Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > Renal > Flashcards

Renal Flashcards

1
Q

Nephrotic syndrome what is it and path

A

proteinuria
= low serum albumin
= which provokes Oedema
& hyperlipidemia

cause = podocyte effacement = more permeable to protein

thefor no renal impairment bc diseases of only filtration barrier (podocytes) (bc nephrin bridges between the podocyte feet are lost which usually filter proteins

normal renal fxn normal Cr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Minimal change disease (MCD), what is it

pt
ix
tx

A

non immune depositing nephrotic syndrome

pt: children post viral infection w nephrotic syndrome (oedema)

Ix: only finding is podocyte effacement on electron microscopy (but normal glomeruli)

tx: corticosteriods resolution and complete recovery & no recurrence is norm. if dont respond = progress to FSGS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ATN types and area

A

TOXIC ATN (PCT)
rhabdo (myoglobin), amphoterecin, contrast dye

ISCHAEMIC/hypoperf ATN (PCT, TA, DCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ATN phases

A

PRODROMAL
Apoptosis of epithelial cells and sloughing
= Inc Cr

OLIGURIC
Filtration impaired (cast obstructing)
hyperkalaemia (ions not filtered)
volume overload (water not filtered)
Increased urea and Cr (ratio<10)
- haemodialysis

POLYURIC
Resorption impaired (cast washed away but epithelium still dont work)
volume depleted
reduced urea and CR
tx - iv fluids n ion replace

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

types of AIN

A

pyelonepthritis
allergic nephritis
NSAID caused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pyelonephritis fx

A

urgency freq and dysuria + fever and loin tenderness

WBC casts (macrophages n neutrophils)

Urine micro: gram -ve ie klebsiella Uti ones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

allergic nephritis fx

A

Eosinophilia + fever + rash post starting new sulf med:

either duiretics or abx eg PCN, cephalo, trimeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NSAID nephropathy

A

reduced prostaglandins = arteriole constriction = hypoperf –> pupillary necrosis

= haematuria
and fibrosis (may lead to urothelial ca of renal pelvis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

hypocalcaemia tx

A

prolonged QT = urgent iv calcium gluconate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SGLT2 inhibitor example and adverse effects

A

dapagliflozin

Urinary genital infection (bc glycosuria)
Fourniers gangrene
normoglycaemic ketoacidosis
inc risk of lower limb amputation: closely moniter feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

fourneiers gangrene

A

necrotizing faciatis of the genetalia or perineum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

prenal AKI

A

hypovolaemia ie diarohea vomiting
renal artery stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

renal AKI cause

A

glomerulonephritis
ATN
AIN
rhabdomyolysis
tumor lysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

post renal aki

A

stone
bph
external compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

unknown cause of aki ix

A

renal tract USS in 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hypercalaemia features

A

bones stones groans and psychic moans
corneal calcification
shortened QT on ecg
hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

young pt started on acei for htn and then has deterioation in renal function

A

undiagnosed bilateral renal artery stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of CKD

A

htn
diabetic nephropathy
chronic pyelonephritis
chronic glomeruloneph
adult polycyctic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

renal USS in CKD why

A

exclude obstruction
renal size (small in ckd)

exclude polycystic kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

drugs in CKD to slow disease

A

ACEi

SGLT2 - dapafloglzin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

signs of CKD on examination

A

oedema, pallor, uremic tinge, purpura, bruising, evidence of scratching
pericardial rub
pleaural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how does haemodialysis work

A

Blood and dialysis fluid flow either side o f a semi permeable
membrane, molecules diffuse down their concentration gradients,
plasma biochemistry changes to become more like the dialysis fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

peritoneal dialysis complications

A

Bacterial peritonitis, local infection at catheter site, constipation, failure, sclerosing peritonitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

organ transplant rejection types

A

hyperacute - abo incompatible

acute - in 6 mths - T cell mediated

chronic = after 6 mths vascular changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

membranous glomerulonephritis histology

A

basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

causes of membranous glomeruloneph

A

idiopathic: due to anti-phospholipase A2 antibodies
infections: hepatitis B, malaria, syphilis
malignancy (in 5-20%): prostate, lung, lymphoma, leukaemia
drugs: gold, penicillamine, NSAIDs
autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

why does nephrotic predispose to vte

A

loss of antithrombin 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

iga nephro vs post strep glomer

A

iga = 2 days post illness

post strep = 1-2weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

FSGS causes

LM
IF
EM

A

idiopathic
congenital
HIV
Sickle cell
heroin

Lm = some glomeruli some sclerosis
IF = -ve (maybe igm)
EM = effacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

membrano prolif path

lm
em
if

A

preformed ag-ab complexes
mesnagial prolif into BM

lm = basement mem splitting/thickening
em = subendothe
if = granular igg +c3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

membranous nepthro

LM
EM
IF

A

lm = diffuse capillary thickening
em = subepithelial deposits
IF = granular igg +c3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

acute urinary retention causes

A

BPH
UTI
dx - Anti cholinergic, opiods, TCAs
urethral structures
constipation
calculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

acute vs chronic urinary retention

A

chronic typically painless
may present with overflow incontinence
larger volume of urine in bladder ie 1.5l+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acute urine retention ix

A

urinalysis and culure (catheterise)
FBC U&E Cr CRP

Bladder USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

acute urinary retention complication

A

post obstructive duireses

check hourly urine output and replace any loss with fluids

36
Q

hyperkalaemia mx

A

10% IV ca gluconate

Dextrose 50% 50ml + 15 units insulin

oral or enema calcium resonium (remove from body)

37
Q

bph tx

A

tamulosin (relax smooth muscle alpha 1 recep)

Finesteride (stops converstion test –>dihydrotest which is more potent to androgen tissue)

38
Q

macrscopic haem causes

A

renal tract trauma or tumor
UTI
nephritic syndrome
renal calculi
shistosomiasis

39
Q

bladder causes risks

A

smoking
male
paint or dye worker (aromatics)
shistosomiasis (SCC)
cyclophosphomide

40
Q

bladder ca ix

A

cystoscopy
bipsy
TURBT

41
Q

bladder ca tx

A

TURBT
intravesical chemo

radical cystectomy or ileal conduit
or radical radiotherapy

42
Q

bladder ca spread

A

local - uterus, rectum, pelvic side wall

lymphatic: iliac, paraortic lymph nodes

haem - liver, lungs, bone

43
Q

Lower urinary tract
storage sx

A

urgency / frequency / nocturia / urinary incontinence / feeling the need to
urinate again immediately after

44
Q

lower urinary tract voiding sx

A

hesitancy / weak or intermittent urinary stream / splitting / spraying / straining
/ incomplete emptying / terminal dribbling

45
Q

screening tool for lower urinary tract sx

A

international prostate symptoms score

46
Q

causes for increased PSA

A

prostate ca
bph
urinary retention
DRE
UTI
anal sex
catheterisation
vigorous excersise

47
Q

zone most affected in prostate cancer

A

peripheral zone

48
Q

prostate ca mc place and type

A

adenocarcinoma

peripheral zone

49
Q

score used for prstate cancer

how does it work

A

gleason grading system

sum of individual scores for two most dominant ca type

50
Q

1st line ix prostate ca

A

multiparametric MRI

51
Q

ADPKD (polycystic kidney)
mc common presenting sx

A

haematuria
loin pain
hypertension

52
Q

types ADPKD

A

1 =more svere
PKD1 on chromosome 16

2 = less severe
PKD2 chromosome 4

53
Q

ADPKD mx

A

refer nephrologist
htn mc
pain mx
tx uti
tx kidney stones

tolvaptan for some to reduce growth rate of cysts

ESRD = transplant

54
Q

signs of ADPKD on examination

A

Palpable kidneys/abdominal mass

Hepatomegaly due to hepatic cysts

Abdominal wall hernias
These are more common in ADPKD, affecting 45% of patients

Cardiac murmur
This is due to an increased incidence of mitral valve prolapse, mitral regurgitation, aortic regurgitation and dilated aortic root in patients with ADPKD.

55
Q

mc cause ckd uk

A

t2dm

56
Q

na resabsorption where and how

A

Main factor determining extracellular volume
drop BP and drop NaCI @ macula densa (DCT) = renin release -> aldosterone release -› more Na/K pumps.

57
Q

water reabsorption

A

At PCT and thin loop
Determines ECF osmolality

inc osmolality or drop in BP = ADH release

58
Q

loop diuretic
eg
work and effect
use

A

furosemide bumetanide

inhibit na/k/2cl transporter in thick ascending limb
= massive nacl ca and k excretion

oedema - ccf, nephrotic, hypercalcaemia

59
Q

thiazide diuretic
eg
work and effect
use
SE

A

bendroflumethiazide

inhibit Nacl cotransport in DCT
= massive nacl excretion, inc Ca resabsortion

Htn, decrenal stones, mild oedema

60
Q

SE loop duiretic

A

hypokalaemia met alkalosis
ototoxic
hypovolameia

61
Q

thiazdie se

A

hypokal
hyperglycaemia
inc urate (CI in gout)

62
Q

casts causes:

RBC

WBC

Tubular

A

glomerular haematuria

interstioal nephritis or pyelonephritis

ATN

63
Q

interpreting urea and Cr

A

isolated urea rise
= dec flow ie hypoperf/dehydration

urea and cr raised = dec filtration ie renal failure

64
Q

causes of post renal disease

A

SNIPPIN
Stone
Neoplasm
Inflammation: stricture
Prostatic hypertrophy
Posterior urethral valves
Infection: TB, schisto
Neuro: post-op, neuropathy

diseases of renal papillae, pelvis, ureter, bladder or urethra

65
Q

hyperkalaemia ecg

A

Peaked T waves
Flattened P waves
1 PR interval
Widened QRS
Sine-wave pattern -» VE

66
Q

causes of sterile pyuria

A

ie wbc in urine but no bacteria

TB
treated uti
appendicitis
calculi
TIN
PCK

67
Q

thin basement disease

A

autosomal dom
mc cause asx haematuria

persistant asx microscopic haemturia
small risk of esrf

68
Q

alport syndrome gene fx

A

mostly x linkes

haematuria , portenuria —> progressive renal failure

Sensorineural deafness
Lens dislocation and cataracts
Retinal “flecks”
Females: haematuria only

69
Q

nephritic syndrome/ acute GN fx

causes

A

Haematuria (macro / micro) + red cell casts
Proteinuria
oedema (esp. periorbital)
Hypertension
Oliguria and progressive renal impairment

1 . Proliferative / post-streptococcal
2. Crescentic / RPGN

70
Q

complications of nephrotic syndrome

A

Infection: reduced lg, reduced complement activity
VTE: up to 40%
Hyperlipidaemia: 1 cholesterol and triglycerides

71
Q

hyperkal tx

A

10ml 10% calcium gluconate
100ml 20% glucose + 10u insulin (Actrapid)
Salbutamol 5mg nebulizer
Calcium resonium 15g PO or 30g PR
Haemofiltration (usually needed if anuric)

72
Q

indications for acute dialysis

A
  1. Persistent hyperkalaemia (>7mM)
  2. Refractory pulmonary oedema
  3. Symptomatic uraemia: encephalopathy, pericarditis
  4. Severe metabolic acidosis (pH <7.2)
  5. Poisoning (e.g. aspirin)
73
Q

AIN/TIN

what is it and causes

A

Immune-mediated hypersensitivity c either drugs or other Ag acting as haptans

Drug hypersensitivity in 70%
NSAIDs
Abx: Cephs, penicillins, rifampicin, sulphonamide
Diuretics: frusemide, thiazides
Allopurinol
Cimetidine

Infections in 15% - Staphs, streps
Immune disorders - SLE, Sjogren’s

74
Q

AIN/TIN
IX AND Results

A

1gE, eosinophilia
Dip: haematuria, proteinuria, sterile pyuria

75
Q

acute urate cyrystal nephropathy what and why

tx

A

AKI due to urate precipitation
Usually after chemo-induced cell lysis
Rx: hydration, urinary alkalinisation

76
Q

rhabdo path

A

Pathogenesis
Skeletal muscle breakdown
release of:
K*, PO4, urate
Myoglobin, CK

inc K and AKI

77
Q

causes of rhabdo

A

ischaemic ie embolsim/surgery
trauma

toxins - statins, fibrates, escstacy, neuroleptics

78
Q

rhabdo ix and results

A

Dipstick: +ve Hb, -ve RBCs
Blood: increased CK, K, P04, urate

79
Q

complications of CKD

A

CRF HEALS

Cardiovascular disease
Renal osteodystrophy
Fluid (oedema)
HTN
Electrolyte disturbances: K, H
Anaemia
Leg restlessness
Sensory neuropathy

80
Q

how does srcoidosis affect kidneys

A

inc ca

TIN

81
Q

renal vascular disease ie bilat renal artery stenosis

ix 1st and gold

A

US + doppler: small kidney red flow
CT/MR angio

Renal angiography: gold standard

82
Q

what is TTP

A

Genetic or acquired deficiency of ADAMTS13 -> giant vWF multimers

83
Q

features of TTP
pentad

A

Adult females

Pentad:
Fever
CNS signs: confusion, seizures
MAHA
Thrombocytopenia
Renal failure

84
Q

tx ttp

A

plasmapharesis
immunosupression
splenectomy

85
Q

dom PCK mx

A

general:
inc water intake, dec Na, deccaffeine (may dec cyst formation)
Monitor U+E and BP
Genetic counselling
MRA screen for Berry aneurysms

med
tx HTn aggressively ie ACEi

surg
maybe helped by laprosc cyst rmova or nephrectomy

dialysis or transplant in those w ESRF (70%by 70yo)

86
Q

renal englargement differentials

A

PHONOS

Polycystic kidneys: ADPKD, ARPKD, TS
Hypertrophy 2° to contralateral renal agenesis
Obstruction (hydronephrosis)
Neoplasia: RCC, myeloma, amyloidosis
Occlusion (renal vein thrombosis)
Systemic: early DM, amyloid

87
Q
A

finals (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions