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Phase 2- Gen Med > Renal > Flashcards

Renal Flashcards

1
Q

What is hypernatraemia?

A

Serum sodium levels >145mmol/L

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2
Q

Give 4 symptoms of hypernatraemia

A 
Lethargy 
Thirst 
Weakness
Irritability 
Confusion 
Coma 
Fits
Signs of dehydration
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3
Q

Give 4 hypotonic causes of hypernatraemia

A 
Vomiting
Diarrhoea
Burns 
Diabetes insipidus 
Osmotic diuresis
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4
Q

Give 2 causes of normotonic hypernatraemia

A

Primary aldosteronism

Iatrogenic (excess IV saline)

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5
Q

How is hypernatraemia managed?

A

Replace water loss orally

Can give 5% glucose slowly (1L/6hrs) or 0.9% saline if hypotonic

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6
Q

What is hyponatremia?

A

Serum sodium <135 mmol/L

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7
Q

Give 5 symptoms of hyponatremia

A 
Anorexia
Nausea
Malaise
Headache
Irritability 
Confusion 
Weakness
Seizures
Increased risk of falls
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8
Q

Give 3 causes of hypervolaemic hyponatraemia

A

Nephrotic syndrome
Heart failure
Liver cirrhosis
Renal failure

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9
Q

Give 4 causes of hypovolaemic hyponatraemia

A 
Diarrhoea
Vomiting 
Trauma 
Small bowel obstruction 
Addison's disease
Renal failure 
Osmotic diuresis 
Diuretic excess
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10
Q

Give 3 causes of normovolaemic hyponatraemia

A

SIADH
Severe hypothyroidism
Glucocorticoid insufficiency
Iatrogenic (excessive IV 5% glucose)

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11
Q

How is chronic hyponatraemia managed?

A

Fluid restriction
ADH antagonist
Treat underlying cause

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12
Q

How is acute symptomatic hyponatraemia managed?

A

Rehydration slowly
Furosemide
ADH antagonist

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13
Q

How is hyponatraemia treated in an emergency?

A

1.8% saline given at 70 mmol of Na+ per hour alongside Furosemide

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14
Q

What is hyperkalaemia?

A

Serum potassium >6.5 mmol/L

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15
Q

What are the symptoms of hyperkalaemia?

A

Fast irregular pulse, chest pain, weakness, palpitations, lightheadedness

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16
Q

What ECG changes are seen in hyperkalaemia?

A

Tall tented T waves
Increased PR interval
Absent P wave
Widened QRS complex

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17
Q

Give 5 potential causes of hyperkalaemia

A 
Oliguric renal failure 
K+ sparing diuretics
Rhabdomyolysis
Metabolic acidosis
Addison's disease
Burns 
ACE inhibitors
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18
Q

How is hyperkalaemia managed in a non-emergency?

A

Treat underlying cause

Calcium resonium 15g/8hrs

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19
Q

How is hyperkalaemia managed in an emergency?

A 
Calcium gluconate 10% (30ml) 
IV insulin (10 units) in 25g of glucose 
Salbutamol nebuliser (10-20mg)
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20
Q

What is hypokalaemia?

A

Serum potassium <2.5 mmol/L

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21
Q

What are the symptoms of hypokalaemia?

A

Muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, lightheadedness, constipation

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22
Q

What ECG changes are seen in hypokalaemia?

A

Small or inverted T waves
U waves
Long PR interval
Depressed ST segments

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23
Q

Give 5 causes of hypokalaemia

A 
Diuretics
Vomiting 
Diarrhoea
Cushing's syndrome 
Steroid excess
Conn's syndrome 
Alkalosis
Pyloric stenosis
Renal tubular failure
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24
Q

How is hypokalaemia treated?

A

Oral K+ supplement
Swap to K+ sparing diuretic
Can give IV potassium if severe

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25
Q

What is hypercalcaemia?

A

Serum calcium >2.6 mmol/L

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26
Q

Give 5 symptoms of hypercalcaemia

A 
Bones, stones, groans and psychiatric moans 
Abdominal pain 
Vomiting 
Constipation 
Polyuria
Polydipsia
Depression 
Anorexia
Weight loss
Tiredness
Weakness
High blood pressure
Confusion 
Pyrexia
Renal stones 
Renal failure 
Ectopic calcification
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27
Q

What ECG change is seen in hypercalcaemia?

A

Reduced QT intervl

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28
Q

Give 4 causes of hypercalcaemia

A 
Bone metastases
Primary hyperparathyroidism 
Sarcoidosis
Thyrotoxicosis
Lithium use
HIV
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29
Q

How is hypercalcaemia treated?

A

IV 0.9% saline to correct dehydration
Bisphosphonates
Treat the cause

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30
Q

What is hypocalcaemia?

A

Serum calcium <2.1 mmol/L

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31
Q

What are the symptoms of hypocalcaemia?

A 
SPASMODIC
Spasms
Perioral paresthesia
Anxious 
Seizures
Muscle tone increased
Orientation impaired (confusion) 
Dermatitis
Impetigo infection 
Choreoarthritis, cataracts, cardiomyopathy
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32
Q

What is Chvostek’s sign?

A

In hypocalcaemia, the corner of the mouth twitches if the facial nerve is tapped

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33
Q

What is Trousseau’s sign?

A

In hypocalcemia when a blood pressure cuff is inflated. The reduced blood flow to the hand causes ischaemia so the hand contracts

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34
Q

Give 3 causes of hypocalcaemia alongside a raised phosphate

A

CKD
Hypoparathyroidism
Rhabdomyolysis
Hypomagnesaemia

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35
Q

Give 3 causes of hypocalcaemia alongside a normal or lowered phosphate

A 
Vitamin D deficiency 
Osteomalacia 
Acute pancreatitis
Overhydration 
Respiratory alkalosis
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36
Q

How is hypocalcaemia treated?

A

Mild: Calcium 5 mmol/6hr PO
Severe: 10 ml 10% calcium gluconate IV over 30 minutes

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37
Q

What is glomerulonephritis?

A

A term for a number of conditions which affect the glomerulus.

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38
Q

What are the 3 main nephrotic syndromes?

A

Minimal change
Focal segmental glomerulonephritis
Membranous

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39
Q

What are the 3 main nephritic syndromes?

A

IgA nephropathy
Goodpasture’s syndrome
Vasculitis disorder

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40
Q

What is a UTI?

A

Infection of the ureter, bladder or prostate

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41
Q

What are the 2 most common microbial causes of a UTI?

A

E.coli

Staphylococcus saprophyticus

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42
Q

Give 4 risk factors for developing a UTI

A 
Sexual activity 
Urinary incontinence
Diabetes
Dehydration 
Immunosuppression 
Pregnancy 
Renal tract malformation 
Elderly
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43
Q

Give 3 symptoms of a UTI

A 
Increased urinary frequency
Dysuria
Urgency 
Suprapubic pain 
Polyuria 
Haematuria
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44
Q

What tests can be done to diagnose a UTI?

A

Urine dipstick
MSU culture
FBC, U&Es, CRP
Ultrasound scan (recurrent UTIs)

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45
Q

What is the treatment for an uncomplicated UTI?

A

3 day course of trimethoprim or nitrofurantoin

46
Q

What is the treatment for a complicated UTI?

A

7 day course of trimethoprim or nitrofurantoin

47
Q

Which UTI antibiotic should be avoided in T1 of pregnancy?

A

Trimethoprim

48
Q

Which UTI drug should be avoided in T3 of pregnancy?

A

Nitrofurantoin

49
Q

What is pyelonephritis?

A

Infection of the upper urinary tract

50
Q

Give 4 symptoms of pyelonephritis

A

Fever, rigors, vomiting, loin to groin pain, costovertebral pain, lower UTI symptoms, septic shock

51
Q

What is the treatment for pyelonephritis?

A

14 day course of trimethoprim or nitrofurantoin

52
Q

What is rhabdomyolysis?

A

Excessive skeletal muscle breakdown causing a release of cellular contents into the blood. Cytokine release and decrease in nitric oxide causes vasoconstriction. Myoglobin release obstructs the glomeruli.

53
Q

Give 4 risk factors for rhabdomyolysis

A 
History of trauma 
Recent surgery 
Immobility 
Seizures
Hyperthermia
Excessive exercise
54
Q

Give 4 symptoms of rhabdomyolysis

A

Muscle pain
Swelling
Tenderness
Red-brown urine

55
Q

How is rhabdomyolysis diagnosed?

A

Serum myoglobin

Serum creatinine kinase

56
Q

What electrolyte disturbance is common in rhabdomyolysis?

A

Hyperkalaemia

57
Q

How is rhabdomyolysis treated?

A

Treat hyperkalaemia

IV fluid rehydration

58
Q

What is hyperuricaemia?

A

High levels of urate in the blood due to increased cell turnover

59
Q

Which drugs can cause hyperuricaemia?

A

Cytotoxics
Thiazides
Loop diuretics
Pyrazinamide

60
Q

Apart from drugs, what are 5 other causes of hyperuricaemia?

A

Gout, CKD, hyperparathyroidism, preeclampsia, lymphoma, psoriasis

61
Q

How is hyperuricaemia treated?

A

Allopurinol
Rehydration
Loop diuretics
Retrograde ureteric catheterisation

62
Q

Where are the 3 most common sites for urinary stones?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

63
Q

What is the composition of most types of urinary stones?

A

Calcium oxalate

64
Q

What are the symptoms of urinary stones?

A 
Loin to groin pain
Renal colic
Lower UTI symptoms 
Haematuria 
Anuria
65
Q

How is a urinary stone treated acutely?

A

Analgesia
IV fluids
Increase fluid intake
Antibiotics if needed

66
Q

How is a urinary stone <5mm treated?

A

Conservative- let it pass naturally

67
Q

How is a urinary stone >5mm treated?

A

Nifedipine
Alpha blockers
Lithotripsy
Percutaneous nephrolithotomy (keyhole surgery)

68
Q

How can kidney stones be prevented?

A

Good hydration, low calcium and oxalate diet, allopurinol, thiazide diuretic

69
Q

What is autosomal dominant polycystic kidney disease?

A

Inherited condition where many small, fluid filled sacs appear on the kidney

70
Q

Give 4 symptoms of autosomal dominant polycystic kidney disease

A 
Abdominal pain 
Hypertension symptoms (headache, nosebleeds, blurred vision, SOB)
Haematuria
Upper UTI symptoms 
Kidney stone symptoms
71
Q

How is autosomal dominant polycystic kidney disease treated?

A

Treat complications as normal (ie. hypertensives)
Analgesia (not NSAIDs)
Tolvaptan (reduces size of the cysts)
Plan for future CKD

72
Q

Give 3 potential complications from autosomal dominant polycystic kidney disease

A

Liver cysts
CV disease
Brain aneurysms

73
Q

What is AKI?

A

Acute decreased renal function

74
Q

What is stage 1 AKI?

A

Serum creatinine >26umol/L over 48 hours
OR >1.5-1.9 x baseline serum creatinine over 7 days

PLUS <0.5 ml/kg/hr urine output over >6 hours

75
Q

What is stage 2 AKI?

A

> 2.0-2.9 x baseline serum creatinine over 7 days

PLUS <0.5 ml/kg/hr urine output over >12 hours

76
Q

What is stage 3 AKI?

A

Serum creatinine >354umol/L over 48 hours
OR >3 x baseline serum creatinine over 7 days
OR if on renal replacement therapy

PLUS <0.3 ml/kg/hr urine output over >24 hours
OR anuric for > 12 hours

77
Q

Give 4 risk factors for AKI

A 
CKD
Old age 
Male 
Diabetes 
CV disease
Malignancy 
Chronic liver disease
Complex surgery
78
Q

Give 5 potential causes for prerenal AKI

A 
Haemorrhage 
D&amp;V 
Burns 
Pancreatitis
Hypotension 
MI 
Cardiogenic shock 
Sepsis 
NSAIDs
ACE inhibitors 
ARB 
Hepatorenal syndrome
79
Q

Give 4 renal causes of AKI

A

Glomerulonephritis
Infection
Drug reaction
Vasculitis

80
Q

Give 5 causes of post renal AKI

A 
Stone 
Malignancy 
Stricture 
Clot 
Prostatic hypertrophy 
Retroperitoneal fibrosis
81
Q

Give 2 potential complications of AKI

A

Hyperkalaemia

Metabolic acidosis

82
Q

How is AKI treated?

A

IV fluids
Treat the cause
Stop nephrotoxic drugs

83
Q

What is CKD?

A

Abnormal kidney function for >3 months which results in health implications

84
Q

What is stage 1 CKD?

A

Mild kidney damage, eGFR >90

85
Q

What is stage 2 CKD?

A

Mild kidney damage with eGFR 60-89

86
Q

What is stage 3 CKD?

A

Moderate kidney damage with eGFR 30-59

87
Q

What is stage 4 CKD?

A

Severe kidney damage with eGFR 15-29

88
Q

What is stage 5 CKD?

A

End-stage renal disease with eGFR <15 or on dialysis

89
Q

Give 4 potential causes of CKD

A 
Diabetes
Glomerulonephritis
Renovascular disease
Heart failure
Nephrotoxic drugs
90
Q

How is CKD managed?

A 
ACE inhibitor
Control diabetes
Lose weight 
Stop smoking 
Reduce CV risk --> aspirin and low dose statins 
Plan for RRT in the future
91
Q

What is dialysis?

A

Artificial filtration of the blood used when the kidneys can no longer function

92
Q

When is dialysis started?

A

1 or more of the following symptoms:

  • Pulmonary oedema
  • Uncontrollable high blood pressure
  • Serositis
  • Acid-base and electrolyte imbalances
  • Pruritis
  • Deterioration of nutritional status
  • Cognitive impairment
93
Q

Explain the process of haemodyalysis

A

Blood is passed over a semi-permeable membrane against dialysis fluid moving in the opposite direction.

94
Q

How many times a week must haemodyalysis be done?

A

3 times a week

95
Q

Where is the blood collected from the body in haemodyalysis?

A

AV fistula in the arm

Uses brachial artery and cephalic vein

96
Q

Give 4 potential problems of haemodyalysis

A 
Creating AV fistula 
Thrombosis 
Stenosis 
Infection 
Blockage 
Cerebral oedema
Hypotension 
Time consuming
97
Q

Explain the process of peritoneal dialysis

A

Uses the peritoneum as a semi-permeable membrane. A catheter is placed into the peritoneal cavity and fluid is infused. The solutes move across and into the blood.

98
Q

Give 2 potential problems of peritoneal dialysis

A

Catheter site infection
Peritonitis
Hernia
Loss of membrane function over time

99
Q

What is haemofiltration?

A

Type of dialysis used in emergency situations when haemodyalysis cannot be used because the blood pressure is too low.

100
Q

Give 5 complications of dialysis

A 
Hypertension 
Vascular stiffness
Dysregulation of calcium and phosphate 
Oxidative stress
Bone disease
Infection 
Carpal tunnel syndrome
Arthralgia
101
Q

In which patients is renal transplantation contraindicated?

A

HIV
Cancer with metastases
Active infection
CV disease

102
Q

Which 4 types of drugs are required for a renal transplant?

A

Monoclonal antibodies
Calcineurin inhibitors
Antimetabolites
Glucocorticoids

103
Q

Give 5 potential complications of a renal transplant

A 
Rejection 
Surgical bleed
Infection 
Thrombosis 
Hernia 
Delayed graft function 
Malignancy (x25 increased risk of cancer)
104
Q

Give 4 symptoms of renal cell carcinoma

A 
Haematuria
Lump in kidney area
Weight loss
Fever
Persistent pain in lower back 
Tiredness 
Loss of appetite 
Weight loss
105
Q

What is stage 1 renal cell carcinoma?

A

<7cm mass inside kidney

106
Q

What is a stage 2 renal cell carcinoma?

A

> 7cm mass inside kidney

107
Q

What is a stage 3 renal cell carcinoma?

A

Cancer has spread to adrenal glands, nearby veins or 1 nearby lymph node

108
Q

What is stage 4 renal cell carcinoma?

A

More than 1 lymph node affected or spread to distant area of the body

109
Q

In what ways can renal cell carcinomas stage 1-3 be treated?

A

Surgery
Cryotherapy
Radiotherapy
Artificial embolisation (block blood flow to kidney)

110
Q

How is a stage 4 renal cell carcinoma treated?

A

Chemotherapy

Hormone therapy

Phase 2- Gen Med (7 decks)

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