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SMS > Renal > Flashcards

Renal Flashcards

1
Q

Pyelonephritis
- causative
organisms
- Rx

A
  • KEEP: klebsiella, e.coli, enterococcus, proteus

- Cefotaxime 1g IV BD

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2
Q

name 4 organisms that cause cystitis

A
  • E.Coli (gram neg rods)
  • staph. saprophyticus (gram pos cocci)
  • proteus
  • klebsiella
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3
Q

3 causes of asymptomatic haematuria

A
  1. IgA nephropathy
  2. Thin BM disease
  3. Alport’s
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4
Q

IgA nephropathy

  • features
  • Diagnosis
  • management
A
  1. young male with episodic macroscopic haematuria a few days after URTI
  2. IgA deposits in mesangium
  3. steroids
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5
Q

Thin BM disease

  • inheritance
  • features
A
  • autosomal dominant

- persistent asymptomatic haematuria

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6
Q

Alport’s Syndrome

  • inheritance
  • clin features
A
  1. X-linked dominant

2. microscopic haematuria, renal failure, bilateral SN deafness, retinitis pigmentosa

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7
Q

You’ve got an Alports patient with failing renal transplant, what’s happening?

A

Caused by anti-GBM antibodies from Goodpasture’s syndrome

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8
Q

Post-streptococcal GN

  • common presentation
  • diagnosis
  • management
A
  1. malaise and nephritic syndrome 1-2 weeks after sore throat/skin infection
  2. raised anti-streptolysin O titre, IgG and C3 deposition
  3. supportive management
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9
Q

Goodpasture’s disease

  • presentation
  • management
A
  • haematuria and haemoptysis (GN and pulmonary haemorrhage)

- plasmapheresis & immunosuppression

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10
Q

Membranous GN

  • associations
  • management
A
  • cancer (lung,colon, breast), autoimmune, HBV infections, drugs (penicillamine, NSAIDs)
  • immunosuppression
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11
Q

granulomatosis with polyangiitis

- presentation

A
  • ENT problems (saddle node deformity) with haematuria and conjunctivitis
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12
Q

Features of AD PCKD

A

presents in adults >40

  • abdo mass
  • haematuria
  • renal stones
  • berry aneurysms (SAH)
  • HTN
  • mitral valve prolapse
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13
Q

definition of CKD

A

GFF <60 for atleast 3 months with evidence of kidney dysfunction

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14
Q

Aetiology of CKD

A
  1. Diabetic nephropathy
  2. PCKD
  3. HTN
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15
Q

clinical manifestation of CKD

A
  • fatigue
  • pleural effusion
  • uraemia: jaundice, pruritis
  • peripheral oedema
  • hydronephrosis
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16
Q

why does tertiary parathyroidism occur in CKD

A

in CKD have v low active Vit D so less calcium reabsorption (leading to secondary hyperparathyroidism)
the chronic release of PTH causes hypertrophy so get even HIGHER baseline of PTH with high calcium and phosphate
* basically eventually so much PTH has been released that the calcium levels start to rise DESPITE the CKD*

17
Q

Conservative management in CKD

A

Fluid and salt restrict
ACEI
Statins
aspirin

18
Q

symptomatic management in CKD for:

a) anaemia
b) low calcium- bone problems

A

a) PO/IV iron- if mild
Darbopoeitin
b) phosphate and calcium binders- calcichew and vit D analogues
- can use Ca supplements- cinacalcet

19
Q

what tests are important when assessing whether suitable for renal transplant

A
  • virology*
  • CMV
  • HIV
  • TB (via CXR)
  • HCV
20
Q

immunosuppression used in renal transplants

A

short term- pred

long term- tacrolimus/ciclosporin

21
Q

what malignancy is commonly linked to immunosuppressed transplant pts

A
  • SCC (most common)
  • BCC
  • NHL
22
Q

how does rhabdo present

- management?

A
  • muscle pain, haematuria, AKI 10hrs later
  • CK in 1000s
  • rehydrate and monitor fluid balance, treat K+, consider sodium bicarb
23
Q

4 cardinal features of AKI

A
  • Uraemia
  • acidosis
  • hyperkalaemia
  • fluid overload
24
Q

RIFLE classification

A

Risk- raised creat x 1.5/ UO <0.5ml/kg/h x6h
Injury- Inc creatinine x2/ UO < 0.5ml/kg/hr x 12 hrs
Failure- inc creatinine x3/ UO <0.3ml/kg/hr x24 (or anuria x24hr)
Loss- persistent ARF >4weeks
ESRD

25
Q

ECG signs of hyperkalaemia in order

A
  1. tented T waves
  2. loss of P waves
  3. wide QRS
  4. Sine wave/ VF
26
Q

Treatments of hyperkalaemia

A
  1. salbutamol neb
  2. insulin/dextrose 10 units IV
  3. 10% calcium gluconate
27
Q

Acute intersitial nephritis

  • causes
  • presentation
  • management
A
  • DRUGS- NSAIDs and abx (also infections and AI)
  • acute renal failure with fever, rash, eosinophilia
  • stop cause/supportive/can use pred if bad
28
Q

common causes of chronic tubulointerstitial nephritis

A

ureteric reflux
chronic pyelonephritis
DM
sickle cell disease

29
Q

Renal artery stenosis

  • causes
  • sx
  • gold standard inv
  • Rx
A

Causes: atherosclerosis, fibromuscular dysplasia (young women), thromboembolism
Sx: refractory HTN, worsening renal function after ACEi, flash pulmonary oedema (no LV impairment)
- inv: renal angio
Rx: Balloon angio +/- stent

30
Q

HUS

  • triad?
  • cause?
  • classic pres
  • blood film shows?
  • Rx
A
  1. MAHA, thrombocytopenia, ARF
  2. E.Coli 0157:H7 (other cause: TTP)
  3. child with abdo pain, (bloody) diarrhoea and rash
  4. Schistocytes
  5. Supportive
31
Q

Diabetic nephropathy

  • what happens to the glomerulus?
  • management?
A
  • Glomerulosclerosis

- good glycaemic control (preventative) and start ACEi even if normotensive but microalbuminuria

32
Q

Renal tubular acidosis

  • how to differentiate between type 1 & 2
  • how are they treated?
A
  • Type 1: can’t acidify urine despite high acid load whereas you can in Type 2
  • replenish HCO3 and correct hypo K+
33
Q

what is Fanconi syndrome?

A

impairment of the proximal convoluted tubule so can’t reabsorb K+, HCO3, glucose

34
Q

Risk factors for RCC

A
  • obesiy
  • smoking
  • HTN
  • VHL syndrome
35
Q

RCC

  • presentation
  • mets to?
  • paraneoplastic features
A
  • haematuria, loin pain, loin mass, systemic sx, LEFT varicocele
  • direct to IVC, lymph, cannonball mets to lung
  • polycythaemia, hypercalcaemia, HTN, cushings
36
Q

Management of RCC

  • medical?
  • surgical?
A
  1. Temsirolimus (mTOR inhibitor)

2. for stage 1&2- radical nephrectomy

SMS (5 decks)

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