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Pathology and final year > RENAL > Flashcards

RENAL Flashcards

1
Q

Nephrotoxic drugs

A

Pre renal:
- NSAIDS
- ACEi
- cyclosporine/ tacrolimus

Intrinsic
ATN
- aminoglycosides (genta/ amikacin)
- Contrast
- amphotericin B
- cisplatin
AIN
- thiazides
- beta lactams/ penicillins
- allopurinol
- sulphonamides

Post renal cyst forming
- aciclovir
- methotrexate
- sulfonamides

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2
Q

causes of pre renal AKI

A

reduced perfusion
- hypovolaemia
- sepsis
- major haemorrhage

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3
Q

causes of intrisic AKI

A

nephrotic
nephritic
ATN
lupus nephritis
Iatrogenic- aminoglycosides, contrast, cisplatin

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4
Q

causes of obstructive AKI

A

any growth obstructing urinary tract
- prostate hyperplasia
- gynae malignancy/ fibroids
- GI growth

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5
Q

indications for dialysis

A

symptomatic uraemia
refractory acidosis (ph <7.1)
severe hyperkalaemia not responding to medical Mx
ESKD (stage 5)
refractory fluid overload

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6
Q

Drugs that can cause an AKI

A

ACEi- vasodilation of efferent arterioles and renal artery stenosis
Aminoglycosides eg. gentamycin and amikacin- acute tubular necrosis
tacrolimus- toxicity-pre renal AKI causing vasoconstriction of afferent arteriole. chronic tacrolimus causing intrinsic nephrotoxicity

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7
Q

how to prevent and minimise AKI

A

minimise duration of administration
narrow therapeutic drug monitoring by monitoring serum drug levels
appropriate renal drug dosing based on eGFR
closely monitor renal function

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8
Q

stages of an AKI

A

stage 1- increased serum Cr > 26umol/L within 48 hrs, <0.5mls/kg/hr urine output
stage 2
stage 3

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9
Q

red man syndrome

A

when given vancomycin too quickly
allergic reaction and AKI

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10
Q

drugs to withold if pt in AKI

A

CANADA
contrast
aminoglycosides
NSAIDs
Diuretics
ACEi

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11
Q

what drugs is a pt with CKD requiring haemodialysis most likely be on

A

antiplatelets eg. clopidogrel and aspirin
synth EPO injections
alfacalciferol
SGLT2 inhibitor eg. dapaglifozin
PPI H+ inhibitors (uraemia can predispose to GI ulcers)
?allopurinol

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12
Q

what would you expect in terms of insulin requirements in a dialysis pt

A

insulin requirements lower in a dialysis pt as the dialysis only clears small molecules, insulin is too big to be cleared so remains in the system longer

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13
Q

CKD A-I assessment

A

A- Anaemia: inadequate secretion of EPO
B- Bone: vit D def, low Ca, high phos, 2/3 hyperparathyroidism
C- Cardiovascular disease: anticoag eg. LMWH, lipids, BP + diabetes
D- Dialysability of drugs/ soluble vitamins (DEK vits all removed) (be mindful of how much of a drug is dialysed)
E- Electrolytes. Na, K, H+, Phos
F- fluid balance. intake/output , diuretics vs dialysis, urinary sx, proteinuria
G- GI disturbances (nausea and loss of appetite post dialysis). Gout from build up of uric acid.
H- How renal failure affects response to drug
I- Infection prophylaxis

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14
Q

what is calciphylaxis

A

calcification of blood vessels in the skin
warfarin can also cause

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15
Q

describe where a tesio line goes

A

central line to Internal Jugular and RA, tunnelled under skin and has 2 lumens entering skin

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16
Q

difference between a tesio and a Swan-Gantz line

A

tesio- 2 lumens
S-G- 3 lumens

17
Q

what is Dialysis Disequilibrium Syndrome

A

The dialysis disequilibrium syndrome (DDS) is characterized by a range of neurologic symptoms that affect patients on hemodialysis, particularly when they are first started on dialysis [1,2]. However, it is also seen among patients who have missed multiple consecutive dialysis treatments.

symptoms are thought to be as a result of CEREBRAL OEDEMA

18
Q

Which immunosuppressants are commonly used in a post renal transplant?

A

calcineurin inhibitors eg. tacrolimus

anti proliferative- Mycophenolate motefil/ azathioprine

steroids

19
Q

Work up of things to think about if someone is showing signs of an AKI

A

STOP

Sepsis/ dehydration
Toxins (ACEi, Abx, NSAIDs, contrast)
Obstrustion
Parenchymal disease

20
Q

Classify the stages of an AKI

A

Standardised definition of AKI (KDIGO): Serum Creatinine (70-100) UO

o AKI Stage 1: Increase ≥26 µmol/L; or by 1.5-1.9x the reference sCr <0.5mL/kg/hr, 6-12hr

o AKI Stage 2: Increase 2.0-2.9x the reference sCr <0.5mL/kg/hr, ≥12hr

o AKI Stage 3: Increase ≥354 µmol/L; or by ≥3x the reference sCr <0.3mL/kg/hr, ≥24hr

Anuric for ≥12hr

21
Q

Consequences of CKD

A

endocrine function:
Anaemia due to reduced EPO production
renal bone disease due to decreased activation of 1ahydroxylase

Cardio:
renal vascular calcification- renal osteodystrophy

Homeostasis:
Hyperkalaemia
acidosis
Uraemia / encephalopathy

22
Q

signs and symptoms of IgA nephropathy

A

Signs & symptoms:

· Purpuric Rash (100%)

o Extensor surface of legs, arms, buttocks, ankles

o Urticarial: maculopapular; spares trunk

· Arthralgia and periarticular oedema (60-80%):

o Large Joints

o Joint pain and swelling of knees and ankles

· Abdominal pain (60%)

o Colicky abdominal pain

o Haematemesis, melena, intussusception

· Glomerulonephritis (20-60% à 97% within 3m of onset) – U&Es typically NORMAL:

o Microscopic or macroscopic haemat

23
Q

Investigations for IgA nephropathy

A

· 1st: FBC, clotting screen, urine dipstick, U&Es

· Urinalysis: RBCs, proteinuria, casts, urea, creatinine, 24hr protein à rule out meningococcal

· Increased IgA, normal coagulation

· Follow-up (weekly for 1 month, 2-weekly for 2 months, 3 months, 6 months, 12 months):

o BP measurements

o Urine dipstick (haematuria)

24
Q

Urine microscopy:

Hyaline casts

A
  • Consist of Tamm-Horsfall protein (secreted by DCT)
  • Seen in normal urine, after exercise, during fever or with loop diuretics
25
Q

Urine microscopy:

white cell casts

A

pyelonephritis
(also maybe glomerulonephritis)

26
Q

Urine microscopy:

‘bland’ urinary sediment

A

seen in prerenal uraemia

27
Q

urine microscopy:

red cell casts

A

nephritic syndrome

28
Q

urine microscopy:

brown muddy casts

A

ATN

29
Q

Hormones influencing renal function and action

A

Vasopressin- water retention

Naturetic petptide (from cardiac atrial cells)- sodium excretion

PTH- phos excretion, Ca resorption, VitD3 activation

aldosterone- Na reabsorption, K excretion

30
Q

adult polycystic kidney disease - Aetiology

A

defect on chromosome 16
most have defect in the GANAB gene, encoding the glucosidase II alpha subunit

31
Q

PCKD presentation

A

Hypertension
haematuria
proteinuria
signs of renal function impairment
Flank pain, due to kidney hemorrhage, obstructive calculi, or urinary tract infection

Kidney cysts visible on US

32
Q

urine microscopy:

waxy casts

A

chronic renal disease

33
Q

what is the Cockcroft and Gault equation

A

(f (140-age) x weight (Kg)) / serum creatinine (μM/L) [f=1.04 femalesf=1.23 males]

34
Q

clinical features of hypokalaemia

A

Absent reflexes
Constipation
Cramps
Weakness
Tiredness

35
Q

medications to stop before contrast dye

A

Diuretics
ACEi/ARBs
Metformin
NSAIDs

as they increase risk of contrast related nephropathy

36
Q

what should you be suspicious of in a pt with haematuria, loin pain and bilateral masses in the flank

and first Ix

A

PCKD

USS of renal tract

Pathology and final year (21 decks)

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