Renal Flashcards
What is the daily required amount of potassium?
1mmol/kg/day (same as for sodium and chloride)
At what rate should maintenance fluids be prescribed?
30ml/kg/24hrs
What are the typical features of interstitial nephritis, and what most commonly causes it?
Fever
Rash
AKI
Medications - penicillin, rifampicin, NSAIDs, allopurinol, furosemide
What cancer are patients on long term immunosuppresants most at risk of developing?
Squamous cell carcinoma of the skin
Aside from cancer, what other complications are long term immunosuppresed patients at risk of?
CVD - Tacro and Ciclo cause HTN and hyperglycaemia
Renal disease - Nephrotoxic effect of the drug OR graft rejection OR recurrence of original disease
What adverse events are patients with nephrotic syndrome at increased risk of, why, and how should this be prevented?
At risk of VTE due to loss of anti-thrombin 3, meaning that LMWH prophylaxis is recommended
Haemorrhagic cystitis is a commone SFx of which drug?
Cyclophosphamide
What should be used as a vit D replacement in CKD patients and why?
Alfacalcidiol - already 1alpha hydroxylased so no need for activation in the liver
What type of nephritis commonly affects children and young adults, and presents with nephrotic syndrome?
Minimal change disease
What is seen on on renal biopsy of membranous IgA nephropathy?
Thickening of the glomerular basement membrane
What is the commonest cause of glomerulonephritis in adults?
IgA disease
What amount of glucose should patients be prescribed per day?
50-100g regardless of weight
What is a common complication of specifically large volumes of saline therapy?
Hyperchloraemic metabolic acidosis
What are the causes of cranial DI?
Idiopathic
Post traumatic
Pit surgery
What are the causes of nephrogenic DI?
Genetic
Electrolytes - HyperCa HypoK
Lithium
Tubulointerstitial disease
What is the management of Cranial and Nephrogenic DI?
Cranial - Desmopressin
Nephro - Thiazides and low salt/protein diet
What is an acceptable drop in renal function after starting an ACEi?
GFR drop up to 25%
Cr rise up to 30%
What are the characteristic biochemical features of DI?
High plasma osmolality
Low urine osmolality
High/normal sodium
Which of the following medicines should be stopped in AKI?
Metformin Asp 300 Ramipril Asp 75 Ibuprofen Bendroflumethiazide
All except Asp 75
Outline the features of ADPKD
HTN
Recurrent UTIs
Renal calculi
Haematuria
Hepatic cysts manifesting as hmegaly Diverticulosis Berry aneurysms Ovarian cysts MV prolapse
How does gentamicin damage kidneys?
Causes an intrinsic AKI
What is the cause of death of 50% of dialysis patients?
IHD
Outline the CKD stages
- > 90
- 60-90
3a. 45-59
3b. 30-44 - 15-29
- <15
NOTE - only diagnose CKD if there are accompanying signs of kidney disease (UnEs, proteinuria etc)
What is the management of nephrotic syndrome secondary to minimal change disease?
Steroids - 80% responsive
Cyclophosphamide if non-responsive
What do eosinophilic casts indicate?
Tubulointerstitial nephritis
What are the causes of hypokalaemia?
- K+ loss - Drugs, GI, dialysis
- Trans-cellular shift - insulin, salbutamol, theophylline
- Decreased intake
- Mg depletion
What is the definition and management of severe hypokalaemia?
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
How do you calculate paediatric maintenance fluids?
100:50:20
What are the features of HSP?
Purpuric rash over legs and buttocks
Polyarthritis
Abdo pain
IgA nephropathy
What are the ABG findings in a renal tubular acidosis?
Metabolic acidosis with normal anion gap
Hyperchloraemia
Low bicarb
What is the most common and important viral infection in solid organ transplant recipients?
CMV
What is the management of CMV?
Ganciclovir
What urinalysis finding would make you consider lupus nephritis?
Proteinuria (with a background of SLE…)
What are the histological findings of lupus nephritis?
Wire loop thickening
Immune complex deposition with capillary wall thickening
Granulation
What is the maximum rate of K+ that can be infused through a peripheral line without cardiac monitoring?
10mmol/hr
What are the complications of haemodialysis?
Site infection Endocarditis Stenosis Hypotension Arrhythmia Anaphylaxis Air embolus
What are the complications of peritoneal dialysis?
Peritonitis Catheter infection/blockage Constipation Fluid retention Hyperglycaemia Herniae Back pain
What are the complications of renal transplantation?
VTE Infections Malignancies BM suppression Recurrence UT obstruction CV disease Rejection
What factors may influence GFR other than renal function?
Serum Cr Age Gender Ethnicity Pregnancy Muscle mass Eating red meat 12 hrs prior
What are the ABG findings in Addison’s disease?
Metabolic acidosis with normal anion gap
What fluid should be prescribed for pre-renal AKI?
500ml 0.9% saline over 15 mins
What is calcium acetate, its use and its side effect
A calcium based phosphate binder used to treat hyperphosphataemia in CKD patients. May cause hypercalcaemia (stones, bones, moans etc.)
What is a Brown’s tumour and who does it typically affect?
A bone tumour secondary to secondary hyperparathyroidism
Outline the presentation and management of an acute graft rejection
<6 months post op presenting with signs and symptoms of an infection
Treat by upping steroid dose
What urea/creatinine picture would indicate AKI 2ary to dehydration?
Disproportionately high rise in urea vs creatinine
What should be done to protect CKD patients who need to have a contrast enhanced scan?
Give 0.9% NaCl for 12 hrs before and after the procedure
ACEi/NSAIDs should be stopped in patients with eGFR<40
How should DM patients be monitored for nephropathy?
Measure albumin/creatine ratio on a spot urine sample. If abnorma (raised) then repeat with first pass morning urine specimen
What are the clinical features of amyloidosis?
Weakness and dyspnoea
Hepatomegaly
Proteinuria
Worsening renal function
What are the features of Alport syndrome?
Presents in early childhood with: Haematuria Renal failure Bilat SNHL Lenticonus Retinitis pigmentosa
What are the side effects of EPO therapy?
Hypertension ->encephalopathy Bone aches Flu-like sx Rashes Pure red cell aplasia Thrombosis IDA
What type of acid base balance would Addison’s disease cause?
Hyperkalaemic metabolic acidosis
What are the causes of a sterile pyuria?
Partially treated UTI Renal TB Chlamydia Renal stones Appendicitis Cancer PKD
What are the similarities and differences between IgA nephropathy and post strep glomerulonephritis?
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
What are the hallmark features of nephritic vs nephrotic syndrome?
Nephritic - HTN and haematuria
Nephrotic - Hypoalbuminaemia, proteinuria, oedema
What are the causes of rapidly progressive glomerulonephritis, and what is the hallmark finding on biopsy?
Goodpastures
Granulomatosis with polyangiitis
SLE
Cresentic glomerulonephritis
What are the histological findings of membranous glomerulonephritis?
BM thickening
Subepithelial spikes on silver stain
PLA2R antibodies
What are the AKI stages?
- Cr increase 1.5-1.9x baseline
- Cr increase 2-2.9x baseline
- Cr increase >3x baseline OR >354
What are the features of salicylate poisoning and what is the remedy?
Raised anion gap metabolic acidosis
IV bicarb
When might you see hyaline casts in a patient’s urine?
In those taking loop diuretics (inocuous)
What must be followed up immediately on detection of bilateral renal calculi?
UnEs
What is a common endocrine complication of hereditary haemochromatosis?
Cranial diabetes insipidus
What are the common first presentations of HH?
Lethargy and arthralgia with family Hx
What is the inheritance pattern of HH?
AR so skips generations
Why do HH patients have venesection?
To prevent iron toxicity
What do HH patients commonly die of?
Cardiac disease due to iron deposition
Which diuretic should be used to prevent ascites in CLD patients, and what are its side effects?
Spironolactone
Hyperkalaemia
What is the difference in presentation between HUS nd TTP?
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
What is dialysis disequilibrium syndrome?
A rare but serious complication of haemodialysis characterised by cerebral oedema with normal bloods - diagnosis of exclusion
What is the key investigative difference between pre-renalAKI and ATN?
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
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.
Chlamydia - causes a sterile pyuria
What is the single commonest extra renal manifestation of ADPKD?
Liver cysts
What are the most common causes of pure nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
Membranous glomerulopathy
What is the classical presentation of fibroumscular dysplasia?
A young female who develops AKIafter initiation of an ACEi, with beading of the renal arteries seen on MR angiography.
What is a normal anion gap?
10-18
What might cause a patient to fail to respond to EPO therapy?
Iron deficiency Inadequate dose Conc infection Hyperparathyroid bone disease Aluminium toxicity
How would you differentiate between primary and secondary hyperaldosteronism?
Look at the renin - if it is high then a secondary cause is more likely - e.g. RAS
What is a common side effect of spironalactone which might warrant switch to eplerenone?
Gynaecomastia
What is reflux nephropathy, and how would you investigate it?
Chronic pyelonephritis due to vesicoureteric reflux
Diagnose with micturating cysttography
What is the prognosis of minimal change glomerulonephropathy in children?
1/3 have infrequent relapses
1/3 have frequent relapses
1/3 have no relapses
What is the commonest cause of peritonitis in peritoneal dialysis patients?
Staph epidermis
What is the screening test for ADPKD?
Ultrasound
Which patients with CKD will NOT have bilateral small kidneys?
ADPKD
Diabetics
AMyloidosis
HIV associated nephropathy