renal Flashcards
CKD diagnosis
egfr less than 60 on 2 occasions 3 months apart
Which nephrotic syndrome is associated with malignancy
membranous nephropathy
When do you send MSU
aged > 65 years
visible or non-visible haematuria
What opioid is preferred in renal impairment
oxycodone: mild-moderate renal impairment
alfentanil, buprenorphine and fentanyl: severe
Renal colic management
- <5mm + no symptoms: watchful waiting
- 5-10mm: shockwave lithotripsy + alpha blocker (tamsulosin)
- > 20mm: percutaneous nephrolithomy
asthma, eosinophillia, impaired kidney function
churg-strauss (pANCA)
How do you diferentiate CKD and AKI
CKD has small kidneys and hypocalcamia
do you get raised or decreased haptoglobin in HUS
decreased
most common organism in peritonitis secondary to peritoneal dialysis
staph epidermis
Complications of RTA1
renal stones and nephrocalcinosis
Complication of RTA2
osteomalacia
pathophysiology of iga nephropathy
mesangial deposits of iga immune complexes
enlarged kidneys on USS with CKD
autosomal dominant polycystic kidney disease
diabetic nephropathy (early stages)
amyloidosis
HIV-associated nephropathy
pathophysiology of membranous nephropathy
IgG immune complex deposits in the basement membrane
God gives people cancer
what kidney issue is HIV associated with
nephrotic syndrome
focal segmental glomerulosclerosis
nephrotic syndrome criteria
- proteinuria >3g/24 hours
- hypoalbuminiea <25g/24 hours
- peripheral oedema
- hypercholesteremia
cause of renal artery stenosis
young: fibromuscular dysplasia
Old: atheroscleoris
what is seen on MR angiography with RAS
string of beads appearance
pathophysiology of post-stre glomeurulonephritis
immune complex (IgG, IgM and C3) deposition in the glomeruli.
most common and important viral infection in solid organ transplant recipients
CMV
why do you get High serum urea:creatinine ratio is seen in pre-renal AKI
urea is passively reabosrbed with sodium
maximum recommended rate of potassium infusion via a peripheral line
is 10 mmol/hour, whereas rates above 20 mmol/hour require cardiac monitoring
How does myoglobin cause AKI
tubular cell necrosis
nephrotic syndrome causes
- focal segmental glomerulosclerosis
- minimal change disease
- membranous nephropathy
- Membranoproliferative Glomerulonephritis
- amyloidosis
Secondary
- diabetic nephropathy
- HIV/hepatitis
- SLE
why do you get increased risk of thrombus in kidney disease
loss of antithrombin III
Lights criteria for exudative
- pleural fluid protein/serum fluid protein ratio > 0.5
- pleural fluid LDH/serum fluid LDH ratio > 0.6
SAAG
> 11g/L is portal hypertension
Choice of drug in PE with low renal function
heparin
Stag-horn calculi
struvite
Drugs that cause AIN
- penicillin
- NSAIDs
- Rifampicin
- Allopurinol
- Furosemide
ATN causes
- Aminoglycosides
- Rhabdo
- Ischamia (shock/sepsis )
drugs to avoid in renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
budd chiari syndrome investigation
doppler USS
liver transplant criteria following PO
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Choice of treatment for CKD bone disease
alfacalcidol (does not need to be activated in the kidneys)
potential complication of nephrotic syndrome
renal vein thrombosis
- loss of antithrombin III creats hypercoaguable state
urine sodium > 40 mmol/L
ATN
urea > creatinine
dehydration
sudden onset abdominal pain, ascites, and tender hepatomegaly
budd-chiari syndrome
most common affected site in crohns
ileum
associated with sewage workers/rat urine
Leptospirosis
causes of transient haematuria
urinary tract infection
menstruation
vigorous exercise (this normally settles after around 3 days)
sexual intercourse
Where do the diuretics work
Aldosterone antagonists: DCT
Loop: ascending look (Na, Cl, K channels)
PCT: carbonic anhydase
goodpastures symptoms
pulmonary haemorrhage
rapidly progressive glomerulonephritis
this typically results in a rapid onset acute kidney injury
nephritis → proteinuria + haematuria
IgG deposits in basement membrane
which nephrotic syndrome is associated with HIV
FSGS
toxic megacolon imagining
abdo x-ray
most likely cause of death with CKD on haemodialysis
IHD
isolated rise in bilirubin
gilbert
complication of ERCP
Pancreatitis
Perforation
Infection (eg acute cholangitis)
Bleeding
Aspiration pneumonia
Cytology reveals malignant cells
what is required before a large volume paracentesis
albumin replacment
complication of TIPS
Inadequate metabolism of nitrogenous waste products by the liver
Blood bypasses liver
first line treatment of nephortic syndrome unknown aetiology
LMWH
pulmonary oedema not responding to diuretics (AKI)
haemodialysis
ACE inhibitors and CKD
A potassium above 6mmol/L should prompt cessation of ACE inhibitors in a patient with CKD (once other agents that promote hyperkalemia have been stopped)
