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Phase 3a > Renal > Flashcards

Renal Flashcards

1
Q

WHAT IS NEPHROTIC SYNDROME

A

PROTEINUREA

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2
Q

WHAT DOES THE PROTEINUREA CAUSE

A

LOW PLASMA ALBUMIN AND OEDEMA

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3
Q

WHAT ARE CAUSES OF NEPHROTIC SYNDROME

A

MINIMAL CHANGE DISEASE

POST STREP GLOMERULONEPHRITIS

SLE

HENLOCH SCHONLEN PURPURA

ALLERGENS IE BEE STINGS

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4
Q

WHAT IS THE PRESENTATION OF NEPHROTIC SYNDROME

A

OEDEMA (GENITAL, ANKLE AND PERIORBITAL)

ASCITES AND PLEURAL EFFUSION (CAUSING SOB)

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5
Q

HOW DO YOU DIAGNOSE NEPHROTIC SYNDROME

A

SCREEN FOR POSSIBLE CAUSES :

  • THROAT SWAB
  • BLOODS: ESR, FBC, U+E (LOW CREATININE AND ALBUMIN)
  • HEPATITIS AND MALARIA SCREEN

URINE DIPSTICK

  • PROETINUREA
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6
Q

WHAT IS THE MANAGEMENT OF NEPHROTIC SYNDROME

A

CORTICOSTEROIDS

  • PREDNISOLONE, AND TITRATE DOWN
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7
Q

WHAT ARE COMPLICATIONS ASSOCIATED WITH NEPHROTIC SYNDROME

A

HYPOVOLUMEA CAUSING

  1. FAINTING
  2. ABDOMINAL PAIN
  3. HYPERCOAGUABLE STATE (THROMBOSIS)

LOW ALBUMIN CAUSING

  • HYPERCHOLESTEROLAEMIA

INFECTIONS

  • ESPECIALLY PNEUMOCOCCUS
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8
Q

HOW DO YOU MANAGE STEROID RESISTENT NEPHROTIC SYNDROME

A

REFER TO NEPHROLOGIST!!

MANAGEMENT IS WITH:

DIURETICS

SALT RESTRICTION

ACEi

NSAIDS

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9
Q

WHAT IS CONGENITAL NEPHROTIC SYNDROME

A

NEPHROTIC SYNDROME (PROETINUREA) CAUSED BY

  1. INHERITED CAUSE
  2. EN-UTERO INFECTION

IS A MORE SEVERE TYPE OF NEPHROTIC SYNDROME AND TENDS TO BE STEROID RESISTENT

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10
Q

AT WHAT AGE ARE PATIENTS USUALLY DIAGNOSED WITH CONGENITAL NEPHROTIC SYNDROME

A

2-5 MONTHS

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11
Q

HOW DOES CONGENITAL NEPHROTIC SYNDROME PRESENT (NOT AT BIRTH)

A

****THINK VERY YOUND SO PRESENTATION DIFFERES TO STANDARD NEPHROTIC SYNDROME BUT MECHANISM IS THE SAME ****

GENERALISED OEDEMA CAUSING

  • WIDENED FONTANELLES AND SUTURES
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12
Q

WHAT ARE THE SIGNS AT BIRTH THAT THE CHILD MAY HAVE CONGENITAL NEPHROTIC SYNDROME

A

PREMATURE

LOW BIRTH WEIGHT

MECONIUM STAINED AMNIOTIC FLUID

LARGE PLACENTA

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13
Q

WHAT ARE COMPLICATIONS OF CONGENITAL NEPHROTIC SYNDROME

A

FREQUENT AND SEVERE INFECTIONS

  • (DUE TO LOSS OF IG’S)

MALNUTRITION

FAILURE TO THRIVE

BLOOD CLOTS

HYPOTHYROIDISM

  • (DUE TO LOSS OF THYROID BINDING PROTEINS)

LOW VIT D

CHRONIC KIDNEY INJURY AND FAILURE

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14
Q

HOW DO YOU MANAGE CONGENITAL NEPHROTIC SYNDROME

A

TRY STEROIDS –> USUALLY RESISTANT

****AIM TO MANAGE PROTEIN LOSS AND SWELLING****

ALBUMIN TRANSFUSIONS

DIURETICS

ACEi

NSAIDs (indomethacin)

VITAMINS

ANTICIAGULATNS

KIDNEY REMOVAL

IMMUNOSUPPRESSION PRIOR TO OPERATION AND ABX

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15
Q

WHAT IS MINIMAL CHANGE DISEASE

A

A CAUSE OF PROTEINUREA, WITH LITTLE TO NO CHANGES ON HISTOLOGY

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16
Q

WHAT IS THE PRESENTATION OF MINIMAL CHANGE DISEASE

A

CAUSES NEPHROTIC SYNDROME SO…

  • OEDEMA + ASSOCIATED SYMPTOMS (IE SOB)
  • WEIGHT GAIN (DUE TO INCREASE IN FLUIDS)
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17
Q

WHAT TESTS ARE REQUIRED IN ORDER TO DIAGNOSE MINIMAL CHANGE DISEASE

A

INVESTIGATE ALL POSSIBLE CAUSES OF NEPHROTIC SYNDROME

  • THROAT SWAB
  • BLOODS: ESR, FBC, U+E (LOW CREATININE AND ALBUMIN)
  • HEPATITIS AND MALARIA SCREEN
  • URINE DIPSTICK
  • PROETINUREA

TRY CORTICOSTEROID TEST IF RESISTANT LOOK AT PERFORMING A RENAL BIOPSY

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18
Q

HOW WOULD YOU MANAGE MINIMAL CHANGE DISEASE

A

CORTICOSTEROIDS

IF UNDRESPONSIVE:

CYCLOSPORINS (these are immunosuppressants)

RUTIXIMAB (biologic)

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19
Q

WHAT IS HENLOCH SCHONLEN PURPURA

A

A VASCULITIS WITH A CHARACTERISTIC TRIAD OF

  1. MACULOPAPULAR PURPURIC RASH
  2. ARTHRALGIA
  3. ABDO PAIN
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20
Q

WHAT IS THE DRIVING PATHOLOGY OF HENLOCH SCHLONLEIN PURPURA

A

IGA VASCULITIS

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21
Q

WHAT IS THE PRESENTATION OF HENLOCH SCHLONLEIN PURPURA

A

CLASSIC TRIAD:

  1. MACULOPAPULAR PURPURIC RASH
  2. ARTHRALGIA
  • knees, ankles and periarticular
    1. ABDO PAIN
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22
Q

WHAT ARE RISK FACTORS OF HENLOCH SCHOLNEIN PURPURA

A

URTI

WINTER

MALE - 3 TO 10 YEARS OLD

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23
Q

WHAT IS THE APPEARENCE OF THE RASH IN HENLOCH SCHONLEIN PURPURA

A

SYMMETRICAL

ON EXTENSOR SURFACES

URTACARIAL

MACULOPAPULAR

PURPURIC

BLANCHING

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24
Q

WHAT ARE COMPLICATIONS OF HENLOCH SCHOLEIN PURPURA

A

INTRACUSSEPTION

CKD

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25
Q

HOW DO YOU MANAGE HENLOCH SCHONLEN PURPURA

A

CORTICOSTEROIDS

FOLLOW UP AFTER 1 YEAR TO CHECK RENAL FUNCTION

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26
Q

WHAT IS POST STREP GLOMERULONEPHRITIS?

A

AN INFLAMMATION OF THE GLOMERULUS AND NEPHRON AFTER A STREP INFECTION EITHER OF THROAT OR SKIN

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27
Q

WHAT CAN POST STREP GLOMEULONEPHRITIS LEAD TO (RENAL)

A

NEPHROTIC / NEPHRITIC SYNDROME AND ASSOCIATED SYMPTOMS

28
Q

HOW DO YOU MANAGE POST - STREP GLOMERULONEPHRITIS

A

FLUID BALANCE AND ELECTROLYTE BALANCE

(POTENTIAL NEED FOR DIURETICS)

CORTICOSTEROIDS

29
Q

WHAT IS THE DEFINITION IF NEPHRiTIC SYNDROME

A

PROTEINUREA AND HAEMATURIA

30
Q

HOW DOES NEPHRiTIC SYNDROME PRESENT

A

BLURRED VISION

ANURIA/OLIGOUREA

DARK BLOODY URINE

OEDEMA

POTENTIAL HYPERTENSION

31
Q

WHAT ARE THE CAUSES OF NEPHRITIC SYNDROME (MORE COMMON IN CHILDREN)

A

IGA NEUROPATHY

POST STREP GLOMERULONEPHRITIS

HAEMOLYTIC URAEMIC SYNDROME

HENLOCH SCHLONLEIN PURPURA

32
Q

WHAT ARE THE CAUSES OF NEPHRITIC SYNDROME (MORE COMMON IN ADULTS)

A

GOODPASTEURES SYNDROME

SLE

INFECTIVE ENDOCARDITIS

33
Q

HOW WOULD YOU DIAGNOSE NEPHRITIC SYNDROME

A

****CHECK FOR UNDERLYING CAUSES****

BLOODS: ESR, UREA(RAISED), CREATININE(RAISED), POTASSIUM(RAISED)

TRAOT SWAB

URINALYSIS: PROETINUREA AND HAEMATURA

HYPERTENSION

KIDNEY BIOSPY

34
Q

HOW WOULD YOU MANAGE NEPHRITIC SYNDROME

A

UNDERLYING CAUSE

ANTIHYPERTENSIVES:

  • ACEi (RAMAPRIL)
  • CCB (AMILODAPINE)
  • DIURETICS (INDAPEMIDE OR FRUSEMIDE)

NSAID

35
Q

WHAT ARE CHILDHOOD CAUSES OF CKD

A

CONGENITAL AND HEREDITARY ARE THE MOST COMMON

  • STRUCTURAL MALFORMATIONS
  • GLOMERULONEPHROPATHIES
  • HEREDITARY NEPHROPATHIES
36
Q

WHEN IS CKD DETECTED?

WHAT ARE INVESTGATIONS USED TO DIAGNOSE CHILDHOOD CKD

A

USUALLY ON FETAL ULTRASOUND

BLOODS:

  • U+E (RAISED CREAT KINASE)
  • CALCULATE eGFR

URINALYSIS:

  • (RAISED ALBUMIN, RAISED CREATININE, +/- HAEMATURIA)

US/CT/MRI

KIDNEY BIOPSY

37
Q

WHAT IS THE PRESENTATION OF CKD IN CHILDHOOS

A

HYPERTENSION

BONY DEFORMITIES - RENAL RICKETS

ANOREXIA + FAILURE OT THRIVE

PROTEINUREA

NORMOCYTIC AND NORMOCHROMIC ANAEMIA

38
Q

HOW DO YOU MANAGE CKD?

A

MANAGE HYPERTENSION

  • ACEi, ARB, DIURETICS,
  • CALCIUM CARBONATE TO REDUCE POTASSIUM

MANAGE GROWTH

  • ENTERIC FEEDS/CALORIE SUPPLIEMENTS
  • PROTEIN, CONTROL
  • SALT SUPPLIMENTS, BICARBONATE SUPPLIMENTS
  • FLUID BALANCE
  • RECOMBINANAT HUMAN GROWTH HORMONE
39
Q

WHAT IS THE DEFINITION OF AKI

A

ACUTE KIDNEY INJURY =

A SUDDEN AND POENTIALLY REVERSIBLE REDUCTION IN RENAL FUNCTION

40
Q

WHAT IS THE PRESENTATION OF AKI

A

ANUREA

OLIGOUREA

41
Q

WHAT SIGNS WOULD YOU FIND ON URINE TESTS IN AKI

A

RAISED CREATININE KINASE

RCC

HAEMATURIA

42
Q

WHAT VALUES ARE CLASSED AS OLIGOUREA

A

<400ML X 24 HRS

43
Q

WHAT VALUES ARE CLASSED AS ANUREA

A

<100ML X 24HR

44
Q

WHERE ARE THE POSSIBLE LOCATIONS FOR CAUSES OF AKI

(WHAT ARE THE TYPES OF AKI)

A

PRE RENAL

RENAL

POST RENAL

45
Q

WHAT ARE THE CAUSES OF PRE RENAL AKI

A

HYPOVOLUMEA (CIRCULATORY FAILURE)

46
Q

WHAT ARE RENAL CAUSES OF AKI

A

VASCULAR

  • THROMBOSIS

TUBULAR

  • NECROSIS, ISCHEMIC EVEN, TOXIC IE DRUGS

GLOMERULONEPHRITESES

47
Q

WHAT ARE CAUSES OF POST RENAL AKI

A

OBSTRUCTION

EITHER CONGENITAL OR ACCQUIRED

48
Q

HOW WOULD YOU MANAGE PRE RENAL AKI?

A

FLUIDS (+ELECTROLYTES) AND CIRCULATORY SUPPORT

49
Q

HOW WOULD YOU MANAGE RENAL AKI?

A

FLUID RESTRICTION

DIURETICS

SODIUM CONTROL

HIGH CALORIE NORMAL PROTEIN FEEDS

50
Q

HOW WOULD YOU MANAGE POST RENAL AKI?

A

NEPHROSTOMY / BLADDER CATHETER

SURGERY TO REMOVE OBSTRUCTION

51
Q

WHAT ARE THE INDECATIONS FOR DIALYSIS?

A

HYPERKALAEMIA

HYPERNATREMIA OR HYPONATREMIA

PULMONARY OEDEMA

PULMONARY HYPERTENSION

SEVERE ACIDOSIS

MULTISYSTEM FAILURE

52
Q

WHAT IS THE PRESENTATION OF ACUTE ON CHRONIC AKI

A

GROETH FAILURE

ANAEMIA (NORMOCYTIC NORMOCHROMIC)

BONEY RICKETS

PLUS THEN

OLIGOURIA, ANURIA

53
Q

WHAT IS ACUTE ON CHRONIC RENAL FAILURE

A

WHEN AN EXACCERBATION CAUSES A SUDDEN DECLINE IN eGFR IN A PATIENT WHO ALREADY HAS CHRONIC KIDNEY INJURY

54
Q

WHAT CAN CAUSE ACUTEON CHRONIC AKI

A

DEHYDRATION

INFECTION

55
Q

WHAT IS THE DEFINITION OF SLE

A

AN AUTOIMMUNE DISEASE AFFECTING MULTISYSTEMS THROUGH THE PRESENCE OF SERUM ANTIBODIES

56
Q

WHAT ARE THE POTENTIAL CAUSES OF SLE

A

HLA B8 (HEREDITARY/GENETICS)

UV FLARES

EBV EXPOSURE (MOLECULAR MIMICARY)

57
Q

WHO IS THE TYPICAL PATIENT WHO DEVELOPS SLE

A

FEMALE

20-40YEARS

58
Q

WHAT IS THE PRESENTATION OF SLE

A

BUTTERFLY RASH

SMALL JOINT ARTHRALGIA

PHOTOSENSITIVITY

ALOPECIA

GLOMERULONEPHROPATHIES

RAYNAUDS SYNDROME

59
Q

HOW DO YOU DIAGNOSE SLE

A

4/11 SYMPTOMS

NORMOCYTIC NORMOCHROMIC ANAEMIA

NORMAL CRP BUT HIGH ESR

60
Q

HOW DO YOU MANAGE SLE

A

MILD

  • NSAIDS

MODERATE

  • CHLORIQUININE (ANTIMALARIA)
  • CORTICOSTERIODS

SEVERE

  • RUTXIMAB (IMMUNOSUPPRESSANT)

MAJOR ORGAN INVOLVEMENT

  • TRANSPLANT
61
Q

WHAT IS THE DEFINITION OF HAEMOLYTIC URAEMIC SYNDROME

A

A TRIAD OF SIGNS

  1. ACUTE RENAL FAILURE
  2. THROMBOCYTOPAENIA
  3. MICROANGIOPATHIC HAEMOLYTIC ANAEMIA
62
Q

WHAT IS THE PRESENTATION OF HAEMOLYTIC URAEMIC SYNDROME

A

LOODY DIAHRROEA

PALE

FATIGUE

63
Q

WHAT IS THE PATHOPHYSIOLOGY OF HAEMOLYTIC URAEMIC SYNDROME

A

POST INFECTIVE

TOXIN ENTERS GASTRIC MUCOSA: E COLI/SHIGELLA

TOXINS SETTLE IN RENAL EPITHELIAL CELLS

CAUSING INTRAVASCULAR THROMBOGENESIS

THIS USES UP PLATELETS CAUSING THROMBOCYTOPENIA

64
Q

WHAT CAUSES HAEMOLYTIC URAEMIC SYNDROME

A

E COLI

SHIGELLA

TOSINS ENTER VIA GI TRACT

65
Q

HOW DO YOU MANAGE HAEMOLYTIS URAEMIC SYNDROME

A

IV FLUIDS

ENTERIC FEEDING

DIALYSIS NEEDED IN 50%

66
Q

WHAT IS PROGNOSIS OF HAEMOLYTIC URAEMIC SYNDROME

A

GOOD IF CAUGHT EARLY

NEPHROTIC SNDROME WITH HTN AND DECREASING RENAL FUNCTION MAY OCCUS IN FOLLOWING YEARS SO FOLLOW UP IS IMPORTANT

67
Q
A

Phase 3a (22 decks)

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