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Finals > Renal > Flashcards

Renal Flashcards

1
Q

Phases to ATN

A

Oligouric
Polyuric
Recovery phase

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2
Q

Causes of ATN

A

Ichaemia from no perfusion
Toxins
- rhabdo
- aminoglycosides
- contrast
- lead

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3
Q

What does haematuria at the end of micturition suggest

A

A distal cause

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4
Q

What is preferred investigation for proteinuria in CKD

A

Albumin creatinine ratio

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5
Q

When treat proteinuria with an ACEi

A

Over 3 with DM
Over 30 with coexistent HTN
Over 70 regardless

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6
Q

What medications can be used to manage patients with proteinuria

A

ACEi
SGLT-2 inhibitors

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7
Q

Which drugs have to stop in AKI

A

Diuretics
ACEi
ARB
NSAIDS
Aminoglycosides

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8
Q

What dose aspirin is acceptable to stay on in an AKI

A

75mg

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9
Q

RFs for AKI

A

DM
The failures- liver, heart
Drugs- ACEi- ARB, diuretics
Contrast agents

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10
Q

What counts as oligouria

A

<0.5ml/kg/hour for 6 hours

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11
Q

What do if no identifiable cause for AKI

A

Involve renal
Do USS

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12
Q

Investigations for AKI

A

All patients should have U&Es monitored and urine dip done
If no identifiable cause do an USS

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13
Q

What drugs can be used to remove potassium from body

A

Calcium resonium
Loop diuretics

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14
Q

Which drugs can be used too shift potassium intracellularly

A

Combined dextrose and insulin
Nebulised salbutamol

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15
Q

Management of hyperkalaemia

A

First to protect the cardiac membrane
- IV calcium gluconate
Short term intracellular shift
- dextrose/insulin
- nebulised salbutamol
Removal of potassium from body
- calcium resonium
- loop diuretics
- dialysis

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16
Q

Indications for dialysis in AKI

A

Refractory hyperkalaemia
Pulmonary oedema
Acidosis
Uraemia with complications- pericarditis, encephalopathy

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17
Q

Which complications of uraemia indicate dialysis

A

Pericarditis
Encephalopathy

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18
Q

Investigations for anti-GBM

A

Anti-GBM antibodies
Renal biopsy- linear IgG depostion on BM
Increased transfer factor in lungs

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19
Q

Presentation of goodpastures

A

Pulmonary haemorrhage
Rapidly progressive glomerulonpehritis

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20
Q

Management of CKD anaemia

A

Options include iron, EPO agents like darbepoetin or EPO and haemodialysis

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21
Q

Presentation of acute interstitial nephritis

A

Fever
Rash
Arthralgia
Renal problems

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22
Q

MCS of acute interstitial nephritis

A

Sterile pyuria
White cell casts

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23
Q

Most likely cause of peritonitis on peritoneal dialysis

A

Staph epidermis

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24
Q

How manage hyperphosphataemia in CKD

A

Initially reduce dietary phosphate
Second line- phosphate binders

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25
Q

What is classification of CKD

A

1- >90 with signs of kidney damage
2- 60-90 with signs of kidney damage
3a- 45-59
3b- 30-44
4- 15-29
5- 15> eGFR

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26
Q

What investigation do if notice underlying pituitary lesion on MRI

A

Pituitary blood profile looking for panhypopituitarism

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27
Q

AKI creatinine criteria

A

Stage 1- 1.5-1.9x baseline or rise in creatinine by over 26
Stage 2- 2.0-2.9x baseline
Stage 3- >3x baseline

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28
Q

When refer an AKI to nephrology

A

Had renal transplant
Unknown cause of AKI
No response to treatment
Stage 3 AKI
If have stage 4 CKD and above

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29
Q

How differentiate ATN from pre renal cause of AKI

A

Pre renal
- Urine sodium low
- Urine osmolality high
ATN
- urine osmolality low
- urine sodium high

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30
Q

What happens to urinary sodium and osmolality in ATN

A

Osmolality low and urine sodium high due to kidney not being able to concentrate urine or retain sodium

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31
Q

What is screening test for autosomal PCKD in family members

A

Abdo USS not genetic testing

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32
Q

What can be used in management of autosomal PCKD

A

Tolvaptan- use when eGFR starts to drop

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33
Q

Causes of RAS

A

90% atherosclerosis
10% fibrous dysplasia

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34
Q

Tetrad of HSP symptoms

A

Purpura
Arthritis
Abdo pain
Renal disease

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35
Q

What use to monitor HSP

A

Blood pressure and urinalysis

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36
Q

Most likely cause of microscopic haematuria in women

A

Menstruation

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37
Q

What renal disease does HIV cause

A

FSGS

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38
Q

What is first thing need to do if patient with CKD develops anaemia

A

Ceck iron status if this normal then can start darbapoeitin
If not give IV iron

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39
Q

Causes of rhabdomyolysis

A

seizure
collapse/coma (e.g. elderly patient collapses at home, found 8 hours later)
ecstasy
crush injury
statins (especially if co-prescribed with clarithromycin)

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40
Q

Management of rhabdomyolysis

A

IV fluids
Urinary alkalisation

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41
Q

Histology of kidney shows positive IgA and C3

A

IgA nephropathy

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42
Q

Best way to differentiate between AKI and CKD

A

Renal USS will show small bilateral kidneys in CKD

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43
Q

How to differentiate between CKD and AKI on blood results

A

In CKD will only see hypocalcaemia as is a chronic change

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44
Q

What are causes of CKD with large kidneys

A

ADPCKD
Early diabetic nephropathy
Amyloid
HIV associated nephropathy

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45
Q

Causes of acute interstitial nephritis

A

penicillin
rifampicin
NSAIDs
allopurinol
furosemide
Infections
Systemic autoimmune conditions

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46
Q

Management of minimal change glomerulonephritis

A

Prednisolone

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47
Q

How manage bone disease in CKD

A

First line- reduce dietary phosphate
Second line- phosphate binders, Vit D

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48
Q

Side effects of phosphate binders

A

Hypercalcaemia

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49
Q

What factors affect eGFR

A

Eating red meat within 12 hours
Pregnancy
Muscle mass

50
Q

Which people is eGFR measurements affected by

A

Amputee and bodybuilders due to their muscle mass
Pregnant women

51
Q

Hyperacute vs acute vs chronic kidney graft failure

A

Hyperacute- minutes to hours
Acute- within 6 months
Chronic- over 6 months

52
Q

Pathology of hyperacute kidney graft failure

A

Pre formed antibodies to HLA or ABO

53
Q

Management of hyperacute kidney graft failure

A

No treatment possible, need to remove kidney

54
Q

Management of acute kidney graft failure

A

Steroids and other immunosuppressants

55
Q

What is most common cause of glomerulonephritis in adults

A

Membranous glomerulonephritis

56
Q

Subepithelial deposits causing BM thickening on renal biopsy

A

Membranous glomerulonephritis

57
Q

Causes of membranous glomerulonephritis

A

Anti phospholipase A2 antibodies
Malignancy
Hep B, malaria
Drugs- penicillamine, gold, NSAIDs

58
Q

How does membranous glomerulonephritis tend to present

A

Nephrotic syndrome with lots of proteinuria

59
Q

What drug should all CKD patients be started on

A

Statinsdue to CVD risk

60
Q

Patient with cancer develops glomerulonephritis

A

Membranous glomerulonephritis

61
Q

What is preferred method of access for haemodialysis

A

AV fistula

62
Q

What drug can cause hyaline casts on urine MCS

A

Loop diuretics

63
Q

Most common extra renal complication of ADPCKD

A

Liver cysts

64
Q

Most likely cause of painless haematuria in elderly person

A

Bladder cancer

65
Q

What causes RAS in a young healthy person

A

Fibrous dysplasia

66
Q

Which medications would you consider stopping in an AKI due to their increased toxicity

A

Metformin
Lithium
Digoxin

67
Q

Differentiating between type 1 and type 2 hepatorenal syndrome

A

Type 1- rapid onset (within 2 weeks)
Type 2- prolonged onset (above 2 weeks)

68
Q

What typically precipitates hepatorenal syndrome

A

Variceal bleeds or refractory ascites

69
Q

Causes of rapidly progressive glomerulonephritis

A

Wegners
SLE
Goodpastures

70
Q

What characterises histology of rapidly progressive glomerulonephritis

A

Formation of epithelial crescents

71
Q

What use to manage hepatorenal syndrome first line

A

Terlipressin

72
Q

What is most likely cause of death in CKD

A

IHD

73
Q

When assessing eGFR, what factors go into equation

A

CAGE
Creatinine
Age
Gender
Ethnicity

74
Q

What presents with tea coloured urine

A

Rhabdomyolysis

75
Q

Presentation of alport syndrome

A

Bilateral sensorineural hearing loss
Haematuria
Progressive renal failure

76
Q

Pathophysiology of alports syndrome

A

X-linked autosomal dominant condition where defect in type IV collagen leads to abnormal glomerular basement membrane

77
Q

How long does it take for an AV fistula to develop properly

A

2 months

78
Q

What is main cause of CKD bone disease

A

High phosphate drags calcium out of bones

79
Q

What is renal dialysis disequillibrium syndrome

A

When start dialysis can get imbalance in fluid and electrolyres causing cerebral oedema. Typically early in presentation

80
Q

What causes sudden onset confusion and lethargy in someone who just started dialysis

A

Renal dialysis disequillibrium syndrome where get cerebral oedema due to imbalances in electrolytes and fluid balance

81
Q

When refer to nephrologist based off eGFR

A

If drops below 30
Drops by over 15 a year

82
Q

What is urinary sodium in ATN vs dehydration

A

ATN = above 45
Dehydrated= below 20

83
Q

What is lenticonus

A

Cone shaped lens seen in alports syndrome

84
Q

Differentiating stage of AKI by urine output

A

Stage 1- less than 0.5ml/kg/hr for 6 hours
Stage 2- less than 0.5ml/kg/hr for 12 hours
Stage 3- less than 0.3ml/kg/hr for 24 hours

85
Q

Management of HUS

A

Purely supportive in hospital depending on severity of renal impairment

86
Q

HTN and bilateral masses

A

PCKD

87
Q

Management of lupus nephritis

A

Steroids with mycophenolate or cyclophosphamide

88
Q

How interpret microscopic haematuria on patient on warfarin

A

Should be investigated as normal due to similair incidence of micrsocopic haematuria seen compared to general population

89
Q

What shows splitting of lamina in GBM or basket weave appearance

A

Alport syndrome

90
Q

How does renal disease increase risk of thrombosis

A

Loss of antithrombin III

91
Q

What drug give hyperphosphataemia in CKD

A

Sevelamer

92
Q

Side effects of darbapoeitin

A

Skin rash
Aches
Flu like illness

93
Q

Which vitamin D give CKD patients vs general population

A

CKD- Alfacidiol which is active 1,25- hydroxy vitamin D
Osteomalacia- 25- hydroxy vitamin D

94
Q

What decreases in blood due to nephrotic syndrome

A

Antithrombin III, Protein S and C
IgG
Thyroxine binding globulin

95
Q

What happens to TFTs during nephrotic syndrome

A

Lowers thyroxine binding globulin levels which affects total thyroxine but not free thyroxine

96
Q

Primary kidney diseases causing nephrotic syndrome

A

Minimal change
Membranous glomerulonpehritis
FSGS

97
Q

Causes of AA amyloidosis in developing countries

A

Chronic infections- Tb, osteomyelitis

98
Q

Management of acute tubulointerstitial nephritis

A

Avoid trigger
Steroids can be used

99
Q

Which medications are renal protective in CKD

A

ACEi as reduces perfusion of kidney
SGLT2i as reduces fibrosis of kidney

100
Q

If ACEi started as renoprotective agent, what is acceptable change in GFR and creatinine

A

GFR drop of up to 25%
Creatinine rise of 30%

101
Q

When start ACEi, what will be effect on kidney function

A

GFR will drop marginally and creatinine will rise as perfusion reduced

102
Q

Causes of rhabdo

A

Intense exercise
Seizures
Ecstasy
Statins
Collapse

103
Q

What are the two main short term complications from dialysis

A

hypoglycaemia
transient hypotension

104
Q

2 options for long term haemodialysis

A

AV fistula
Tunnelled cuffed catheter into subclavian vein

105
Q

Complications of AV fistula

A

Aneurysm
Infection
Thrombosis
Stenosis
STEAL syndrome
High-output heart failure

106
Q

Main 2 complications of tunnelled cuffed catheter dialysis

A

Infection
Clots

107
Q

When does CKD require long term dialysis

A

Stage 5

108
Q

CKD potential symptoms

A

Fatigue
Pallor
Foamy urine
Nausea
Loss of appetite
Pruritus
Oedema
Hypertension
Peripheral neuropathy

109
Q

When give SGLT2i for kidney disease

A

DM and ACR over 30

110
Q

General CKD manamement

A

Atorvastatin 20mg
ACEi and SGLT2i if meet criteria
Dialysis if stage 5
Treat complications
- bone disease
- phosphate
- anaemia
- acidosis

111
Q

What gets released in rhabdo

A

K+
CK
Myoglobin- this which is nephrotoxic

112
Q

What will give false positive haematuria on dipstick

A

Myoglobin

113
Q

Complications of rhabdo

A

DIC
Compartment syndrome
AKI

114
Q

Complications of PCKD

A

SAH
Liver cysts
Mitra valve prolapse
HTN
Infected cysts

115
Q

Complications of nephrotic syndrome

A

Thrombosis
High cholesterol
Immunodeficiency

116
Q

Management of membranous glomerulonephritis

A

Start ARB or ACEi
Steroids and cyclophosphamide

117
Q

HSP management

A

Paracetamol
Steroids if nephrotic syndrome, severe abdo pain or testicular involvement

118
Q

What is c anca

A

Proteinase 3

119
Q

What is p anca

A

Myeloperoxidase

120
Q

When medically treat hyperkalaemia

A

Above 6.5
ECG changes

Finals (29 decks)

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