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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

What is Eculizumab used to treat?

A

HUS

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2
Q

What is Dapaglifozin used for?

A

SGLT-2 inhibitor

Often given w/ACEi to DM + CKD pts

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3
Q

What is cyclophosphamide used for?

A

multiple myeloma

goodpasture’s syndrome

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4
Q

What does Tolvaptan treat?

A

PCKD

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5
Q

What are the 3 agents used for immunosuppresison in renal transplant?

A

Tacrolimus
Mycophenolate
Prednisolone

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6
Q

What is the daily requirement of potassium?

A

1mmol/kg/day

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7
Q

What is the daily requirement of water?

A

25-30ml/kg/day

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8
Q

What is the daily requirement of glucose?

A

50-100g/day

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9
Q

What are routine maintenance fluids?

A

25-30ml/kg/day NaCl 0.18% in 4% glucose with 27mmol/l potassium

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10
Q

What do you have to watch out for when prescribing maintenance fluids?

A

Hyperchloraemic acidosis

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11
Q

What is the Holliday-Segar formula?

A

Paediatric fluid prescribing

1st 10kg = 100ml/kg
2nd 10kg = 50ml/kg
3rd 10kg = 20ml/kg

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12
Q

Which drugs do you need to take off in someone with an AKI?

A

DIANA (+lithium)

Duretics
Iodinated contrast
ACEi/ARB
NSAIDs (apart from cardioprotective Aspirin 75mg)
Aminoglycosides

+lithium

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13
Q

How do you manage a diabetic patient with CKD?

A

ACEi + Dapaglifozin (SGLT-2 inhibitor)

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14
Q

How do you manage Goodpasture syndrome?

A

Plasmapheresis
Steroids
Cyclophosphamide

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15
Q

How do you manage minimal change nephrotic syndrome

A

Steroids

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16
Q

How do you manage DM nephropathy?

A

Give an ACEi if ACR>30

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17
Q

How is renal tubular acidosis managed?

A

Types 1-3 - Bicarbonate

Type 4 - fludrocortisone because reduced aldosterone (consider bicarb and hyperkalaemia management too)

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18
Q

Name 5 drugs causing AIN

A

5P’s

Penicillins
PPI
Pain free (NSAIDs)
Pee (diuretics)
rifamPicin

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19
Q

Which 3 drugs do you use to manage hyperkalaemia?

Name 2 bonus ones

A

Insulin
Dextrose
Calcium gluconate

Salbutamol neb - temporarily drives potassium into cells

Oral calcium resonium - GI excretion of K+

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20
Q

Which 4 things are used to treat HUS?

A

Anti HTN
Blood transfusions
Dialysis
Eculizumab

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21
Q

How would you treat cranial and renal DI?

A

Cranial - desmopressin
Renal - thiazide diuretics

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22
Q

Which bug might cause staghorn calculus?

A

Proteus Mirabilis

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23
Q

What causes a normal anion gap metabolic acidosis?

A

Loss of HCO3-, renally or from GiT

GI loss - diarrhoea, fistula, stoma
Isotonic saline infusion
renal tubular acidosis
Acetazolamide
Addison’s

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24
Q

What might cause a high anion gap metabolic acidosis?

A

XS acid in the blood

Lactic acidosis
Ketoacidosis (diabetic, alcoholic, starvation)
Uraemia
Methanol / ethanol / ethylene glycol
Salicylate toxicity
CO toxicity

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25
Q

How do you prevent contract-induced nephropathy?

A

Volume expansion with 0.9% saline

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26
Q

What drug is offered in ascites?

A

Spironolactone

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27
Q

What is the maximum recommended rate of K+ infusion via peripheral line?

A

10mmol/hour

Rates above 20mmol/hour require cardiac monitoring

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28
Q

How might nephrotic syndrome affect TFTs?

A

Loss of thyroid-binding globulins causes a low total T4 level

29
Q

How might you differentiate primary and secondary aldosteronism?

A

Look at renin levels

high - secondary cause more likely (i.e. renal artery stenosis)

30
Q

What would a positive immunohistochemistry for PLA2 on renal biopsy suggest?

A

Membranous glomerulonephritis

31
Q

Name 4 causes of Nephritic syndrome

A

IgA
post-strep
Goodpasture syndrome
Rapidly progressive

32
Q

Name 3 causes of Nephrotic syndrome

A

Minimal change
FSGS
Membranous glomerulonephritis

33
Q

How would diabetic nephropathy affect the size of the kidneys?

A

bigger, Bigger, BIGGER

34
Q

How would ATN affect urine sodium levels?

A

Urine sodium ^

35
Q

How would pre-renal uraemia affect urine sodium levels?

A

decrease urine sodium

Kidneys hold on to sodium to preserve volume

36
Q

Which organism is responsible for peritonitis secondary to peritoneal dialysis?

A

Staph epidermis

37
Q

How do you prevent contrast-induced nephropathy?

A

volume expansion with 0.9% saline

38
Q

What mumurs are associated with PCKD?

A

Mitral valve prolapse (mid-systolic click)

MItral regurgitation

39
Q

What sort of AKI is caused by Rhabdomyolysis?

A

ATN

40
Q

What might cause an isolated rise in creatinine following a UTI?

A

Timethoprim

41
Q

What is the most common complication of haemodialysis?

A

Dialysis-induced hypotension

42
Q

What finding is indicative of end stage renal disease on US?

A

shrunken kidneys

43
Q

How might a young woman initiated on an ACEi develop on AKI?

A

fibromuscular dysplasia

44
Q

What ABG findings are associated with diarrhoea?

A

Normal anion gap metabolic acidosis with hypokalaemia

45
Q

How might nephrotic syndrome progress to nephritic syndrome?

A

Renal vein thrombosis

nephrotic syndrome is associated with a hypercoagulable state due to the loss of antithrombin III via the kidneys

46
Q

What medications may cause the presence of hyaline casts in urine?

A

Loop diuretics

(e.g. Furosemide)

47
Q

Can you name 2 calcineurin inhibitors?

What adverse effects might they have in the context of renal transplant?

A

Tacrolimus
Ciclosporin

nephrotoxocity
HTN
tremor
post-transplant DM

48
Q

How might CMV (immunosuppression) affect a blood film?

A

low WCC

49
Q

In IgA nephropathy, what type of haematuria is a good prognostic indicator?

Why?

A

Macroscopic haematuria

microscopic haematuria occurs later in disease

50
Q

What sort of stroke is most commonly associated with ADPCKD?

A

SAH (berry aneurysms)

51
Q

By what mechanism does gentamicin cause renal failure?

A

ATN

52
Q

By what mechanism do PPIs cause renal failure?

A

AIN

53
Q

What bedside investigation would tell you how much urine is in the bladder?

A

Bladder scan

54
Q

Name one similarity and one difference between uric acid stones and cystine stones

A

similarity - both radioluscent

difference - cytine is inherited

55
Q

Why might someone with ADPCKD how a positive Kernig’s sign?

A

Meningeal irritation in berry aneurysm / SAH

56
Q

How might someone with Wilson’s disease develop DVT

A

Treated with Penicillamine, which is a copper-chelating agent

This can cause membranous nephropathy

Loss of antithrombin III -> hypercoagulability

57
Q

What factors are involved in calculating eGFR and Creatinine Clearance?

A

eGFR (CAGE) - creatinine, age, gender, ethnicity)

CC - replace ethnicity with weight

58
Q

Why don’t you tend to gie Abx in HUS?

A

Worsen disease by increasing toxin release

59
Q

What is the characteristic feature of type 4 RTA?

A

Hyperkalaemia

(low aldosterone)

60
Q

Which infection is commonly associated with membranous nephropathy?

A

Hep B

yeah normally you think of malignancy with memb. g. but quesmed had this interesting question

61
Q

How does nephrotic syndrome increase your risk of VTE?

A

Loss of antothrombin III

62
Q

Why is it important to monitor creatinine after you’ve started an ACEi?

A

a rise of 30% in 2 weeks means you should stop the ACEi

63
Q

What absolute creatinine value would automatically result in a CKD stage 3 diagnosis?

A

353.6

64
Q

What would the presence of anti-DNase Ab suggest?

A

post-streptococcal glomerulonephritis

65
Q

What is the management for uraemic pericarditis?

A

Haemodialysis

66
Q

Which chromosome is ADPCKD inherited via?

A

chromosome 16

67
Q

How long does it take for an AV fistula to fully develop?

A

6-8 weeks

68
Q

What is Sevelamer?

A

Sevelamer is a non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease

Medicine (21 decks)

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