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Finals > Renal > Flashcards

Renal Flashcards

1
Q

How much is GFR?

A

120 ml/min/1.73m2

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2
Q

What is creatinine?

A

Chemical waste product of muscle metabolism

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3
Q

Misleading creatinine level?

A

Cachexia

Bodybuilder

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4
Q

Why is creatinine clearance > GFR?

A

Secreted as well as filtered

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5
Q

3 hormones in Na excretion (and therefore volume control)

A

Aldosterone –> decrease excretion
Angiotensin II –> decrease excretion
ANP –> increase excretion (released by the heart in response to high BP)

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6
Q

Which hormone dilates afferent arteriole in kidney?

Constricts?

A

Prostaglandin dilates

Angiotensin II constricts

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7
Q

2 SEs of ACEi

A 
Impaired renal function
Hyperkalaemia
Post hypo
Dry cough (bradykinin)
Fatigue
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8
Q

2 SEs of ARB

A

Renal impairment
Post hypo
Hyperkalaemia

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9
Q

Medications causing hypokalaemia?

A

Loop diuretics

Thiazides

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10
Q

Medications causing hyperkalaemia?

A

Spironolactone
Amiloride
ACEi
ARB

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11
Q

Transporter in LoH?

A

NKCC2

Na K Cl Cotransporter

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12
Q

Where do ADH and aldosterone take effect?

A

DCT and CD

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13
Q

Barter’s syndrome?
Effect of..?
When?
Features?

A

Effect of loop diuretics

In childhood

Metabolic alkalosis, low Mg, High urinary Ca

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14
Q

Gitelman’s syndrome?
Effect of..?
When?
Features?

A

Same as thiazide (DCT)

Late childhood

Metabolic alkalosis, Mg decreased, urine Ca norm/low

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15
Q

Renal Tubular Acidosis causes what ABG?

A

Hypercholoraemic metabolic acidosis + hypobicarbonate + decreased arterial pH

Normal anion gap

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16
Q

Causes of renal tubular acidosis?

A

Drug induced

Fanconi syndrome

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17
Q

What is fanconi syndrome?

A

Generalised dysfunction of renal proximal tubule

–> urinary loss of bicarb, glucose, AA, phosphate, peptides

SALT WASTING AND VOLUME DEPLETION

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18
Q

2 RFs for renal tubular acidosis?

A 
Childhood
Urinary tract obstruction
DM
Stones
Adrenal insufficiency
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19
Q

Pres of RTA?

A 
Growth retardation
FTT
Muscle weakness (Fanconi)
Hypoglycaemia
Rickets
Kussmaul breathing in severe
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20
Q

Mx of RTA?

If hyperkalaemia + mineralocorticoid deficiency?

A

Sodium alkali

Dietary restriction of K

Fludrocortisone

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21
Q

Comps of RTA?

A 
Volume depletion
Nephrocalcinosis
Osteoporosis
Growth retardation
Rickets
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22
Q

Causes of end stage renal failure?

A 
DM
HTN
Glomerulonephritis
Pyelonephritis
PKD
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23
Q

Cause of pyelonephritis?

A

E. coli (ascending from LUTI)
UPEC

OR spread hematogenously to kidney (DM, HIV, malignancy, transplant)

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24
Q

3 RFs for severe pyehlonephritis?

A 
Extremes of age
Anatomical abnorm
Foreign body
Immunocomp
Obstruction
Pregnancy
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25
Q

Pyelonephritis cause in men

A

prostate causing urethral blockage

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26
Q

Triad in pyelonephritis presentation

A

Fever
Loin pain
Renal tenderness

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27
Q

Ix in pyelonephritis

A

Urine dip, urinalysis, gram stain, culture
FBC, ESR/CRP, Blood cultures
Imaging [USS/CT w contrast]

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28
Q

Gram stain in pyelonephritis?

A

Gram negative rods (e.coli, klebsiella, proteus)

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29
Q

Mx of pyelonephritis:

  1. mild
  2. severe
A
  1. ciprofloxacin PO BD
2. Admit
IV fluids
IV pcm
IV ceftriaxone/cipro/gent
\+/- catheter
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30
Q

2 comps of pyelo

A

renal failure, abscess, renal scarring, recurrent UTIs

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31
Q

2 types of RCC

A

80% clear cell

15% papillary

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32
Q

RFs for RCC

A

smoking, obesity, HTN

Occupational exposure [asbestos, lead, chlorine}

Genetics: VHL

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33
Q

Pres of RCC

A

Asympto

Triad [abdo mass, haematuria, loin pain]

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34
Q

Genetics cause increases risk of RCC?

A

Von Hippel Lindau

AD

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35
Q

Ix in RCC

A

Check function - U+Es, FBC, Calcium, LFT,
Check structure - USS, CT
Check for mets - CT abdo pelvis, MRI, CXR (?cannonball mets)

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36
Q

Comp of RCC?

A

paraneoplastic syndrome - anaemia

hypercalcaemia, SIADH

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37
Q

Mx of RCC?

A

Surgical [partial / laparascopic nephrectomy]

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38
Q

Drug to use in late stage RCC?

A

Tyrosine kinase inhibitor

eg Sunitinib

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39
Q

Renal tumour in kids?

A

Wilm’s –> nephroblastoma

40
Q

What is AKI?

A

Acute decline in GFR from baseline/increase in creatinine

+/- oliguria

41
Q

Causes of AKI

A

Pre renal - azotaemia, renovascular disease

Renal - acute tubular necrosis (mainly due to sepsis); glomerulonephritis, nephritis, vascular

Post-renal - obstruction

42
Q

What is azotaemia? Features?

A

High N containing compounds in blood eg Ur, Cr

Hypovolaemia, haemorrhage, sepsis

43
Q

Who can you not give NSAIDs to?

A

B/l renal artery stenosis

44
Q

Most common cause of AKI?

A

Acute tubular necrosis

45
Q

Nephrotoxic drugs?

A

CANT DAMAG

Contrast, abx (penicillin, ceph), NSAIDs, Therapeutic index (narrow), Diuretics, ACEi, Metformin, ARB, Gentamicin

46
Q

How to measure AKI?

A

Creatinine

UO

47
Q

Ix in AKI?

A

U+Es, FBC, VBG
Urine dip, MC+S
ECG
Imaging

48
Q

Mx in AKI?

A 
Stop nephrotoxic drugs
ABCDE
Catheterise
If obstruction --> urgent USS KUB,
Dialysis if uraemic/severe acidosis/hyperkalaemia
49
Q

What is CKD?

A

Proteinuria/haematuria and/or reduction in GFR to <60 for >3months

50
Q

Causes of CKD?

A

DM
HTN

Autoimmune
Smoking
Obesity

51
Q

Mx of CKD?

A

Glycaemic control

Optimise BP

52
Q

Stages of CKD?

A

Based on GFR

1 > 90
2 > 60
3a > 45
3b > 30
4 > 15
5 < 15 / on dialysis
53
Q

Primary prevention of CKD?

Secondary prevention?

A

Optimise DM + BP, smoking cessation

Salt + protein restricted diet

54
Q

How does uraemic syndrome present?

A 
Uraemic tinge (grey/yellow)
N+V
Itch
*encephalopathy
*pericarditis
*bleeding

URGENT RRT

55
Q

Comps of CKD

A 
Anaemia
Osteodystrophy
CV disease
Protein lsos
HyperK
Metabolic acidosis
Pulm oedema
56
Q

Ix in CKD

A

U+E, FBC
Urinalysis
Renal USS
Bone profile

57
Q

Mx of CKD

A 
Treat reversible causes
Optimise CVS risk factors
Education re RRT 
EPO for anaemia
Ca for bones
Low protein and potassium diet
58
Q

Stage 5 CKD mx?

A

RRT
Dialysis
Transplant

59
Q

Indications for RRT in AKI?

A 
Uraemia
Resistant Pulm oedema
Severe hyperK
Severe metabolic acidosis
Renal failure
60
Q

Comps of haemodialysis?

A

Infection, thrombosis, aneurysm, IE, stenosis

Hypotension

N+V, headache, cramps

Anaphylazis

Diseuilibration syndrome

61
Q

Comps of peritoneal dialysis?

A

Peritonitis

Problems with catheters

Constipation, fluid retention, hyperglycaemia,
weight gain
hernia

62
Q

Why transplant > dialysis?

A

Survival, QoL, economic, enables pregnancy, reverse aneamia + bone disease

63
Q

LT immunosuppression post transplant?

A

Prednisolone
Calcineurin inhib [tacrolimus / ciclosporin]
Anti-metabolite [azathioprine]

64
Q

CIs for renal transplant in CKD?

A

Active infection
Uncontrolled IHD
AIDS

65
Q

Comps for renal transplant?

A

Immediate [Local infection, DVT, pain]

Immunosuppression [infections]

Obstruction

Drugs [bone marrow suppression]

Rejection

Other [cancer, CV disease]

66
Q

Types of rejection?

What time frame?

A

Hyperacute (mins) - due to crossmatch

Accelerated (days) - T-cell mediated crisis

Acute cellular (weeks)

Chronic (years)

67
Q

Causes of glomerulonephritis?

A

Focal segmental glomerulonephritis in nephrotic syndrome

68
Q

Causes of nephrotic syndrome?

A 
Deposition (amyloidosis, light chain dep)
MCD (kids)
Focal + segmental GN (younger adults)
Membranous nephropathy (adults)
Membranoproliferative GN

NephrOtic depOsit

69
Q

Causes of nephritic syndrome?

A 
IgA nephropathy
Postinfectious GN
Rapidly progressing GN
Vasculitis
Anti-GBM

Nephritic is prolific

70
Q

Signs of nephrotic syndrome?

A

Proteinuria (>3.5g/24h)
Hypoalbuminaemia
Peripheral oedema
Hyperlipidaemia

71
Q

Signs of nephritic syndrome?

A

Oliguria
HTN
Haematuria

72
Q

Mx of MCD

A

Prednisolone

73
Q

DDx of nephrotic syndrome?

A

CCF
Liver disease

(both cause oedema)

74
Q

Comps of nephrotic syndrome?

A

Infection (urinary loss of IgG)

Hypercoaguability

Hypercholesterolaemia

Hypocalcamia

75
Q

Most common cause of nephritic syndrome?

What happens?

A

IgA nephropathy (Buerger’s disease)

Macroscopic haematuria 24-48h post GI/URTI
IgA deposit in mesangial matrix

76
Q

Causes of rapidly progressive glomerulonephritis?

A

Goodpastures (anti-GBM)
Wegeners
Microscopic polyangitis

77
Q

Ix in glomerulonephritis?

A

FBC, U+Es, LFT
Urinalysis
Renal biopsy
Antibody testing (ANCA, GMB, dsDNA)

78
Q

Mx of post strep glomerulonephritis?

A

IM BenPen

79
Q

Mx of mild glomerulonephritis?

isolated haematuria, normal GFR

A

Abx / antivirals

Limit salt + fluid

80
Q

Mx of severe glomerulonephritis?

haematuria, proteinuria, reduced GFR

A

ACEi + Abx + furosemide +/- prednisolone (if nephrotic syndrome)

81
Q

Mx of Goodpastures?

A

Plasma exchange + IV methylprednisolone + IV cyclophosphamide

82
Q

Mx of immune complex glomerulonephritis?

A

IV methylprednisolone

83
Q

Mx of lupus nephritis?

A

IV methylprednisolone + cyclophosphamide

84
Q

Comps of PKD?

A

HTN, CV morbidity, CKD, SAH, ESRD

85
Q

Protein in PKD?

A

Polycystin

86
Q

Which is worse?

ADPKD or ARPKD

A

ARPKD worse –> if homozygous will die in utero

If heterozygous presents in neonatal period (enlarged kidneys), death by teens

87
Q

Pres of PKD?

A 
FH of PKD
Flank/abdo discomfort + lumbar pain + haematuria
HTN 
Infections
Palpable kidneys
Hepatomegaly
88
Q

Where do you get cysts in PKD?

A 
Kidneys
Liver
Pancreas
Seminal vesicles
Brain
89
Q

Ix in PKD?

A

Renal USS
Geneitc
CT abdo/pelvis
Urinalysis

ECG, Echo, MRI angiography (screen for aneurysm annually)

90
Q

Family screening in PKD

A

Screen for SAH in 1st degree relatives

91
Q

Mx of infection in PKD?

A

Ciprofloxacin

92
Q

Mx in PKD:
Limit fluid secretion?
Target cell proliferation?

A

Calcium mimetics, CFTR inhibitors, Metformin

Somatostatin

93
Q

Causes of glomerulonephritis

A

Idiopathic
Infection
Systemic [SLE, RA, Wegners, HUS, HSP, Goodpastures]
Drugs [penicillamine, NSAIDs, cicosporin]
Metabolic [HTN, DM]
Other [amyloidosis]

94
Q

Comps of CKD

A

NS [peripheral neuropathy, restless leg, tiredness, fatigue]
CV [fluid overload, pericarditis, atherogenesis]
GI [altered taste, reduced Ca absorp]
Bone [Hyperparathyroidism, osteodystrophy]
Electrolyte [hyperK, acidosi]
Blood [anaemia]

95
Q

Pain relief in renal colic? (drug, route and dose)

Which class is better?

A

IM diclofenac 75mg

NSAIDs > opioids

96
Q

Mx of renal stones

<5mm?

<2cm? If pregnant?

> 2cm/complicated?

A

<5mm pass spontaneously

<2cm - ESWL
–> if pregnant - ureteroscopy

> 2cm - percutaenous nephrolithotomy

Finals (20 decks)

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