Renal 2 Flashcards by Lisa Azizi

Patients with active Henoch-Schonlein purpura

monitor what?

blood pressure and urinanlysis
> progressive renal involvement

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how to calculate anion gap?

sum of positive cations

negative anions

[Na+ K] - [Cl+HCO3]

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what is a normal anion gap?

10-18 mmol/L

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What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism

loss of antithrombin III

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muddy brown casts

acute tubular necrosis
> epithelial cell damage

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‘bag of worms’ texture
right-sided testicular swelling

varicocele

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negative fluid balance

tachycardia

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Chronic diabetic nephropathy

imaging results?

bilateral enlarged kidneys

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Ix for diabetes insipidus?

water deprivation test

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acute interstitial nephritis
drug causes?

abx
NSAIDS
salicylates
acei
diuretics

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polyuria

random capillary glucose is normal

lithium use
diabetes insipidus - nephrogenci

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HUS management

when is plasma exchange indicated?

no diarrhoea present

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MAHA is coombs?

coombs negative haemolysis

> formation of schistocytes

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shiga toxins are seen by?

PCR

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Investigating frank haematuria?
Gold standard?

urgent referral on cancer pathway

cystoscopy

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urgent referral for haematuria?

> 45
- visible haematuria wo UTI
- visible persistent

> 60
- dysuria
- raised WCC
non visibile hameutria

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why would you USS KUB when suspecting AKI?

post renal causes
catheter blockage
stones
malignancy
prostatic hypertrophy

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hypoxaemia is defined as?

<8.0

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type 2 respiratory failure is?

hypercapnia and hypoxia

CO2
>6

O2
<8

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noradrenaline infusion can cause what kind of acid base?

tissue Hypoperfusion + increased lactate

metabolic acidosis

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Bowel ischaemia acid base?

metabolic acidosis
due to raised lactate

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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?

acute urinary retention mx PMHx of bladder cancer and BPH bladder scan confirms residual volume of >1000ml

bladder irrigation via 3 way urethral catheter