Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 > Renal > Flashcards

Renal Flashcards

1
Q

What are the key homeostatic functions of the kidney?

A

Regulation of BP, fluid and electrolyte balance
Acid base homeostasis
Removal of drugs and toxins
Waste elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

At what point in an AKI are the homeostatic functions of the kidney disturbed?

A

Early in AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

At what point in CKD are the homeostatic functions of the kidney disturbed?

A

Late in CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the endocrine functions of the kidney?

A 
EPO synthesis
Renin synthesis
Gluconeogenesis
Degradation of peptide hormones
Hydroxylation of Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the pre-renal causes of AKi?

A
  1. Hypovolamia (hypotension, haemorrhage, trauma, surgery, GI bleed)
  2. Sepsis (vasodilation)
  3. Renal artery stenosis
  4. Heart failure
  5. Drugs which affect BP eg NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common cause of AKI?

A

Pre-renal: Usually hypovolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which drugs should be avoided in renal impairment?

A 
Metronidazole
Aminoglycosides (Gentamycin)
NSAIDs
Potassium sparing diuretics
Lithium
Nitrofurantoin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the renal causes of AKI?

A
  1. Infection/ inflammation: pyelonephritis.glomerulonephritis
  2. Trauma
  3. Ischemia
  4. Drug toxicity eg. Gentamicin, NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the post renal causes of AKI?

A
  1. BPH
  2. Renal stones
  3. Cancer
  4. Fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How many stages of AKI are there?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What measurements are used to diagnose AKI?

A

Serum creatinine
Urine output
eGFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Stage 1 AKI?

A

Serum creatinine 1.5-2 x baseline or increase in 26umol/l in 48 hours

Urine output <0.5ml/kg/hr for 6-12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Stage 2 AKI?

A

Serum creatinine 2-3x baseline

Urine output <0.5 for >12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Stage 3 AKI?

A

Serum creatinine >3x baseline

Urine output <0.3 for >24 hours or ANURIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Compare the following for pre-renal vs renal AKI:

  • Urine output
  • Urine Na+
  • Serum Na+
  • Serum urea vs creatinine
A

PRE-RENAL:
Urine output LOW, Urine Na LOW
Serum Na HIGH, Serum Urea>Creatinine

RENAL:
Urine output initially HIGH, Urine Na HIGH
Serum Na LOW, Serum Urea=Creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should pre-renal AKI be treated in general?

A

FLUIDS

As renal perfusion and urine output is LOW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How should renal AKI not be treated in general?

A

DO NOT GIVE FLUIDS

Kidneys can’t concentrate urine, Na is lost in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In intrinsic causes of AKI what electrolyte disturbances are seen?

A

Loss of Na in urine, so Hyponatraemia
Hyperkalaemia

Leads to metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How should AKI be managed?

A
  1. Determine cause (drugs? volume loss? infection?)
  2. Stop or avoid nephrotoxic drugs (NSAIDs, ACE/ARBS)
  3. Restore renal perfusion in pre-renal AKI
  4. Correct electrolyte disturbances
  5. If life threatening intrinsic AKI, may need haemofiltration or dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What will the serum and urine sodium levels be in PRE-RENAL AKI?

A

Serum sodium HIGH

Urine sodium LOW (<15)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What will the serum and urine sodium levels be in RENAL AKI?

A

Serum sodium LOW

Urine sodium HIGH (>40)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the causes of CKD? (chronic kidney damage over >3 months, causing gradual irreversible changes in renal function)

A 
Hypertension
Atherosclerosis
Diabetes
Polycystic kidney disease
Long term NSAID use
Recurrent pyelonephritis/ glomerulonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What symptoms/signs may a patient with CKD have?

A 
Swollen ankles
SOB
Tiredness
Nausea
Haematuria
Bleeding tendency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which waste products will accumulate in the blood of CKD patients?

A

Urea
Creatinine
Phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What tests are used to monitor CKD?
eGFR Creatinine for end stage Albumin:creatinine ratio to look for protein leakage
26
How many stages of CKD are there?
1,2,3a,3b,4,5
27
What is the eGFR in stage 1 CKD?
>90
28
What is the eGFR in stage 2 CKD?
60-90
29
What is the eGFR in stage 3a CKD?
45-60
30
What is the eGFR in stage 3b CKD?
30-45
31
What is the eGFR in stage 4 CKD?
15-30
32
What is the eGFR in stage 5 CKD?
<15
33
How are serum potassium and calcium levels affected in CKD?
K+ increases leading to metabolic acidosis | Ca2+ decreases leading to secondary hyperparathyroidism
34
What are the biochemical changes in Stage 3-4 CKD?
Raised serum creatinine, raised albumin:creatinine ratio Raised cholesterol and trigylceride Decrease eGFR Hypocalcaemia (leading to secondary hyperparathyroidism)
35
What are the biochemical changes in Stage 4-5 CKD?
Raised serum creatinine and urea Raised serum phosphate Hyperkalaemia
36
Which treatments do patients with stage 3b-4 CKD require?
EPO injections Calcidiol Phosphate binders (reduces risk of metastatic calcification) Bicarbonate (corrects acid-bas disturbances)
37
Which treatments do patients with stage 5 CKD require?
Dialysis | Transplant
38
How would GLOMERULAR damage affect urine output in CKD?
Low urine output (oliguria) | Due to little glomerular filtrate
39
How would TUBULAR damage affect urine output in CKD?
High urine output (polyuria) | Due to poor reabsorption
40
What is renal bone disease?
1. Increased bone reabsorption 2. Osteitis fibrosa 3. Metastatic calcification (arteries, skin) 4. Oesteoporosis
41
What management do patients with Stage 2-3a CKD require?
Management in GP Monitoring of eGFR, bone profile, PTH Treat cause (HTN, diabetes) Drugs eg. statins, antihypertensives
42
What are renal tubular disorders?
Defects in transporting glucose, AAs, phopshate etc. | Cause electrolyte disturbances but do NOT cause renal failure
43
What are TYPE 1 renal tubular disorders?
Defect in the DCT; failure to excrete H+ ions and acidify urine. Leads to acidosis, kidney stones.
44
What are TYPE 2 renal tubular disorders?
Defect in PCT (Eg. Part of Fanconi syndrome) | Leads to alkalosis
45
What is a NON-RENAL cause of increased serum creatinine?
Muscle breakdown
46
What is a NON-RENAL cause of decreased serum creatinine?
Low muscle mass eg. Duchenne muscular dystrophy
47
What is a NON-RENAL cause of increased serum urea?
Raised protein load eg. upper GI bleed
48
What is a NON-RENAL cause of decreased serum urea?
Low protein load eg. malnutrition, anorexia
49
What are the 7 steps to diagnosis in urology?
1. History 2. Examination 3. Basic Investigations 4. Specialist investigations 5. Imaging 6. Endoscopy 7. Biopsy
50
What are examples of Irritative/storage LUTS?
1. Increased daytime freq (>7) 2. Increased nighttime freq (>1) 3. Urgency 4. Incontinence
51
What are examples of obstructive/ voiding LUTS?
1. Hesitancy 2. Poor stream 3. Terminal dribbling 4. Post micturition dribbling
52
What is sensory urgency?
Frequent urination due to a bladder issue eg. cystitis
53
What is motor urgency?
Sudden urgency to urinate due to a nervous influence eg. Caffeine, MS
54
What are the different types of incontinence?
1. Stress - weakness of pelvis floor muscles when coughing etc. Does not happen in men unless they have had prostatic surgery 2. Urge - due to detrusor overactivity eg. in stroke, alzheimer's parkinsons 3. Overflow - due to retention eg. in BPH 4. Anatomical - incontinence due to a sphincter injury or congenital issue
55
What happens to the detrusor muscle and sphincter during the storage stage of the micturition cycle?
Detrusor muscle is relaxed | Sphincter is contracted
56
What happens to the detrusor muscle and sphincter during the voiding stage of the micturition cycle?
Detrusor muscle contracted | Sphincter relaxed
57
Which nerves control the detrusor muscle?
Pelvic nerve (parasympathetic)
58
Which nerves control the urethral sphincter?
``` Pudendal nerve (voluntary) Hypogastric nerve (sympathetic) ```
59
What is a normal urine flow rate?
>15mls/second
60
What is an obstructed urine flow rate?
<10mls/second
61
How can LUTS be managed? (conservative, medical, surgical)
1. Conservative 2. Medical Alpha blockers (eg. Terazosin, Doxazosin) relax the ureter/ prostate 5 alpha reductase inhibitors-Finasterise Dutaseride Anticholinergics 3. Surgical- TURP, laser prostatectomy
62
What is the % chance a uroepithelial cancer is present if a patient has visible haematuria?
25% Need a CT urogram
63
What is the % chance a uroepithelial cancer is present if a patient has non-visible haematuria?
<5% If symptomatic; need CT urogram If non symptomatic; need USS and KUB Xray
64
Why might a PSA value be high?
BPH Prostatitis Prostate cancer Sports injury eg. cycling
65
What is acute urine retention?
Short term painful retention, residual volume <1000mls, relief on catheterisation
66
What is chronic urine retention?
Chronic painless retention, residual volume >1000mls
67
What is the International Prostate Symptom Score (IPSS) used for?
Assessing severity of symptoms in BPH Score <7 is mild Score >20 is severe
68
What are the risk factors for renal cancer?
``` Men Genetics Smoking Obesity Hypertension CKD ```
69
What are the different types of renal cancer?
1. Clear cell carcinoma (most common) 2. Papillary carcinoma 3. Chromophobe cell carcinoma 4. Collecting duct carcinoma (rare and aggressive) 5. Unclassified RCC 6. Transitional cell carncinoma (kidney and ureter junction) 7. Renal sarcoma 8. Neuroblastoma (Wilm's tumour)
70
What are the types of benign renal tumour?
Oncocytoma | Adenoma
71
What are the signs and symptoms of renal cancer?
``` Haematuria Lower back pain Abdominal mass Fatigue Weight loss Fever ```
72
How can renal cancer be diagnosed?
USS | CT or MRI
73
How can renal cancer be treated?
Radical or partial nephrectomy Radical= whole kidney, adrenal gland and ureter
74
What are the potential causes of haematuria?
``` UTI Trauma Kidney stones Cancer- renal/bladder Drugs eg. Cyclophosphamide Obstruction ```
75
What should urine cytology normally appear like?
Few cells Squamous cells = skin contamination Urothelial cells= round and lots of cytoplasm
76
Which cells should not be seen on normal urine cytology?
Polylobar neutrophils- with large irregular nuclei
77
What are the main types of bladder cancer?
1. Urothelial/ transitional cell (90%) 2. Squamous cell (5-10%) usually invasive. More common if schistomiasis is widespread 3. Adenocarcinoma (1-2%) rare
78
How is bladder cancer diagnosed?
Urine cytology Cystoscopy IV Pyelogram
79
How is bladder cancer treated?
``` Intravesicular BCG/ Mitomycin C Transurethral resection of bladder tumour (TURBT) Cystectomy Radiotherapy Chemotherapy ```
80
What is the main type of prostate cancer?
Acinar adenocarcinoma (peripheral zone)
81
Compare a focal vs diffuse glomerular lesion?
Focal- <50% all glomerular involved | Diffuse- >50% all glomerular involved
82
Compare a segmental vs global glomerular lesion?
Segmental <50% of individual glomerular involved | Global >50% individual glomerular involved
83
Nephrotic syndrome is a triad of ___________
1. Proteinuria 2. Hypoalbuminaemia 3. Oedema
84
What are the main types of nephrItic glomerulonephritis?
1. Post infection | 2. Necrotising/ Crescenteric eg. Anti GBM, Immune Complex Mediated (eg. IgA nephropathy), ANCA asssociated.
85
What are the main types of nephrOtic glomerulonephritis?
1. Minimal change disease 2. Membranous nephropathy 3. FSGS Focal segmental glomerulosclerosis
86
What is the commonest cause of end stage renal failure?
Diabetic nephropathy
87
Which systemic disease leading to renal disease is diagnosed by a Congo red stain on biopsy?
Amyloidosis
88
How does minimal change disease (nephrotic syndrome) appear on light and electron microscope?
Light microscope- normal glomeruli | EM- Fusion of podocyte foot processes
89
Does minimal change disease respond to steroids?
Yes
90
Does Focal segmental glomerulosclerosis respond to steroids?
No- poor response
91
Which type of nephrotic syndrome has spikes on silver stain?
Membranous nephropathy
92
Which type of nephrotic syndrome is usually idiopathic with Anti PLA2R?
Membranous nephropathy
93
Which type of nephrotic syndrome is due to abnormal podocytes eg. the APOL1 gene?
FSGS
94
Fanconi syndrome usually affects which part of the renal tubule?
PCT
95
Which diuretics work on the PCT?
Osmotic diuretics eg. Mannitol | Carbonic anhydrase inhibitors eg. Acetazolamide
96
Which diuretics work on the DCT?
Thiazide diuretics eg. Bendroflumethiazide | Thiazide like diuretics eg. Indapamide
97
Which diuretics work on the collecting duct?
Potassium sparing eg. Spironalactone
98
What is nephritic syndrome?
Pathology of the glomerulus involving haematuria due to inflammation.
99
What is pyelonephritis?
Kidney infection, which is usually bacterial due to an ascending UTI.
100
Which area of the prostate is affected in BPH?
Transitional zone (inner)
101
Which drugs can be used in BPH?
1. Alpha blockers eg. Doxazosin, Tamsulosin- decrease smooth muscle tone 2. 5aplha reductase inhibitors eg. Finasteride- decrease conversion of testosterone to Dihydrotestosteron
102
What are the side effects of alpha blockers used for BPH?
``` Drowsiness Depression Hypotension Dry mouth Extra pyramidal signs Ejaculatory failure ```
103
How is gonorrhoea treated?
Amoxicillin | Clarithromycin
104
How is chlamydia treated?
Azithromycin | Doxycycline
105
How is pyelonephritis treated?
Coamoxiclav Clarithromycin Gentamicin

Year 3 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions