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Year 6 > Renal > Flashcards

Renal Flashcards

1
Q

AKI diagnosis

A

Rise in creatinine of 26umol/L or more in 48hrs OR
>50% rise in creatinine over 7 days OR
fall in urine output to <0.5ml/hr for more than 6 hours

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2
Q

Prerenal causes of AKI

A

Ischaemic
Hypovolaemia (secondary to D%V, haemorrhage, burns, insufficient input, sepsis, post surgical)
Renal artery stenosis

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3
Q

Renal causes off AKI

A

Intrinsic damage to glomeruli, renal tubules or interstitium eg
- glomerulonephritis
- acute tubular necrosis
- acute interstitial nephritis
- rhabdomyolysis
- tumour lysis syndrome

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4
Q

Post renal causes of AKI

A

Obstruction post renal
- kidney stone in ureter or bladder
- benign prostatic hyperplasia
- external compression of the ureter

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5
Q

Assessment in AKI?

A
  1. is it acute or chronic?
  2. Are they volume depleted (postural hypotensi, reduced JVP, incr pulse, poor skin turgor)
  3. is there GU tract obstruction? (suprapubic discomfort/palpable bladder, enlarged prostate, catheter, complete anuria)
  4. Rarer cause? proteinuria or haematuria, or vasculitic rash
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6
Q

Drugs which should be stopped in AKI (may worsen renal function)

A

NSAIDs (except cardioprotective aspirin)
Aminoglycosides
ACE inhiitors
ARBs
Diuretics

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7
Q

Drugs should consider stoppnig in AKI as risk of drug toxicity

A

Metformin
Lithium
Digoxin

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8
Q

Features of acute interstitial nephritis

A

Fever, rash, arthralgia
Eosinophilia
Hypertension
Sterile pyuria and white cell casts

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9
Q

Normal plasma osmolality hyponatraemia

A

Pseudohyponatraemia: hyperproteinuria or hypertriglyceridaemia cause apparent low Na. Eg myeloma
TURP syndrome: large bolumes glycine used for irrigation, so water also absorbed and drop in plasma Na, with no drop in osmolality
Osmolality is NORMALLY REDUCED. and then look at fluid status

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10
Q

Causes of hypovolaemic hyponatraemia with high urine Na (>20mM)

A

Renal loss
Diuretics
Addison;s
Osmolar diuresis eg glucose
Renal failure

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11
Q

Causes of hypovolaemic hyponatraemia (low urine Na (<20mM)

A

Extra-renal loss eg diarrhoea, vomiting, fistula, small bowel obstruciton, burns

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12
Q

Causes of euvolaemic hyponatraemia

A

urine osmolality >500: SIADH
If urine osmolality <500: water overload, severe hyperthyroidism, glucocorticoid insufficiency

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13
Q

Causes of hypervolaemic hyponatraemia

A

Cardiac failure
Cirrhosis
Renal failure
Nephrotic syndrome

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14
Q

Management of hyponatraemia

A

replace sodium at same rate as loss
If chronic then 10mmM/day
If acute 1mM/hour
Asymptomatic and chronic: fluid restriction
Symptoms/acute/dehydrated: cautious rehydration w 0.9% NaCl
If hypervolaemic consider furosemide
emergency (seizures, coma), consider hypertonic saline

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15
Q

Causes of SIADH

A

Resp: SCLC pneumonia, TB
CNS: meninogencephalitis, head injury, SAH
Endo: hypothyroidism
Drugs: cyclophosphamide, SSRIs

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16
Q

Presentation of hyponatraemia depending on Na concentration

A

<135: nausea and vomiting, anorexia, malaise
<130: headache, confusion, irritability
<125: seizures, non cardiogenic pulmonary oedema
<115: coma and death

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17
Q

Presentation of hypernatraemia

A

Thirst
Lethargy
Weakness
Irritability
Confusion, fits, coma
Signs of dehydration (NORMALLY)

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18
Q

Causes of hypovolaemic hypernatraemia

A

Diarrhoea, vomiting
Diuretics incl osmotic diuresis (eg DM)
Sweating, burns

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19
Q

Causes of euvolaemic hypernatraemia

A

Decr fluid intake
diabetes insipidus
fever

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20
Q

Causes of hypervolaemic hypernatraemia

A

Hyperaldosteronism (incr BP, decr K, decr H)
Hypertonic saline

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21
Q

Diabetes insipidus symptoms and why

A

Polyuria
Polydipsia
Dehydration
Lack of production or action of ADH = failure to concentrate urine

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22
Q

Ix in diabetes insipidus

A

Plasma osmolality high
Low urine osolality
Elevated 24hr urine volume, esp nocturia
High/high normal plasma sodium
Water deprivation test:failure to concentrate urine on deprivation. If cranial, will successfully concentrate when given desmopressin, if nephrogenic then will not

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23
Q

Nephrogenic causes of diabetes insipidus

A

Hypercalcaemia
lithium
Post obstructive uropathy
Polycystic kidney disease
Amyloid

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24
Q

Cranial causes of diabetes insipidus

A

Idiopathic
congenital
tumours
trauma eg head injury
Infiltration of pituitary eg sarcoid
Vascular: haemorhage
Meningoencephalitis

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25
Q

Symptoms of hypokalaemia

A

Muscle weakness
paralytic ileus
hypotonia
hyporeflexia
cramps
tetany
palpitaitons
arrhytmias
polyuria, polydipsia (nephrogenic DI)

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26
Q

ECG changes in hypokalaemia

A

Flattened/inverted T waves
Prominent U waves
ST depression
Long PR interval
Long QT interval

27
Q

CAuses of hypokalaemia

A

Internal distribution: alkalosis, incr insulin, beta agonists
Incr excretion: D&V, renal tubular acidosis, diuretics, Conn’s syndrome, Cushing’s syndrome
Decr input: inappropriate fluid management, anorexia

28
Q

replacement of potassium

A

ORally: can give supplements >80mmol/day
If severe or symptoms: IV cautiously, 10mmol/hr max
Anything more definitely need cardiac monitoring
replace Mg

29
Q

Differentials for hypertension and hypokalaemia

A

Conn’s syndrome (hyperaldosteronism)
Cushing’s syndrome (hyperglucocorticoid)
Phaeochromocytoma (excess metanephrines)

30
Q

Ix for hypertension and hypokalaemia

A

Conn’s: aldosterone: renin ration
Cushing’s: overnight dex suppression test, 24hr urine cortisol excretion
Phaeo: urine metanephrines

31
Q

Symptoms hyperkalaemia

A

Fast, irregular pulse
palpitations
chest pain
weakness

32
Q

ECG hyperkalaemia

A

Tented T waves
Flattened p waves
incr PR interval
Wide QRS
Sine wave pattern, progressing to V fib

33
Q

Artefactual causes of hyperkalaemia

A

Haemolysis
EDTA contamination from lavender bottle
Taken from drip arm

34
Q

Internal distribution causes for hyperkalaemia

A

Acidosis
decr insulin
cell death/tissue trauma/burns/tumour lysis syndrome
digoxin poisoning
suxamethonium

35
Q

Incr input causes hyperkalaemia

A

Excess K therapy
Massive transfusion

36
Q

Decreased K excretion causes of hyperkalaemi

A

AKI
Addison’s
ACE inhibitors

37
Q

Management of K acutely

A

Calcium gluconate IV
Insulin dextrose
Salbutamol nebs
Calcium resonium PR

38
Q

when is hyperkalaemia emergency

A

Evidence of myocardial instability on ECG
K+ >6.5

39
Q

Trousseau’s sign

A

Inflated BP cuff causes hand wrist flexion, MCP flexion and finger extension
= hypocalcaemia

40
Q

Chvostek’s sign

A

Tap on masster muscle and facial muscles contract or twitch in response
= sign of hypocalcaemia

41
Q

Symptoms of hypocalcaemia

A

Spasms muscles
perioral paraesthesia
ancious feeling
seizures
muscle tone increase -> colic, wheeze, dysphagia
confusion
dermatitis, impetigo herpetiformis
Cardiomyopathy

42
Q

Causes of hypocalcaemia if incr phosphate

A

Chronic kidney disease
Hypoparathyroidism
Decr magnesium
acute rhabdomyolysis

43
Q

Causes of hypocalcaemia if normal or low phosphate

A

osteomalacia
Active pancreatitis
Respiratroy alkalosis

44
Q

Presentation of hypercalcaemia

A

Stones: renal stones, nephrogenic DI, nephrocalcinosis
Bones: bone pain, pathological fractures
Moans: depression, confusion
Groans: abdo pain, nausea and vomiting, constipation, pancreatitis, peptic ulcer disease
Incr BP
Decr QT interval

45
Q

differentials for hypercalcaemia with high phosphate and high ALP

A

Bone mets (thyroid, breast, lung, kidney, prostate colon common)
Sarcoidosis
THyrotoxicosis
Lithium

46
Q

Differentials for hypercalcaemia with high phosphate and normal ALP

A

Myeloma
Hyper vitamin D
Sarcoidosis
Milk alkali syndrome

47
Q

Causes of hypercalcaemia with normal or decreased phosphate

A

Primary or tertiary hyperparathyroidism
Familial benign hypercalciuria
Paraneoplastic

48
Q

Presentation of nephrotic syndrome

A

Oedema. Periorbital and genital included
Frothy urine
Breathlessness with pleural effusion, high JVP
Signs of hypovolaemia/intravasc depletion: tachycardia, cold peripheries, oliguria
Signs of dyslipidaemia: xanthomata, xanthelasma
Signs of infeciton
Muehrcke’s lines= multiple transverse white lines on nail, assoc w hypoalbuminaemia

49
Q

Defining values of nephrotic synddrome

A

Heavy proteinuria (>3.5g//day)
Hypoalbuminaemia (<30g/L)
And peripheral oedema

50
Q

Management of nephrotic symptoms

A

Treat symptoms, and then dependent oon specific cause
Low salt diet, fluid restriciton, loop diuretic, K sparing diuretic. Monitor daily weight
Minimal change disease = start children straight away on steroids
membranous disease = ACE inhibitors

51
Q

Differentiating between CKD and AKI

A

Renal ultrasound likely to show small kidneys bilaterally in CKD
Hypocalcaemia due to lack of vitamin D suggests chronic

52
Q

Causes of CKD

A

Common: diabetes, hypertension
Others: glomerulonephritis, RAS, polycystic disease, drugs, pyelonephritis, SLE, myeloma, amyloidosis

53
Q

Drugs good for CKD

A

ACEi/ARB
SGLT2i
Finerenone (monitor K+ carefully)

54
Q

Renal features of APKD

A

ABdo pain
Abdo mass
HAematuria
Recurrent UTI
Renal impairment
Renal stones
POlyuria

55
Q

Extra renal features of APKD

A

Hypertension
Liver partic cysts
SAH
Valvular defects
Herniae
Other cysts eg intestine, pancreas

56
Q

Alport’s dyndrome

A

Mostly X linked inheritance
Haematuria, proteinuria, progressive renal failure
Sensorineural deafness
Lens dislocaion and cataracts
retinal flexks
Females may have haematuria only

57
Q

Acute tubular necrosis

A

Most common cause of intrinsic AKI
Ischaemic damage or direct toxicity to tubular epithelial cells
Urinalysis: muddy brown casts are pathognomonic
Mx: correcting underlyin cause, remove nephrotoxins, and potentially need haemofiltration until recovery

58
Q

Absolute indications for dialysis

A

Refractory hyperkalaemia
Severe intractable metabolic acidosis
Intractable fluid overload and pulmonary oedema
Uraemic complications eg pericarditis, encephalopathy and seizures

59
Q

Key differentials for nephritic syndrome

A

SLE
HSP
Goodpasture’s disease (GBM)
Rapidly progressive glomerulonephritis
Post-strep glomerulonephritis
ALport’s syndrome
IgA nephropathy
Membranoproliferative glomerulonephritis

60
Q

Pulmonary renal syndromes

A

Anti-glomerular basement membrane disease
Granulomatosis with polyangitis
Microscopic polyangitis

61
Q

Haemolytic uraemic syndrome key triad

A

Haemolytic anaemia (jaundice)
Thrombocytopenia
Renal failure (oliguria)
Following E.coli 0157 infection

62
Q

ACE inhibitors in AKI

A

Should be held
As angiotensin II constricts efferent arteriole and helps to maintain renal perfusion, so blocking this can reduce renal perfusion = not good

63
Q

Dehydration urea and creatinine

A

Urea rise proportionally higher than creatinine

Year 6 (9 decks)

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