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4th year passmed > Renal > Flashcards

Renal Flashcards

1
Q

What is the daily required amount of potassium?

A

1mmol/kg/day (same as for sodium and chloride)

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2
Q

At what rate should maintenance fluids be prescribed?

A

30ml/kg/24hrs

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3
Q

What are the typical features of interstitial nephritis, and what most commonly causes it?

A

Fever
Rash
AKI

Medications - penicillin, rifampicin, NSAIDs, allopurinol, furosemide

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4
Q

What cancer are patients on long term immunosuppresants most at risk of developing?

A

Squamous cell carcinoma of the skin

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5
Q

Aside from cancer, what other complications are long term immunosuppresed patients at risk of?

A

CVD - Tacro and Ciclo cause HTN and hyperglycaemia

Renal disease - Nephrotoxic effect of the drug OR graft rejection OR recurrence of original disease

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6
Q

What adverse events are patients with nephrotic syndrome at increased risk of, why, and how should this be prevented?

A

At risk of VTE due to loss of anti-thrombin 3, meaning that LMWH prophylaxis is recommended

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7
Q

Haemorrhagic cystitis is a commone SFx of which drug?

A

Cyclophosphamide

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8
Q

What should be used as a vit D replacement in CKD patients and why?

A

Alfacalcidiol - already 1alpha hydroxylased so no need for activation in the liver

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9
Q

What type of nephritis commonly affects children and young adults, and presents with nephrotic syndrome?

A

Minimal change disease

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10
Q

What is seen on on renal biopsy of membranous IgA nephropathy?

A

Thickening of the glomerular basement membrane

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11
Q

What is the commonest cause of glomerulonephritis in adults?

A

IgA disease

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12
Q

What amount of glucose should patients be prescribed per day?

A

50-100g regardless of weight

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13
Q

What is a common complication of specifically large volumes of saline therapy?

A

Hyperchloraemic metabolic acidosis

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14
Q

What are the causes of cranial DI?

A

Idiopathic
Post traumatic
Pit surgery

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15
Q

What are the causes of nephrogenic DI?

A

Genetic
Electrolytes - HyperCa HypoK
Lithium
Tubulointerstitial disease

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16
Q

What is the management of Cranial and Nephrogenic DI?

A

Cranial - Desmopressin

Nephro - Thiazides and low salt/protein diet

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17
Q

What is an acceptable drop in renal function after starting an ACEi?

A

GFR drop up to 25%

Cr rise up to 30%

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18
Q

What are the characteristic biochemical features of DI?

A

High plasma osmolality
Low urine osmolality
High/normal sodium

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19
Q

Which of the following medicines should be stopped in AKI?

Metformin
Asp 300
Ramipril
Asp 75
Ibuprofen
Bendroflumethiazide
A

All except Asp 75

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20
Q

Outline the features of ADPKD

A

HTN
Recurrent UTIs
Renal calculi
Haematuria

Hepatic cysts manifesting as hmegaly
Diverticulosis
Berry aneurysms
Ovarian cysts
MV prolapse
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21
Q

How does gentamicin damage kidneys?

A

Causes an intrinsic AKI

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22
Q

What is the cause of death of 50% of dialysis patients?

A

IHD

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23
Q

Outline the CKD stages

A
  1. > 90
  2. 60-90
    3a. 45-59
    3b. 30-44
  3. 15-29
  4. <15

NOTE - only diagnose CKD if there are accompanying signs of kidney disease (UnEs, proteinuria etc)

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24
Q

What is the management of nephrotic syndrome secondary to minimal change disease?

A

Steroids - 80% responsive

Cyclophosphamide if non-responsive

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25
Q

What do eosinophilic casts indicate?

A

Tubulointerstitial nephritis

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26
Q

What are the causes of hypokalaemia?

A
  1. K+ loss - Drugs, GI, dialysis
  2. Trans-cellular shift - insulin, salbutamol, theophylline
  3. Decreased intake
  4. Mg depletion
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27
Q

What is the definition and management of severe hypokalaemia?

A

Defined as a k+<2.5

Treat with cardiac monitoring and replace K+ quickly but at no greater a rate than 20mmol/hour - e.g. 3 bags normal saline with 40mmol KCl in 24hrs

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28
Q

How do you calculate paediatric maintenance fluids?

A

100:50:20

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29
Q

What are the features of HSP?

A

Purpuric rash over legs and buttocks
Polyarthritis
Abdo pain
IgA nephropathy

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30
Q

What are the ABG findings in a renal tubular acidosis?

A

Metabolic acidosis with normal anion gap
Hyperchloraemia
Low bicarb

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31
Q

What is the most common and important viral infection in solid organ transplant recipients?

A

CMV

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32
Q

What is the management of CMV?

A

Ganciclovir

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33
Q

What urinalysis finding would make you consider lupus nephritis?

A

Proteinuria (with a background of SLE…)

34
Q

What are the histological findings of lupus nephritis?

A

Wire loop thickening
Immune complex deposition with capillary wall thickening
Granulation

35
Q

What is the maximum rate of K+ that can be infused through a peripheral line without cardiac monitoring?

A

10mmol/hr

36
Q

What are the complications of haemodialysis?

A 
Site infection
Endocarditis
Stenosis
Hypotension
Arrhythmia
Anaphylaxis
Air embolus
37
Q

What are the complications of peritoneal dialysis?

A 
Peritonitis
Catheter infection/blockage
Constipation
Fluid retention 
Hyperglycaemia
Herniae
Back pain
38
Q

What are the complications of renal transplantation?

A 
VTE
Infections
Malignancies
BM suppression
Recurrence
UT obstruction
CV disease
Rejection
39
Q

What factors may influence GFR other than renal function?

A 
Serum Cr
Age
Gender
Ethnicity
Pregnancy
Muscle mass
Eating red meat 12 hrs prior
40
Q

What are the ABG findings in Addison’s disease?

A

Metabolic acidosis with normal anion gap

41
Q

What fluid should be prescribed for pre-renal AKI?

A

500ml 0.9% saline over 15 mins

42
Q

What is calcium acetate, its use and its side effect

A

A calcium based phosphate binder used to treat hyperphosphataemia in CKD patients. May cause hypercalcaemia (stones, bones, moans etc.)

43
Q

What is a Brown’s tumour and who does it typically affect?

A

A bone tumour secondary to secondary hyperparathyroidism

44
Q

Outline the presentation and management of an acute graft rejection

A

<6 months post op presenting with signs and symptoms of an infection
Treat by upping steroid dose

45
Q

What urea/creatinine picture would indicate AKI 2ary to dehydration?

A

Disproportionately high rise in urea vs creatinine

46
Q

What should be done to protect CKD patients who need to have a contrast enhanced scan?

A

Give 0.9% NaCl for 12 hrs before and after the procedure

ACEi/NSAIDs should be stopped in patients with eGFR<40

47
Q

How should DM patients be monitored for nephropathy?

A

Measure albumin/creatine ratio on a spot urine sample. If abnorma (raised) then repeat with first pass morning urine specimen

48
Q

What are the clinical features of amyloidosis?

A

Weakness and dyspnoea
Hepatomegaly
Proteinuria
Worsening renal function

49
Q

What are the features of Alport syndrome?

A 
Presents in early childhood with:
Haematuria
Renal failure
Bilat SNHL
Lenticonus
Retinitis pigmentosa
50
Q

What are the side effects of EPO therapy?

A 
Hypertension ->encephalopathy
Bone aches
Flu-like sx
Rashes
Pure red cell aplasia
Thrombosis 
IDA
51
Q

What type of acid base balance would Addison’s disease cause?

A

Hyperkalaemic metabolic acidosis

52
Q

What are the causes of a sterile pyuria?

A 
Partially treated UTI
Renal TB
Chlamydia
Renal stones
Appendicitis
Cancer
PKD
53
Q

What are the similarities and differences between IgA nephropathy and post strep glomerulonephritis?

A

Similarities- - Both present after a recent URTI with haematuria

Differences - IgA develops 1-2 days after, while PSGN is 1-2 weeks after URTI
PSGN also shows proteinuria dna low complement, unlike IgA nephropathy

54
Q

What are the hallmark features of nephritic vs nephrotic syndrome?

A

Nephritic - HTN and haematuria

Nephrotic - Hypoalbuminaemia, proteinuria, oedema

55
Q

What are the causes of rapidly progressive glomerulonephritis, and what is the hallmark finding on biopsy?

A

Goodpastures
Granulomatosis with polyangiitis
SLE

Cresentic glomerulonephritis

56
Q

What are the histological findings of membranous glomerulonephritis?

A

BM thickening
Subepithelial spikes on silver stain
PLA2R antibodies

57
Q

What are the AKI stages?

A
  1. Cr increase 1.5-1.9x baseline
  2. Cr increase 2-2.9x baseline
  3. Cr increase >3x baseline OR >354
58
Q

What are the features of salicylate poisoning and what is the remedy?

A

Raised anion gap metabolic acidosis

IV bicarb

59
Q

When might you see hyaline casts in a patient’s urine?

A

In those taking loop diuretics (inocuous)

60
Q

What must be followed up immediately on detection of bilateral renal calculi?

A

UnEs

61
Q

What is a common endocrine complication of hereditary haemochromatosis?

A

Cranial diabetes insipidus

62
Q

What are the common first presentations of HH?

A

Lethargy and arthralgia with family Hx

63
Q

What is the inheritance pattern of HH?

A

AR so skips generations

64
Q

Why do HH patients have venesection?

A

To prevent iron toxicity

65
Q

What do HH patients commonly die of?

A

Cardiac disease due to iron deposition

66
Q

Which diuretic should be used to prevent ascites in CLD patients, and what are its side effects?

A

Spironolactone

Hyperkalaemia

67
Q

What is the difference in presentation between HUS nd TTP?

A

Both presentwith thrombocytopaenia, anaemia and purpuric rash, however Hus generally presents over days-weeks with renal features, whereas TTP generally presetns more acutely and with neurological signs

68
Q

What is dialysis disequilibrium syndrome?

A

A rare but serious complication of haemodialysis characterised by cerebral oedema with normal bloods - diagnosis of exclusion

69
Q

What is the key investigative difference between pre-renalAKI and ATN?

A

ATN has raised urinary sodium >40, while it is <20 in pre-renal disease

I.e. In pre-renal, the kidneys will retain sodium to hold on to as much water as possible

70
Q

A 21-year-old female complains of dysuria for the past week, despite just completing a three day course of trimethoprim. Urine dipstick is positive for blood + and leucocytes +. A MSSU shows no organism.

A

Chlamydia - causes a sterile pyuria

71
Q

What is the single commonest extra renal manifestation of ADPKD?

A

Liver cysts

72
Q

What are the most common causes of pure nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

Membranous glomerulopathy

73
Q

What is the classical presentation of fibroumscular dysplasia?

A

A young female who develops AKIafter initiation of an ACEi, with beading of the renal arteries seen on MR angiography.

74
Q

What is a normal anion gap?

A

10-18

75
Q

What might cause a patient to fail to respond to EPO therapy?

A 
Iron deficiency
Inadequate dose
Conc infection
Hyperparathyroid bone disease
Aluminium toxicity
76
Q

How would you differentiate between primary and secondary hyperaldosteronism?

A

Look at the renin - if it is high then a secondary cause is more likely - e.g. RAS

77
Q

What is a common side effect of spironalactone which might warrant switch to eplerenone?

A

Gynaecomastia

78
Q

What is reflux nephropathy, and how would you investigate it?

A

Chronic pyelonephritis due to vesicoureteric reflux

Diagnose with micturating cysttography

79
Q

What is the prognosis of minimal change glomerulonephropathy in children?

A

1/3 have infrequent relapses
1/3 have frequent relapses
1/3 have no relapses

80
Q

What is the commonest cause of peritonitis in peritoneal dialysis patients?

A

Staph epidermis

81
Q

What is the screening test for ADPKD?

A

Ultrasound

82
Q

Which patients with CKD will NOT have bilateral small kidneys?

A

ADPKD
Diabetics
AMyloidosis
HIV associated nephropathy

4th year passmed (28 decks)

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