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INTERNSHIP > Renal > Flashcards

Renal Flashcards

1
Q

Acute tubular necrosis

A

TBC

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2
Q

How does surgery affect renal function (acutely)?

A

Patients can experience a mild acute kidney injury after surgery (which will impair renal function transiently).

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3
Q

Rivaroxaban is contraindicated below what level of renal function?

A

Creatinine clearance <15 mL per minute

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4
Q

Rivaroxaban should have its dose reduced below what level of renal function?

A

Creatinine clearance <50 mL per minute

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5
Q

What is a common electrolyte implication of chronic kidney disease?

A

Patients with chronic kidney disease are at risk for hyperkalaemia.

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6
Q

What is renal osteodystrophy?

A

An alteration of bone composition in patients with chronic kidney disease (CKD).

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7
Q

What is Stage 3 CKD?

A

Stage 3 of chronic kidney disease (CKD) occurs when your estimated glomerular filtration rate (eGFR) falls between 30-59, indicating moderate kidney damage

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8
Q

What should be done for VTE prophylaxis in patients with severe renal impairment?

A

Use heparin (not enoxaparin).

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9
Q

What are 6 factors to consider relating to drug therapy in renal patients?

A
  1. CREATININE/UREA – pattern/percentage change. Creatinine does not necessarily need to be above the normal range for a significant change in renal function
  2. AGE, HEIGHT, WEIGHT – creatinine clearance decreases by ~10mL/min with every 10y of age. Anticipated maximum creatinine clearance for a 70y old will be 70mL/min
  3. DIALYSIS – what type, specific dialysis machine if known, timing of medications in relation to dialysis
  4. CREATININE – ensure no hepato-renal syndrome/renal impairment if using medications which are renally cleared
  5. THERAPEUTIC INDEX & DURATION OF USE – assists dose recommendations
  6. NEPHROTOXICITY – hold/suspend any non-essential medications which could have caused nephrotoxicity
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10
Q

Can patients be born with one kidney?

A

Yes

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11
Q

What type of blood cell are kidneys mostly involved with the production of?

A

Red blood cells

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12
Q

Are patients with chronic kidney disease usually aware of their condition?

A

No

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13
Q

How may kidney stones be implicated in chronic kidney disease?

A

Kidney stones can cause chronic kidney disease as they form an obstruction.

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14
Q

What is a risk of chronic kidney disease in diabetic patients?

A

Chronic kidney disease doubles the risk of a diabetic patient having a hypoglycaemic event.

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15
Q

What is an implication if patients with chronic kidney disease have an acute kidney injury?

A

If patients with chronic kidney disease have an acute kidney injury it is highly unlikely they will return to their base level of renal function.

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16
Q

What is an important factor to remember when managing medications in patients with chronic kidney disease?

A

Patients with chronic kidney disease will have to hold certain medications when they are acutely unwell.

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17
Q

What is it important to consider when interpreting urinary protein excretion?

A

Urinary protein excretion follows a circadian rhythm so results will vary at different stages of the day.

18
Q

Why are patients with chronic kidney disease at an elevated risk of anaemia?

A

Patients with chronic kidney disease absorb iron poorly from the diet and supplementation and they are more prone to bleeding due to their inflammatory state, and both of these factors can lead to anaemia.

19
Q

What is a potential risk with pushing a chronic kidney disease patient’s haemoglobin too high?

A

This increases the risk of strokes and other cardiovascular events.

20
Q

What is renal bone disease?

A

A general term for the spectrum of complex changes to mineral metabolism and bone strength seen in patients with chronic kidney disease.

21
Q

What is renal osteodystrophy?

A

A broad term that incorporates all the biochemical abnormalities and skeletal manifestations in patients suffering from chronic kidney disease or end-stage renal disease

22
Q

Describe the relationship between thyroid function and the kidneys.

A

Hypothyroidism is associated with reduced GFR and hyperthyroidism results in increased GFR as well as increased renin-angiotensin-aldosterone activation.

23
Q

What is acute tubular necrosis (ATN)?

A

A kidney disorder involving damage to the tubule cells of the kidneys, which can lead to kidney failure.

24
Q

What are the tubules of the kidneys?

A

Tiny ducts in the kidneys that help to filter the blood as it passes through the kidneys.

25
Q

What is the renin-angiotensin-aldosterone system?

A

A hormone system that regulates blood pressure, fluid and electrolyte balance, and systemic vascular resistance.

26
Q

What do the kidneys do when blood pressure falls (for example systolic blood pressure <100 mmHg)?

A

They release the enzyme renin into the bloodstream.

27
Q

What does renin do to angiotensin?

A

Renin splits angiotensinogen, into pieces, one of which is angiotensin I

28
Q

What is angiotensinogen?

A

A large protein that circulates in the bloodstream

29
Q

Describe the reactivity of Angiotensin I.

A

It is relatively inactive

30
Q

What is the relationship between Angiotensin I and angiotensin-converting enzyme (ACE).

A

Angiotensin I split into pieces by angiotensin-converting enzyme (ACE), one of which is angiotensin II

31
Q

What is angiotensin II?

A

A hormone (which is very active).

32
Q

How does angiotensin II effect blood pressure?

A

Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict, increasing blood pressure.

33
Q

Describe the hormonal effects of angiotensin II.

A

Angiotensin II triggers the release of the hormone aldosterone from the adrenal glands and vasopressin (antidiuretic hormone) from the pituitary gland.

34
Q

What are the effects of aldosterone and vasopressin on blood pressure?

A

They cause the kidneys to retain sodium. Aldosterone also causes the kidneys to excrete potassium. The increase in sodium leads to fluid retention, increasing blood pressure.

35
Q

What is the effect of renal disease on calcium?

A

CKD can lead to hypocalcaemia as the kidneys are less able to produce active vitamin D, meaning less calcium is absorbed from the diet. The extra phosphorus in the blood in CKD patients may also bind to calcium in the blood.

36
Q

What is a practical limitation of haemodialysis?

A

It is quite invasive.

37
Q

What is a practical benefit of peritoneal dialysis over haemodialysis?

A

Peritoneal dialysis can be done at home while the patient is asleep.

38
Q

Which is usually more accurate: de-indexed eGFR or CrCl?

A

De-indexed eGFR

39
Q

How is the risk of fungal peritonitis managed in peritoneal dialysis patients?

A

Nystatin is given for fungal peritonitis prophylaxis.

40
Q

What are 3 common causes of acute tubular necrosis (ATN)?

A
  1. Hypotension
  2. Sepsis leading to renal hypoperfusion
  3. Nephrotoxic drugs.

INTERNSHIP (189 decks)

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