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Clinical Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Autosomal dominant kidney disease type 1 is associated with gene mutations on which chromosome?

A

Chromosome 16

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2
Q

Autosomal dominant kidney disease type 2 is associated with gene mutations on which chromosome?

A

Chromosome 4

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3
Q

Classify the drug tolvaptan

A

Vasopressin receptor II antagonist

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4
Q

Recall the 3 hallmark symptoms of nephrotic syndrome

A
  1. Proteinuria
  2. Hypoalbunemia
  3. Hyperlipidemia
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5
Q

Familial amyloid cardiomyopathy is associated with misfolding of which protein?

A

Transthyretin

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6
Q

Name a cardiac pathology associated with ATTR amyloidosis

A

Restrictive cardiomyopathy

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7
Q

What is the normal mode of inheritance of Alport’s syndrome?

A

X - linked dominant

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8
Q

Briefly describe the pathophysiology of Alport’s syndrome

A

Defect in a gene coding for type IV collagen that results in an abnormal glomerular basement membrane

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9
Q

Define Fanconi syndrome

A

Generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule

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10
Q

Suggest 5 potential causes of Fanconi syndrome

A
  1. Cystinosis
  2. Sjorgen’s syndrome
  3. Multiple myeloma
  4. Nephrotic syndrome
  5. Wilson’s disease
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11
Q

What are the 2 cardinal features of Goodpasture’s syndrome?

A
  1. Pulmonary haemorrhage

2. Followed by rapidly progressive glomerulonephritis

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12
Q

What will a renal biopsy show from a patient with Goodpasture’s syndrome?

A

Linear IgG deposits along the basement membrane

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13
Q

What is the most common causative organism of Post-steptococcoal glomerulonephritis?

A

Streptococcus Pyogenes

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14
Q

What form of acid-base disturbance would be caused by alcohol poisoning?

A

Raised anion gap metabolic acidosis

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15
Q

What is the normal anion gap expected range?

A

10-18 mmol/L

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16
Q

Sickle cell anemia may be associated with what form of kidney degeneration?

A

Renal papillary necrosis

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17
Q

A normal urea:serum creatine ratio is associated with what type of AKI?

A

Acute tubular necrosis

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18
Q

What is the most common prerenal cause of AKI?

A

Hypovolemia e.g. dehydration

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19
Q

What is the pathological consequence of poor renal perfusion?

A

Acute tubular necrosis

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20
Q

Name the classic tetrad of ‘drugs’ that may cause AKI

A
  1. NSAIDS
  2. ACE inhibitors
  3. Gentamicin
  4. CT contrast dye
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21
Q

Give 6 key components of assessment for a fluid status exam

A
  1. Skin turgour/ mucous mebranes
  2. JVP
  3. Postural blood pressure
  4. Heart rate
  5. Urine output
  6. Peripheral/ pulmonary oedema
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22
Q

Name 2 causes of palpable kidneys

A
  1. Polycystic kidney disease

2. Pyelonephritis

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23
Q

Give 4 clinical manifestations of uraemia

A
  1. Pericarditis
  2. Twitching
  3. Hiccups
  4. Uraemic frost
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24
Q

Suggest 6 potential causes of prerenal AKI

A
  1. Diarrhoea and vomiting (GI fluid loss)
  2. Haemorrhage
  3. Decreased cardiac output e.g. heart failure
  4. Hepatorenal syndrome
  5. Burns
  6. Dehydration
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25
Q

What are the 2 main causes of post renal AKI

A
  1. Obstruction

2. Urinary retention

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26
Q

The presence of red cell casts on microscopy is pathognomonic of what form of renal injury?

A

Glomerulonephritis

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27
Q

Broadly, how can urine biochemistry be used to differentiate between a prerenal AKI and acute tubular necrosis?

A

In prerenal AKI there is significant sodium and water retention leading to a low urinary sodium (<20mmol/L) and high urinary osmolality (>500mmol/L) compared to acute tubular necrosis

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28
Q

What are the 4 questions to ask yourself when evaluation a patient with AKI?

A
  1. Are there any life-threatening complications
  2. Is this renal impairment acute or chronic
  3. If acute, is this prerenal, renal or post renal AKI
  4. If intrinsic renal failure, what is the cause
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29
Q

Name the 4 life-threatening complications of AKI

A
  1. Hyperkalemia
  2. Pulmonary oedema
  3. Acidosis
  4. Symptomatic uraemia
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30
Q

Hyperkalemia is consider life-threatening at what level?

A

> 6.5 mmol/L

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31
Q

Outline the 4 conventional therapies for the treatment of pulmonary oedema

A
  1. High-flow oxygen
  2. High dose duiretics
  3. Nitrates
  4. Opiates ( only low doses due to renal excretion)
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32
Q

What eGFR level defines severe renal failure?

A

< 30mL/min

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33
Q

Give the 2 most common medical causes of end-stage renal failure

A
  1. Diabetes mellitus

2. Hypertension

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34
Q

Name the 2 most common inherited disorders to cause end stage renal failure

A
  1. Autosomal dominant polycystic kidney disease

2. Alport’s disease

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35
Q

What is the classical clinical feature associated with Alpert’s syndrome?

A

Sensorineural deafness

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36
Q

What is the most significant complication of chronic kidney disease?

A

Premature cardiovascular disease

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37
Q

Name the 2 pathological mechanisms that contribute to renal osteodystrophy

A
  1. Disturbed vitamin D deficiency

2. Secondary hyperparathyroidism

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38
Q

What type of anemia is seen in renal failure?

A

Normocytic normochromic anemia

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39
Q

Give 7 indications for dialysis in patients with end stage renal failure

A
  1. Symptomatic uraemia
  2. Hyperkalemia
  3. Metabolic acidosis
  4. Peripheral neuropathy
  5. Pericarditis
  6. CNS disorders
  7. Poor control with more conservative treatments
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40
Q

What are the 4 main challenges faced by dialysing a patient?

A
  1. Loss of vascular access
  2. Infection
  3. Hypotension
  4. Maintenance of fluid and electrolyte balance
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41
Q

Give 11 systemic disorders which may involve the glomerulus

A
  1. Diabetes
  2. Amyloidosis
  3. SLE
  4. Rheumatoid arthritis
  5. Ankylosing spondylitis
  6. Neoplasia
  7. Myeloma
  8. Vasculitic syndromes
  9. Liver disease
  10. Sarcodosis
  11. Partial lipodystrophy
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42
Q

What are the 3 components of nephritic syndrome?

A
  1. Proteinuria
  2. Haematuria
  3. Renal failure
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43
Q

Recall the triad of symptoms associated with nephrotic syndrome

A
  1. Significant proteinuria (>3g/day)
  2. Hypoalbuminaemia ( < 20g/L)
  3. Peripheral oedema
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44
Q

What is the most likely cause of nephrotic syndrome?

A

Primary glomerulonephritis

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45
Q

Recall the secondary causes of nephrotic syndrome (DAVID)

A 
D - Diabetes mellitus 
A - Amyloidosis 
V - Vasculitis 
I - Infections 
D - Drugs
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46
Q

Name 2 types of glomerular disease in which ANCA antibodies may be present

A
  1. Microscopic polyangitis

2. Wegener’s Granunlomatosis

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47
Q

Name 2 antibodies associated with SLE

A
  1. Anti dsDNA

2. Antinuclear antibodies

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48
Q

Which antibodies are used for the diagnoses of Goodpastures syndrome

A

Anti-glomerular basement membrane antibodies

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49
Q

Classify the diuretic metolazone

A

Thiazide-like diuretic

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50
Q

What is the treatment of choice for rapidly progressive glomerulonephritis?

A

Immunosuppression with high dose hydrocortisone

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51
Q

Define pyuria

A

Presence of pus in the urine - usually secondary to bacterial infection

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52
Q

What are the 5 potential causes of sterile pyuria?

A
  1. Tuberculosis of the urinary tract
  2. Analgesic nephropathy
  3. Partially treated UTI
  4. Neoplasia
  5. Intra-abdominal inflammation
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53
Q

Name 3 tumour types that may present with polycythaemia

A
  1. Renal cell carcinoma
  2. Hepatoma
  3. Cerebellar haemangioblastoma
54
Q

Suggest 4 symptoms of prostatism

A
  1. Hesitancy
  2. Frequency
  3. Nocturia
  4. Post micturition dribbling
55
Q

What is the most common position for a Berry aneurysm related to autosomal dominant polycystic kidney disease?

A

Anterior communicating artery of the circle of Willis

56
Q

What are the 2 main types of thrombotic microangiopathies?

A
  1. Haemolytic uraemic syndrome

2. Thrombotic thrombocytopenia purpura

57
Q

What is the risk of correcting sodium levels too quickly?

A

Central pontine myelinolysis may occur

58
Q

Suggest 5 potential causes of parenchymal AKI

A
  1. Malignant hypertension
  2. Bilateral cortical necrosis
  3. Pyelonephritis
  4. Amyloidosis
  5. Nephrotoxins
59
Q

Recall the 7 absolute indications for the imitation of RRT in patients with AKI

A
  1. Anuria
  2. Severe oliguria
  3. Hyperkalemia
  4. Severe metabolic acidosis
  5. Volume overload
  6. Pronounced azotemia
  7. Clinical complications of uraemia
60
Q

Suggest 3 clinical complications associated with uraemia

A
  1. Encephalopathy
  2. Pericarditis
  3. Neuropathy
61
Q

Define Oliguria

A

A urine output <400mls/day

62
Q

What is the most common cause of AKI in the hospital setting?

A

Sepsis

63
Q

Briefly outline the 3 subcategories of intra-renal disease

A
  1. Acute tubular necrosis (ATN) - Toxicity or ischaemia leading to a reduced GFR
  2. Nephrotoxcity e.g. aminoglycosides or contrast nephropathy
  3. Renal parenchymal disease -as a result of ATN
64
Q

When investigating AKI, what are the two main features to look for on urine microscopy?

A
  1. Red cells

2. Red cell casts

65
Q

Suggest 4 potential options for renal replacement therapy

A
  1. Haemodialysis
  2. Peritoneal dialysis
  3. Haemofiltration
  4. Renal transplantation
66
Q

Suggest 8 indications for renal replacement therapy

A
  1. Fluid overload
  2. Hyperkalemia
  3. Hypocalcaemia
  4. Metabolic acidosis
  5. Pericarditis
  6. Uraemic Symptoms
  7. GFR < 15ml/min1.73m2
67
Q

What is the main initial investigation for suspected obstruction?

A

USS of the kidneys

68
Q

What are the 4 main causes of pre-renal AKI?

A
  1. Hypovolaemia
  2. Hypotension
  3. Decreased cardiac output
  4. Vascular disease
69
Q

Suggest 6 clinical signs of pre-renal uraemia

A
  1. History of blood/ fluid loss
  2. Sepsis - leading to vasodilation
  3. Cardiac disease
  4. Postural hypotension
  5. Weak rapid pulse
  6. Low JVP
70
Q

Name the 3 mechanisms by which ischaemia results in a reduction in GFR

A
  1. Glomerular contraction
  2. Back-leak of filtration
  3. Obstruction of the tubule
71
Q

Outline the 6 main biochemical features associated with AKI

A
  1. Hyperkalaemia
  2. Metabolic acidosis
  3. Hyponatraemia
  4. Pulmonary oedema
  5. Hypocalcaemia and hyperphosphataemai
  6. General symptoms of uraemia
72
Q

Suggest 6 possible symptoms of uraemia

A
  1. Anorexia
  2. Vomiting
  3. Nausea
  4. Fits
  5. Coma
  6. Haemorrhagic episodes
73
Q

Name 4 aminoglycosides

A
  1. Vancomycin
  2. Gentamycin
  3. Kanamycin
  4. Streptomycin
74
Q

5 signs of hypovolaemia

A
  1. JVP
  2. Low BP
  3. Low urine output
  4. Poor tissue turgor
  5. Fast, weak pulse
75
Q

Metformin should be stopped at what creatine level?

A

Creatine >150mmol/L

76
Q

What is the risk of administering bicarbonate too quickly?

A

Inducing hypocalcaemia which may result in tetany

77
Q

Name the 4 main causative categories of anemia of chronic disease

A
  1. Chronic infection
  2. Chronic inflammation
  3. Neoplasia
  4. Chronic kidney disease
78
Q

Why does CKD lead to anemia of chronic disease?

A

Reduced renal synthesis of EPO

79
Q

What is the vascular supply to the bladder and urethra?

A

Internal iliac artery

80
Q

Recall 7 common extra-renal manifestations of ADPKD?

A
  1. Hepatic cysts
  2. Pancreatic and intestinal cysts
  3. Abdominal wall hernias
  4. Valvular heart disorders
  5. Aortic regurgitation
  6. Coronary artery aneurysm
  7. Cerebral aneurysm
81
Q

What are the 3 principle physiological roles of calcium?

A
  1. Contraction of skeletal, cardiac and smooth muscle
  2. Blood clotting
  3. Control of nerve impulses
82
Q

What are the 2 main functions of PTH in regards to calcium homeostasis?

A
  1. Increase osteoclast activity

2. Decrease excretion of calcium by the kidneys

83
Q

Suggest 5 causes of hypocalcaemia

A
  1. Renal failure
  2. PTH deficiency i.e. hypoparathyroidism
  3. Insufficient vitamin D
  4. Insufficient dietary calcium
  5. Excessive dietary magnesium
84
Q

Which ethnic group has a predisposition to the development of ESRF as a result of hypertensive nephropathy?

A

Black populations

85
Q

What are the 2 main causes of CKD in African populations?

A
  1. Malaria

2. Schistosomiasis

86
Q

Give 6 risk factors for the development of CKD

A
  1. CV disease
  2. Diabetes
  3. Smoking
  4. Hypertension
  5. AKI
  6. Chronic use of NSAIDS
87
Q

Give 4 congenital causes of CKD

A
  1. Polycystic kidney disease
  2. Alports syndrome
  3. Medullary cystic disease
  4. Tuberous sclerosis
88
Q

Name 6 glomerular diseases that may lead to CKD

A
  1. IgA nephropathy
  2. Wegeners granulomatosis
  3. Amyloidosis
  4. Diabetic glomerulosclerosis
  5. TTP
  6. Sickle cell anemia
89
Q

Suggest 8 potential clinical signs associated with CKD

A
  1. Increased skin pigmentation
  2. Excoriation
  3. Pallor
  4. Hypertension
  5. Postural hypotension
  6. Peripheral oedema
  7. Pleural effusion
  8. Peripheral neuropathy
90
Q

What are the 2 diagnostic criteria that can be used to diagnose CKD?

A
  1. eGFR <60 on 2 separate occasions more than 2 weeks apart

2. Albuminuria (ACR>30) on 2 occasions within 3 months

91
Q

What are the 3 core components of preventative heath measures for patients with CKD?

A
  1. BP management
  2. Prevention of CV disease
  3. Lifestyle factors
92
Q

Outline the 4 components of CV disease prevention in patients with CKD

A
  1. Statins
  2. B12 and folate supplementation
  3. Aspirin
  4. Oral anticoagulants
93
Q

What are the 3 primary functions of angiotensin-II

A
  1. Massive vasoconstriction
  2. Release of ADH and aldosterone
  3. Kidney activation in the setting of low BP
94
Q

Describe the action of ADH

A

Acts on distal convoluted tubule to up-regulate synthesis of water channels, thereby increasing water reabsorption.

95
Q

What is the most common indication for the use of an osmotic diuretic?

A

Prevention/ treatment of cerebral oedema

96
Q

Define Goodpasture’s syndrome

A

Rare genetic autoimmune condition characterised by a combination of glomerulonephritis with alveolar haemorrhage in the presence of circulating anti - GBM antibodies

97
Q

Give 6 predisposing factors to Goodpasture’s syndrome

A
  1. Association with HLA-DR2
  2. Exposure to organic solvents or hydrocarbons
  3. Smoking
  4. Infections e.g. Influenza A2
  5. Cocaine inhalation
  6. Exposure to metal dusts
98
Q

Define hepatorenal syndrome

A

Renal failure secondary to liver disease - most commonly seen as a complication of alcoholic hepatitis

99
Q

Recall the triad of symptoms associated with nephrotic syndrome

A
  1. Proteinuria >3g/24hrs
  2. Hypoalbuminaemia <30g/L
  3. Oedema
100
Q

What is the main difference between nephrotic and nephritic syndrome?

A

Haematuria is present in nephritic syndrome

101
Q

Name the 2 ‘standard features’ of nephritic syndrome

A
  1. Hypertension

2. Red cell casts

102
Q

Suggest 8 potential causes of postural hypotension

A
  1. Dehydration
  2. Pregnancy
  3. Drugs
  4. Tricyclic antidepressants
  5. Age
  6. Addison’s disease
  7. Diabetes - due to autonomic neuropathy
  8. Parkinson’s disease
103
Q

Name 5 drug categories that may cause postural hypotension in patients

A
  1. ACE inhibitors
  2. Diuretics
  3. Calcium channel blockers
  4. Beta blockers
  5. Vasodilators
104
Q

How is postural hypotension diagnosed?

A

Lying and standing BP measured after the patient has been lying down for at least 15 minutes. A drop of >20mmHg alongside symptoms is diagnostic of postural hypotension

105
Q

Name 4 things that will shift K+ into the cells

A
  1. Insulin
  2. Aldosterone
  3. Beta agonists
  4. Alkalosis
106
Q

Name 4 things that will shift K+ outside of cells

A
  1. Addison’s disease
  2. Beta blockade
  3. Acidosis
  4. Cell lysis
107
Q

What are the ECG changes associated with hypokalaemia?

A
  1. T wave depression
  2. ST sagging
  3. U wave prominence
  4. P-R prolongation
108
Q

Outline the 6 potential causes of hyperkalaemia

A
  1. Renal e.g. oliguric renal failure or potassium sparing diuretics
  2. Metabolic acidosis
  3. Adrenal insufficiency
  4. Drugs e.g. ACE inhibitors, beta blockers, NSAIDS
  5. Rhabdomyolysis
  6. Artefact as a result of haemolysis
109
Q

What are the ECG changes associated with hyperkalaemia?

A
  1. Tall tented T waves
  2. Small P waves
  3. Wide QRS complex
  4. Ventricular fibrillation
110
Q

What are the 5 components of management of severe hyperkalaemia

A
  1. Calcium gluconate 10 mms of 10% IV over 2 minutes (repeat as necessary)
  2. IV Insulin and glucose
  3. Nebulised salbutamol
  4. Calcium resonium
  5. Dialysis
111
Q

Briefly define a renal cell carcinoma

A

A form of adenocarcinoma that arises from the proximal tubular epithelium

112
Q

Give 6 risk factors for the development of renal cell carcinoma

A
  1. Irradiation
  2. Exposure to oestrogens
  3. Hypertension
  4. Smoking
  5. Exposure to cadmium
  6. Urban/ industrial populations
113
Q

Congenital renal cell carcinoma is associated with what genetic defect?

A

Defect on chromosome 3p

114
Q

Name an inherited condition that has a strong association with renal cell carcinoma

A

von Hippel-Lindau disease

115
Q

What are the 4 main types of renal replacement therapy?

A
  1. Haemodialysis
  2. Peritoenal dialysis
  3. Haemoflitration
  4. Renal transplant
116
Q

What are the 3 modes of access that can be used for renal replacement therapy?

A
  1. Cannulation
  2. Arterovenous fistula
  3. Synthetic graft
117
Q

What degree of blood flow is required for adequate access for renal replacement therapy?

A

Blood flow of at least 200mls/min

118
Q

What is the most common form of AV fistula?

A

Radiocephalic fistula in the patient’s non dominant arm

119
Q

Suggest 7 possible drug reactions which may lead to rhabdomyolysis

A
  1. Statins
  2. Fibrates
  3. Alcohol
  4. Ecstasy
  5. Heroin
  6. Carbon monoxide
  7. Neuroleptic malignant syndrome
120
Q

Name 2 genetic muscular disorders that carry a risk of rhabdomyolysis

A
  1. McArdle’s disease

2. Duchenne’s muscular dystrophy

121
Q

Name 3 infections which may cause rhabdomyolysis

A
  1. EBV
  2. Coxackie virus
  3. Infleunza
122
Q

Give 4 products that are released into the blood as a result of muscle breakdown

A
  1. Myoglobin
  2. Potassium - resulting in hyperkalaemia
  3. Creatine kinase
  4. Phosphate urate
123
Q

Suggest 4 complications associated with rhabdomyolysis

A
  1. Hyperkalaemia
  2. Acute renal failure
  3. Increased coagulability
  4. Compartment syndrome
124
Q

Recall the categories of the RIFLE criteria for assessment of AKI

A 
R - Risk 
I - Injury 
F - Failure 
L - Loss
E - End stage kidney disease
125
Q

Suggest 4 causes of hypovolaemic hyponatraemia

A
  1. Diuretics
  2. Mineralocorticoid insufficiency (Addison’s disease)
  3. Osmotic diuresis (low glucose, urea)
  4. Nephropathy
126
Q

Give 5 medical causes of hypovolaemic hyponatraemia

A
  1. Diarrhoea and vomiting
  2. Burns
  3. Rhabdomyolysis
  4. Pancreatitis
  5. Peritonitis
127
Q

Outline the 4 potentially causes of hypervolaemic hyponatraemia

A
  1. Heart failure
  2. Renal failure
  3. Liver failure
  4. Hyperglycaemia
128
Q

Outline the action of thiazide diuretics

A

Act on distal convoluted tubule and collecting duct and inhibit the sodium/chloride cotransporter

129
Q

What are the 3 main causes of renal failure

A
  1. Hypertension
  2. Diabetes
  3. Pyelonephritis/ Glomerulonephritis
130
Q

Give 2 electrolyte imbalances commonly associated with AKI

A
  1. Hyperkalaemia

2. Hyperphosphataemia

131
Q

What is the most common cause of AKI among hospital inpatients?

A

Sepsis

Clinical Medicine (8 decks)

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