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Yr 3 ALS > Renal > Flashcards

Renal Flashcards

1
Q

Functions of Kidney (A WET BED)

A 
Acid - base balance
Water balance
Erythropoeisis
Toxin removal
Blood pressure
Electrolyte balance
D vitamin activation
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2
Q

3 features of AKI

A
  • Uremia
  • Oliguria
  • High creatinine
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3
Q

2 most important diagnostics for AKI

A
  • USS - within 24hrs

- Dipstick

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4
Q

Biggest risk factor for AKI

A

Hypertension

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5
Q

What sign in AKI is associated with poor prognosis

A

-Oliguria

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6
Q

4 progressive ECG changes with hyperkalemia

A
  • Tall tented T waves
  • Small/absent P waves
  • Wide QRS
  • Sine wave = fatal
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7
Q

Treatment protocol hyperkalemia

A

-Calcium gluconate - stabilize myocardium
-Dextrose with Insulin
-(Salbutamol)
-Sodium bicarb
(Dialyse if necessary)

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8
Q

When would you use a loop diuretic in AKI

A

Pulmonary oedema

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9
Q

What NT contraindicated with AKI

A

Dopamine

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10
Q

Most common form of AKI

A

Pre-renal

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11
Q

Commonest cause of AKI in hospital and why is it difficult to manage

A
  • Sepsis

- Vancomycin and Gentamycin = nephrotoxic

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12
Q

Definition of pre-renal AKI and 4 major causes

A
  • Impaired renal blood flow
  • Hypovalemia (shock)
  • Hypotension
  • CO decrease
  • Vascular disease (stenosis of renal vessels or emboli)
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13
Q

Impact of pre-renal AKI on RAAS

A

Decreased blood flow activates RAAS, Na and H20 resorbed causing increased creatinine and urea

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14
Q

3 Sub-categories of Intra-renal AKI

A
  • Acute tubular necrosis
  • Acute Interstitial nephritis
  • Glomerulonephritis
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15
Q

Causes of acute tubular necrosis

A
  • Ischemia

- Drugs - aminoglycosides, lead, contrast, myoglobin

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16
Q

What is tumor lysis, and how does it relate to acute tubular necrosis.

A

Tumor cells release nephrotoxic uric acid during chemo damaging tubules. - drink water during chemo

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17
Q

Acute Interstitial Nephritis

  • Causes
  • Diagnostics
A
  • Drugs: Penicillin, AlloP, PPI, Chemo, NSAID’s, Rifampacin
  • Infective: Staph A, Hantavirus
  • Eosinophilia
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18
Q

What is glomerulonephritis and what does it encompass

A

Inflammation of the glomerulus and includes noth nePHROTIC and nePHRITIC pictures.

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19
Q

Features of Nephritic syndromes

A
  • Haematuria -
  • High BP
  • Low urine output
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20
Q

4 Nephritic syndromes and their clinical features

A
  • Goodpastures = Anti-GBM on basement membrane, tends to affect adults
  • ANCA-Vasculitis = SLE, autoimmune, may present with endocarditis
  • IgA Nephropathy = Most common form, begins few days after infection, IgA deposits in mesangial cells, young men often affected
  • Alport syndrome: Kids, hearing loss, inherited collagen defect
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21
Q

2 rarer forms of Nephritic syndrome

A
  • HUS

- Henloch-Schonlein Purpura

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22
Q

2 conditions that present with mixed nephrotic and nephritic picture

A
  • Post Strep: Kids. 7-14 days after, starry sky and necrophilia
  • Membranous proliferative: poor prognosis associated with hepatitis B and C patients.
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23
Q

Features of Nephrotic syndrome

A
  • Proteinuria
  • Low albumin
  • Oedema
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24
Q

3 primary causes Nephrotic syndrome

A
  • Minimal Change: Most common, esp kids
  • Focal Segmental: Most common, adults. associated with HIV and heroin users
  • Membranous: Autoimmune cause suspected
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25
Q

3 Secondary causes Nephrotic syndrome

A
  • Diabetic nephropathy - causes membranous and focal segmental
  • Sarcoidosis/Amyloidosis
  • SLE
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26
Q

2 Marked features of nephrotic syndrome

A
  • Hyperlipidemia

- Hypercoagulability

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27
Q

Define CKD

A

Chronic (3month) decline in renal function, with low urine, low eGFR and high creatinine

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28
Q

How can you classify severity of CKD

A

RIFLE criteria

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29
Q

Most common causes of CKD in order of most to least likely

A
  • Diabetes
  • Hypertension
  • Glomerular disease
30
Q

Main indicator for dialysis

A

Hyperkalemia

31
Q

Best diagnostic tool to determine Acute/Chronic KD

32
Q

3 Features of Uremia

A
  • Encephalopathy
  • Pericarditis
  • Skin frost
33
Q

3 Features of Na retention (RAAS activation)

A
  • oedema
  • thirst
  • hypertension
34
Q

Cause and treatment of CKD anemia

A
  • Normocytic normochromic due to decreased EPO

- Recombinant EPO

35
Q

Treat CKD acidosis and biggest risk to this

A

Sodium bicarb - oral

-oedema and BP

36
Q

2 Causes of CKD bone disease and treatment

A

-High phosphate = High PTH = Osteoclast breakdown bone
-Low vitamin D = low calcium = High PTH
TREAT =
-Activated vit D (1-alfacalcidol)
-Decrease dietary phosphate

37
Q

Endocrine complication of renal transplant

A

New onset diabetes

38
Q

5 absolute contraindications for transplantation

A
  • Active Cancer (2-5yrs free)
  • Active infection
  • Drug misuse
  • Uncontrolled psychiatric condition
  • <5yrs life expectancy
39
Q

Basis for Acute + Chronic transplant rejections

A

MHC incompatibility

40
Q

Basis for Hyperacute transplant rejection

A

Blood group rejection

41
Q

Basis HLA typing

A

Tyhe more matched between A, B and DR group the better the prognosis

42
Q

000 and 666 in relation to HLA matching

A 
000 = No mismatch
666 = Complete mismatch
43
Q
  • Histology Renal cell carcinoma
  • Main symptom
  • 3 clinical signs
A
  • Adenocarcinoma
  • Haematuria
  • High BP, Anemia, High ESR
44
Q

Spread and route of spread

A

Bony mets via para-aortic nodes

45
Q

Indication for poor prognosis and treatment in this case

A
  • Metastasis (vascular involvement)

- Biologics

46
Q

Bladder cancer

  • M:F
  • Risk factors
A
  • 5:2

- Smoking, dyes, benzidine, radiation

47
Q

What bladder cancer subtype is only associated with chronic UTI and schistosomiasis

A

Squamus cell carcinoma

48
Q

Most common area and histology of prostate CA

A
  • Peripheral zone

- Adenocarcinoma

49
Q

Unique feature of prostate bony mets

A

Increased bone density (osteosclerotic) - other cancers cause a decrease

50
Q

3 instances where NICE recommends PSA use

A
  • LUT
  • Erectile dysfunction
  • Frank Haematuria
51
Q

Treatment for both low and med/high rick prostate CA

A
  • Low: Watch/active surveillance

- Med/High: Radical prostatectomy and radio

52
Q

Brachytherapy

A

Implantation of radioactive seeds into prostate - associated with fewer side effects. Only recommended for low risk patients.

53
Q

Androgen suppressors for non-localized disease

A
  • Bicalutamide
  • “Relins”
  • Finasteride - prophylactic for cancer developing
54
Q

2 types of testicular CA

A
  • Seminoma

- Teratoma

55
Q

Most likely sites for seminoma spread (3 L’s)

A
  • Lungs
  • Liver
  • Lymphatics
56
Q

Serum markers

  • Teratoma
  • Both
  • Seminoma
A 
T = alpha-fetoprotein (AFP)
Both = B-HCG
S = Lactate dehydrogenase
57
Q

Treatment protocol and cure rate

A

Orchiectamy and platinum based chemo

95%

58
Q

Stress Incontinence

A

Leakage due to an incompetent sphincter typically when laughing or couching (increased abdo pressure)

59
Q

Urge Incontinence

A

Detrusor over-activity, caused by unstable muscle and increased contraction

60
Q

Overflow Incontinence

A

Dribbling due to increased bladder volume - residual volume

61
Q

What medication is not advised for overflow incontinence

A

Anticholinergics - chronic retention

62
Q

3 types of renal calculi in order of most prevalent

A
  • Calcium
  • Uric acid
  • Styruvate
63
Q

Initial investigation

A

X-ray / CT

64
Q

2 Smooth muscle relaxers for renal colic

A

Alpha receptor blockers - Tamsulosin

Ca channel blockers - Rifedipine

65
Q

Unique treatment and imaging for uric acid stones

A

Not seen on X-ray (CT)

-Allopurinol

66
Q

Symptom score for BPH

67
Q

Alpha-blockers for BPH, risk

A

Tamsulosin - “Ulosins” , floppy iris

68
Q

5-alpha reductase for BPH MOA

A

Finasteride = decreases conversion of testosterone to DHDT so helps shrink prostate size

69
Q

Meaurement for albumin

A

Early morning Albumin : Creatinine

70
Q

First line management for calculi

A

NSAIDS + alpha blocker (moves stone)

71
Q

What type of glomerular damage is post strep

A

Diffuse proliferative

72
Q

2 types of PKD

A
  • Multicystic/dysplastic = commonest form renal cystic disease in childhood
  • Autosomal Dominant = most common mono-genetic disease. Extra-organ manifestations. Presents late!
  • Autosomal Recessive = less likely childhood cause

Yr 3 ALS (10 decks)

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