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General Medicine > Renal > Flashcards

Renal Flashcards

1
Q

What blood result is most suggestive of the diagnosis of rhabdomyolysis?

A

Raised CK

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2
Q

What characterises rhabdomyolysis?

A

Muscle damage and lysis of muscle cells

Cellular content degradation –> release of K, myoglobin, CK, phosphate

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3
Q

Why does rhabdomyolysis cause renal impairment

A

Excessive myoglobin release - filtered by kidney –> renal tubular damage + cast formation.
Prostaglandins etc –> renal arteriole constriction –> decreased perfusion.

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4
Q

Causes of rhabdomyolysis

A 
Trauma
Compartment syndrome
Crush injury
Ischaemia
Severe electrolyte disturbance 
Bacterial / viral infection
Inherited metabolic disorders 
Drugs
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5
Q

Criteria of nephrotic syndrome

A

Albumin < 35g/L
Urine protein > 3 - 3.5 g/24 hrs
Marked pitting oedema

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6
Q

Causes of nephrotic syndrome

A 
Glomerulonephritis - e.g. Minimal change disease, membranous glomerulonephritis  
Focal segmental glomerulosclerosis
Diabetic nephropathy 
Amyloid 
Connective tissue disorder - SLE
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7
Q

Main function of kidneys

A

Excretion of nitrogenous waste - from protein catabolism

= urea

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8
Q

What is renal tubular acidosis?

A

Failure of the kidney to excrete acids into the urine –> acidaemia

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9
Q

What is type 1 renal tubular acidosis

A

Distal RTA

Failure of acid secretion

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10
Q

Define nephrotic syndrome

A

> 3G Proteinuria
Low albumin
Oedema

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11
Q

Causes of nephrotic syndrome

A 
minimal change glomerulonephritis 
Membranous nephropathy
Mesangiocapillary glomerulonephritis 
Focal segmental glomerulonephritis 
Thin basement membrane nephropathy
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12
Q

Define nephritic syndrome

A

Haematuria
(Proteinuria <3g)
Hypertension
Uraemia

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13
Q

Causes of nephritic syndrome

A

Post-streptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
IgA nephropathy
SLE

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14
Q

Pre-renal causes of AKI

A 
Hypoperfusion (haemorrhagic shock, sepsis, severe dehydration, burns, CHF) 
RAS
Renal vein thrombosis  
Drugs (NASIDS / ACEi) 
Pancreatitis,Cirrhosis --> ascites
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15
Q

Renal causes of AKI

A

ATN
Acute glomerulonephritis (immune)
Acute interstitial nephritis (drugs, bacteria)
Septic renal failure
Endogenous renal toxins (Hb, urate, myoglobin)
Hepatorenal syndrome

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16
Q

Post-renal causes of AKI

A

Bladder outlet obstruction (stones, tumour, clot, prostate)

Bilateral ureteric obstruction (retroperitoneal fibrosis,

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17
Q

What is IgA nephropathy

A

Autoimmune

Increased IgA forms immune complexes which deposit in mesangial cells

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18
Q

What is goodpastures syndrome

A

Anti-glomerular basement membrane disease
Autoantibodies to type 4 collagen in kidney and lung
–> macroscopic haematuria, haemoptysis

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19
Q

What is analgesic nephropathy

A

Prolonged heavy ingestion of compound analgesics (esp containing caffeine)

  • -> interstitial nephritis + papillary necrosis
  • -> slow progressive CRF
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20
Q

What is glomerulonephritis

A

Immunologically mediated inflammation of renal glomeruli

  • -> haematuria
  • -> subcutaneous oedema
  • -> polyuria or oliguria
  • -> proteinuria
  • -> hx of recent infection
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21
Q

Inheritance of polycystic kidney disease

A 
Autosomal dominant (usually)
Autosomal recessive (less common)
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22
Q

Anatomical features of PKD

A

Multiple renal cysts
Gradually expanding
Replace normal kidney structure

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23
Q

What predisposes to UTI

A 
Female
Renal calculi
Catheter
Post-GA
Double ureter
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24
Q

Presentation of PKD

A 
30-40yo
Pain in flanks due to cyst expansion, stones, blood clots, infection
Haematuria
Hypertension
SAH from burst berry aneurysm
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25
Q

Causes of RAS

A

Older pts - atherosclerosis
Younger pts - fibromuscular dysplasia

Causes hypertension

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26
Q

Types of renal calculi

A 
65% calcium oxalate
15% calcium phosphate 
10% magnesium ammonium phosphate
5% uric acid
1% cystine
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27
Q

Risk factors for renal calculi

A 
Dehydration
Change in urine PH
UTI
Hypercalciuria
Hypercalcaemia
Oxalates
Hyperuricaemia
Cyst injuries
Horseshoe kidney
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28
Q

Presentation of renal calculi

A 
Loin to groin pain
Dysuria
Frequency 
Strangury
Penis tip pain
Urine retention
Haematuria
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29
Q

What is Alports syndrome

A

Inherited mutation of gene coding collagen IV

–> haematuric nephritis + sensorineural deafness

30
Q

What is Medullary sponge kidney

A

Dilation of terminal collecting ducts in medulla

Causes cysts and calcium phosphate stones

31
Q

Tumour markers of testicular cancer

A

Alpha-fetoprotein

Beta-HCG

32
Q

Antibodies in Wegeners granulomatosis

A

cANCA

33
Q

Antibodies in goodpastures disease

A

Anti-glomerular basement membrane antibodies

34
Q

Treatment for goodpastures disease

A

Steroids

Avoid smoking

35
Q

Main cause of nephrotic syndrome in children?

A

Minimal change glomerulo-nephritis

36
Q

Treatment of minimal change disease

A 
Steroids
Fluid restriction
Low-salt diet
Penicillin prophylaxis 
ACE inhibitors 
Statins for hyperlipidaemia
37
Q

Most common cause of nephrotic syndrome in adults

A

Membranous glomerulonephritis

38
Q

What happens in Membranous glomerulonephritis

A

Immune complexes form when circulating antibodies bind to basement membrane antigens, or antigens deposited in the glomerulus by the circulation.
–> immunological response
Damage glomerular basement membrane –> permeability

39
Q

Causes of Membranous glomerulonephritis

A 
90% idiopathic 
SLE
Hepatitis B
Systemic infection 
Drugs
40
Q

Treatment of Goodpastures syndrome

A

Plasmapheresis
Corticosteroids
Immunosuppression

41
Q

What happens in IgA nephropathy

A

IgA antibodies deposited in the mesangium and trigger an immune response.

42
Q

Presentation of an IgA nephropathy

A

Urine dip - microscopic haematuria + proteinuria
Or
Frank haematuria (usually 2 days after URTI)

43
Q

Diagnosis of IgA nephropathy

A

Renal biopsy - mesangium proliferation + expansion of extracellular matrix
Immunofluorescence shows IgA deposition
Raised serum IgA in 50 %

44
Q

What is post-streptococcal glomerulonephritis

A

Glomerulonephritis seen 1-2 weeks post beta-haemolytic streptococcus infection
E.g. Tonsillitis / cellulitis

45
Q

Features suggesting post-streptococcal glomerulonephritis

A 
Recent Tonsillitis / skin infection
Dark urine (tea / cola)
Oedema
Hypertension
Haematuria
Oliguria
46
Q

Investigations for post-streptococcal glomerulonephritis

A

Raised Streptolysin-o
Reduced complement
Urine protein and haematuria

47
Q

Management of post-streptococcal glomerulonephritis

A

Fluid restriction
Anti hypertensives
Low salt diet

Prognosis is usually good

48
Q

Symptoms of renal colic

A

Severe loin pain
Radiates to groin
Patient writhes around in agony
+/- vomiting, pallor, sweating, pyrexia, haematuria

49
Q

Investigation of renal colic

A 
Urine dipstick
FBC
U+E
KUB xray 
(IV urogram, CT urogram, renal tract USS)
50
Q

What % of renal calculi are radio-opaque

A

90%

51
Q

Management of renal calculi

A

Initial tx = supportive + analgesics - diclofenac

If stone will not pass spontaneous seek surgical opinion - extracorporeal shock wave lithotripsy, cystoscopy, uretoscopy, percutaneous nephrolithotomy

52
Q

Investigation of deteriorating function in a transplanted kidney

A

Renal biopsy

53
Q

Causes of deteriorating function in a transplanted kidney

A

Organ rejection
Vessel thrombosis
Infection
Recurrence of existing disease

54
Q

Presentation of UTI in young children

A

Poor feeding
Vomiting
Lethargy
Abdominal pain

55
Q

Important causes of UTI in children

A 
Vescicouretric reflux
Urinary tract obstruction
Duplex ureters
Constipation
Sexual abuse
56
Q

Features of renal TB

A 
Sterile pyuria (leucocytes + negative culture) 
Lethargy
Dysuria
Urinary frequency
Weight loss
Night sweats
57
Q

Features of adult polycystic kidney disease

A

Multiple, large cysts in the kidneys
Also in liver, pancreas and spleen.

–> renal failure and hypertension
Berry aneurysms in circle of willis –> rupture –> SAH

58
Q

Management of low calcium in chronic renal failure

A

Prescribe alfacalcidol (vitamin D supplement)

59
Q

What causes encephalopathy in renal failure?

A

Serum urea crosses the blood brain barrier

60
Q

Features of uraemic encephalopathy

A

Fluctuating confusion,
cognitive impairment,
myoclonic jerk,
seizures

61
Q

Treatment of uraemic encephalopathy

A

Dialysis

Haemofiltration in an emergency

62
Q

What is Henoch-schonlein purpura

A

IgA mediated Autoimmune vasculitis of childhood.

Often preceded by a viral respiratory illness

63
Q

Commonest renal cancer

A

Renal cell adenocarcinoma

64
Q

Presentation of renal cell carcinoma

A

Haematuria
Flank pain
Palpable mass
New left sided varicocele may occur in M

Hypertension.
Polycythaemia
Hypercalcaemia

65
Q

What congenital conditions may be associated with renal cell carcinoma

A

Von Hippel-Lindau

Tuberous sclerosis

66
Q

What is Waterhouse-friedrichsen syndrome

A

Bilateral haemorrhage into the adrenal glands caused by meningococcal sepicaemia

67
Q

What is renal osteodystrophy

A 
Skeletal disorder seen in patients with renal failure. 
combination of:
- secondary hyperparathyroidism
- osteomalacia
- vitamin D deficiency
68
Q

What is secondary hyperparathyroidism

A

Chronic renal failure - hyperphosphataemia + reduced vit D –> chronic hypocalcaemia
Parathyroid produces more PTH in response
Promotes bone resorption –> renal osteodystrophy

69
Q

Symptoms of Renal osteodystrophy

A

Chronic renal failure
Bone pain
Pathological fractures
(Osteomalacia)

70
Q

In what 2 ways can NSAIDS cause renal problems

A

Haemodynamic acute renal failure

Acute interstitial nephritis with Nephrotic syndrome

71
Q

Best investigation for suspected renal injury after trauma

A

CT

General Medicine (25 decks)

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