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Z MD 2 > Renal > Flashcards

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
Q

explain what would happen if you loose isotonic fluid (eg. diarrhoea)

A

ECV depletion ICV normal - Na conc normal (but total Na low) get low BP, high HR, low JVP, … etc

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26
Q

what are the causes of fluid overloaded hyponatraemia

A

CCF

cirrhosis

nephrotic syndrome

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27
Q

causes of normal fluid balanced hyponatraemia

A

SIADH

hypothyroidism

addisonian

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28
Q

which fluid do you give a patient if you want to give them free water (increase both ICV and ECV)

A

5% dextrose

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29
Q

which fluid do you give for resuscitation

A

cyrstalloid/Hartmann’s or colloid or blood

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30
Q

clues pointing to CKD over AKI

A
  • pre existing illness
  • DM, HTN, age, vascular disease
  • small, echogenic kidneys by ultrasound
  • endocrine abnormalities
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31
Q

how do you decide whether a patient with AKI requires dialysis

A

AEIOU

Acidosis

Electrolyte

imbalance - hyperkalaemia Intoxication

Oedema

Uraemia

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32
Q

what do patients with CKD typically die of

A

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)

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33
Q

workup for haematuria

A
  • bloods
  • MSU –> MCS
  • upper tract imaging (CT-IVP or US)
  • cystoscopy
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34
Q

describe the histology of IgA nephropathy

A

focal areas of proliferation of mesangial cells

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35
Q

major causes of anuria

A

complete obstruction

major vascular catastrophy

Severe ATN

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36
Q

what are some causes of painLESS inability to pass urine

A

neurogenic - central or peripheral l

ongterm voiding dysfunction with decompensated detrusor

aging

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37
Q

irritative symptoms

A

frequency

urgency

nocturia

incontinence

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38
Q

in severe CKD where fluid overload can be a problem - which drug should you use to treat them and why

A

high dose frusemide - because it needs to enter a functional renal tubule to exert its effect

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39
Q

explain the breakdown of fluid compartments in the body

A

40% solid, 60% liquid

of the liquid: ⅔ ICF ⅓ ECF

  • 80% interstitial fluid and 20% plasma
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40
Q

hyponatraemia is due to

A

excess water intake or decreased water excretion (nothing to do with Na intake or excretion)

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41
Q

how can you tell if haematuria is due to glomerular damage or non glomerular damage

A

glomerular = dysmorphic RBCs

non-glomerular = isomorphic RBCs

42
Q

explain ECV, ICV and total sodium with SIADH

A

retained free water (⅔ into ICV and ⅓ into ECV) increased ICV, increased ECV, total sodium normal (conc low)

43
Q

Less common types of renal stones

A

uric acid

magnesium ammonium phsophate

cystine

other

44
Q

when is dialysis generally offered to patients

A

when they are expected to live >1 year when GFR >10ml/min

45
Q

when do you give isotonic saline to a patient

A

if they have low ECV

46
Q

main medication to help CKD

A

ACEi to treat hypertension

47
Q

acute workup for renal stones

A
  • Bloods - FBE, UEC, CRP, WCC
  • Serium calcium and uric acid
  • MSU
  • CT-KUB AND plain KUB
48
Q

which two things point to evidence of complicated urinary retention

A

obstructive nephropathy

sepsis

49
Q

management of hyponatraemia

A

if dehydrated

  • replace fluid with normal saline normal volume
  • fluid restrict or increase free water clearance volume overloaded
  • fluid and Na restriction, diuretics
50
Q

eGFR is only accurate when…

A

the creatinine is in a steady state (if rising - overestimates, falling - underestimates)

51
Q

explain what happens if you gain isotonic fluid (eg. given normal saline)

A

normal Na concentration (high total sodium) osmolality unchanged can lead to oedema, high JCP, pulmonary oedema (if CVS)

52
Q

management for uric acid stones

A

urinary alkalinisation - potassium citrate/sodium bicarbonate

High fluid intake

53
Q

what type of anaemia is it that you get with CKD

A

normocytic and normochromic

54
Q

main type of renal stones

A

calcium oxalate

55
Q

which fluid do you give for maintenance fluids

A

alternate 5% dextrose and crystalloid

56
Q

treatment for SIADH

A

fluid restriction

increase free water clearance (domeclocycline or vaptans)

57
Q

explain what happens if you administer 3 litres of free water into the veins (given 5% dextrose fluid)

A

will go ⅔ into the ICS and ⅓ into the ECS - slightly low Na conc (normal total sodium) - slightly low osmolality

58
Q

management of obstructive pyelonephrosis

A
  • IV antibiotics
  • urgent decompression (nephrostomy, stent)
  • supportive care
59
Q

how do you treat hypocalcaemia in AKI

A

calcium carbonate

calcium gluconate

60
Q

explain what would happen if you did not drink for 3 days

A

loss of free water - ⅔ of fluid needed will come from ICV and ⅓ from ECV - plasma Na increased a little concentrated urine

61
Q

what 3 things in CKD causes anaemia

A
  • fibrosed kidney cannot make EPO anymore
  • uremia causes the bone marrow to fail
  • uremia causes RBCs not to last very long
62
Q

AKI staging is based on what 2 criteria

A

creatinine and urine output

63
Q

which GNs are mostly nephritic

A

crescent associated GN

IgA nephropathy

Post strep (diffuse proliferative)

64
Q

which fluid do you give to replace fluid loss (bile, vomit etc)

A

crystalloid/Hartmanns

65
Q

what causes hypernatraemia

A

increased water loss

decreased water intake

diabetes insipidus

66
Q

why is low ECV a bad thing

A

leads to poor perfusion of organs (especially brain and kidneys)

67
Q

3 key assessments in someone with AKI

A

volume status

urine studies

renal ultrasound

68
Q

surgical treatment of obstructive urinary symptoms

A

TURP - Transurethral resection of the prostate

BNI - bladder neck incision

open prostatectomy

69
Q

medical drug treatment of obstructive urinary symptoms

A

alpha blockers

5-alpha reductase inhibitors

combination

70
Q

what should you measure at every visit in someone with CKD

A

creatinine and urea

fluid state

potassium

anaemia

Ca

71
Q

how will a bladder stone look on ultrasound

A

very echogenic and show posterior acoustic shadowing

72
Q

what is the difference between nephrotic and nephritic

A

nephrotic - Lots of protein in the urine

nephritic - blood in the urine and maybe some protein

73
Q

2 main causes of CKD in Australia

A

Diabetic nephropathy

glomerulonephritis

74
Q

treatment of CKD with ACEi is contraindicated in

A

those with bilateral renal stenosis

75
Q

in a child presenting with proteinuria, the most likely cause is to be due to

A

minimal change disease

76
Q

what is acute urinary retention

A

sudden and PAINFUL inability to pass urine

77
Q

how can NSAIDs cause kidney failure

A

can cause chronic intersitital nephritis (dont get papillary necrosis unlike with APC ingestion)

78
Q

what are some conditions that can cause irritative symptoms

A

secondary to obstruction

UTI

Ca bladder

stone

diabetes

TB

79
Q

which GNs are mostly nephrotic

A

minimal change

focal sclerosing

membranous

80
Q

what presentation of haematuria suggests cancer until proven otherwise

A

painless, macroscopic haematuria

81
Q

what does proteinuria suggest as a cause of AKI

A

nonproliferative GN

82
Q

how do you define chronic kidney disease

A

GFR less than 60ml/min for more than 3 months (microalbuminaemia, proteinuria, glomerular haematuria, pathological abnormality, anatomical abnormality)

83
Q

normal ranges for extracellular Na, K and chloride

A

Na = 135-145 mmol/L

K = 3.5-5.5 mmol/L

Cl = 110 mmol/L

84
Q

acute treatment of hyperkalaemia

A

Ca gluconate

insulin & dextrose

resonium bicarbonate/dialysis

85
Q

acute management of acute urinary retention

A

pass a catheter

86
Q

what will the serum and urine results show in SIADH

A

low serum osmolality

high urine osmolality

87
Q

explain what would happen to ECV, ICV and total sodium in a comatose man found after 3 days

A

no free water going in.. ECV low, ICV low, total sodium normal (conc high)

88
Q

acute management of renal stones

A
  • pain relief - NSAIDs, opiods and paracetamol
  • hydration
89
Q

if someone has kidney problems.. which medications/agents should you avoid

A

NSAIDs

aspirin (Cox-2 Inhibitor)

gadolinium-based contrast agents

90
Q

which medication do we give patients to help expel renal stones

A

alpha blockers

91
Q

what things can cause pseudo-hyponatraemia

A

increased blood sugar levels

increased lipids

mannitol

92
Q

5 main functions of the kidneys

A

sieve for small waste

solutes disposal

fluid balance

electrolyte balance and acid base balance

erythropoietin Vitamin D

93
Q

How should you monitor CKD

A

measuring GFR (creatinine is not good enough as it is not a linear relationship to kidney disease)

94
Q

how is obstructive nephropathy defined

A

elevated Cr

bilateral hydronephrosis

95
Q

how does gout cause kidney failure

A

the crystals themselves do direct damage to the kidneys –> interstitial nephritis

96
Q

post renal causes of AKI

A

stones

prostate

trauma

tumour

97
Q

when are you classed with stage 5 CKD

A

when GFR less than 15 ml/min

98
Q

hypovolaemia is due to

A

loss of sodium and fluid (isotonic loss)

99
Q

risk factors for developing renal stones

A

dehydration

diet (increased animal protein or increased sodium)

100
Q

obstructive symptoms

A

poor flow

hesitancy

intermittency

terminal dribbling

straining

incomplete emptying

Z MD 2 (15 decks)

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