renal Stones
Rheumatoid, SLE

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2
Q

Type 2 renal Tubular Acidosis

A

Reduced HCO3 reabsorption
Hypo K+
Causes Osteomalacia
Fanconi, Wilsons, Carbonic Anhydrase Inhibitors use

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3
Q

Type 3 Renal Tubular Acidosis

A

Rare due to Carbonic Anhydrase deficiency

Hypo K+

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4
Q

Type 4 Renal Tubular Acidosis

A

Hyper K+

Due to reduced Aldosterone

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5
Q

When can grade 1 and 2 CKD be diagnosed?

A

Only if signs and symptoms of CKD are present like altered U+Es.

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6
Q

What NSAID isn’t stopped during an AKI?

A

Aspirin at a cardio protective dose.

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7
Q

What are some signs of a prerenal injury?

A

Increased Serum Urea : Creatine ratio
Urea Plasma : Urea Urine is > 10:1
Urine Osmolarity >500
Low Urine Na+

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8
Q

Muddy brown casts within urine can indicate what?

A

Acute Tubular Necrosis

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9
Q

Causes of enlarged kidneys on USS

A

Polycystic kidney disease
Diabetic Nephropathy
Amyloidosis
Chronic HIV associated Nephropathy

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10
Q

What is the effect of CKD of kidney size?

A

Usually shrunken

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11
Q

Before a diagnosis of Renal Anaemia and EPO can be started what must be done?

A

Iron Studies and treatment of low iron

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12
Q

What is the commonest form of renal stones?

A

Calcium Oxalate - Radiopaque

Hypercalciuria

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13
Q

List some radiopaque renal stones and the common causes

A

Calcium Phosphate - Tubular Acidosis

Struvite Stones - Urease producing bacteria

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14
Q

What is the commonest Radiolucent renal stones?

A

Uric Acid stones

Xanthine stones

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15
Q

Struvite Stones

A

Magnesium Ammonia and Phosphate - Radiopaque
Staghorn Calculi
Urease producing bacteria

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16
Q

What bacteria are linked to struvite stones?

A

Proteus…

Ureaplasma

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17
Q

Signs of Acute Tubular Necrosis

A

> 40mmol of urinary Na+
<350 Urine osmolarity
Brown Casts
Poor response to fluid challenge

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18
Q

Risk Factors for Contrast Nephrotoxicity

A

> 70
Renal disease
Dehydration
Nephrotoxic drugs

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19
Q

How is the risk of contrast nephrotoxicity decreased?

A

12 hours pre and post operation give

IV 0.9% saline 1ml/kg/hour

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20
Q

What medication should be withheld post contrast and for how long?

A

Metformin for at least 48 hours until risk of AKI is decreased

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21
Q

Describe presentation, investigation results and management of Membranous Nephropathy.

A

Commonest nephropathy in adults
Linked to malignancy, hepatitis, Anti PLa2r antibodies
Thickened basement membrane and sub epithelial spikes on biopsy
ACEi + Statin + Corticosteroid + Cyclophosphamide + Anticoagulation if high risk

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22
Q

What is the screening test used in Adult Polycystic Kidney Disease

A

USS

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23
Q

What is the commonest type of APKD

A

Type 1
Chromosome 16
Early renal failure

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24
Q

What is the diagnostic criteria for APKD

A

USS
Two cysts uni or bilateral if <30
two cysts bilaterally 30-50
Four cysts bilaterally >50 years

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25
Q

What is the management of APKD?

A

Tolvaptan

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26
Q

Biochemistry in Multiple Myeloma

A

Increased Calcium
Normal or raised ALP
Normal Phosphate
Is ALP is raised think metastatic disease

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27
Q

First line investigation in renal colic

A

Non Contrast CT - KUB

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28
Q

How does CKD cause bone disease?

A

Increased Phosphate - drags calcium out of bones

Decreased Vitamin D - reduces calcium levels - 2 hyperparathyroidism

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29
Q

How do you manage CKD related bone disease?

A 
Bisphosphonates - reduce bone turn over
Reducing dietary phosphate is first line 
Phosphate binders
Vit D 
Parathyroidectomy
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30
Q

If a stone is below 5mm what is the management?

A

Symptomatic - diclofenac and supportive

Passes within 4 weeks usually

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31
Q

Renal Stone over 2 cm

A

Lithotripsy

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32
Q

Renal Stone >2cm but pregnant

A

Ureteroscopy

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33
Q

Complex renal calculi + Staghorn

A

Percutaneous Nephrolithotomy

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34
Q

A patient presents with an infection secondary to a ureteric calculi obstruction. What is the management ?

A

Surgical decompression
Nephrostomy Tubeplacement
Ureteric Catheters
Ureteric Stent

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35
Q

General advice to reduce renal stones

A

Increase fluid
Reduce animal proteins
Thiazides
Reduce salt

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36
Q

What can help reduce the frequency of oxalate stones?

A

Cholestyramine

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37
Q

What can help reduce the frequency of uric acid stones?

A

Allopurinol

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38
Q

What is indicative of an AKI due to dehydration?

A

Urea and Creatinine have both increased but urea has increased by more.

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39
Q

In a young child presenting with an abdominal mass what must be considered?

A

Wilms Nephroblastoma

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40
Q

Sterile Pyuria + white cell casts + eosinophilia indicates what?

A

Acute Interstitial nephritis
Rash and a fever is common
Hypertension and mild renal impairment

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41
Q

How is Nephrogenic diabetes insipidus managed?

A

Thiazide + low salt diet

42
Q

Acute Interstitial Nephritis causes

A

Penicillin NSAIDs Allopurinol

SLE Sjogrens Staphylococci infection

43
Q

Signs of dehydration onFBC and U+Es

A

increased haematocrit haemoglobin urea and creatinine

Urea> Creatinine

44
Q

What is the fastest rate K+ can be infused at?

A

10mmol / hour unless in an ICU with intensive cardiac monitoring

45
Q

What should be done immediately if there is new onset hyperkalameia in a patient?

A

ECG

46
Q

CKD classifications

A 
Stage 1 = >90 plus signs and symptoms 
Stage 2 = 60 - 90 plus signs and symptoms 
Stage 3a = 45 - 59 
Stage 3b = 30 - 44
Stage 4 = 15 - 30
Stage 5 = <15
47
Q

Diarrhoea causes what type of metabolic disorder?

A

metabolic acidosis - loss of HCO3-

48
Q

Vomiting causes what type of metabolic disorder?

A

Metabolic alkalosis

Loss of HCl

49
Q

What is a normal anion gap?

A

8 - 14 mol

50
Q

If the albumin creatinine ratio is >30 what medication should be started?

A

ACEi -only if hypertensive

51
Q

If the albumin to creatinine ratio is >70 what medication should be started regardless?

A

ACEi

52
Q

What medication is always given in CKD

A

Statins

53
Q

AKI - 1.5 to 2x creatinine increase

< 0.5ml/kg/hr urine

A

Stage 1 AKI

54
Q

AKI - 2.0x - 2.9x creatinine increase

Urine <0.5ml/kg/hr

A

Stage 2 AKI

55
Q

AKI - >3x creatinine increase

< 0.3ml/kg/hr

A

Stage 3

56
Q

What is the first line dialysis in an independent patient?

A

Peritonial dialysis

57
Q

A peritonitis related to peritoneal dialysis is likely to be due to what?

A

Staph Epidermidis

58
Q

Signs of a Pre Renal AKI

A

Good response to a fluid challenge
Low urinary Na
Increased Urea to creatinine ratio

59
Q

How much fluid should be used a fluid challenge?

A

500ml NaCl STAT

250ml if signs of Heart Failure

60
Q

Excessive fluid resus with NaCl can cause what?

A

Hyperchloraemic metabolic acidosis

61
Q

What is a common cause of acute tubular necrosis?

A

Haemorrhage

62
Q

In an AKI of unknown cause what investigations should be done?

A

Urinalysis

USS

63
Q

Struvite stones are made up of what?

A

Magnesium and Ammonium

64
Q

Days post URTI

Macroscopic haematuria

A

IgA nephritis

65
Q

Weeks post URTI
Proteinuria
Low complement levels

A

Post Strep Nephropathy

66
Q

IgA nephritis management

A

Normal eGFR + no proteinuria = follow up check
Slightly low eGFR + persistent proteinuria = ACEi
Falling eGFR and no response to ACEi = Steroid

67
Q

What kind of stones may be lined to a patient with Crohns disease?

A

Calcium Oxalate

68
Q

List the types of graft rejection and what mediates them

A

Hyperacute - HLA or ABO
Acute - Mismathed HLA
Chronic - Antibody and T cell mediated

69
Q

Hyperacute graft rejection

A

Within minutes to hours post surgery.
Thrombosis ischaemia and infarction of organ
No treatment apart from removal

70
Q

Acute Graft rejection

A

Within 6 months of graft insertion
Usually asymptomatic - picked up on monitoring Increased creatinine
Acute T cell is commonest variant
Some are reversible with steroids and immunosuppression

71
Q

Chronic graft rejection

A

Over 6 months

Fibrosis of the organ

72
Q

Let the order of most important HLA antibodies to match

A

DR > B > A

73
Q

What is it in nephrotic syndrome that causes hyper coagulability?

A

Loss of anti thrombin III

74
Q

What is a cause of a semi opaque kidney stone?

A

Cystine

75
Q

Management of Haemolytic Uraemic Syndrome

A

Supportive - bloods, fluids and dialysis
No role for Abx
Monitor Blood pressure and renal function

76
Q

Severe haemolytic syndrome with no diarrhoea before hand

A

Plasma exchange

Eculizumab

77
Q

Common causes of acute tubular necrosis

A

NSAIDs
Ischaemia
Contrast agents

78
Q

Acceptable responce to ACEi initiation

A

Creatine increased by 30%

eGFR reduced by 25%

79
Q

When is furosemide indicated for hypertension in CKD

A

eGFR below 45

80
Q

Metformin in CKD

A

Caution if eGFR <45

Stop if eGFR <30

81
Q

Management of Anti GMB

A

Plasma exchange
Steroids
Cyclophosphamide

82
Q

What can help reduce the frequency of calcium stones?

A

Thiazides

83
Q

Isograft

A

Received from a twin

84
Q

Autograft

A

Tissue harvested from own body

85
Q

Allograft

A

Tissue taken from another person

86
Q

Sterile pyuria + negative culture
Dysuria
Haematuria
Abdopain

A

Renal TB

87
Q

Differentiating a Chronic Kidney Injury from an AKI

A

CKD = anaemia and low vitamin D alongside normal urinary output

88
Q

Urinary ACR >3 - what medication should you start?

A

ACEi / ARB

89
Q 
Brown grey skin
N+V
Confusion (encephalopathy)
Seizures
Comas
A

Urea toxicity

90
Q

X linked dominant mutation in type IV collagen.

A

Allports
Bilateral sensorineural hearing loss
Microscopic haematuria and progressive renal failure
Retinitis pigmentosa

91
Q

An AKI + pulmonary oedema is an indication for what?

A

Haemodialysis

92
Q

What DOAC is preferred in CKD?

A

Apixiban

93
Q

Formulae for working out an Anion Gap

A

(Na + K) - (Cl + HCO3) = Anion Gap

Normal anion gap ( if involving K+) = 10-18
- without K+ = 8-14

94
Q

Management of systemic sclerosis with renal involvement.

A

ACEi

95
Q

Kimmelstein Wilson nodules are seen in

A

Nodular glomerulosclerosis due to diabetes

96
Q

Left sided flank pain + haematuria during or after a nephrotic syndrome.

A

Renal vein thrombosis - loss and antithrombin III causes hyper coagulability

97
Q

Focal segmental Glomerulosclerosis - causes

A 
HIV
Idiopathic 
Heroin
Alports
Secondary to other renal nephropathy
98
Q

Focal segmental glomerulosclerosis - presentation

A

Nephrotic syndrome and CKD in young adults

99
Q

Management of focal segmental glomerulosclerosis

A

Steroids + immunosuppression

100
Q

How does investigation of nephrotic syndrome differ between adults and children?

A

In adults you do a renal biopsy.

In children it is assumed to be minimal change disease. Biopsy is done if failure to resolve with prednisolone.

101
Q

Pentameric Antibody

A

IgM - Waldenstroms

102
Q

Monomeric antibody

A

IgG - Multiple Myeloma

Things I don't know, but need to know, for fourth year (31 decks)

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