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Renal Flashcards

1
Q

3 types of urinary catheters

A

indwelling urethral catheter

intermittent self catheterisation

suprapubic catheter

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2
Q

what is the main factor that determines how long you will survive on dialysis

A

if you have residual native GFR and how much you have

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3
Q

how can you tell the difference between pre renal AKI and ATN

A

pre renal AKI - concentrating ability still intact

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4
Q

what are some conditions that can cause obstructive urinary symptoms

A

BPH

Ca prostate

stricture

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5
Q

how do we treat proteinuria

A

lowering of BP!! - ACEi - ANGRB - direct renin inhibitor - spironolactone

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6
Q

hypernatraemia is due to

A

water that has been lost that is not replaced

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7
Q

how can you recognise AKI

A

1.5 x increase in creatinine from most recent baseline OR 6 hours of oliguris

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8
Q

what clinical features would make you want to admit someone for renal stones

A
  • septic
  • solitary kidney
  • severe renal impairment
  • bilateral stones
  • cant get symptoms under oral control
  • intractable N&V
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9
Q

How to prevent stone recurrence

A
  • adequate fluid intake
  • dietary modification (more citric fruits, reduce animal protein, reduce salt)
  • urinary alkalinisation
  • medical therapy if recurrent stones (allopurinol, thiazide diuretics)
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10
Q

What are some gastrointestinal symptoms of CKD

A

N&V

weight loss

anorexia

metallic taste in the mouth

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11
Q

management of hypernatraemia

A

replace water loss

normal saline infusion if more rapid correction needed

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12
Q

if a patient talks about a sore throat and then getting kidney failure straight away.. what does this point to

A

IgA nephropathy

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13
Q

explain ICV, ECV and total body sodium with 6 days of vomiting

A

loss of isotonic fluid: low ECV, normal ICV, low total sodium (conc normal)

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14
Q

which drugs and situations can shift potassium into cells

A

insulin, Beta agonists, aldosterone and alkalosis

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15
Q

what are the indications for intervention for renal stones

A
  • Infection/sepsis
  • renal impairment
  • bilateral stones
  • solitary kidney
  • inability to control Sx
  • prolonged obstruction
  • unlikely to pass spontaneously (size >5mm)
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16
Q

which type of renal stone is radio-lucent (unable to be seen on plain xray)

A

uric acid stone

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17
Q

what causes ATN

A

ischaemic depletion of ATP, release of ROS and apoptosis –> cell desquamation, obstructive cast, and back-leak of tubular fluid

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18
Q

what can occur if you give someone fluids too quickly and correct long standing SIADH too quickly

A

central pontine myelinosis

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19
Q

which condition is associated with diabetes and hyperkalaemia

A

hyporeninaemic hypoaldosteronism

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20
Q

what are the causes of SIADH

A

CNS disease

pulmonary disease tumours - especially small cell lung cancer

postoperative drugs

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21
Q

what are the cardiovascular symptoms of CKD

A

HT

heart failure

pericarditis

IHD

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22
Q

pre-renal causes of AKI

A

hypovolaemia (shock, haemorrhage), decreased arterial volume (CCF/liver), vasoconstriction ( contrast/NSAIDs)

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23
Q

oedema is due to

A

retention of sodium and fluid (isotonic retention)

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24
Q

what are the neurological symptoms of CKD

A

peripheral neuropathy

seizures

restless legs

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25
explain what would happen if you loose isotonic fluid (eg. diarrhoea)
ECV depletion ICV normal - Na conc normal (but total Na low) get low BP, high HR, low JVP, ... etc
26
what are the causes of fluid overloaded hyponatraemia
CCF cirrhosis nephrotic syndrome
27
causes of normal fluid balanced hyponatraemia
SIADH hypothyroidism addisonian
28
which fluid do you give a patient if you want to give them free water (increase both ICV and ECV)
5% dextrose
29
which fluid do you give for resuscitation
cyrstalloid/Hartmann's or colloid or blood
30
clues pointing to CKD over AKI
- pre existing illness - DM, HTN, age, vascular disease - small, echogenic kidneys by ultrasound - endocrine abnormalities
31
how do you decide whether a patient with AKI requires dialysis
AEIOU Acidosis Electrolyte imbalance - hyperkalaemia Intoxication Oedema Uraemia
32
what do patients with CKD typically die of
vascular disease! the toxins cause the media of BVs to close off (THE RISK OF DYING FROM CVD EVENTS IS 20 TIMES GREATER THAN GETTING TO DIALYSIS/TRANSLANT)
33
workup for haematuria
- bloods - MSU --\> MCS - upper tract imaging (CT-IVP or US) - cystoscopy
34
describe the histology of IgA nephropathy
focal areas of proliferation of mesangial cells
35
major causes of anuria
complete obstruction major vascular catastrophy Severe ATN
36
what are some causes of painLESS inability to pass urine
neurogenic - central or peripheral l ongterm voiding dysfunction with decompensated detrusor aging
37
irritative symptoms
frequency urgency nocturia incontinence
38
in severe CKD where fluid overload can be a problem - which drug should you use to treat them and why
high dose frusemide - because it needs to enter a functional renal tubule to exert its effect
39
explain the breakdown of fluid compartments in the body
40% solid, 60% liquid of the liquid: ⅔ ICF ⅓ ECF - 80% interstitial fluid and 20% plasma
40
hyponatraemia is due to
excess water intake or decreased water excretion (nothing to do with Na intake or excretion)
41
how can you tell if haematuria is due to glomerular damage or non glomerular damage
glomerular = dysmorphic RBCs non-glomerular = isomorphic RBCs
42
explain ECV, ICV and total sodium with SIADH
retained free water (⅔ into ICV and ⅓ into ECV) increased ICV, increased ECV, total sodium normal (conc low)
43
Less common types of renal stones
uric acid magnesium ammonium phsophate cystine other
44
when is dialysis generally offered to patients
when they are expected to live \>1 year when GFR \>10ml/min
45
when do you give isotonic saline to a patient
if they have low ECV
46
main medication to help CKD
ACEi to treat hypertension
47
acute workup for renal stones
- Bloods - FBE, UEC, CRP, WCC - Serium calcium and uric acid - MSU - CT-KUB AND plain KUB
48
which two things point to evidence of complicated urinary retention
obstructive nephropathy sepsis
49
management of hyponatraemia
if dehydrated - replace fluid with normal saline normal volume - fluid restrict or increase free water clearance volume overloaded - fluid and Na restriction, diuretics
50
eGFR is only accurate when...
the creatinine is in a steady state (if rising - overestimates, falling - underestimates)
51
explain what happens if you gain isotonic fluid (eg. given normal saline)
normal Na concentration (high total sodium) osmolality unchanged can lead to oedema, high JCP, pulmonary oedema (if CVS)
52
management for uric acid stones
urinary alkalinisation - potassium citrate/sodium bicarbonate High fluid intake
53
what type of anaemia is it that you get with CKD
normocytic and normochromic
54
main type of renal stones
calcium oxalate
55
which fluid do you give for maintenance fluids
alternate 5% dextrose and crystalloid
56
treatment for SIADH
fluid restriction increase free water clearance (domeclocycline or vaptans)
57
explain what happens if you administer 3 litres of free water into the veins (given 5% dextrose fluid)
will go ⅔ into the ICS and ⅓ into the ECS - slightly low Na conc (normal total sodium) - slightly low osmolality
58
management of obstructive pyelonephrosis
- IV antibiotics - urgent decompression (nephrostomy, stent) - supportive care
59
how do you treat hypocalcaemia in AKI
calcium carbonate calcium gluconate
60
explain what would happen if you did not drink for 3 days
loss of free water - ⅔ of fluid needed will come from ICV and ⅓ from ECV - plasma Na increased a little concentrated urine
61
what 3 things in CKD causes anaemia
- fibrosed kidney cannot make EPO anymore - uremia causes the bone marrow to fail - uremia causes RBCs not to last very long
62
AKI staging is based on what 2 criteria
creatinine and urine output
63
which GNs are mostly nephritic
crescent associated GN IgA nephropathy Post strep (diffuse proliferative)
64
which fluid do you give to replace fluid loss (bile, vomit etc)
crystalloid/Hartmanns
65
what causes hypernatraemia
increased water loss decreased water intake diabetes insipidus
66
why is low ECV a bad thing
leads to poor perfusion of organs (especially brain and kidneys)
67
3 key assessments in someone with AKI
volume status urine studies renal ultrasound
68
surgical treatment of obstructive urinary symptoms
TURP - Transurethral resection of the prostate BNI - bladder neck incision open prostatectomy
69
medical drug treatment of obstructive urinary symptoms
alpha blockers 5-alpha reductase inhibitors combination
70
what should you measure at every visit in someone with CKD
creatinine and urea fluid state potassium anaemia Ca
71
how will a bladder stone look on ultrasound
very echogenic and show posterior acoustic shadowing
72
what is the difference between nephrotic and nephritic
nephrotic - Lots of protein in the urine nephritic - blood in the urine and maybe some protein
73
2 main causes of CKD in Australia
Diabetic nephropathy glomerulonephritis
74
treatment of CKD with ACEi is contraindicated in
those with bilateral renal stenosis
75
in a child presenting with proteinuria, the most likely cause is to be due to
minimal change disease
76
what is acute urinary retention
sudden and PAINFUL inability to pass urine
77
how can NSAIDs cause kidney failure
can cause chronic intersitital nephritis (dont get papillary necrosis unlike with APC ingestion)
78
what are some conditions that can cause irritative symptoms
secondary to obstruction UTI Ca bladder stone diabetes TB
79
which GNs are mostly nephrotic
minimal change focal sclerosing membranous
80
what presentation of haematuria suggests cancer until proven otherwise
painless, macroscopic haematuria
81
what does proteinuria suggest as a cause of AKI
nonproliferative GN
82
how do you define chronic kidney disease
GFR less than 60ml/min for more than 3 months (microalbuminaemia, proteinuria, glomerular haematuria, pathological abnormality, anatomical abnormality)
83
normal ranges for extracellular Na, K and chloride
Na = 135-145 mmol/L K = 3.5-5.5 mmol/L Cl = 110 mmol/L
84
acute treatment of hyperkalaemia
Ca gluconate insulin & dextrose resonium bicarbonate/dialysis
85
acute management of acute urinary retention
pass a catheter
86
what will the serum and urine results show in SIADH
low serum osmolality high urine osmolality
87
explain what would happen to ECV, ICV and total sodium in a comatose man found after 3 days
no free water going in.. ECV low, ICV low, total sodium normal (conc high)
88
acute management of renal stones
- pain relief - NSAIDs, opiods and paracetamol - hydration
89
if someone has kidney problems.. which medications/agents should you avoid
NSAIDs aspirin (Cox-2 Inhibitor) gadolinium-based contrast agents
90
which medication do we give patients to help expel renal stones
alpha blockers
91
what things can cause pseudo-hyponatraemia
increased blood sugar levels increased lipids mannitol
92
5 main functions of the kidneys
sieve for small waste solutes disposal fluid balance electrolyte balance and acid base balance erythropoietin Vitamin D
93
How should you monitor CKD
measuring GFR (creatinine is not good enough as it is not a linear relationship to kidney disease)
94
how is obstructive nephropathy defined
elevated Cr bilateral hydronephrosis
95
how does gout cause kidney failure
the crystals themselves do direct damage to the kidneys --\> interstitial nephritis
96
post renal causes of AKI
stones prostate trauma tumour
97
when are you classed with stage 5 CKD
when GFR less than 15 ml/min
98
hypovolaemia is due to
loss of sodium and fluid (isotonic loss)
99
risk factors for developing renal stones
dehydration diet (increased animal protein or increased sodium)
100
obstructive symptoms
poor flow hesitancy intermittency terminal dribbling straining incomplete emptying

Z MD 2 (15 decks)

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