Renal Flashcards by Lisa Azizi

metformin and AKI

stop metformin as it can cause lactic acidosis

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drugs safe to continue in AKI?

paracetamol
warfarin
statin
aspirin at cardioprotective dose
clopi
beta blocker

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acute interstitial nephritis presents with

allergic type picture

urinary WCC and eosinophilia

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features of acute interstitial nephritis?

fever
rash
arthralgia
eosinophilia

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Focal segmental glomerulosclerosis

nephrotic

peripheral oedema
high grade proteinuria

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goodpasture syndrome

pulmonary haemorrhage and glomerulonephritis

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Renal Biopsy
FSGS

focal and segmental sclerosis and hyalinosis on light microscopy

effacement of foot processes on electron microscopy

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prevention of contrast induced nephropathy

1L of 0.9% sodium chloride

volume expansion

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withold metformin for how long?

48 hours and until renal function shown to be nornal

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Mainstay mx of rhabdomyolysis?

IV fluid rehydration
> normal saline

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why normal saline > hartmann

IV hartmann contains potassium

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why does hypocalcaemia occur in rhabdo?

myoglobin binds to calcium

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why does spironolactone cause gynaecomastia?

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

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

in severe hyperkalaemia

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

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ascites management?

spironolactone

fluid overload

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Mx ascites

spironolactone

large volume paracentesis
albumin infusion
prphylactix ciprofloxacin

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how is dehydration characterised?

urea that is proportionally higher than rise in creatinine

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most common cause of peritonitis

coagulase negative staphlyococcus epidermis

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peritonitis

BNF recommends ?

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

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pts on long term immunosuppresion are at risk of?

skin malignancy
squamous cell carcinoma

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Renal transplant

> ciclosporin
tacrolimus
steroids

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ciclosporin MOA?

inhibits calcineurin
phosphatase involved in t cell activation

MMF MOA?

mycophenolate mofetil

blocks purine synthesis by inhibition of IMPDH

> proliferation of B and T cells

s/e GI and marrow suppression

Sirolimus

blocks T cell proliferation
> IL 2 receptor

selective inhibitors of IL-2 receptor

daclizumab basilximab

causes of haematuria?

transitional cell carcinoma of the bladder stones BPH urethritis neal causes

in pts with suspected anaemia of chronic disease management?

check iron status prior to commencing EPO

recommended fluid challenge?

500mL normal saline

renal cause of AKI acute tubular necrosis

kidneys not able to concentrate or retain sodium urine osmolality is low urine sodium is HIGH

Membranous glomerulonephritis histology

++ PLA2 basement membrane thickening on light microscopy subepithelial spikes on silver staisn

goodpastures is ?

nephritic

sterile pyuria and white cell casts?

acute interstitial nephritis

How does insulin/dextrose work? in hyperkalaemia management?

drives potassium from extracellular > intracellular (insulin) activating the Na-K-ATPase on cell membranes

SGLT-2 moa?

blocking reabsorption of glucose in the proximal tubule lowers renal glucose threshold > glycosuria reduce sodium reabsorption → natriuresis

Alport's syndrome

x linked dominant microscopic haematuria, bilateral sensorineural deafness, lenticonus

IgA nephropathy

1-3 days - very acute only haemutria

eGFR od 68 and no features / symptoms of CKD

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

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR what to look at?

urinalysis renal USS

when is renal replacement therapy indicated in AKI?

not responsive to medical management >hyperkalaemia >pulmonary oedema >uraemia

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

does not need kidney activation

adult polycystic kidney disease screening?

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

diarrhoea acid-base

normal anion gap metabolic acidosis excessive bicarbonate loss via the GI tract

A reduced anion gap is normally caused by?

loss of albumin more cations - calcium

Class 1 antigens : HLA

A B C

HLA class 2

DP Dq DR

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

DR > B > A

Hyperacute rejection (minutes to hours)

ABO /HLA type 2 hypersensitivity thrombosis and ischaemia and necrosis of transplanted organ > only mx is removal of graft

Acute graft failure (< 6 months)

HLA mismatch cell mediated- cytotoxic t cell rising creatinine pyuria and proteinuria

preferred method of access for haemodialysis

arteriovenous fistula

should severe hyperkalaemia be treated regardless of symptoms and no ECG changes?

yes

staging of AKI creatinine?

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

daily maintenance fluid requirement for water in adults

25-30ml/kg/day

approximately ________of glucose to limit starvation ketosis

50-100 g/day