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Finals HH > Renal > Flashcards

Renal Flashcards

1
Q

Most common nephrotic syndrome in children?

A

Minimal change disease

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2
Q

Most common nephrotic syndrome in adults?

A

Focal segmental glomerulonephritis

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3
Q

IgG and complement deposition on basement membrane?

A

Membranous glomerulonephritis

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4
Q

IgA deposits and glomeruleral mesangial proliferation?

A

IgA nephropathy

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5
Q

Nephritic syndrome 1-3 weeks after an URTI?

A

Post strep glomerulonephritis

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6
Q

Antibodies in goodpasture syndrome?

A

Anti-GBM antibodies (agianst type IV collagen)

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7
Q

Common drug causes of acute interstitial nephritis?

A

NSAIDs
PPIs
Penicillin

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8
Q

Px of interstitial kidney disease?

A

Hypertension + AKI

Other features:
- Eosinophilia
- Rash
- Fever

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9
Q

eGFR stages?

A

G1 >90
G2 60 – 89
G3a 45 – 59
G3b 30 – 44
G4 15 – 29
G5 <15

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10
Q

When to give an ACEi in CKD?

A
  • Diabetes + ACR>3
  • Hypertension + ACR>30
  • ACR >70
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11
Q

What is the pathology and results in type 1 acute tubular acidosis?

A

Distal tubule can’t excrete H+ resulting in:
- Hypokalaemia
- Metabolic acidosis
- High urinary pH

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12
Q

What is the pathology and results in type 2 acute tubular acidosis?

A

Proximal tubule unable to reabsorb bicarbonate resulting in:
- Hypokalaemia
- Metabolic acidosis
- High urinary pH

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13
Q

Condition related with type 2 acute tubular acidosis?

A

Fanconi’s syndrome

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14
Q

Mx of type 1, type 2 and type 4 acute tubular acidosis?

A

Type 1 & 2 -> Oral bicarbonate
Type 4 -> Fludrocortisone + bicarbonate maybe if high potassium

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15
Q

What is pathology and results of type 4 acute tubular acidosis?

A

Reduced aldosterone due to adrenal insufficiency resulting in:
- Hyperkalaemia
- High Cl-
- Metabolic acidosis
- Low urinary pH

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16
Q

NICE criteria for AKI?

A
  • Rise in creatinine of >25micromol/L in 48h
  • Rise in creatinine of >50% in 7 days
  • Urine output < 0.5ml/kg/hr for >6hr
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17
Q

What can cause an AKI?

A

Pre-renal -> inadequate blood supply

Renal -> Glomerulonephritis, interstitial nephritis, acute tubular necrosis

Post-renal -> obstruction

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18
Q

Common pre-renal AKI causes?

A

Fluid loss - blood, sweat, vomit, diarrhoea
Sepsis - peripheral vasodilation

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19
Q

Common post-renal AKI causes?

A

Obstruction due to:
- Prostate enlargment
- Urethral stricture
- Stones
- Tumours

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20
Q

Mx of pre-renal AKI?

A

Fluids (crystalloid - 0.9% NaCl for volume resuscitation)

Stop bad drugs (anti-hypertensives & nephrotoxic)

Control loss of fluid – anti-emetics & mx underlying cause

Monitor urine output

BP not improving -> HDU + ensure enough fluid + vasopressors

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21
Q

Mx of post-renal AKI?

A

Imaging (USS) -> looking for hydronephrosis (ureter enlargement upwards)

Relieve the obstruction:
- Stenting with cystostomy
- Nephrostomy

Fluid balance chart as polyuria after obstruction

22
Q

When to start acute haemodialysis?

A

When to acute haemodialysis?
- Hyperkalaemia (>6)
- Uraemic pericarditis (urea >40)
- Acidaemia
- Pulmonary oedema

23
Q

Nephritic syndrome px?

A
  • Acute decline in kidney function
  • Oliguria (reduce urine output)
  • Oedema caused by fluid retention
  • Hypertension
  • Active urinary sediment
    o RBCs, RBC Casts
    o (Non-visible haematuria)
24
Q

Nephrotic syndrome px?

A

Nephrotic syndrome:
- Proteinuria > 3g/day
- Hypoalbuminemia (<30) -> oedema
- Hypercholesterolemia
- Normal renal function

25
Q

Mnemonic for myeloma?

A

C - calcium (elevated)
R - renal failure
A - anaemia
B - bone lesions / pain

26
Q

Blood results in myeloma?

A

FBC - low WCC
Calcium - Raised
ESR - raised
Plasma viscosity - raised

27
Q

Initial Ix mnemonic for myeloma?

A

B - Bence-Jones protein (on urine electrophoresis)
L - Serum-free Light-chain assay
I - Serum Immunoglobulins
P - Serum Protein electrophoresis

28
Q

Confirm Dx in myeloma?

A

Bone marrow biopsy
Imaging to assess bone lesions (MRI > CT > skeletal survey)

29
Q

X-ray signs in myeloma?

A

Punched out lesions
Lytic lesions
“Raindrop skull”

30
Q

Complications of AKI?

A

Hyperkalaemia
Fluid overload -> heart failure & pulmonary oedema
Metabolic acidosis
Uraemia -> encephalopathy or pericarditis

31
Q

Indications for acute dialysis mnemonic?

A

AEIOU

A - Acidosis (pH <7.15)
E - Electrolyte abnormalities (K+ >7 or >6.5 if unresponsive to mx)
I - Intoxication (overdose of certain medications)
O - Oedema (pulmonary oedema)
U - Uraemia (urea>40) -> Pericarditis or encephalopathy px

For all, this is when severe and unresponsive to other Mx

32
Q

Indication of long-term dialysis?

A

CKD stage 5 (end-stage renal failure)
Acute indication continuing long-term

33
Q

Options for maintenance dialysis?

A

Continuous ambulatory peritoneal dialysis
Automated peritoneal dialysis
Haemodialysis

34
Q

What are some downsides of peritoneal dialysis?

A

Bacterial peritonitis
Peritoneal sclerosis
Ultrafiltration failure
Weight gain

35
Q

Usual immunosuppressant regime in renal transplant patient?

A

Tacrolimus
Mycophenolate
Prednisolone

35
Q

Usual immunosuppressant regime in renal transplant patient?

A

Tacrolimus
Mycophenolate
Prednisolone

36
Q

Glomerulonephritis which present with nephrotic syndrome?

A

Minimal change
Focal segmental glomerulosclerosis
Membranous nephropathy

37
Q

Who does ADPKD and ARPKD affect?

A

ADPKD affects adults (>30y)
ARPKD affects neonates (oligohydramnios in pregnancy)

38
Q

What inheritance in Alport syndrome and andreson Fabry’s syndrome?

A

X-linked

39
Q

Alport syndrome px?

A

Haematuria
Sensorineural deafness
Ocular defects
Mild proteinuria

40
Q

Mx of Alport syndrome?

A

Antihypertensives & ACEi

41
Q

What BP to aim for in CKD?

A

<140/90 if CKD
<130/80 if CKD + diabetes

42
Q

Stages of hyperkalaemia?

A

Normal K+ = 3.5 – 5
Hyperkalaemia = >5.5
Life-threatening = >6.5
Severe = >9

43
Q

What ions are primarily extra-cellular and what ions are primarily intra-cellular?

A

ECF: Na+, Cl-, HCO3-
ICF: K+, Mg2+

44
Q

6 functions of the kidney?

A
  1. Water balance / salt balance
  2. Maintain plasma volume / osmolarity
  3. Acid-base balance
  4. Excretion of metabolic waste
  5. Secretes renin & erythropoietin
  6. Converts VitD to active form
45
Q

What causes haemolytic uraemic syndrome?

A

Triggered by shiga toxin
- This is produced by e. coli and shigella

46
Q

Px of haemolytic uraemic syndrome?

A

Triad of:
- Haemolytic anaemia
- Acute kidney injury
- Low platelet count

Occurs around 5 days after gastroenteritis often with bloody diarrhoea

AKI px:
- Haematuria, anuria, abdo pain, lethargy, hypertension, bruising, confusion

47
Q

Mx of haemolytic uraemic syndrome?

A

Medical emergency, 10% mortality

Mx - supportive
- Anti-hypertensives, blood transfusions, dialysis

48
Q

Causes of rhabdomyolsis?

A

Prolonged immobility
Extremely rigorous exercise
Crush injuries
Seizures

49
Q

Px of rhabdomyolosis?

A
  • Muscle aches and pain
  • Oedema
  • Fatigue
  • Confusion
  • Red-brown urine
50
Q

What do muscle cells release in rhabdomyolysis?

A

Myoglobin -> AKI as toxic to kidneys
Potassium -> hyperkalaemia
Phosphate
Creatine kinase

51
Q

Mx of rhabdomyolysis?

A

IV fluids

Consider:
- IV sodium bicarbonate - reduces toxicity of myoglobin on kidneys
- IV mannitol - increases GFR and reduces oedema (hypovolaemia is a contra-indication)

Mx any hyperkalaemia

Finals HH (21 decks)

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