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3B GH > Renal > Flashcards

Renal Flashcards

1
Q

causes of CKD

A 
DM
age
IgA nephropathy
reflux
obstruction
renovascular disease
HTN
PKD
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2
Q

Ix in CKD

A 
FBC
U and E
ANCA/ANA, complement (glomerulonephritis/vasculitis)
urine dipstick
PCR
US
renal biopsy
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3
Q

Sx in advanced CKD

A 
fatigue (anaemia)
breathless (fluid)
anorexia, vomiting (uraemia)
pruritis
restless legs
bone pain
leg swelling
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4
Q

lifestyle modifications in CKD

A

HTN control
DM control
low salt diet
stop smoking

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5
Q

CKD Mx options

A

transplant
peritoneal dialysis
HD
conservative

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6
Q

contraindications for renal transplant

A

absolute: cancer w/mets (imm sup after)
relative: HF (anaesthetic + perfusion of 3 kidneys), CVD
temporary: active infection, HIV w/viral replication, unstable CVD

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7
Q

main complication of peritoneal dialysis

A

peritonitis

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8
Q

contraindications of PD

A

stoma
hernia
abdo surgery
blind

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9
Q

pros of peritoneal dialysis

A

retain some kidney fn
home and holidays
don’t have to have fistula/needles
constant blood levels = well

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10
Q

pre-renal causes of AKI

A 
ACE/ARB/NSAIDs
hypovolaemia
hypoTN
HF (pump failure)
vascular disease
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11
Q

renal causes of AKI

A 
drugs
trauma
glomerulonephritis
infection
acute tubular necrosis
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12
Q

post-renal causes of AKI and Ix

A 
enlarged prostate (Ca/BPH)
pelvic Ca compressing ureter
bladder Ca
stone
renal US (hydronephrosis, dilated ureters)
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13
Q

mx of postrenal AKI

A

urethral catheter

percutaneous nephrostomy

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14
Q

features of nephrotic syndrome

A

oedema
proteinuria
hypoalbuminaemia
hypercholesterolaemia

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15
Q

electron microscope feature of minimal change

A

flattening of foot processes

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16
Q

life-threatening complication of Granulomatosis with polyangiitis (wegeners) and good pastures

A

haemoptysis

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17
Q

why do nephrotic pt.s have hypercholesterolaemia

A

liver tries to make more albumin to replace loss, leads to cholesterol production

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18
Q

in what circumstances would you advise a patient to stop their ACE/ARB and why

A

pregnancy - teratogenic

D and V - can cause AKI

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19
Q

how does proteinuria worsen kidney disease

A

protein excreted in glomerulus, then reabsorbed in tubules. Causes inflamm in tubules -> scarring

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20
Q

most common cause of autosomal dominant PKD is what gene

A

PKD1 on chromosome 16

codes for polycystin 1

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21
Q

Mx of hyponatraemia

A

hypovol - saline
normal vol - fluid restrict
hypervol - furosemide, ACE, fluid restrict

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22
Q

Mx of hypokal

A

oral K+/ IV KCl slow or heart stops

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23
Q

mx of hyperkal

A

calcium gluconate + insulin + glucose.
Salb neb.
Calcium resonium

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24
Q

haematuria only apparent at the start of micturition is usually due to…

A

urethral disease

[trauma/infection/tumour]

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25
Q

haematuria at the end of micturition suggests bleeding from…

A

prostate or bladder base

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26
Q

haematuria as even discolouration throughout urine suggests bleeding from…

A

bladder or above

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27
Q

Mx of hypocalc

A

Ca2+ PO
CKD - may require alfacalcidol
Severe: calcium gluconate IV

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28
Q

mx of hypercalc

A

Fluids. Furosemide. Pamidronate (bisphos)

Treat the cause

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29
Q

Sx and signs of peritonitis in a peritoneal dialysis patient

A

pyrexia
abdo pain
cloudy effluent
+ve cultures

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30
Q

complications of HD

A

hypoTN - headache, dizzy, nausea
cramps [Na+ level]
air embolus
clot

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31
Q

what does ramipril do to GFR

A

slows down by efferent dilatation

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32
Q

how are NSAIDs dangerous to the kidney

A

reduce renal blood flow by afferent constriction

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33
Q

what factors other than kidney fn can affect creatinine

A

ethnicity
male^
age^
muscle mass^

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34
Q

what would you see on a bone marrow biopsy to confirm myeloma?

A

high number of plasma cells

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35
Q

drugs that cause hyperkalaemia

A

spironalactone [K+ sparing]

ACE inhib

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36
Q

ecg changes in hyperkalaemia

A

tall tented T waves
small/ absent/ inverted P wave
wide QRS

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37
Q

Mx of hyperkalaemia

A

calcium gluconate
insulin + glucose [insulin drive K+ into cells]
treat cause

others:
salb neb
loop diuretic [furos]
calcium resonium
dialysis
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38
Q

reasons for emergency dialysis

A

high urea -> pericarditis
HF/ sepsis -> fluid overload -> pulm oedema
hyperkalaemia

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39
Q

primary differential of dysuria

A

UTI

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40
Q

differential diagnoses for polyuria

A

DM
diabetes insipidus
hypercalc

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41
Q

differentials for pain confined to the loin [not radiating to groin and anteriorly, as in renal colic]

A

pyelonephritis
renal cyst pathology
renal infarct

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42
Q

risk factors for AKI

A 
CKD
age
male
DM
CV diseease
malgnancy
chronic liver disease
complex surgery
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43
Q

name 5 of the 7 commonest causes of AKI

A
  1. sepsis
  2. major surg
  3. cardiogenic shocl
  4. other hypovolaemia
  5. drugs
  6. hepatorenal syndrome
  7. obstruction
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44
Q

causes of pre-renal AKI

A

reduced vascular vol [haemorrhage, D+V, burns, pancreatitis]
redcued cardiac output [cardiogenic shock, MI]
systemic vasodilation [sepsis, drugs]
renal vasoconstirction [NSAIDs/ARB/ACEi, hepatorenal syndrome]

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45
Q

renal causes of AKI

A

glomerulonephritis, acute tubular necrosis.
drug Rn, infection, infiltration [sarcoid].
vasculitis, HUS, TTP, DIC

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46
Q

causes of post-renal AKI

A

stone, renal tract malignancy, stricture, clot.

Pelvic malignancy, prostate, retroperitoneal fibrosis.

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47
Q

AKI Mx

A 
ABCDE
treat ^K+ [calc chloride/gluconate, insulin-glucose, salb]
fluid
catheter/ fluid balannce
treat cause e.g. sepsis ABx
stop nephrotoxic drugs
dialysis
[nephrostomy/surg for post-renal]
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48
Q

Ix in AKI

A 
US
urine dip
FBC, U+E, LFT
platelets [HUS/TTP]
film
renal biopsy in intrinsic
[Ig, paraprotein, complement, ANA/ANCA/anti-GBM]
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49
Q

signs of hypovol

A 
low BP
low UO
low JVP
poor tissue turgor
^pulse
weight loss
long cap refill
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50
Q

signs of fluid overload

A 
^BP
^JVP
lung creps
peripheral odema
gallop rhythm
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51
Q

Mx of fluid overload in AKI

A

O2
fluid restrict
diuretics if symptomatic
RRtherapy

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52
Q

give 5 causes of haemoaturia

A
  1. malignancy [kidney/ureter/bladder]
  2. calculi
  3. IgA nephropathy
  4. Alport syndrome
  5. other glomerulonephritis
  6. PKD
  7. schisto
  8. anticoags
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53
Q

in a patient with non-visible haematuria on dipstick, what other factors, in the history, exam or investigations, would indicate renal aetiology/ indicate renal referral?

A

HTN
low eGFR
proteinuria
FH

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54
Q

how would you monitor a patient with non-visible haematuria where no cause was found

A

eGFR
BP
A:C ratio

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55
Q

causes of glucose on dipstick

A

DM
pregnancy
sepsis
proximal renal tubule pathology

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56
Q

causes of ketonuria

A

ketoacidosis

starvation

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57
Q

give some causes of white blood cells on urine microscopy

A 
UTI
glomerulonephritis
tubulointerstitial nephritis
renal transplant rejection
malignancy
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58
Q

on urine microscopy:

  1. causes of red cell casts
  2. causes of white cell casts
  3. causes of granular casts
A
  1. glomerulonephritis
  2. glomerulonephritis, pyelonephritis, interstitial nephritis
  3. CKD
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59
Q

define ‘complicated’ UTI

A

structural or functional abnormality of the GU tract

e.g. obstruction, catheter, stones, neurogenic bladder, transplant

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60
Q

give 5 risk factors for UTI

A 
sexual activity
urinary incontinence
faecal incont 
constipation
spermicide
low oestrogen, menopause
dehydration
obstruction/stone
DM
imm.supp.
catheter
tract malformation
preg
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61
Q

Sx of cystitis

A 
frequency
dysuria
urgency
suprapubic pain
polyuria
haematuria
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62
Q

Sx of acute pyelonephritis

A 
fever
rigor
vomiting
loin pain/tenderness
costovertebral angle pain
cystitis Sx [freq. etc]
shock
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63
Q

Sx of prostatitis

A 
pain [perineum, rectum, scrotum, penis, bladder, lower back]
fever
malaise
nausea
urinary Sx
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64
Q

Ix in UTI

A 
dipstick
MSU culture
FBC, U+E, CRP, blood culture (if systemically unwell), glucose
US
(cystoscopy, urodynamics, CT)
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65
Q

most common organism for UTI

A

E. coli

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66
Q

Abx for female UTI

A

trimeth or nitrofurantoin. if fails, culture + sensitivty

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67
Q

Abx for male UTI, with Sx that suggest prostatitis

A

longer course [4 weeks] ciprofloxacin

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68
Q

most common causes of CKD in the UK

A
  1. DM
  2. glomeruloneph
  3. HTN/renovascular disease
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69
Q

CKD Sx

A 
SOB
peripheral oedema
anorexia
N+V
restless legs
fatigue
weakness
pruritis
bone pain 
amenorrhoea
impotence
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70
Q

give 5 exam findings in CKD

A 
peripheral oedema
uraemic flap
anaemia signs
yellow tinge
raised JVP
HTN
pulm oedema or effusion
PD catheter/tunnelled line/AV fistula
transplant scar/palpable 3rd kidney
palpable polycytic kidneys
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71
Q

blood findings in CKD

A 
normocytic anaemia
U+E [^creat etc]
^glucose
low Ca2+
^phosphate
^PTH
ANA/ANCA/antiphospholipid antibodies/paraprotein etc
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72
Q

what urine Ix are reqiured in ckd

A

dipstick
MC+S
alb:creat
bence jones

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73
Q

what imaging reqiured in ckd

A

US

isotope scan

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74
Q

risk factors for ckd decline

A 
smoking
HTN
DM
metabolic dist
vol deplete
infection
NSAIDs
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75
Q

mx to slow CKD progression

A

HTN Mx
ACEi/ARB
glycaemic control
lifestyle - EXERCISE, weight loss, smoking cessation, low salt intake

76
Q

Give examples of CKD complications

A 
anaemia
acidosis
oedema
bone mineral disorders
restless legs
enceph
77
Q

Mx of anaemia in CKD

A

EPO
iron, B12, folate if deficient
[dont miss other causes of anaemia e.g. GI bleed]

78
Q

Mx of acidosis in CKD

A

sodium bicarb supplements

79
Q

Mx of oedema in CKD

A

fluid and Na+ restrict
loop diuretics
loop + thiazide

80
Q

Mx of restless legs in CKD

A

exclude iron def
sleep hygiene advice
gabapentin [off licence + beware side effects]

81
Q

how does PKD present?

A

become symptomatic due to ^size or haemorhage

loin pain
haematuria
cyst infection
renal calculi
high BP
progressive renal failure
82
Q

extrarenal aspects of PKD

A 
liver cysts
intracranal aneurysm >SAH
mitral prolapse
ovarian cyst
diverticular disease
83
Q

diagnostic Ix for PKD

and the diagnostic criteria

A

US

15-39 3 cysts
40-59 2 cysts in each

84
Q

mx of PKD

A 
3/4L water /day
treat HTN [ACE/ARB > thiazide > BB]
treat infections
cyst decompression
RRT
85
Q

which antihypertensive drug should not be used in PKD and why?

A

CCB

reduced calcium entry is part of the pathology

86
Q

briefly describe how haemodialysis works

A

blood is passed through a dialysis machine over dialysis fluid flowing the opposite direction. Waste products (solutes) pass down concentration gradient into dialysis fluid through a semi-permeable membrane

87
Q

problems with haemodialysis

A

access:

  • fistula thrombosis/stenosis/hand ischaemia.
  • tunnelled line infection/ blockage

cerebral oedema

hypoTN

time consuming

88
Q

briefly describe how peritoneal dialysis works

A

uses peritoneum as semi-permeable membrane. Fluid infused in peritoneal cavity, solutes diffuse across

89
Q

problems with peritoneal dialysis

A

catheter site infection
peritonitis
hernia
loss of membrane fn over time

90
Q

complications of renal transplant

A

surgical:
bleed, thrombosis, infection, urinary leaks, lymphocoele, hernia

delayed graft function

rejection:
acute [antibody mediated, cellular], chronic [antibody mediated]

infections

malignancy

CVD

91
Q

factor that increase risk of graft loss in renal transplant

A 
donor:
^age
comorbidity
deceased [vs living]
cardiac death [vs brain death]
rejection
infection
BP/CVD
recurrent renal disease in graft
92
Q

blood iX in glomerulonephritis

A 
FBC
U+E
LFT
CRP
immunoglobs
electrophoresis
complement
autoantibodies
ANA
ANCA
anti-dsDNA
anti-GBM
blood culture
hepatitis serology
anti-streptolysin O titre
93
Q

urine Ix in glomerulonephritis

A

MC+S
bence jones proteins
A:Cr ratio
RBC casts

94
Q

how is glomerulonephritis diagnosed

A

renal biopsy

95
Q

what is the commonest primary glomerulonephritis in high income countries?

A

IgA nephropathy

96
Q

how does IgA nephropathy present?

A 
asymptomatic
non-visible haematuria OR episodic visible
may be within 12-72hrs of infection
^BP
small proteinuria
97
Q

Mx of IgA nephropathy

A

ACEi/ARB for BP

sometimes pred/cyclophos/azathiop

fish oil

98
Q

what is the pathophysiology behind henoch schonlein purpura?

A

systemic variant of IgA nephropathy

IgA deposition in skin/joints/ gut/kidney

99
Q

features of henoch schonlein purpura?

A

purpuric rash on extensors [LEGS]
polyarthritis
abdo pain [GI bleed]
nephritis

100
Q

renal biopsy in henoch schonlein purpura is identical to biopsy in which other glomerulonephritis

A

IgA nephropathy

101
Q

diagnosis of HSP is usually clinical, but can be confirmed by what Ix?

A

positive immunofluorescence for IgA and C3 [complement] in the skin

102
Q

post strep glomerulonephritis occurs after infection in what 2 locations?

A

throat or skin

103
Q

what is the pathophysiology behind post strep glomerulonephritis?

A

streptococcal antigen deposits in the glomerulus, leading to immune complex formation and inflammation

104
Q

presentation of post strep glomerulonephritis

A 
haematuria
\+/-
oedema
^BP
oliguria
105
Q

Mx of post strep glomerulonephritis

A

supportive

Abx

106
Q

pathophysiology behind anti-GBM disease [goodpastures]

A

auto-antibodies to type IV collagen [present in glomerular and alveolar basement membranes]

107
Q

presentation of anti-GBM disease [goodpastures]

A

oligo/anuria
haematuria
aki
renal failure

pulmonary haemorrhage: SOB, haemoptysis

108
Q

diagnosis of anti-GBM disease [goodpastures] is made on…

A

anti-GBM in serum/biopsy

109
Q

Tx of anti-GBM disease [goodpastures]

A

plasma exchange
corticosteroids
cyclophosphamide

110
Q

nephrotic syndrome is a triad of…

A

proteinuria
hypoalbuminuria
oedema

111
Q

nephrotic syndrome is due to primary renal disease or secondary to a systemic disorder. Give some examples of secondary causes.

A 
DM
lupus nephritis
myeloma
amyloid
pre-E
112
Q

differential diagnosis for the presentation of nephrotic syndrome

A

CCF

liver disease

113
Q

Mx of nephrotic syndrome.

what investigation is vital to establish cause [in adults]?

A 
fluid + salt restrict
furosemide
\+/- thiazide
ACEi/ARB [reduces proteinuria]
treat cause e.g. corticosteroids in minimal change

renal biopsy

114
Q

complications of nephrotic syndrome

A

thromboembolisms [DVT/PE/ renal vein thrombosis]
infection
hyperlipidaemia

115
Q

why is there ^risk of infection in nephrotic syndrome?

And what type of infections are seen?

A

urinary loss of Ig etc
- urinary, resp, CNS infection

infection in areas of fluid accumulation - cellulitis, peritonitis, empyema

116
Q

Mx of ^infection risk in nephrotic syndrome

A

pneumococcal vaccine

post-exposure prophylaxis in varicella in non-immune

117
Q

drugs that can cause minimal change

A

lithium

NSAIDs

118
Q

most minimal change disease is idiopathic. But what else can cause it?

A

drugs [NSAIDs, lithium]

paraneoplastic [haem CA, usually hodgkins]

119
Q

does minimal change casue renal failure

A

no - if progressive consider missed FSGS [focal segmental]

120
Q

what Ix.s are used in diagnosing minimal chnage + what results?

A

renal biopsy, light microscopy normal. electron microscopy shows effacement of podocyte foot processes

121
Q

Tx minimal chnage

A

pred.

frequent relapse - cyclophosphamide/ calcineurin inhibitors

122
Q

blood and urine findings in SIADH

A

hyponat
low or normal urea and creat
low plasma osmol

high urine osmol
high urine Na+

123
Q

signs and Sx of hypernatraemia

A 
thirst
lethargy, weakness
irritable
confusion, coma, fits
signs of dehydration
124
Q

causes of hypernatraemia

A 
diarrhoea, vomiting, burns: (fluid loss) 
diabetes insipidus
osmotic diuresis e.g. DKA
primary aldosteronism
iatrogenic e.g. too much saline
125
Q

serum Na+ findings and osmolality findings (urine +serum) in diabetes insipidus

A

hypernatraemia

high plasma osmolality, low urine osmolality

126
Q

Mx of hypernatraemia

A

water orally if possible
5% glucose IV
0.9% saline if hypovolaemic [its still hypotonic]

127
Q

signs and Sx of hyponatraemia

A

anorexia
nausea
malaise

headache, irritable, weakness. FALLS IN ELDERLY.
Confusion, low GCS, seizure.

128
Q

Mx of hyponatraemia

A

[correct the cause]

hypervolaemic - fluid restrict, demeclocycline [ADH antag]. Vaptans.

dehydrated - 0.9% saline

euvolaemic - 0.9% saline + furosemide. Vaptans.

129
Q

danger of rapid correction of hyponatraemia using 0.9% saline

A

central pontine myelinolysis (demyelination of the pons, irreversible, often fatal)

130
Q

when can central pontine myelinolysis occur?

and what is the presentation?

A

malnourished alcoholics, rapid correction of hyponat

lethargy, confusion, pseudobulbar palsy, weak arms + legs, coma, locked-in syndrome

131
Q

causes of hyponatraemia. Pt is dehydrated with high urine Na+

A

(Na+ and water lost by kidneys)

addisons
renal failure
diuretics
osmolar diuresis [^glucose or urea]

132
Q

causes of hyponatraemia. Pt is dehydrated WITHOUT high urine Na+

A

(Na+ and water lost, but NOT via kidneys)

D+V
fistula
burns
rectal villous adenoma
small bowel obstruction
trauma
CF
heat exposure
133
Q

causes of hyponatraemia. Pt is oedematous

A

nephrotic syndrome
CCF
liver failure
renal failure

134
Q

Hyponatraemic, Euvolaemic patient with high urine osmolality. What is the cause of their hyponatraemia?

A

SIADH

135
Q

give 5 causes of SIADH

A

malig (SCLC, pancreas, prostate, thymus, lymphoma)

CNS (meningoenephalitits abscess, stroke, SAH, subdural, head injury, GBS, neurosurg, vasculitis, SLE)

chest (TB, pneumonia, abscess, aspergillosis, SCLC)

endocrine (hypothyroid)

drugs (opiates, psychotropics, SSRIs, cytotoxics)

136
Q

Tx of SIADH

A

treat cause
fluid restrict
consider salt +/- Furosemide
vaptans

137
Q

Mx of acute heart failure/ severe pulmonary oedema

[including Ix plz :) ]

A

sit upright
high flow O2 if hypoxia

CXR 
ECG for arrhythmias
U+E, trop, (BNP)
ABG
(echo)

diamorphine
furosemide
GTN, nitrate infusion

CPAP

138
Q

differentials for orbital oedema

A
  1. allergies [make up/ stings]
  2. angioedema
  3. infection [orbital cellulitis, EBV, sinusitis]
  4. graves
  5. connective tissue disease [dermatmyositis, SLE, sarcoid, amyloid]
139
Q

Mx of diabetic nephropathy

A 
DM control
BP control
ACEi/ARB for CV + renal protection
Na+ restrict
statins
140
Q

how does lupus cause nephritis

A

deposition of antibody complexes -> inflamm, tissue damage

141
Q

what are the antibodies against in SLE

A

nuclear components of cells [stuff inside the nucleus] e.g. anti-dsDNA, which is a ANA [anti-nuclear]

142
Q

how do you diagnose lupus nephritis

A

clinical
ANA, anti-dsDNA
biopsy

143
Q

Mx of lupus nephritis

A

ACE-/ARB for renal protection
hydroxychloroquine for extra-renal disease

more severe (class III-V) - mycophenolate, glucocorticoids, cyclophos, ritux

144
Q

what causes non-pitting oedema?

A

lymphoedema

[radiotherapy, malignant infiltration, infection, filariasis, primary/milroy’s]

145
Q

causes of bilateral leg oedema

A 
RHF
low albumin [renal/liver failure]
venous insufficiency
vasodilators [nifedipine, amlodipine]
pelvic mass
pregnancy, preE
146
Q

Mx of renal small vessel vasculitis

A

pred
cyclophos/ritux
plasma exchange (in renal failure/ pulm haemorrhage)

147
Q

describe the different way in which myeloma can cause of renal disease

A
  1. renal tract infection due to immunoparesis
  2. IgA light chain deposition in glomerulus > proteinuria
  3. IgA light chain casts obstruct tubules
  4. hypercalcaemia
148
Q

Tx of renal dysfunction in myeloma

A

hydration
bisphosphonates for ^Ca2+
chemo including dex

149
Q

A pregant patient presents with AKI. Her bloods show a haemolytic anaemia, [ low Hb, ^LDH, low haptoglobin, fragment on blood film] + thrombocytopenia.
She reports noticing some blood in her urine and that it was frothy. Diagnosis?

A

Haemolytic uraemic syndrome.

Can be precipitated by pregnancy

150
Q

Mx of HUS

A

supportive

severe may need: transfuse, plasma exchange, dialysis, treat HTN

151
Q

5 aspects of thrombotic thrombocytopenic purpura

A 
microangiopathic haemolytic anaemia
thrombocytopenia
AKI
neuro [headache, palsy, seizure, confusion, coma]
fever
152
Q

Mx of thrombotic thrombocytopenic purpura

A

plasma exchange
corticosteroids
low dose aspirin while recovering
rituximab

153
Q

what does atherosclerotic renovascular disease do to the renin-angiotensin system

A

upregulation -> ^BP

154
Q

what is reabsorbed at the proximal tubule of the kidney

A 
Na+
HCO3-
phosphate
glucose
amino acids
155
Q

what is absorbed at the distal tubule of the kidney

A

Na+

Cl-

156
Q

what is reabsorbed at the thick ascending loop of the kidney

A

Na+, K+, 2Cl-

157
Q

what is excreted at the non-cortical part of the collecting of the kidney

A

water

158
Q

where in the kidney does mannitol act

A

PCT

159
Q

where do thiazides act in the kidney

A

DCT

160
Q

where do K+ sparing diuretics act in the kidney?

A

cortical collecting duct

161
Q

where do vaptans act in the kidney?

A

collecting duct

162
Q

Tx of proximal renal tubular acidosis

A

bicarb and K+ replacement

163
Q

what is mannitol used for

A

^ICP
^IOP
(holds water in tubules by osmosis and into urine)

164
Q

what is Acetazolamide

A

diuretic.

used in glaucoma, altitude sickness, metabolic acidosis

165
Q

give the names of 2 loop diuretics

A

furosemide

bumetanide

166
Q

how do loop diuretics work?

A

blokc Na+/K+/2Cl- transporter. ^ing concentrate of filtrate so reducing water resorption

^loss of water, Na+, Cl-, K+, phosphate, Mg2+, Ca2+, H+

167
Q

side effects of loop diuretic use

A

hypokalaemia
hypovolaemia
metabolic alkalosis
ototoxicity

168
Q

how do thiazide [bendroflumethiazide] and thiazide-like [indapamide] diuretics work?

A

inhibit NaCl transporter, so inhibit Na+/Cl- reabsorption, thereby ^ing concentration of solute to ^ water loss.

169
Q

side effects of thiazide diuretics

A 
hypokalaemia
hyponatraemia
hypoMg2+
precipitate gout by sparing uric acid
glucose intolerance
170
Q

of loop diuretics and thiazide diuretics, which is used for peripheral oedema [HF/ascites] and which for HTN?

A

furosemide - peripherla oedema

thiazide - HTN

171
Q

where does aldosterone act in the renal tubule + what does it do?

A

collecting duct

retain Na+, excrete K+

172
Q

what is the pathology behind distal renal tubular acidosis

A

failure of acid (H+) secretion

173
Q

how is distal renal tubular acidosis diagnosed

A

urine fails to acidify despite metabolic acidosis

174
Q

Tx for distal renal tubular acidosis

A

bicarb

manage underlying

175
Q

what are K+-sparing diuretics used for + how do they work?

A

HF
cirrhosis
aldosteronism
K+ wasting states

decrease Na+ and K+ excretion

176
Q

adverse effects of K+-sparing diuretics

A

hyperkalaemia

acidosis

177
Q

how do the aminoglycosides [gentamicin, streptomycin etc] cause AKI?

A

tubular necrosis

178
Q

how can you prevent radiocontrast nephropathy?

A

pre-hydrate with IV saline + continue after

discontinue other nephrotoxic meds 24 hrs pre and post procedure

tell radiologist about RFs so they can use lowest dose

179
Q

causes of unilateral leg oedema

A 
DVT
cellulitis
bite
tumour
necrtizing fasciitis
trauma
compartment syndrome
arthritis
bakers cyst
180
Q

causes of pulmonary oedema

A

CV: LVF (IHD/MI), vavular, arrhythmia, malignant HTN

ARDS: trauma, drugs, sepsis

fluid overload

neurogenic [head injury]

181
Q

how does rhabdomyolysis damage the kidney?

A
  1. myoglobin released from muscle breakdown is filtered at glomerulus -> obstruction -> inflamm
  2. low NO and high cytokines -> renal vasoconstriction
182
Q

presentaiton of rhabdomyolysis - symptoms + important recent history/ predisposing factors

A

muscle pain
swelling
AKI sx
red-brown urine

history of: trauma, surgery, immobility, hyperthermia, seizures

183
Q

how do you diagnose rhabdomyolysis? [4 Ix features]

A
  1. serum myoglobin [but short half life]
  2. plasma CK
  3. cola urine false +ve for blood on dipstick, but no RBC on microscopy
  4. ^K+, ^phosphate, low Ca2+
184
Q

Tx rhabdomyolysis

A

supportive
treat hyperkal
fluids to maintain UO til myoglobinuria ceased
[RRT]

185
Q

what is urate nephropathy + what particular situaiton/ condition is it seen in?

A

uric acid crystals precipitate within the tubulointerstitium -> low GFR + inflamm

tumour lysis syndorme [high tumour burden + sensitvity to chemo]

3B GH (16 decks)

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