Renal Flashcards
What are the risk factors to developing a UTI?
Female Intercourse Spermicide Pregnancy Urinary tract obstruction
Name 3 organisms that can cause a UTI?
E.coli, staph saprophyticus, Proteus mirabilis
Name 4 symptoms of pyelonephritis?
Fever, vomiting, loin pain, rigors
What are the signs of a UTI?
Fever, abdominal tenderness, foul smelling urine
In a UTI, name a test you could perform and what you would be looking for?
Urine dip
Nitrites, Leukocytes, blood or protein
How do you manage a UTI?
Advise to drink plenty of fluids
Prescribe trimethoprim (200mg/12hr;3-6days) or nitrofurantoin.
Upper UTI should have urine cultured
Name the four types of renal stone?
Calcium oxalate
Cystine
Uric acid
Calcium phosphate
What are the symptoms of a renal stone?
Loin to groin pain Nausea and vomiting Blood in urine Urinary frequency/urgency Dysuria
You suspect a renal stone, name 2 investigations you would order and why?
Urine dip-blood Renal imaging (US, CT)-showing the stones
Give 4 steps of management in a renal stone pt?
Analgesia
IV fluids
?Lithotripsy
Pt. to drink plenty of fluids
You suspect pyelonephritis, name 3 blood tests you would do and why?
FBC-high WCC and neutrophils in infection
CRP-high in infection
U+E-high urea and creatinine in renal impairement
Apart from imaging and blood test in pyelonephritis, what other test could you do?
Urine dip and culture
Blood culture
Give 3 steps in the management of pyelonephritis?
Analgesia
IV fluids
IV antibiotics
Monitor renal function
Give 2 possible complications of pyelonephritis?
Acute renal failure
Sepsis
Perinephric abscess
Recurrence of pyelonephritis
State 3 pieces of advice to prevent further UTI’s in a female?
Wipe from front to back Wear cotton undergarments Urinate after intercourse Keep genital area clean Drink plenty of fluids Drink cranberry juice
Name 3 symptoms of hypernatraemia?
Lethargy
Thirst
Weakness
Confusion
Give 3 causes of hypernatraemia?
Fluid loss (diarrhoea, vomit or burns)
Incorrect fluid replacement (excessive saline)
Diabetes insipidus
Primary aldosteronism
What is the appropriate management of hypernatraemia?
Water orally
If not then dextrose 5% IV guided by urine output and plasma sodium
What are the concerning signs and symptoms of hyperkalaemia?
Fast irregular pulse Chest pain Weakness Palpitations Light headedness
What are the ECG changes seen in hyperkalaemia?
Tall tented T waves
Small P waves
Wide QRS complex
Ventricular fibrillation
Give 3 causes of hyperkalaemia?
Oliguric renal failure
Potassium sparing diuretics
Metabolic acidosis
Massive blood transfusion
In a non emergency case, how do you manage hyperkalaemia?
Calcium resonium
In an emergency case of hyperkalaemia, give 4 steps in the management?
Calcium gluconate Insulin+glucose Nebulized salbutamol Calcium resonium ?Dialysis
Name 5 symptoms of hypercalcaemia?
Stones (renal/biliary) Bones (bone pain) Groans (abdominal pain, N&V) Thrones (polyuria) Psychiatric overtones (Depression, anxiety, insomnia etc.)
What is the usual genetic inheritance of Polycystic Kidney Disease?
Autosomal Dominant
Suggest 2 symptoms that a patient could suffer from in PCKD?
Abdo pain Noctouria Haematuria Drowsiness Joint pain
Give 2 aspects of the long term management of PCKD?
Anti hypertensives Diuretics Low salt diet Prompt treatment of UTI ?Renal transplant
Give 2 features of U+E which indicate AKI?
High urea
High potassium
High creatinine
Low eGFR
What are the 3 categories of AKI and give 2 examples each?
Pre-renal
•hypovolaemia
•sepsis
•renal artery stenosis
Renal
•acute tubular necrosis; drugs or ischaemia
•pyelonephritis
•glomerulonephritis
Post-renal
•bilateral kidney stones
•prostatic enlargement
•bladder cancer obstructing outflow
Give 5 aspects of management for AKI?
Urine microscopy US scan Palpable bladder Catheterise IV fluids Fluid balance and daily weights Stop any nephrotoxic medication Daily U&E to monitor renal function
Give 2 symptoms of AKI?
Oliguria/anuria
N & V
Confusion
Give 3 possible complications of AKI?
Metabolic acidosis
Hyperkalaemia
Pulmonary oedema
Increased risk of bleeding
State 3 indications for acute dialysis and AKI patients?
Untreatable pulmonary oedema Persistent hyperkalaemia K>7mmol/L Severe metabolic acidosis pH<7.2 Uraemic Pericarditis Uraemic encephalopathy
Give 3 causes of Chronic renal failure?
Hypertension
Diabetes
Glomerulonephritis
Obstructive uropathy
Give 3 symptoms of CKD?
Malaise Lethargy N&V Headache Pruritis Weight loss/loss of appetite Palpitations
Name 3 risk factors for developing CKD?
Diabetes Age Race Smoking Hypertension Family history
Give 3 complications of CKD?
Cardiovascular disease
Anaemia
Pericarditis
What is the indication for dialysis in a CKD patient?
GFR <15mL/min with symptoms
What are the possible complications of renal transplantation? 3 things
Rejection Drug toxicity Infection Malignancy Graft failure CVD
Name 4 things that can cause metabolic acidosis with increased anion gap?
Lactic acid (shock, infection, ischaemia)
Urate (renal failure)
Ketones (diabetes, alcohol)
Drugs (salicylate, biguanides, methanol)
Give 3 causes of metabolic alkalosis?
Vomiting
Burns
Diuretics
Ingestion of a base
What is a cause of respiratory acidosis?
Type 2 respiratory failure
Apart from living related donors, give 3 other sources of transplants?
Cadaver
Living emotionally related donors
Living non related donor
Xenograft
List the triad which points to nephrotic syndrome?
Hypoalbuminaemia
Proteinuria
Peripheral oedema
List 3 causes of nephrotic syndrome?
Infection
Lupus
Diabetes
Allergic reactions
List 2 complications of nephrotic syndrome?
Renal failure
Renal vein thrombosis
Sepsis
Give 4 causes of hypercalcaemia?
Malignancy (myeloma, bone mets)
Primary hyperparathyroidism
Dehydration
Vit D excess
Give 2 management steps in hypercalcaemia?
Correct dehydration (IV Saline) Bisphophanates
Give 4 causes of hypocalcaemia?
High phosphate:
CKD, Hypoparathyroidism, Vit D deficiency
Low phosphate:
Osteomalacia, Acute pancreatitis, Over hydration
Give 4 clinical features of hypocalcaemia?
SPASMODIC Spasms Perioral paraesthesiae Anxious Seizures Muscle tone up Orientation impared Dermatitis Impetigo Cataract
Name 4 things that can cause metabolic acidosis with a normal anion gap?
Renal tubular acidosis
Diarrhoea
Addisons disease
Ammonium chloride ingestion
State 4 clinical features seen in metabolic acidosis?
Hyperventilation
Air hunger
Cardiovascular dysfunction (enzyme denaturing)
Venoconstriction
Give 3 clinical features for metabolic alkalosis?
Hypoventilation Apathy Drowsiness Confusion Cardiac arrythmias
Give 4 contraindications to a renal transplant?
Active infection
Cancer
Severe heart disease
Comorbidity
What are the advantages and disadvantages of haemodialysis? 3 of each
Advantages:
Treatment free 4 days
Effective (long term survivors)
Disadvantages: Fluid/diet restrictions AV fistula needed Time consuming Expensive Limits social life (no holidays)
What are the advantages and disadvantages of peritoneal dialysis? 4 of each
Advantages: Simple to perform Less complex equipment Perform at home Maintain mobility Cardiovascular stability
Disadvantages: Peritonitis Exit site infection Hernias Back pain May not work (catheter malfunction, loss of membrane function)
Give 4 causes of painless haematuria?
Renal and urothelial tumours
Prostatic hypertrophy
Acute glomerulonephritis (IgA nephropathy)
Bleeding disorders – anticoagulants, thrombocytopenia
