Renal Flashcards by Charis Gibson

When do you give calcium gluconate?

If K+ >5.5

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What indicates that Kidney disease is chronic and not acute?

Calcium (hypocalcaemia)

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What does protein in the urine dipstick rule out cause wise for an AKI?

Pre-renal
Post-renal

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Muddy brown casts in urine?

Acute tubular necrosis

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Urea that is proportionally higher than creatinine?

Dehydration

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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

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New chest pain with background of AKI? DDx and management?

Pericarditis
Haemodialysis

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ECG findings of widespread PR depression and ST elevation?

Pericarditis

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What medication should all CKD patients be on?

Statin

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InvgX for patient with sus anaemia of chronic disease?

Iron status (before starting EPO)

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Patients with CKD who have albumin:creatinine ratio of more than 30mg/mmol…what med should you give them?

ACE Inhibior eg Ramipril

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eGFR variables in calculation?

Creatinine
Age
Gender
Ethnicity

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Most likely cause of death in patients on haemodialysis for CKD?

Ischaemic Heart Disease

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Isolated rise of GGT in context of macrocytic anaemia?

Alcohol XS

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When does Post-strep Glomerulonephritis develop compared to IgA?

PSGN: 1-2 weeks
IgA: 1-2 days

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Haemoptysis +/- AKI/proteinuria/haematuria?

Anti-GBM disease

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HIV patient with fatigue, peripheral oedema and foamy urine? Diagnosis=

Focal Glomerulosclerosis

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Sick 2 weeks ago + sad kidneys now?

Post-Streptococcal glomerulonephritis

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NSAIDS can cause what kidney problem?

Acute interstitial nephritis

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Oedema + proteinuria = what?

Nephrotic syndrome

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What type of syndrome is IgA nephropathy?

Nephritic

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Haematuria + Proteinuria= what?

Nephritic syndrome

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Child nephrotic syndrome?

Minimal change disease

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Diagnostic test for PSGN?

Anti-streptolysin O Titre (Raised in PSGN)

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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?

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 >>> 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