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Medicine finals > Renal > Flashcards

Renal Flashcards

1
Q

Define hyperkalaemia

A

Elevated serum potassium >5.5mM

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2
Q

What are the stages of hyperkalaemia?

A

Mild: 5.5-6.0mM
Moderate: 6.1-6.9mM
Severe: >7mM

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3
Q

Give causes of hyperkalaemia

A

Excess intake (potassium supplements, massive blood transfusions)

Release from intracellular fluid (rhabdomyolysis, burns, crush injury, tumour lysis syndrome)

Inadequate excretion (renal impairment, medications - ACEi, ARBs, NSAIDs, K sparing diuretics)

Pseudohyperkalaemia (haemolysis during venepuncture)

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4
Q

How can hyperkalaemia present?

A 
Asymptomatic
N&V
Diarrhoea
Hypotonia
Muscle weakness
Hyporeflexia
Paraesthesia 
Cardiac arrhythmias
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5
Q

What are the classical changes seen on an ECG which are indicative of hyperkalamia?

A

Flattened P waves
Tall tented T waves
Wide QRS - becoming sinusoidal

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6
Q

What are the three components of the management of hyperkalaemia?

A

Myocardial protection
Drive potassium into ICF
Potassium elimination

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7
Q

What drugs are used to protect the myocardium during hyperkalaemia?

A

Calcium gluconate/chloride (10ml of 10% by slow IV injection)

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8
Q

What can be used to drive potassium into the ICF?

A

Salbutamol 5mg nebs
Insulin-dextrose infusion
Sodium bicarbonate

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9
Q

How can potassium be eliminated?

A

Calcium resonium

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10
Q

When should RRT be considered in a patient with hyperkalaemia?

A

Serum potassium >6.5mM and refractory to medical management

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11
Q

What are the complications of hyperkalaemia?

A

Cardiac arrhythmias - VF

Cardiac arrest

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12
Q

Define nephritis

A

Inflammation of the kidneys

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13
Q

What are the features of nephritic syndrome?

A

Haematuria
Oliguria
Proteinuria (<3g per 24 hours)
Fluid retention

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14
Q

What criteria must be fulfilled before a patient can be said they have nephrotic syndrome?

A

Peripheral oedema
Proteinuria >3g in 24 hours
Serum album <30g per litre
Hypercholesteraemia

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15
Q

Define interstitial nephritis

A

Inflammation of the space between the cells and tubules

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16
Q

What are the two types of interstitial nephritis?

A

Acute interstitial nephritis

Chronic interstitial nephritis

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17
Q

Define glomerulosclerosis

A

Describes the pathological process of scarring of the tissue in the glomerulus

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18
Q

What can cause glomerulosclerosis?

A

Any type of glomerulonephritis
Obstructive uropathy
Focal segmental glomerulosclerosis

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19
Q

How can most types of glomerulonephritis be treated?

A

Immunosuppression

Blood pressure control using ACEi/ARBs

20
Q

How might a patient present with nephrotic syndrome?

A

Oedema

Frothy urine

21
Q

What does nephrotic syndrome predispose a patient too?

A

Thrombosis
Hypertension
High cholesterol

22
Q

What is the most common cause of nephrotic syndrome In children?

A

Minimal change disease

23
Q

Describe minimal change disease

A

Usually idiopathic

Treated successfully with steroids

24
Q

What is the most common cause of nephrotic syndrome in adults?

A

Focal segmental glomerulonephritis

25
Q

What is the most common cause of primary GN?

A

IgA nephropathy

26
Q

What is the peak age of presentation of IgA nephropathy?

A

20s

27
Q

What is the classical histology appearance of IgA nephropathy?

A

IgA deposits and glomerular mesangiall proliferation

28
Q

What is the most common type of glomerulonephritis overall?

A

Membranous glomerulonephritis

29
Q

When are the peaks in membranous glomerulonephritis?

A

20s and 60s

30
Q

What does histology show in membranous glomerulonephritis?

A

IgG and complement deposits on the basement membrane

31
Q

What are the causes of membranous glomerulonephritis?

A

Idiopathic 70%

Secondary to malignancy, rheumatoid disorders and drugs

32
Q

Describe post streptococcal glomerulonephritis

A

Patients are generally <30 years
1-3 weeks after a streptococcal infection
Develop a nephritic syndrome
Usually make a full recovery

33
Q

Describe Goodpasture’s syndrome

A

Anti-GBM attack the glomerulus and pulmonary basement membrane
Glomerulonephritis + pulmonary haemorrhage

34
Q

What histology is suggestive of rapidly progressive glomerulonephritis?

A

Crescentic glomerulonephritis

35
Q

What can rapidly progressive glomerulonephritis present secondary too?

A

Goodpasture’s syndrome

Granulomatosis with polyangiitis

36
Q

What is the most common cause of glomerular pathology and chronic kidney disease in the UK?

A

Diabetic nephropathy

37
Q

In patients with diabetes, how should they be regularly screened to detect diabetic nephropathy?

A

ACR + U&Es

38
Q

How should a patient with diabetic nephropathy be managed?

A

Optomise blood sugar control

Optomise BP - using ACEi

39
Q

What drug should be started in all patients with diabetic nephropathy regardless of their BP?

A

ACEi

40
Q

How does acute interstitial nephritis present?

A

AKI

HTN

41
Q

What can cause acute interstitial nephritis?

A

Hypersensitivity reaction to drugs/infection

42
Q

What features may be associated with acute interstitial nephritis?

A

AKI +…
Rash
Fever
Eosphilia

43
Q

How can acute interstitial nephritis be managed?

A

Treat the underlying cause

Steroids - reduce inflammation, improve recovery

44
Q

How does chronic interstitial nephritis present?

A

Chronic kidney disease

45
Q

What are potential causes of chronic interstitial nephritis?

A

Autoimmune
Infectious
Iatrogenic
Granulomatous disease

Medicine finals (12 decks)

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