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Final year > Renal > Flashcards

Renal Flashcards

1
Q

What controls plasma osmolality?

A

Post pituitary- produces ADH if the plasma osmolality gets too high (300)

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2
Q

How much ADH is secreted when the plasma osmolality is 280?

A

None (no fluid needs to be retained).

Normal values is 280-300

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3
Q

What is paradoxical acid-urea

A

When you are vomiting and this causes a metabolic alkalosis (low K+), there will be H+ ions in the urine because your body wants to conserve the k+. So a baby with pyloric stenosis would have a low urinary pH.

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4
Q

How do you calculate plasma osmolality?

A

Glucose + urea + 2(sodium) 320

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5
Q

What would a seriously high osmolality indicate?

A

Hyperosmolic hyperglycaemic state

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6
Q

Why does SIADH occur?

A

The posterior pituitary will release ADH if there is an increase in serum osmolality OR in response to stress- ie in stroke, SAH, all neuro things basically.

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7
Q

Signs of hypervolaemia

A

pulmonary rales, S3 gallop (third heart sound), jugular venous distention, peripheral oedema, ascites.

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8
Q

Signs of hypovolaemia

A

dry mucous membranes, tachycardia, diminished skin turgor.

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9
Q

Random- but which hormone is also produced in stress?

A

Prolactin (this will be high post seizure). This rises in females in famine (evolution).

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10
Q

What is the test of choice for polycystic kidney disease?

A

Abdomen ultrasound

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11
Q

Which drug can aid ureteric stone passage?

A

Alpha blockers

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12
Q

What is the preferred choice of imaging for ureteric stones?

A

USS then Non-contrast CT (99% of stones are visible in NCCT)

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13
Q

What size of stones will usually pass spontaneously?

A

<5mm

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14
Q

What are the indications for dialysis?

A

Resistant hypokalaemia (>7), eGFR<15, Acidosis <7.2 and pulmonary oedema despite treatment.

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15
Q

P’s of chronic renal failure?

A 
Pigmentation (uraemia) Pallor
Pruritis
Pulmonary oedema/ peripheral odema
Painful big toe
Pericarditis
Parathyroid overactivity
Bruising easily also Peachy
Proteinuria
Phosphate raised
Potassium raised
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16
Q

Most common type of nephrotic syndrome in children?

A

Minimal change

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17
Q

Most common type of nephrotic syndrome in adults?

A

Membranous glomerulonephritis

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18
Q

In which syndrome would you see urinary casts?

A

Nephritic syndrome

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19
Q

How do you treat minimal change nephropathy?

A

Steroids

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20
Q

Name 2 types of nephritic syndrome?

A

Post strep, focal glomerulonephritis (tx is immunosuppression).

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21
Q

Most common type of renal cell carcinoma?

A

Clear cell

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22
Q

Symptoms of RCC?

A

Haematuria + mass + pain

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23
Q

Gold standard method of imaging in RCC?

A

Contrast CT

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24
Q

What is the triad associated with polycystic kidneys?

A

Renal cysts + aneurysms + hernias ( SO LAURA REMEMBER TO DO AN ABDO USS)

25
Q

When can an acute reaction to a transplant occur?

A

Within 6 months of transplantation

26
Q

What is goodpastures?

A

Pulmonary haemorrhage and rapidly progressive glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen.

27
Q

How is eGFR commonly calculated?

A 
The most commonly used formula is the Modification of Diet in Renal Disease (MDRD) equation, which uses the following variables:
serum creatinine
age
gender
ethnicity
28
Q

Factors which may affect the eGFR calculation?

A

pregnancy (eGFR goes up in pregnancy)
muscle mass (e.g. amputees, body-builders)
eating red meat 12 hours prior to the sample being taken

29
Q

Surgical mgmt of testicular cancer?

A

Orchidectomy via inguinal approach to minimise seeding

30
Q

Mgmt of bladder cancer?

A

Intravesicle chemotherapy + transurethral resection of tumour

31
Q

Removal of stones in a pregnant person?

A

Ureteroscopy

32
Q

AKI definition

A

A rise in serum creatinine of 26 micromol/litre or greater within 48 hours
A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
A fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than

33
Q

What is the triad for nephrotic syndrome?

A

Proteinuria, oedema & hypoalbuminaemia

34
Q

Why are patients with nephrotic syndrome predisposed to VTEs?

A

Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels predispose to thrombosis. Loss of thyroxine-binding globulin lowers the total, but not free, thyroxine levels.

35
Q

What is IgA nephropathy?

A

Also called beurgers or mesangioproliferative glomerulonephritis

36
Q

How do patients with beurgers normally present?

A

young male, recurrent episodes of macroscopic haematuria
typically associated with mucosal infections e.g., URTI
nephrotic range proteinuria is rare
renal failure

37
Q

How do you differentiate between beurgers and post strep glomerulnephritis?

A

Pose strep- low complement levels. The MAIN symptom in post strep is proteinuria. It develops 1-2 weeks after URTI but beurgers develops 1-2 days after URTI.

38
Q

What is the triad for nephritic syndrome?

A

HTN, haematuria, oliguia (proteinuria).

39
Q

Inv for renal stones?

A

Following initial US assessment, NCCT should be used to confirm stone diagnosis in patients with acute flank pain, because it is superior to IVU. (intravenous urography)

40
Q

Features of rhabdomylysis?

A

Acute renal failure with disproportionately raised creatinine
Elevated CK
Myoglobinuria
Hypocalcaemia (myoglobin binds calcium)
elevated phosphate (released from myocytes)

41
Q

Causes of hypokalaemia?

A

All the ones you know + magnesium depletion

42
Q

What predisposes to digoxin toxicity?

A

Hypokalaemia, hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis

43
Q

Mgmt of Complex renal calculi and staghorn calculi?

A

Percutaneous nephrolithotripsy

44
Q

Name a drug which can cause interstitial nephritis?

A

Penicillin

45
Q

What is the screening test for polycystic kidney disease?

A

Abdo USS

46
Q

BP aim for diabetics and people with CKD (ACR<70)?

A

130/80

47
Q

Blood picture in CKD (haem)

A

Normocytic anaemia (due to decreased EPO). Tx is give EPO

48
Q

Ca in secondary hyperparathyroidism?

A

Low- PTH high, phosphate high. This happens secondary to CKD.

49
Q

Why is having increased levels of phosphate bad?

A

Promotes vascular calcification

50
Q

Mgmt of high phosphate and low ca in CKD?

A

Give Vit D (alfacalcidol)
Reduce phosphate in diet.
Dialysis promotes the loss of phosphate.

51
Q

Patients with CKD pre-op problems?

A

Fasting can put them into acute-on-chronic

52
Q

When should you stop metformin?

A

When eGFR is <30 and day of surgery + a few days after.

53
Q

When would you perform a percutaneous nephrostomy?

A

This is performed as an emergency procedure to relieve kidney (which is in renal failure) caused by an obstructing calculus. Be cautious with bleeders.
Also performed when diverting urine following damage to the ureters, also obstruction in relation to pregnancy and to allow the drainage of a perinephric abscess.

54
Q

When do you use extracorpeal shock wave lithotripsy?

A

This is penetration of the skin to break large renal calculi which can then be passed- performed as an outpatient procedure with local anaesthetic.

55
Q

When would you perform a percutaneous nephrolithotomy?

A

This is for removal of stones which are in the upper ureter or kidney so to avoid open procedure.

56
Q

3 associations with PKD?

A

Berry aneurysms, mitral valve prolapse & hepatic cysts.

57
Q

Urgent 2 week referral for bladder

A

Painless haematuria in anyone >45

>60- nonvisible haematuria + (WCC raised or dysuria)

58
Q

TNF-alpha inhibitors increase your risk of?

A

Opportunistic infections eg aspergillosis

Final year (16 decks)

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