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Scott's Notes > Renal > Flashcards

Renal Flashcards

1
Q

Roughly how much blood do the kidneys filter in one minute?

A

250ml

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2
Q

How is sodium reabsorption regulated?

A

Hypotension or hyponatraemia are detected a the macula densa ->renin release -> aldosterone release -> Na/K pump insertion

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3
Q

What part of the nephron is responsible for the majority of Na reabsorption?

A

PCT - 70%

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4
Q

Where are NaK2Cl symporters found?

A

Ascending limb

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5
Q

Where is calcium reabsorbed?

A

DCT

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6
Q

What are the three endocrine products of the kidneys?

A

Renin
EPO
1alpha hydroxylase

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7
Q

Name one carbonic anhydrase inhibitor and suggest when it is used clinically

A

Acetazolamide - used as a diuretic in glaucoma

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8
Q

What are the side effects of loop diuretics?

A

Hypokalaemic metabolic alkalosis
Ototoxicity
Hypovolaemia

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9
Q

What are the side effects of thiazide diuretics?

A

Hypokalaemia
Hyperglycaemia
Hyperuricaemia

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10
Q

What are the side effects of Ksparing diuretics?

A

Hyperkalaemia

Antiandrogenic e.g. gynaecomastia

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11
Q

What are the causes of haematuria?

A

Renal or Extra renal

Renal
PKD
Trauma
Pyelonephritis
Neoplasm
Immune complex deposition
Extra renal
Stones
Catheter
Infection
Neoplasm
Drugs (NSAIDs, furosemide)
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12
Q

What are the cut offs for PCR?

A

<20 is normal,

>300 is nephrotic

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13
Q

What are the commonest causes of proteinuria?

A 
DM
Minimal change
Membranous 
Amyloidosis
SLE
HTN
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14
Q

What might cause a falsely low or high urea?

A

Raised in protein meal, UGI bleed, supplements, dehydration

Low in hepatic impairment

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15
Q

What are the causes of renal impairment?

A

Pre, renal, post

Pre-renal
Shock
RAS
Toxins
Thrombosis
Hepatorenal syndrome

Renal
Glomerulonephritis
ATN
Interstitial disease

Post renal
Obstruction (stone, cancer, prostate, valves, strictures, infection, post op)

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16
Q

What are the ECG features of hyperkalaemia?

A 
Peaked T waves
Flat P waves
PR prolongation
Wide QRS
VF
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17
Q

What are some causes of a sterile pyuria?

A

TB
Treated UTI
Appendicitis
Calculi

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18
Q

What are the four commonest causes of UTI?

A

E coli
S saphrophyticus
Proteus (causes struvite calculi)
Klebsiella

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19
Q

WHen would you ultrasound a UTI patient?

A

Children
Men
Recurrent
?pyelonephritis

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20
Q

Which UTI Abx is contraindicatedin renal failure?

A

Nitrofurantoin

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21
Q

How might GN present?

A

Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome

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22
Q

What are the causes of GN?

A 
Idiopathic
Immune - SLE, Goodpastures, vasculitis
Infection - mainly hepatitis, Strep
Drugs - penicillamine
Amyloid
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23
Q

How would you investigate GN?

A 
Bloods - 
Basics
Complement (SLE)
ANA, dsDNA, ANCA, GBM
Serum electrophoresis
Serology

Urine -
Dip, spot PCR, Bence Jones,MCnS

Imaging -
CXR for infiltrates
Renal USS +- biopsy

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24
Q

What is the management of GN?

A

Refer
Aggressive HTN management
Use ACEi and ARBs

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25
Q

What are the three common causes of asymptomatic haematuria?

A

IgA nephropathy (Berger’s)
Young men with episodic macroscopic haematuria days after URTI
Treat with steroids

Thin BM disease (commonest)

Alports - XLR
Leads to progressive renal failure with SNHL and retinal flecks

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26
Q

What is the classical triad of nephritic syndrome?

A

Haematuria with RC casts
Proteinuria -> oedema
Hypertension

27
Q

What are the two causes of nephritic syndrome?

A
  1. Post strep

2. Cresentic (Rapidly progressing GN)

28
Q

What are the features, treatment and prognosis of post strep nephritic syndrome?

A

Young children with malaise, haematuria, oedema and HTN 2 weeks after URTI or skin infection

Biopsy shows IgG and C3 deposition

Treatment is supportive and 95% of children recover fully

29
Q

What are the presenting features of an AKI?

A

Uraemia
Acidosis
Hyperkalaemia
Fluid overload

30
Q

What are the causes of AKI?

A

Pre, renal, post

Pre -
Hypovolaemia, RAS

Renal -
ATN (HUS, HTN, TTP, shock), direct nephrotoxins
Nephritic syndrome

Post renal -
Obstruction

31
Q

What is the management of hyperkalaemia?

A

10ml 10% CaGluconate
100ml of 20% dextrose + 10units of actrapid
Salbutamol 5mg neublised

32
Q

What are the indications for dialysis in AKI?

A 
Persistent K>7
Refractory pulmonary oedema
Symptomatic uraemia
pH<7.2
Poisoning
33
Q

How would you manage an AKI?

A 
Resus and assess fluid status
Treat life threatening complications
Treat shock or dehydration
Monitor - cardiac, urine, fluid balance
Investigate post renal causes
Hx and Ix
Treats sepsis
34
Q

What are the causes of interstitial nephritides?

A

Drug hypersensitivity in 70%
NSAIDs, Abx, diuretics, allopurinol, cimetidine

Infection - staphs and streps

Immune - SLE, Sjogren’s

35
Q

How does interstitial nephritis present?

A 
Fever
Arthralgia
Rash
AKI
Uveitis
36
Q

What is found on investigation of an interstitial nephritis?

A 
IgE
Eosinophilia
Haematuria
Proteinuria
Sterile pyuria
37
Q

How would you treat an acute interstitial nephritis?

A

Stop offending drug/infection and give prednisolone

38
Q

What are the commonly seen nephrotoxins?

A

Exo vs endogenous

Exo
NSAIDs
Antimicrobials (aminoglycosides, vancomycin, aciclovir, sulphonamides, tetracycline)
ACEi
Ciclosporin and Tacrolimus
Contrast media
Endo
Haemoglobin
Myoglobin
Urate
Ig in myeloma
39
Q

In the case of rhabdomyolysis, how long does it take for AKI to develop>

A

10-12 hours

40
Q

How would you treat rhabdomyolysis?

A

Manage hyperkalaemia
IV rehydration
IV NaHCO3 can detoxify myoglobin

41
Q

What are the two commonest causes of CKD?

A

DM
HTN

Others inc RAS, GN, PKD, drugs, pyelonephritis

42
Q

How would you investigate CKD?

A

Blood -
Low HB, UnEs off, ESR, Low Ca high Po4, High ALP, high PTH
Immune profile
Film - burr cells

Urine - all that stuff

Imaging - 
CXR (cardiomegaly, PE(ffusion), oedema)
AXR - stones
Renal USS (cysts?)
Bone Xrays (fractures)
CTKUB - cortical scarring from pyelonephritis
43
Q

WHat are the complications of CKD?

A

CRF HEALS

Cardiovascular disease
Renal osteodystrophy
Fluid overload

HTN
Electrolyte disturbances
Anaemia
Leg restlesness
Sensory neuropathy
44
Q

What is the management of CKD?

A

General - treat reversibles and stop nephrotoxins

Lifetsyle - Exercise, weight control, stop smoking, Na, fluid and Po4 restriction

CV risk management (statins, aspirin, DM control)

HTN - target <130/80 if diabetic with ACEi/ARB

Oedema -> Furosemide (nephrotoxic)

Bone disease -
Phosphate binders
Vit D analogues
Ca supplements

Anaemia - EPO

Restless legs - clonazepam

45
Q

What things are involved in the assessment for renal transplant?

A

Virology status
CVD
TB
ABO and haplotype

46
Q

What are the contraindications to renal transplant?

A

Active infection
Active cancer
Severe comorbidities

47
Q

What is the predicted half life for a cadaveric renal repacement?

A

15 years

48
Q

What complications may occur after renal transplant?

A

Post op - bleeding, thrombosis, infection, leakage

Hyperacute rejection (minutes) - ABO incompatabily presents with thrombosis and SIRS

Acute rejection (<6 months) - cell mediated and responds to immunosuppression

Chronic rejection (>6 months) - interstitial fibrosis and tubular atrophy which doesnt respond to immunosuppression

Ciclosporin/tactrlimus nephrotoxicity

Impaired immune function ->inf, cancer

CV disease

49
Q

How does diabetes cause nephropathy?

A

Hyperglycaemia causes renal hyperperfusion resulting in hypertrophy and an increase in size. THis, and metabolic defects increase ROS production resulting in glomerulosclerosis, nephron loss, RAS activation and subsequent HTN

50
Q

What screening should DM patients undergo to pick up renal damage?

A

6 monthly microalbuminuria screening

51
Q

What is the commonest cause of renal artery stenosis?

A

Atherosclerosis

52
Q

What efffect do ACEi and ARBs have on renal function in RAS patients?

A

Worsened function

53
Q

What is the gold standard investigation for RAS?

A

Renal angiography

54
Q

What are the featuers of HUS?

A

Bloody diarrhoea and abdo pain followed by:
MAHA
Thrombocytopaenia
Renal failure

55
Q

What are the investigation results in HUS?

A

Schistocytes
Thrombocytopaenia
Anaemia
Normal clotting

56
Q

What are the biochemical fetuers of renal tubular acidosis?

A

Hyperchloraemic metabolic acidosis with hypokalaemia

57
Q

WHat is Bartter’s syndrome?

A

NaCL channel blockage in LoH resulting in hypokalaemic metabolic alkalosis

58
Q

What is Gitalman syndrome?

A

Blockage of NaCl channel in DCT resulting in hypokalaemic metabolic alkalosis with hypocalcuria

59
Q

What is the pathology and progression of ADPKD?

A

Large cysts from all parts of nephron cause gradual decline in renal function, often in ESRF by 70

60
Q

When does ARPKD typically present and with what?

A

Infancy with renal cysts and congenital hepatic fibrosis

61
Q

Whsat are the featuers of ADPKD?

A

MISSHAPES

Mass
Infected cyst
Stones
SBP high
Haematuria
Aneurysms 
Polyuria
Extra renal cysts
Systolic murmur
62
Q

What are the features of tuberous sclerosis?

A 
Skin - 
Adenoma sebaceum
Ash leaf spots
Shagreen patches
Periungual fibromas

Neuro -
Low IQ
Epilepsy

Renal -
Cysts
Angiomyolipomas

63
Q

What are the differentials for renal enlargement?

A

PHONOS

Polycystic kidneys
Hypertrophy (due to contralateral renal agenesis)
Obstruction
Neoplasia
Occlusion (RV thrombosis)
Systemic (early DM or amyloid)

Scott's Notes (21 decks)

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