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**Clinical Med** UoL by SJC > Renal > Flashcards

Renal Flashcards

learn info from renal booklet

1
Q

What 4 diseases should you specifically ask for in a family history for a patient with renal problems

A

Kidney disease, heart disease, diabetes, high blood pressure

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2
Q

What symptoms might a patient with renal disease present with? (7)

A 
Dyspnoea, 
leg swelling,  
nausea and/or vomiting, 
ENT symptoms, 
constitutional symptoms, 
lower urinary tract symptoms, 
flank pain
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3
Q

List up to 8 signs of advanced renal disease (these are rare)

A 
Brown nails, 
Yellow-brown discolouration of the skin from uraemia,
Muscle wasting (from undernutrition), 
Uraemic frost (urea crystals on skin from sweat),
Hyperreflexia, 
Pericardial rub, 
GI ulceration, 
Bleeding
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4
Q

List 6 blood tests used to assess renal function

A 
FBC, 
U and Es,
CRP,
Haematinics (iron, B vitamins), 
Bone profile, 
HbA1c
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5
Q

What is included in the bone profile blood test

A

Calcium,
Phosphate,
PTH,
Alkaline Phosphatase

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6
Q

What is the value of normal anion gap

A

8 to 12

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7
Q

What is the most usual cause of hypernatremia

A

Usually due to water deficit (dehydration)

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8
Q

how can hypernatraemia cause bleeding and thrombosis?

A

Create vascular shear stress

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9
Q

List symptoms of hypernatraemia (10)

A 
Thirst, 
Apathy, Irritability, Weakness, 
Confusion, Reduced consciousness, 
Seizures, Hyperreflexia, Spasticity, 
Coma
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10
Q

What are the 2 main types of diabetes insipidus

A

Cranial (impaired release of ADH),

Nephrogenic (resistance to ADH)

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11
Q

Give 5 causes of reduced release of ADH

A 
Cerebral vasculitis (eg SLE)
Cerebral sarcoid or TB, 
Trauma, 
Meningitis or encephalitis, 
Tumours, 
(VITAMIN CDEF)
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12
Q

What are the symptoms of hyponatraemia.

A

Decreased perception, gait disturbance, yawning, nausea, reversible ataxia, headache, apathy, confusion, seizures, coma

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13
Q

Give 4 causes of pseudo-hyponatraemia

A

High lipids,
Hyperglycaemia,
Uraemia,
Myeloma

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14
Q

List 6 risk factors for AKI

A

Diabetes,
CKD,
Ischaemic heart disease or congestive cardiac failure, Aged over 75,
Sepsis,
Medications such as ACE inhibitors and angiotensin receptor blockers NSAIDs or antibiotics

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15
Q

Give 3 vascular causes of AKI

A

Vasculitis,
Malignant Hypertension (BP >180/120)
Thrombotic Thrombocytopenic Purpura Haemolytic Uraemic Syndrome (i.e. TTP HUS)

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16
Q

List 4 potential sources of endogenous nephrotoxins

A

Haemolysis,
Rhabdomyolysis,
Myeloma,
Intra-tubular crystals

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17
Q

What are the indications for renal replacement therapy in AKI? (5)

A 
Hyperkalaemia or metabolic acidosis refractory to medical therapy, 
Anuric on diuretics,
Uraemic pericarditis,
Uraemic encephalopathy, 
Dialysable toxin
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18
Q

List 3 signs of uraemic encephalopathy

A

Vomiting,
Confusion,
Drowsiness or Reduced Consciousness

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19
Q

List 5 complications of nephrotic syndrome

A 
Venous ThromboEmbolism,
Hypertension, 
High risk of infection, 
Hyperlipidaemia
Progression of CKD,
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20
Q

4 causes of nephrotic syndrome

A

Minimal change disease (most common cause in children),
Focal Segmental Glomerulosclerosis,
Membranous Nephropathy,
MembranoProliferative GlomeruloNephritis (most commonly presents as nephritic syndrome)

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21
Q

3 diseases that may cause nephrotic range proteinuria but not necessarily the nephrotic features

A

Amyloidosis,
Myeloma,
Diabetes

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22
Q

How can nephritic syndrome present

A 
AKI,
Incidental dipstick findings,
Mild to moderate oedema,
Hypertension, 
Visible haematuria
23
Q

List 3 types of small vessel vasculitis causing nephritic syndrome (anca associated vasculitis)

A

Granulomatosis with polyangiitis (GPA),
Microscopic PolyAngiitis (MPA),
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)

24
Q

Causes of nephritic syndrome

A 
ANCA vasculitis, 
Post infectious glomerulonephritis,
IgA nephropathy, 
Anti-GBM disease /Goodpasture syndrome,
Thin basement membrane disease,
Lupus nephritis (can be nephrotic)
Alport syndrome,
25
Q

What are the symptoms of IgA nephropathy?

A

Episodic gross haematuria during or directly after upper respiratory tract or gastrointestinal infections or strenuous exercise

26
Q

What’s the pathophysiology of Goodpasture’s syndrome?

A

Autoantibodies against type IV collagen affecting basement membrane in lungs and glomerulus particularly

27
Q

What’s the inheritance pattern for Alport syndrome?

A

X linked

28
Q

What age group are usually affected in post infectious glomerulonephritis?

A

Kids aged 3 to 12

29
Q

What type of bacteria can cause nephritis as a post-infective syndrome?

A

Group A beta- haemolytic streptococci (1 to 2 weeks after tonsillitis or pharyngitis, 3 to 4 weeks after impetigo or cellulitis)

30
Q

2 blood tests to estimate kidney damage

A

Albumin-Creatinine ratio (ACR), estimated GFR or creatinine

31
Q

Complications of chronic kidney disease (5)

A 
Anaemia of chronic disease, 
Mineral and bone disease, 
Secondary and tertiary hypoparathyroidism, Hypertension, 
Cardiovascular disease, 
Malnutrition or sarcopenia
32
Q

5 direct complications of late stage CKD

A

Electrolyte disturbances, fluid overload, metabolic acidosis, uraemic pericarditis

33
Q

Why is it important to reduce cardiovascular risk in CKD patients?

A

Cardiovascular disease is an important complication of CKD is the number 1 cause of mortality

34
Q

How do you reduce cardiovascular risk?

A

Start on statin, control blood pressure, improve diabetic control, advise weight loss and exercise, smoking cessation!!

35
Q

How do you slow the progression of CKD?

A

Reduce proteinuria with ACE inhibitors or angiotensin receptor blockers, monitor blood tests, control blood pressure

36
Q

What should CKD patients limit in their diet?

A

Phosphate and potassium (avocados, bananas, brown bread, cola)

37
Q

When would you suspect diabetic nephropathy in a diabetic patient?

A

Raised urine albumin: creatinine ratio,
Long-standing or poorly controlled diabetes,
Evidence of other microvascular disease (retinopathy, peripheral neuropathy)

38
Q

5 investigations for chronic hypertension (to diagnose cause)

A 
24-hour urinary metanephrines, 
Aldosterone:renin ratio, 
Cortisol and Dexamethasone suppression test, 
TSH, 
MRA
39
Q

Endocrine causes of hypertension (4)

A 
Hyperthyroidism, 
(Adrenal:)
Cushing's syndrome, 
Primary aldosteronism, 
Pheochromocytoma (starts in adrenal gland)
40
Q

What is the most common cause of polycystic disease? (be specific)

A

(type 1 PKD is most common)
PKD 1 mutation on chromosome 15
(so inheritance is autosomal dominant like type 2)

41
Q

What is Tolvaptan used for?

A

For CKD in Polycystic Kidney disease to slow progression

42
Q

Factors contributing to development of anaemia in CKD (8)

A

 Decreased production of erythropoietin from the kidney
 Absolute iron deficiency (poor absorption and malnutrition)
 Functional iron deficiency (inflammation, infection)
 Blood loss
 Shortened Red Blood Cell survival
 Bone marrow suppression from uraemia
 Medication induced
 Deficiency of Vit B12 and folate

43
Q

What Haemoglobin level should you aim for in CKD?

A

Aim for Hb 100 to 120 for CKD

44
Q

3 types of abnormalities that would allow you to diagnose Mineral bone diease in a CKD pt

A
  1. Calcium, phosphate, alkaline phosphatase, PTH or vitamin D metabolism
  2. Vascular and/or soft tissue (calcification)
  3. Bone turnover, metabolism, volume, linear growth or strength
45
Q

List ways CKD can cause mineral bone disease (5)

A 
 Increased Fibroblast Growth Factor-23 
 Increased Alkaline Phosphatase and PTH 
 Increased Phosphate 
 Decreased Serum Calcium 
 Decreased 1,25 – Vitamin D
46
Q

List 3 causes of abnormal bone turnover states

A

 Adynamic bone disease (Low turnover)
 Osteomalacia “
 Osteitis Fibrosa (High turnover state)

47
Q

How does the liver regulate Vitamin D?

A

25 alpha-hydroxylase in liver metabolises VitD3 to 25(OH)VitaminD / calcidiol

48
Q

How does PTH affect the kidney?

A

Increases calcium reabsorption,

Increases metaboism of Vitamin D into its active form (1,25 dihydroxy Vitamin D)

49
Q

Potential complications of peritoneal dialysis (7)

A 
Drainage problems, 
Malposition, 
Leaks, 
Hernias, 
Hydrothorax, 
Encapsulating peritoneal sclerosis if long term use, 
Infection -> peritonitis
50
Q

Potential complications of haemodialysis (8)

A
  • Infection/Bacteraemia
  • Haemodynamic instability
  • Reactions to dialysers
  • Haematomas/risk of bleeding
  • Muscle cramps
  • Anaemia due to clotted lines/Haemolysis
  • AVF steal syndrome
  • SVCO from central lines
51
Q

When would you consider active conservative management over Renal Replacement Therapy?

A

Patient over 80
OR
WHO performance score 3 or more (3 = Capable of only limited self-care, confined to bed or chair more than 50% of waking hours)

52
Q

Which drugs are used before kidney transplant to limit risk of hyperacute rejection?

A

Methylprednisolone in combination with any of the following:
Basiliximab and Thymoglobulin;
less commonly used are alentuzumab and rituximab

53
Q

5 types of drugs used to maintain kidney transplant

A

Steroids,
Calcineurin inhibitors (tacrolimus, cyclosporine, voclosporin),
Antimetabolite medications (mycophenolate, azathioprine),
Rapamycin inhibitors (sirolimus and everolimus)
T-cell regulation: Belatacept and belimumab

54
Q

What monitoring will a renal transplant patient require long term?

A 
GFR, 
CNI levels, 
proteinuria, 
Calcium, phosphate and PTH, 
Lipids and glucose. 
Screening for infections and malignancy (3x more likely to get cancer)

**Clinical Med** UoL by SJC (10 decks)

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