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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Managing UTI in non pregnant woman (uncomplicated)

A

Trimethoprim - 200mg BD x 3 days

Nitrofuratoin - 500mg QDS x 3 days (7D in men)

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2
Q

UTI in pregnancy

A

Amoxicillin - 250mg TDS x 7 days

Cephalexin - 500mg BD x 7 days

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3
Q

Lower UTI in children

A

Refer if < 3months
Trimethoprim: 3mo-12yrs = 4mg/kg BD (max 200mg) x 3 days
Nitrofuratoin: 750mg/kg QDS

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4
Q

Upper UTI in children

A

Amoxicillin, Co-amoxiclav
< 1yr: 168mg max x 7-10 days
1-6 years: 156mg x 7-10days
6-12 years: 312mg TDS x 7-10days

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5
Q

Acute pyelonephritis

A

Ciprofloxacin: 500mg BD x 7 days
Co-amoxiclav: 500mg/125mg TDS x 14 days
If severe: Cefuroxime 1.5g/8hr IV - then oral for 7 days.

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6
Q

Cockcroft-Gault Formula: Calculation of GFR

A

CrCl (ml/min) = [(140-age) x wt (kg) x 1.2 /

[Cr]plasma (umol/L) ] (x0.85 in women)

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7
Q

Urea - clinical setting in which it is affected independent of renal function

A

Increase: volume depletion, GI hemorrhage, high protein intake, sepsis, catabolic state, corticosteroid or cytotoxic drugs

Decrease: low protein diet, liver disease.

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8
Q

Electrolyte values:

A 
Na = 135-145 mmol/L
K = 3.5 - 5 mmol/L
Cl = 95-105 mmol/L
HCO3 = 18-23 mmol/L
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9
Q

Cause of hyponatremia

HypoNa + hypervolemic + UNa < 20

A

CHF
Cirrhosis and ascites
Pregnancy

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10
Q

Cause of hyponatremia

HypoNa + hypervolemia + Una > 20

A

ARF, CFR

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11
Q

Cause of hyponatremia + euvolemia + Uosm>100

A

SIADH
Adrenal insufficiency
Hypothyroidism

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12
Q

Cause of hyponatremia + euvolemia + Uosm < 100

A

Psychogenic polydipsia

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13
Q

Cause of: hypoNa + hypovolemic + Una>20

A

Diuretics

Salt Wasting nephropathy

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14
Q

Cause of: hypoNa + hypovolemic + Una<10

A

Diarrhea
Excessive sweating
Third spacing = peritonitis, pancreatitis, burns

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15
Q

Symptoms of hyponatremia

A

Depend on the degree of hypoNa and velocity of progression.
Main symptoms:
Headache, nausea, malaise, lethargy, muscle weakness and cramps, anorexia, somnolence, disorientation, personality changes, depressed reflexes, decrease/LOC

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16
Q

SIADH: Definition and causes

A 
Definition:
- Urine that is inappropriately concentrated    
  for the serum osmolality
- High urine Na > 20-40mmol/L
- High FEna
Causes:
-  Tumors: Small cell ca, broncogenic Ca,  
   AdenoCa of pancreas, Hodgkins
-  Resp: pneumonia, TB, PPV
-  CNS: mass, SAH, stroke
-  Drugs: TCA, SSRIs, carbamazepine,  
   barbituates, chlorporpamide.
-  Misc: Postop, pain, nausea, HIV
17
Q

Hypernatremia: Cause

A
  • Too little water relative to total body Na.
    Always associated with a hyperosmolar
    state.
  • Usually due to net water loss.
  • We are protected against hyperNa due
    to thirst and ADH.
  • Causes: Insensible water loss,
    GI/diahrrea, osmotic (lactulose), Renal
    losses - diuretics, osmotic diuresis from
    hyperglycemia, Diabetes inspidious
18
Q

Symptoms of hypernatremia

A

AMS, weakness, NMJ irritability, thirst, polyuria

19
Q

Diabetes inspidious: Cause, diagnosis.

A

Definition: Collecting tubule inpermeable to water due to absence or impaired response to ADH.
Central DI: neurosurgery, granulomatous disease, trauma, vascular event, malignancy.
Nephrogenic DI: Lithium, hypo-K, hyper-Ca, congenital
Dx: Urine osm inappropriately low in patient with hyperNa (Uosms cannot respond.

20
Q

HypoK: Definition, Causes

A

Serum K+ < 3.5 mEq/L
Decreased intake
Increased loss:
1. GI - Diarrhea, laxatives, villous adenoma
2. Renal losses: Diuretics, hypo-Mg, hyperaldosterism, inherited rental tubular lesions (Barters, Gitelmans), DKA, RTA.
Redistribution into cells:
1. Metabolic alkalosis
2. Insulin
3. Catecholamines, B2 agonists, theophylline
4. Uptake into newly forming cells - Vit B12 injection, WBC production.

21
Q

Signs and symptoms of hypo-K+

A

Asymptomatic when mild (3-3.5)
N,V, fatigue, generalized weakness, muscle cramps/spasms, constipation.
If severe: arrhythmias, muscle necrosis, paralysis
ECG changes: U waves, flattened T-waves, depressed ST segment, prolonged QT interval.

22
Q

Hyperkalemia: Definition + Causes

A

Serum K+ > 5.0mEq/L
Causes:
(1) Factitious - sample hemolysis, sample taken from vein, IV KCL running, prolonged use of tourniquet.
(2) Increased intake: diet, KCL tablets
(3) Cellular release: intravascular hemolysis, rhabdomyolysis, inslin def, hyperosmolar states = hyperglycemia, MA = keto and lactic acidosis, TLS, Drugs = b-blockers, digitalis overdose, succinylcholine.
(4) Decreased excretion: Renal failure, NSAIDs, low effective circulating volume, hypoaldosterism.
(5) Drugs - spironolactone, amiloride, triamterene

23
Q

Signs and symptoms of hyperkalemia

A

Nauses, palpitations, muscle weakness, paresthesia, areflexia, ascending paralysis, hypoventilation
ECG changes: peaked and narrow T-waves, loss of P waves, prolonged PR interval, widening of QRS, AV block, VF, asystole.

24
Q

Treatment of hyperkalemia

“SEE BIG K DROP”

A

SEE - Calcium gluconate 10mL 10% solution IV.
BIG: B-agonist, Bicarb, Insulin, Glucose
Ventolin = 10mg inhaled
Bicarb = 1-3 amps of 7.5% NaHCO3 in 1L D5W
Insulin = regular insulin 10-20U with D50W
K: Kayexalate, calcium resonium
DROP: Diuretics, dialysis
Furosemide = > 40mg IV

25
Q

Causes of increased anion gap metabolic acidosis: MUDPILES

A 
M - methanol
U - uremia
D - DKA/alcoholic/starvation
P - Paraldehyde
I - Iron
L - Lactic Acidosis
E - Ethylene glycol
S - Salicylates
26
Q

Causes of non-anion Gap Metabolic acidosis

HARDUP

A

Diarrhea*
RTA*
Acetazolamide
Ureteroenteric fistula

27
Q

Metabolic alkalosis

A

UCl < 20 mEQ/L:
Saline responsive
GI losses - Vomiting, NG tube

UCl > 20 mEQ/L:
Saline unresponsibe
Diuretic use
Hyperaldosterism
Cushings syndrome
Milk alkali syndrome
Severe hypo-K
Bartter's Kitelmans
28
Q

Acute Kidney Injury: Definition + Cause

A

Definition: Abrupt decline in renal function over hours/days leading to an increase in urea and creatinine.
Clinical features: azotemia = increased BUN, Cr + oliguria/anuria
Causes: Pre-renal, renal, post-renal
Pre-renal
- Hypovolemia = hemorrhage, GI losses,
renal losses, low CO, cirrhosis, third
spacing
- NSAIDS, ACEI/ARBS, hyperCa

Renal
- GN, AIN, ATN, vascular = vasculitis, HTN

Post-renal

  • Neurogenic
  • Anatomic = ureter, bladder, urethra
29
Q

Chronic kidney disease: Definition + Causes + Complications

A 
Definition:  Irreversible and long standing loss of renal function.
1.  GFR < 60 ml/min for > 3mo
2.  Kidney pathology seen on biopsy
3.  Decreased kidney size on US < 9cm
Classified according to GFR (Stage 1-5)
Stage 4 GFR 15-29 - symptoms begin
Stage 5 GFR < 15 - dialysis needed

Causes:

  • Diabetes
  • HTN
  • GN
  • IN
  • Pyelonephritis
  • Cystic/hereditary/congenital
  • Secondary GN/vasculitis
Complications
-  HyperK, hyperPO, metabolic acidosis,   
   hypo-Ca
-  Secondary hyperparathyroidism, renal 
   osteodystrophy
-  Vitamin D deficiency
-  Anemia/decreased erythropoietic
-  Fluid overload
-  HTN
-  Coagulopathy
-  Pruritis
-  Restless leg syndrome
-  Infection
30
Q

Nephrotic syndrome: Definition, cause, investigation, complications, treatment.

A

Defintion:
- Proteinuria > 3.5gday accompanied by
generalized oedema, hyperlipedemia,
hypoalbuminemia, HTN.

Causes:
- Glomerular disease:  minimal change, 
  membranous GN, proliferative GN.
-  Systemic disease:  DM, SLE, 
   amyloidosis, drugs, syphilis, HIV, cancer, 
   HBV, MM.
Investigations:
- Creatinine clearance, 24h urinary protein, 
  urine electrophoresis.
- FBC, ESR
- Urea, electrolytes, serum Cr, albumin.
- Serum cholesterol
- ANA, p-ANCA, c-ANCA, complement  
  levels.
- Renal biopsy
Complications:
-  Thromboembolic events = renal vein 
   thrombosis, DVT - PE
-  Protein malnutrition
-  Accelerated atherosclerosis
- Infection
Treatment:
-  Diuresis
-  Heparin, Warfarin, TEDS stockings.
-  Albumin if symptomatic
-  Pneumococcal vaccine
-  INF in HBV and HCV associated 
   nephropathy.
-  Steroids: Minimal change
31
Q

Principals in managing CKD (e.g Stage 4)

A
  • ACEI and target BP < 130/80
  • Thiazide diuretic should be replaced with
    loop diuretic.
  • Limit dietary protein to 0.8-1g/kg/day
  • Treat hyperlipedemia with statin
  • Aspirin to reduce risk of CVD
  • Tobacco cessation
  • Anemia: EPO, target Hg 110-120g/L
  • Phosphate binders.
  • Low dose Vit D = helps control hyper-
    PTH
  • NaHCO3 for MA
32
Q

Indications for renal replacement therapy

A
  1. HyperK > 7mmol - not responsive to medical treatment
  2. HCO3 < 12mmol
  3. Urea > 20mmol/L
  4. Cr > 500umol/L
  5. Refractory pericarditis, pulmonary edema, encephalopathy.
33
Q

Causes of nephrotic syndrome

A 
Congenital
Acquired
- GN = minimal change, focal sclerosing, 
  membranous, diabetic nephropathy.
- Systemic vasculitis = SLE
- SLE drugs = gold, penicillamine
-  Infection = malaria
34
Q

IgA Nephropathy: Presentation

A

Classical nephritic presentation in teenager/early adulthood.
Recurrent episodes of gross hematuria associated with recent infection.
Normal complement
Treat HTN with ACE-I

35
Q

Wegerner’s Granulomatous Disease

A 
Midline vasculitic picture
Collapse of nasal bridge
Sinusitis
Hematuria
c-ANCA Positive
36
Q

Membranous nephropathy

A 
Nephrotic syndrome
Most common in caucasian adults.
Causes:
-  Idiopathic
-  Secondary to solid tumors = bronchial  
   ca, Hodgkins lymphoma.
-  Systemic disease = amyloidosis, SLE
-  HIV, Heroin
-  HBV, syphillis, malaria
-  Gold
Treatment:  Na restriction+ furosemide

Medicine (6 decks)

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