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SAQ for finals > Renal > Flashcards

Renal Flashcards

1
Q

Other than diabetes, give 4 common causes of CKD

A

Hypertension
Medication (lithium, NSAIDs)
Glomerulonephritis
Polycystic kidney disease
Obstructive uropathy

*Diabetes is the most common cause of CKD in UK

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2
Q

Give 2 reasons why a renal USS would be requested in CKD

A

exclude obstruction, assess renal size, exclude polycystic kidneys

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3
Q

2 medical management options in CKD

A

ACE inhibitor
SGLT2 inhibitor (beneficial in proteinuric CKD regardless of diabetic status)

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4
Q

Give 2 common side effects of ACEi

A

Dry cough
Hypotension
Hyperkalaemia

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5
Q

Give 2 blood tests to check regularly in CKD

A

[Renal bone disease]:

Phosphate (high)
Calcium (low)
ALP
PTH
FBC

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6
Q

3 signs of CKD on examination

A

Pallor (anaemia)
Peripheral oedema
Peripheral neuropathy
Pruritis (uraemia)
Bruising

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7
Q

Explain the basic principles of haemodialysis

A

Blood from AV fistula flows into dialyser
Molecules diffuse down their conc. gradient via semipermeable mebrane from blood into the dialysis fluid
Filtered blood flows back into body

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8
Q

Give 2 complications of peritoneal dialysis

A

Bacterial peritonitis
Weight gain

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9
Q

Organ rejection is a possible complication of renal transplantation. What time period determines whether it is acute or chronic?

A

6 months

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10
Q

Why would someone with a renal transplant be seen annually by a dermatologist

A

Increased risk of SCC due to long term immunosuppression

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11
Q

Type of hyperparathyroidism

Low calcium + high PTH

A

Secondary e.g. CKD causes chronic hypocalcaemia which triggers excess PTH

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12
Q

Give 2 actions of PTH

A

Increased osteoclast activity (increased Ca and PO4 release from the bone)
Increased Ca and PO4 reabsorption via the kidney
Increased hydroxylation of vitamin D

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13
Q

At what sites does hydroxylation of vitamin D occur

A

Liver, kidney

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14
Q

What is the term given to bone disease in pts with renal failure

A

Renal osteodystrophy

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15
Q

Tertiary hyperparathyroidism - calcium and PTH results + why does tertiary develop?

A

High PTH (hyperplasia from primary) causes high calcium

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16
Q

Give 2 causes of pre-renal AKI

A

Dehydration
Shock (hypovolaemia, sepsis)
Renal artery stenosis
Congestive HF

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17
Q

Give 2 causes of intrinsic AKI

A

Acute tubular necrosis
Haemolytic uraemic syndrome
Glomerulonephritis
Nephrotoxins (nephrotoxic drugs, contrast)
Rhabdomyolysis

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18
Q

Give 2 causes of post-renal AKI

A

Renal calculi
Renal tumours
Ureteric tumours
BPH
Prostate cancer

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19
Q

Other than blood tests in AKI, give 2 other investigations you would request

A

Urinalysis
Renal USS

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20
Q

Name 2 potentially life-threatening complications of AKI

A

Pulmonary oedema
Hyperkalaemia

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21
Q

Give 2 indications for dialysis in a patient with AKI

A

AEIOU:
Acidosis
Electrolyte (hyperkalaemia)
Intoxification (NSAID, lithium)
Oedema (refractory pulmonary oedema)
Uraemic symptoms (pericarditis, encephalopathy)

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22
Q

How does rhabdomyolysis cause AKI?

A

ATN

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23
Q

What blood test is raised in rhabdomyolysis

A

Creatinine kinase

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24
Q

What urine test confirms the diagnosis of rhabdomyolysis

A

Urinary myoglobin

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25
Q

What would you see on urine microscopy of rhabdomyolysis

A

Muddy brown casts

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26
Q

Which drugs to stop in AKI

A

stop the DAAAMN drugs

Diuretics
ACEi, aminoglycosides, ARBs
Metformin (risk of acidosis)
NSAIDs

27
Q

Other than prolonged immobility, give 3 causes of rhabdomyolysis

A

Excessive exercise
Crush injuries
Seizures
Drugs (ecstacy, heroin)
Muscular dystrophy disorders

28
Q

3 ECG changes in hyperkalaemia

A

Tall, tented T waves
Widened QRS complex
Flat P waves
Prolonged PR interval

29
Q

Treatment for hyperkalaemia with ECG changes (3)

A

10ml 10% calcium gluconate IV over 5 minutes
IV insulin + dextrose
Salbutamol nebulisers

30
Q

Urgent blood tests for significant AKI and haemoptysis

A

p-ANCA (microscopic polyangiitis)
c-ANCA (granulomatosis with polyangiitis)
Anti-GBM (goodpasture syndrome)

31
Q

Medication immediately started for rapidly progressive glomerulonephritis

32
Q

Investigation to confirm the diagnosis of rapidly progressive glomerulonephritis

A

Renal biopsy shows glomerular crescents

33
Q

Define nephrotic syndrome

A

Highly permeable basement membrane causing:
Proteinuria (>3g/24h)
Hypoalbuminaemia
Peripheral oedema

34
Q

Commonest cause of nephrotic syndrome in a) children and b) adults

A

a) minimal change disease
b) membranous nephropathy

35
Q

Investigation to give a definitive diagnosis in of nephrotic syndrome

A

Renal biopsy

36
Q

2 complications of nephrotic syndrome and 1 measure you would take to manage each

A

Hyperlipidaemia (statin)
Infections (prompt Abx if suspected infection)
Thromboembolism (avoid prolonged bed rest, consider anticoag)

37
Q

2 pieces of dietary advice to give to a patient with nephrotic syndrome

A
  1. Normal protein
  2. Low salt
38
Q

Serum osmolality equation

A

2 (Na+ and K+) + Glucose + Urea (all in mmol/L)

39
Q

3 clinical observations and investigations to establish volume status

A

Examine JVP
Postural blood pressure
Peripheral oedema
Measure urine output
CXR
U&Es

40
Q

Risk of correcting chronic hyponatraemia too quickly

A

Central pontine myelinolysis

41
Q

Where is ADH secreted

A

posterior pituitary

42
Q

How does ADH increase water reabsorption

A

Recruits aquaporin channels to the apical membrane making it water-permeable

43
Q

3 characteristic features of SIADH

A
  1. Euvolaemic
  2. Sodium in urine
  3. Hyponatraemia
  4. Osmolality - urine vs blood
44
Q

Name a drug used to treat SIADH

A

Vasopressin receptor antagonists e.g. tolvaptan

45
Q

Organism responsible for most UTIs

46
Q

4 risk factors for UTIs

A

Female
Pregnancy
Diabetes
Renal calculi
Long-term catheter
Immunosuppression

47
Q

Positive dipstick results indicating the presence of infection (2)

A

Nitrites
Leucocytes

48
Q

Young woman not pregnant - which antibiotic and how many days?

A

Nitrofurantoin, amoxicillin, trimethoprim for 3 days

49
Q

3 pieces of advice for recurrent UTIs

A

Post-coital voiding
Keep well hydrated
Wipe front to back

50
Q

3 initial management steps in pyelonephritis

A

ABC
IV fluids
Start empirical antibiotics

51
Q

4 investigations for pyelonephritis

A

FBC
U&Es
CRP
Urine MC&S
Blood cultures
Renal USS

52
Q

Anaphylaxis
2 signs on assessment of
a) Airway
b) Breathing
c) Circulation

A

A) stridor, hoarse voice, tongue swelling
B) tachypnoea, cyanosis, wheeze
C) tachycardia, hypotension, pale

53
Q

Adrenaline
Route
Concentration
Dose
(adult)

A

IM
1 in 1000
0.5

54
Q

Benefit of renal biopsy in IgA nephropathy

A

Definitive diagnosis to guide appropriate management

55
Q

2 contraindications to renal biopsy

A

Abnormal coagulation results
Single functioning kidney
Systolic >160 or diastolic >90

56
Q

3 complications of renal biopsy

A

Haematuria requiring blood transfusion
Haematuria requiring nephrectomy
Infection

57
Q

1 histological finding in IgA nephropathy

A

Mesangial proliferation, IgA deposits

58
Q

Other than HSP, give 3 causes of a purpuric rash

59
Q

Appropriate urine tests for patient >65 with suspected UTI

A

Urine microscopy, culture and sensitivities

*>65 urine dipstick is unreliable

60
Q

Role of tolvaptan in polycystic kidney disease

A

Reduce the growth rate of cysts

61
Q

Give 2 non-pharmacological management options for end-stage CKD

A

Dialysis
Renal transplant

62
Q

2 features of nephritic syndrome

A

Haematuria
Oliguria
Mild proteinuria
Fluid retention/oedema

63
Q

Most likely diagnosis for haemoptysis with AKI

A

Goodpasture syndrome (anti-GBM)

64
Q

Name 3 causes of glomerulonephritis

A

Goodpasture syndrome
IgA nephropathy
Post-streptococcal glomerulonephritis

SAQ for finals (20 decks)

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