Renal Flashcards
When do you give calcium gluconate?
If K+ >5.5
What indicates that Kidney disease is chronic and not acute?
Calcium (hypocalcaemia)
What does protein in the urine dipstick rule out cause wise for an AKI?
Pre-renal
Post-renal
Muddy brown casts in urine?
Acute tubular necrosis
Urea that is proportionally higher than creatinine?
Dehydration
What are eosinophilic casts a sign of?
Tubulointerstitial nephritis
-Can be often due to drug reaction to strep pyogenes assoc with post-strep glomerular nephritis
New chest pain with background of AKI? DDx and management?
Pericarditis
Haemodialysis
ECG findings of widespread PR depression and ST elevation?
Pericarditis
What medication should all CKD patients be on?
Statin
InvgX for patient with sus anaemia of chronic disease?
Iron status (before starting EPO)
Patients with CKD who have albumin:creatinine ratio of more than 30mg/mmol…what med should you give them?
ACE Inhibior eg Ramipril
eGFR variables in calculation?
Creatinine
Age
Gender
Ethnicity
Most likely cause of death in patients on haemodialysis for CKD?
Ischaemic Heart Disease
Isolated rise of GGT in context of macrocytic anaemia?
Alcohol XS
When does Post-strep Glomerulonephritis develop compared to IgA?
PSGN: 1-2 weeks
IgA: 1-2 days
Haemoptysis +/- AKI/proteinuria/haematuria?
Anti-GBM disease
HIV patient with fatigue, peripheral oedema and foamy urine? Diagnosis=
Focal Glomerulosclerosis
Sick 2 weeks ago + sad kidneys now?
Post-Streptococcal glomerulonephritis
NSAIDS can cause what kidney problem?
Acute interstitial nephritis
Oedema + proteinuria = what?
Nephrotic syndrome
What type of syndrome is IgA nephropathy?
Nephritic
Haematuria + Proteinuria= what?
Nephritic syndrome
Child nephrotic syndrome?
Minimal change disease
Diagnostic test for PSGN?
Anti-streptolysin O Titre (Raised in PSGN)
Loss of what predisposes patients with nephrotic syndrome to be at increase risk of venous thromboembolism?
Antithrombin III
Presentation of acute interstitial nephritis?
Allergic type picture
Fever, arthralgia, and rash alongside AKI
-Raised WBC & eosinophils
-Impaired renal function
Urine osmolality <350 mOsm/kg?
Acute tubular necrosis
Which GlomNeph is associated with malignancy?
Membranous nephropathy
How soon can acute graph rejection occur and what would indicate this in tests?
Within 6 months
Rising creatinine, pyuria, proteinuria
Initial management of acute graph rejection?
Steroid dose increase
Investigation for ant ptnt presenting with AKI of unknow cause?
Renal tract US within 24 hours
Treatment for a patient with K+ => 6.5 mmol/L OR ECG changes of hyperkalaemia?
-IV Calcium Gluconate
-Insulin/dextrose infusion
SEs of erythrpoietin?
Bone aches
Flu-like symptoms
Skin rashes
What is type 1 resp failure?
Hypoxia without hypercapnia
Mechanism of calcium gluconate on K+ levels?
Nothingggggg
Only stabilises the myocardium
Heart manifestation of ADPKD?
Mitral valve prolapse
Prolonged diarrhoea acid base results?
Metabolic acidosis + hypokalaemia
Potassium requirement per day is how much?
1 mmol/kg/day
Risk if large volumes of 0.9% saline solution are administered?
Hypercholoraemic metabolic acidosis
Max rate of K+ infusion via peripheral line ?
10 mmol/hour
Will an isolated respiratory alkalosis affect the base excess?
NO
If a patient has respiratory alkalosis + low bicarb + negative base excess….what do you think it is?
Predominant respiratory alkalosis + underlying metabolic acidosis
-Can be caused by aspirin overdose (salicylic acid derivative)
ABG of patient with sepsis?
Metabolic acidosis with raised anion gap
-Often have raised serum lactate due to hypoperfusion of peripheries
(anion gap = difference between plasma cations (Na+ & K+) and anions (Cl- & HCO3-)
Normal range of anion gap?
10-18mmol/L
What does it suggest if anion gap is raised, give examples?
Increased production, or reduced excretion, of fixed/organic acids.
Lactic acid (sepsis, ischaemia)
Urate (renal failure)
Ketones (DKA)
Drugs/toxins (salicylates, methanol, ethylene glycol)
Medication for hyperphosphataemia in patients with CKD MBD?
Sevalamer
Mechanism of diabetes insipidus in patient’s taking Lithium?
Lithium desensitizes the kidney’s ability to respond to ADH in CDs
in CAPD related peritonitis what is the most common causative organism?
Staphylococci
Staph epidermidis
Normal anion gap?
8-14 mmol/L
Causes of normal anion gap or hyperchloraemic metabolic acidosis?
GI Bicarb loss: diarrhoea, ureterosigmoidostomy
Renal Tubular Acidosis
Drugs: acetazolamide
Ammonium chloride injection
Addison’s disease
Causes of raised anion gap metabolic acidosis?
Lactate: shock, hypoxia
Ketones: DKA
Urate: Renal failure
Acid poisoning: salicylates, methanol
5-oxoproline: chronic paracteamol use
Which kidney problem has enlarged kidneys?
Diabetic nephropathy
Bag of worms texture?
Variocele
Trriad of HUS?
Anaemia
Thrombocytopenia
Acute Renal Failure
Alport’s syndrome?
Can’t pee
Can’t see
Can’t hear thee
Pixorize: Airplane, foggy can’t see to land in the alPort. Planes funny, one day you’re in college (collagen) and then you’re out the door (four) flying across the world (collagen IV defect)
Dominant X shaped aircraft also trying to land….X-linked dominant inheritance
Defective BM, downstream effect on eyes, ears and kidney
Basket weave appearance: basket for picnic when you’re nervous eating in plane landing
Big risk following renal transplants?
Squamous cell carcinomas
Initial management of CKD-MBD?
Dietary changes»_space;> then phosphate binders
What type of renal syndrome can be an effect of taking lithium?
Nephrogenic diabetes insipidus
What type of diuretic is spiranolactone?
Aldoseterone antagonist
Non-compensated respiratory acidosis is what?
Type 2 respiratory failure
Criteria for AKI?
-Increased creatinine >26 umol/L in 48 hours
-Increased creatinine >50% in 7 days
-Decreased urine output <0.5 ml/kg for more than 6 hours
2 episodes of painless frank haematuria?
Cystoscopy/urgent referral on cancer pathway if older age and presentation
Maintenance fluids rule?
20-30ml/kg/day
Patient with non visible haematuria, where do you refer them to?
<40 years old: nephrology
>40 years old: Urology
What can invalidate an eGFR test?
Eating red meat the night before (creatinine in the meat)
Amputation
Pregnancy
Muscle mass: body builders
Mechanism of calcium resonium?
Removes potassium from the body
Treatment of nephrogenic diabetes?
Chlorothiazide
Infusion rate of KCL for hypokalaemia?
Shouldn’t exceed 20mmol/hr
What anti-emetic can cause urine retention in elderly?
Cyclazine
(H1 receptor antagonist, anticholinergic effects
What is schistosomiasis a RF for?
SSC of bladder
