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Renal Flashcards

1
Q

Management of AKI

A 
1. ) ASSESS volume and potassium status: 
O/E: BP, JVP, skin turgor, cap refill
Urine output ( catheterize). 
ABG: URGENT K+ 
ECG for hyperkalaemia!!

2) Aim for EUVOLEMIA: Fluids /Fluid restriction
3) Stop NEPHROTOXIC drugs: NSAIDs, ACE-I, gentamicin
4. ) Tx underlying cause

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2
Q

Complications of AKI

A 
Complications of AKI 
Uraemia 
Volume overload 
Hyperkalaemia 
Hyperphosphataemia 
Metabolic Acidosis 
Chronic progressive kidney disease
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3
Q

What complication of AKI can result in pericarditis

A

Uraemia.

Can also cause N&V, arrhythmia, pneumonitis etc

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4
Q

Symptoms of hyperkalaemia

A 
fatigue or weakness.
a feeling of numbness or tingling.
nausea or vomiting.
problems breathing.
chest pain.
palpitations or skipped heartbeats
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5
Q

Symptoms of metabolic acidosis

A

rapid breathing

confusion

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6
Q

Hyperkalaemia Management

A

10ml 10% calcium gluconate IV ( cardioprotective )
Intravenous insulin + glucose
Salbutamol nebulisers

If patient is acidotic: IV sodium bicarbonate can help drive K+ into cells.

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7
Q

Pulmonary odema management

A

Sit up and high flow oxygen
Venous vasodilator ( eg diamorphine)
Furosemide IV

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8
Q

Indications for dialysis in AKI

A
  1. Refractory pulmonary oedema
  2. Persistent hyperkalaemia ( >7mmol/L)
  3. Severe metabolic acidosis (pH < 7.2 or base excess <10)
  4. Uraemic complications : encephalopathy or pericarditis
  5. Drug OD : Barbituates, Lithium, Alchohol, Salicylates, Theophyline
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9
Q

ESRF cut off

A

GFR < 15

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10
Q

Consequences of CKD

A 
1]Progressive failure of homeostatic function
	-Acidosis 
	-Hyperkalaemia
2]Progressive failure of hormonal function
	-Anaemia
	-Renal Bone Disease
3]Cardiovascular disease
	-Vascular calcification
	-Uraemic cardiomyopathy
4]Uraemia and Death
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11
Q

Anaemia of chronic renal disease Tx

A

Normochromic, normocytic anaemia

Management: EPO replacement

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12
Q

Renal Dystrophy

A

Kidneys cant convert vitamin D3 into calcitriol = hypocalcaemia
Leads to secondary hyperparathyroidism
PTH stimulates bone resorption
Poor quality bones= osteomalacia: pain, fractures

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13
Q

Renal osteodystrophy Tx

A

TREATMENT:
Calcichew- Ca supplement,
Calcium acetate - phosphate binders

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14
Q

CKD 1) Limiting progression/ complications

A

BP: target <130/80 ( <125/75 is diabetic)
Tight glucose control in DM
Decrease CVD risk ( stop smoking, lose weight etc)

Diet: multidisciplinary team: moderate protein, restrict K+, avoid high phosphate foods.

Renal osteodystrophy:
TREATMENT:
Calcichew- Ca supplement,
Calcium acetate - phosphate binders

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15
Q

CKD 2) Symptom control

A

Anaemia: Human EPO might be required

Acidosis: consider sodium bicarbonate supplements for patients with low serum bicarbonate.

Oedema: loop diuretics, restriction of fluids

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16
Q

CKD 3) Preparation for Renal Replacement Therapy

A

The access is a surgically created vein used to remove and return blood during hemodialysis.

1) Arteriovenous fistula :)
2) Arteriovenous graft

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17
Q

CKD Management outlineL

A

1) Limiting progression/ complications
2) Symptom control
3) Preparation for Renal Replacement Therapy

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18
Q

Scar for renal transplant

A

Rutherford Morrison/ hockey stick scar in L/R IF

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19
Q

Signs of chronic immunosuppression ( renal transplant)

A

Cushings disease signs, gingival hyperplasia from cyclosporin

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20
Q

Obstructive symptoms

A 
Poor stream 
Hesitancy 
Terminal dribbling 
Incomplete voiding 
Overflow incontinence 
Near retention
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21
Q

Irritative Symptoms

A

Frequency (polyuria)
Urgency
Dysuria
Nocturia

22
Q

Prostate cancer most commonly metastasise to which areas

A

BONES, Lungs, liver, brain

23
Q

Ix for prostate cancer

A

Examination
DRE: hard nodules/ lumps, irregular surface

Investigations
Urine dip: haematuria
Bloods: PSA
Trans-rectal US with biopsy

24
Q

MOST common presenting complain of bladder cancer

A

Haematuria

25
Q

Ix for bladder cancer

A 
Investigations 
Urine dip: haematuria 
Urine cytology – Ca cells 
Cystoscopy with tissue sampling
CT and MRI (if further imaging required)
26
Q

RFs for Bladder cancer

A

–>Smoking
–> Aromatic amines used in rubber and dye
–> Schistosomiasis
Being Egyptian (most common cancer in Egyptian males – probably due to schistosomiasis)
Age
FH

27
Q

Inheritance of polycyctic kidney disease

A

Autosomal dominant inheritance,

28
Q

O/E PKD

A

Examination
HTN
Liver cysts
Bilateral palpable kidneys

29
Q

Renal Cell Carcinoma Triad

A

Also known as von Grawitz tumour
Clasical triad: haematuria, loin pain, abdominal mass.

Histology
Renal tubular cell
Adenocarcinomas

30
Q

Ix for renal cell carcinoma

A 
Investigations 
Urine dip: haematuria 
Bloods: work up for paraneoplastic syndromes 
Imaging: US, contrast enhanced CT 
Tissue sample: US guided biopsy
31
Q

Management of renal stones

A

Immediate
ANALGESIA (diclofenac IM or PR)
Rehydration if necessary
Antiemetics if necessary

Conservative
Most stones will pass by themselves within 3 weeks.
Progress should be monitored at weekly intervals
If signs of infection/ obstruction/ too painful will need intervention

Medical
CCBs and alpha blockers – medical expulsive therapy

Surgical
Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy
Ureteroscopy (with laser)
Open surgery
32
Q

Normal Pressure Hydrocephalus

Causes and Px

A

Causes: meningitis, head injury and indipathic
Px: wobbly gait, urge incontience, wacky dementia

33
Q

Urge incontinence causes

A

Causes
UMN pathology → loss of higher inhibition of micturition reflex
Eg. Parkinson’s, MS, stroke

Detrusor muscle overactivity

Temporary causes – infection, urethritis

34
Q

Urge incontinence is percipitated by

A 
Precipitated by
The cold
Sound of running water
Coffee, tea or cola
Obesity
35
Q

When do you preform an doppler US for torsion

A

if unsure, will show decreased blood flow

36
Q

Ix and Tx for epidydimorchitis

A

Investigations
MSU
Swabs

Management
Chlamydia → azithromycin/ doxycycline
Gonorrhoea → ceftriaxone
EColi after UTI

37
Q

Dull Ache

A

Variocele

38
Q

Tumor markers for testicular cancer

A

Seminoma - ↑βhCG, αFP normal (better prognosis)

Teratoma - ↑αFP, ↑βhCG

39
Q

Tx for testicular cancer

A

Seminoma: surgery and radiotherapy
Teratoma: chemo and surgery

40
Q

Management of hydrocele

A

Management

Tap fluid, plicate tunica vaginalis (Lord’s repair)

41
Q

Ureteric stones, (no contrast required, more sensitive and specific than IV pyelography)
Tumour staging – bladder, renal

A

CTKUB

42
Q

Good imaging of kidney and bladder, not very good for ureters due to overlying bowel gas

A

US kidney

43
Q

Urge incontinence that is not resolving

A

Urodynamic Study

44
Q

contrast + X-Ray images → filling defects within collecting system, identification of congenital urinary tract abnormalities, strictures

A

IV pyelography

45
Q

If have irritative symptoms suggestive of UTI

A

MC&S

46
Q

Scope inserted into bladder + biopsy

A

Cystoscopy

47
Q

Generally done for staging, higher radiation

A

CTKUB

48
Q

Done as work up of haematuria to determine presence of renal masses

A

USS

49
Q

Intrinsic renal abnormality (signs of renal failure, HTN, haematuria)

A

Renal Biopsy

50
Q

Drug that can cause thyroid problems

A

amiodarone

Resp (13 decks)

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