Renal 2 Flashcards
Patients with active Henoch-Schonlein purpura
monitor what?
blood pressure and urinanlysis
> progressive renal involvement
how to calculate anion gap?
sum of positive cations
negative anions
[Na+ K] - [Cl+HCO3]
what is a normal anion gap?
10-18 mmol/L
What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism
loss of antithrombin III
muddy brown casts
acute tubular necrosis
> epithelial cell damage
‘bag of worms’ texture
right-sided testicular swelling
varicocele
negative fluid balance
tachycardia
Chronic diabetic nephropathy
imaging results?
bilateral enlarged kidneys
Ix for diabetes insipidus?
water deprivation test
acute interstitial nephritis
drug causes?
abx
NSAIDS
salicylates
acei
diuretics
polyuria
random capillary glucose is normal
lithium use
diabetes insipidus - nephrogenci
HUS management
when is plasma exchange indicated?
no diarrhoea present
MAHA is coombs?
coombs negative haemolysis
> formation of schistocytes
shiga toxins are seen by?
PCR
Investigating frank haematuria?
Gold standard?
urgent referral on cancer pathway
cystoscopy
urgent referral for haematuria?
> 45
- visible haematuria wo UTI
- visible persistent
> 60
- dysuria
- raised WCC
non visibile hameutria
why would you USS KUB when suspecting AKI?
post renal causes
catheter blockage
stones
malignancy
prostatic hypertrophy
hypoxaemia is defined as?
<8.0
type 2 respiratory failure is?
hypercapnia and hypoxia
CO2
>6
O2
<8
noradrenaline infusion can cause what kind of acid base?
tissue Hypoperfusion + increased lactate
metabolic acidosis
Bowel ischaemia acid base?
metabolic acidosis
due to raised lactate
hyperchloraemic metabolic acidosis
when you aggressivle fluid resus
++ Na but also ++ CL-
Types of renal replacement therapy
haemodialysis
peritoneal dialysis
renal transplant
Haemodialysis?
dialysis 3x a week
lasts 3-5 hours
arteriovenous fistula
Peritoneal dialysis
Continuous ambulatory peritoneal dialysis
30-40 mins lasts 3/4 hours
Automated peritoneal dialysis
sleeping
3-5 exchanges over 8-10 hours
usual first line for renal replacement therapy?
when would haemodialysis be good instead?
peritoneal dialysis
crohns patients
prolonged diarrhoea results in what type of acid - base?
metabolic acidosis w hypokalaemia
Triad of renal cell carcinoma?
presents with?
haematuria, loin pain, abdominal mass
pyrexia
left varicocele due to occlusion of left testicular vein
all patients with CKD should be on?
statin
prolonged diarrhoea is associated with?
metabolic acidosis with hypokalaemia
____ disease has a good response to fluid challenge
pre renal
if there is an increase risk fo VTE in a patient with nephrotic syndrome
what prophylaxis?
LMWH
nephrotic syndrome leads to = loss of antithrombin 3
to prevent a thrombus give LMWH
pathophysiology of nephrotic syndrome
glomerular basement membrane is damaged
= increased permeability to proteins
= hypoalbumin
= oedema
lose antithrombin 33
differentiating primary and secondary aldosteronism
look at?
renin
if renin is high than secondary cause as not suppressed by action of increased aldosterone (expected in bilateral hyperplasia and Conns)
renal artery stenosis
due to?
atherosclerosis
fibromusuclar dysplasia
hereditary haemochromatosis is a cause of
cranial diabetes insipidus
nephrogenic DI causes
adrenalcortical insuffiency
sjogrens syndrome
urine osmolality of >______ excludes?
700mOsm/kg excludes DI
investigating diabetes insipidus?
water deprivation test
what is useful in differentiating between AKI and CKD?
uss of urinary tract as small kidneys bilateral is sign of CKD
calcium also
raised anion gap metabolic acidosis
septic shock due to lactate
> inadequate tissue perfusion
addisons disease
acid base
hyponatraemia with hyperkalaemia
acidosis is caused by a loss of bicarb due to cortisol deficiency
raised anion gap metabolic acidosis
lactate: shock
ketones: DKA /alcohol
urate : renal failure
acid poisoning
5-oxoproline - chronic paracetamol usage
daily amount of glucose?
50-100g/day regardless of weight
what is the principle behind glucose requirements?
2g/kg of ideal or 100g
initial management of CKD related bone disease?
correct hyperphosphataemia first
with dietary changes
> phosphate binders
managing hypercalcaemia?
IV fluids first due to cardiac stability
what is an expected rise of creatinine ?
> 30% from baseline
calcium acetate is?
calcium based binder used to treat the hyperphosphataemia
sevelamer
non calcium based phosphate binder - would not cause hypercalcaemia
what is stage 3 AKI based on urine output
<0.3mL /kg/hr for 24 hours
CKD on haemodialysis most likely cause of death?
IHD
does HSP present with thrombocytopenia?
no
acute urinary retention
mx
PMHx of bladder cancer and BPH
bladder scan confirms residual volume of >1000ml
bladder irrigation via 3 way urethral catheter
