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Final Year - Passmed > Renal > Flashcards

Renal Flashcards

1
Q

metformin and AKI

A

stop metformin as it can cause lactic acidosis

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2
Q

drugs safe to continue in AKI?

A

paracetamol
warfarin
statin
aspirin at cardioprotective dose
clopi
beta blocker

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3
Q

acute interstitial nephritis presents with

A

allergic type picture

urinary WCC and eosinophilia

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4
Q

features of acute interstitial nephritis?

A

fever
rash
arthralgia
eosinophilia

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5
Q

Focal segmental glomerulosclerosis

A

nephrotic

peripheral oedema
high grade proteinuria

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6
Q

goodpasture syndrome

A

pulmonary haemorrhage and glomerulonephritis

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7
Q

Renal Biopsy
FSGS

A

focal and segmental sclerosis and hyalinosis on light microscopy

effacement of foot processes on electron microscopy

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8
Q

prevention of contrast induced nephropathy

A

1L of 0.9% sodium chloride

volume expansion

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9
Q

withold metformin for how long?

A

48 hours and until renal function shown to be nornal

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10
Q

Mainstay mx of rhabdomyolysis?

A

IV fluid rehydration
> normal saline

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11
Q

why normal saline > hartmann

A

IV hartmann contains potassium

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12
Q

why does hypocalcaemia occur in rhabdo?

A

myoglobin binds to calcium

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13
Q

why does spironolactone cause gynaecomastia?

A

inhibits free testosterone from binding to androgen receptors in cells located in the breast

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14
Q

between IV calcium gluconate and IV insulin/dextrose infusion what is given first?

in severe hyperkalaemia

A

IV calcium gluconate is given first for stabilisation of the cardiac membrane

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15
Q

ascites management?

A

spironolactone

fluid overload

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16
Q

Mx ascites

A

spironolactone

large volume paracentesis
albumin infusion
prphylactix ciprofloxacin

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17
Q

how is dehydration characterised?

A

urea that is proportionally higher than rise in creatinine

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18
Q

most common cause of peritonitis

A

coagulase negative staphlyococcus epidermis

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19
Q

peritonitis

BNF recommends ?

A

Vancomycin or (teicoplanin)
+ ceftazidime added to dialysis fluid / vancomycin

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20
Q

pts on long term immunosuppresion are at risk of?

A

skin malignancy
squamous cell carcinoma

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21
Q

Renal transplant

A

> ciclosporin
tacrolimus
steroids

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22
Q

ciclosporin MOA?

A

inhibits calcineurin
phosphatase involved in t cell activation

23
Q

MMF MOA?

A

mycophenolate mofetil

blocks purine synthesis by inhibition of IMPDH

> proliferation of B and T cells

s/e GI and marrow suppression

24
Q

Sirolimus

A

blocks T cell proliferation
> IL 2 receptor

25
Q

selective inhibitors of IL-2 receptor

A

daclizumab
basilximab

26
Q

causes of haematuria?

A

transitional cell carcinoma of the bladder

stones
BPH
urethritis
neal causes

27
Q

in pts with suspected anaemia of chronic disease

management?

A

check iron status prior to commencing EPO

28
Q

recommended fluid challenge?

A

500mL normal saline

29
Q

renal cause of AKI

acute tubular necrosis

A

kidneys not able to concentrate or retain sodium

urine osmolality is low
urine sodium is HIGH

30
Q

Membranous glomerulonephritis histology

A

++ PLA2

basement membrane thickening on light microscopy
subepithelial spikes on silver staisn

31
Q

goodpastures is ?

A

nephritic

32
Q

sterile pyuria and white cell casts?

A

acute interstitial nephritis

33
Q

How does insulin/dextrose work?
in hyperkalaemia management?

A

drives potassium from extracellular > intracellular (insulin)

activating the Na-K-ATPase on cell membranes

34
Q

SGLT-2 moa?

A

blocking reabsorption of glucose in the proximal tubule

lowers renal glucose threshold

> glycosuria

reduce sodium reabsorption → natriuresis

35
Q

Alport’s syndrome

A

x linked dominant
microscopic haematuria,

bilateral sensorineural deafness,

lenticonus

36
Q

IgA nephropathy

A

1-3 days - very acute
only haemutria

37
Q

eGFR od 68 and no features / symptoms of CKD

A

do not diagnose stage 1 / 2 without abnormality on imaging or symptoms

38
Q

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR

what to look at?

A

urinalysis
renal USS

39
Q

when is renal replacement therapy indicated in AKI?

A

not responsive to medical management

> hyperkalaemia
pulmonary oedema
uraemia

40
Q

Alfacalcidol is used as a vitamin D supplement in end-stage renal disease

why?

A

does not need kidney activation

41
Q

adult polycystic kidney disease

screening?

A

USS abdo

two cysts, unilateral or bilateral, if aged < 30 years
two cysts in both kidneys if aged 30-59 years
four cysts in both kidneys if aged > 60 years

42
Q

diarrhoea

acid-base

A

normal anion gap metabolic acidosis

excessive bicarbonate loss via the GI tract

43
Q

A reduced anion gap is normally caused by?

A

loss of albumin

more cations - calcium

44
Q

Class 1 antigens : HLA

A

A
B
C

45
Q

HLA class 2

A

DP
Dq
DR

46
Q

when HLA matching for a renal transplant the relative importance of the HLA antigens are as follows

A

DR > B > A

47
Q

Hyperacute rejection (minutes to hours)

A

ABO /HLA

type 2 hypersensitivity

thrombosis and ischaemia and necrosis of transplanted organ

> only mx is removal of graft

48
Q

Acute graft failure (< 6 months)

A

HLA mismatch

cell mediated- cytotoxic t cell

rising creatinine pyuria and proteinuria

49
Q

preferred method of access for haemodialysis

A

arteriovenous fistula

50
Q

should severe hyperkalaemia be treated

regardless of symptoms and no ECG changes?

A

yes

51
Q

staging of AKI
creatinine?

A

1: 1.5-1.9
2:2.0-2.9
3: 3x baseline or >354umol/l

52
Q

daily maintenance fluid requirement for water in adults

A

25-30ml/kg/day

53
Q

approximately ________of glucose to limit starvation ketosis

A

50-100 g/day

54
Q
A

Final Year - Passmed (22 decks)

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