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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

State 4 or more risk factors for patients getting AKI.

A
  1. CKD (especially if eGFR below 60)
  2. Other chronic disease- heart failure, liver disease, diabetes
  3. Hypovolaemia
  4. Age over 65
  5. Iodine contrast agent in past week
  6. Drugs- NSAIDs, ACEIs, ARBS, Aminoglycosides
  7. Neurological or cognitive impairment
  8. Oliguria (output below 0.5ml/kg/hr)
  9. Sepsis
  10. Deteriorating Early Warning Score
  11. Past history of AKI
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2
Q

What do NICE recommend measuring in patients with a recognised risk factor for AKI?

eGFR
Serum Urea
Serum Creatinine
Urinary Creatinine

A

Serum creatinine

and compare to baseline

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3
Q

Which of the following increases a patients risk of AKI?

  1. CT scan with iodine contrast 3 weeks ago
  2. Gentamicin
  3. Urine output of 0.6ml/kg/hr
  4. MEWS score of 3
A

Gentamicin

Iodine contrast in the past 1 week, urine output below 0.5ml/kg/hr and DETERIORATING Mews score increase risk

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4
Q

Which 2 investigations/ tests are used to detect AKI in adults?

  1. Serum creatinine and urea
  2. Serum urea and eGFR
  3. Serum creatinine and urine output
  4. Urine output and USS
A

Serum creatinine
and

Urine output

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5
Q

Name 2 or more complications of AKI.

A
  1. Fluid overload (pulomary oedema)
  2. Hyperkaelamia (arrythmias)
  3. Metabolic acidosis
  4. Uraemia (pericarditis and encephalopathy)
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6
Q

Calcium gluconate is used to manage which complication of AKI?

A

Hyperkalaemia

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7
Q

Sodium bicarbonate is used to manage which complication of AKI?

A

Metabolic acidosis

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8
Q

What are the 2 most common causes of CKD?

A

Diabetes

Hypertension

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9
Q

Other than diabetes and hypertension, state 2 or more causes of CKD.

A
  1. Polycystic kidney disease
  2. Glomerulo nephrotic/ nephritic syndromes
  3. Chronic pyelonephritis
  4. Long term NSAID use
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10
Q

Which 2 tests should be used to diagnose CKD?

  1. eGFR and urinalysis
  2. Serum creatinine and eGFR
  3. eGFR and urine ACR
A
  1. eGFR and urine ACR
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11
Q

Which 4 patient variables are used in calculating eGFR?

A
  1. Age
  2. Gender
  3. Ethnicity
  4. Serum creatinine
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12
Q

Which blood tests should be done to investigate a patient with haematuria/ proteinuria, to identify the cause of glomerular/ systemic disease?

A
  1. Immunology- ANA, ANCA, Anti GBM, Paraprotein

2. Serology- BBV, blood cultures, ASOT (for Strep)

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13
Q

Name 2 or more classes of drug used for immunosuppression in renal transplant patients.

A
  1. Monoclonal antibodies eg. Daclizumab
  2. Calcineurin inhibitors eg. Tacrolimus, Ciclosporin
  3. Antimetabolites eg. Mycophenolate, Azathioprine
  4. Steroids
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14
Q

Acute graft failure occurs within ___ months of renal transplant.

A

6 months

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15
Q

State 4 or more causes of CKD.

A
  1. Diabetes
  2. Hypertension
  3. Vasculitis
  4. SLE
  5. Glomerulonephritis
  6. Genetic eg. Alport syndrome, Polycystic kidney disease
  7. Drugs- NSAIDs, Calcineurin inhibitors
  8. Obstruction- stones, tumours, BPH, fibrosis
  9. Infection- HBV, HCV, HIV
  10. Atherosclerosis
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16
Q

Alport syndrome is an X linked inherited disorder that affects the kidneys and which 2 other organs?

A
  1. Ears - sensorineural deafness

2. Eyes- anterior lenticonus and retiniti pigmentosa

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17
Q

The levels of which of the following immunosuppresive drugs should be monitored post renal transplant, as the drug can build up and cause acute drug toxicity?

Prednisolone
Ciclosporin
Azathioprine
Tacrolimus

A

Tacrolimus

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18
Q

Which of these immunosuppressive drugs can cause side effects including tremor, nephrotoxicity, diabetes and neurotoxicity?

Prednisolone
Mycophenolate
Azathioprine
Tacrolimus

A

Tacrolimus

19
Q

Fanconi syndrome is a disorder of which part of the nephron?

Loop of Henle
DCT
PCT
Collecting duct

A

PCT

Global disorder of proximal convoluted tubule, leads to loss of reabsorption of sodium, bicarbonate, phosphate, amino acids and glucose. Increased urinary levels of these solutes. Osteomalacia.

20
Q

Type 2 Renal tubular acidosis is a disorder of which part of the nephron?

Loop of Henle
DCT
PCT
Collecting duct

A

PCT

21
Q

Which class of diuretics can cause side effects including gynaecomastia, testicular atrophy, metabolic acidosis and hyperkalaemia?

Loop diuretics
Thiazide diuretics
Potassium sparing diuretics

A

Potassium sparing diuretics eg Spironalactone

22
Q

Which class of diuretics can cause side effects including metabolic alkalosis, gout and hyperglycaemia?

Loop diuretics
Thiazide diuretics
Potassium sparing diuretics

A

Thiazide diuretics

23
Q

Which class of diuretics is used for glaucoma?

A

Carbonic anhydrase inhibitors

24
Q

Name 4 or more drugs which are nephrotoxic.

A
  1. NSAIDs
  2. Antimicrobials- Aminoglycosides (Gentamicin), Sulfamethoxazole (in Co-Trimoxazole), Penicillin, Rifampicin
  3. Anti-epileptics- Phenytoin, Lamotrigine, Sodium Valproate
  4. Lithium
  5. PPIs
  6. Furosemide
  7. Iron
  8. Calcineurin inhibitors eg. Tacrolimus, Cyclosporin
  9. ACEIs, ARBs
25
Q

Other than drugs, name 2 or more nephrotoxic substances.

A
  1. Microbes eg. Bacteria, viruses and parasites
  2. Radiocontrast dye
  3. Haemoglobin in haemolysis
  4. Light chains
  5. Myoglobin in rhabdomyolysis
  6. Immunoglobulins in myeloma
  7. Urate crystals
26
Q

Name 4 or more causes of HIGH anion gap metabolic acidosis.

A 
Methanol
Uraemia (renal failure)
Diabetic Ketoacidosis
Propylene glycol
Iron, Isoniazid
Lactic Acidosis
Ethanol, Ethylene glycol
Salicylates/ aspirin
27
Q

Name 2 or more causes of NORMAL anion gap metabolic acidosis.

A
  1. GI losses- Diarrhoea, Pancreatic fistula, ileostomy, ureterosigmoidostomy
  2. Addison’s (Hypoaldosteronism)
  3. Renal tubular acidosis
  4. Drugs- Acetazolamide
28
Q

The triad of Fever, rash and arthralgia is seen in some patients with which renal condition?

Renal tubular acidosis
Acute interstitial nephritis
Acute tubular necrosis
Polycystic kidney disease

A

Acute interstitial nephritis

29
Q

Name 2 or more causes of metabolic alkalosis.

A
  1. Primary hyperaldosteronism- Conn’s
  2. Diarrhoea
  3. Vomitting
  4. Diuretics- Loop and Thiazide
  5. Cushing’s syndrome
  6. Burns
  7. Hypokalaemia
  8. Bartter’s syndrome
30
Q

Which classes of diuretic drug can cause metabolic ACIDOSIS as side effects?

A
  1. Carbonic anhydrase inhibitors eg. Acetazolamide

2. Potassium sparing diuretics eg. Spironalactone

31
Q

Which classes of diuretic drug can cause metabolic ALKALOSIS as side effects?

A
  1. Loop diuretics

2. Thiazide diuretics

32
Q

Which condition may present with muscle pain, AKI, serum hyperkalaemia and hyperphosphataemia?

  1. Acute tubular necrosis
  2. Rhabdomyolisis
  3. Diabetic nephropathy
A

Rhabdomyolysis

33
Q

What is tested for on a urine dipstick?

A
  1. Leukocytes
  2. Nitrites
  3. Urobilinogen
  4. Protein
  5. pH
  6. Blood
  7. Specific gravity
  8. Ketones
  9. Bilirubin
  10. Glucose
34
Q

Name 2 or more features of CKD that may be seen in a patient on history/examination?

A
  1. Fluid overload- peripheral oedema, pulmonary oedema, raised JVP
  2. Fatigue
  3. Anorexia
  4. Nausea and vomit
  5. Pruritis
  6. Bone pain
  7. Anaemia - conjunctival pallor
  8. Hypertension
  9. Amenorrhoea
  10. Uraemia- flap/ encephalopathy
35
Q

State 2 or more causes of sterile pyuria (WCC >10 but no UTI).

A
  1. Recently treated UTI
  2. STI eg. Chlamydia
  3. Polycystic kidney disease
  4. Endometriosis
  5. Recent urological procedure
  6. Balanitis
  7. Prostatitis
  8. Renal TB
  9. Renal calculi
  10. Pelvic radiotherapy
36
Q

State 2 or more causes of proteinuria.

A
  1. Glomerulonephritis (nephrotic syndrome)
  2. Diabetes
  3. Amyloidosis
  4. Myeloma
  5. SLE
  6. Infection- post step GN, HBV, HIV
  7. Pre-eclampsia
  8. CKD
37
Q

What can cause ketonuria?

A
  1. DKA

2. Starvation states- low carbohydrate diets, eating disorders

38
Q

What can cause glucosuria?

A
  1. Diabetes
  2. Pregnancy
  3. Sepsis
  4. Proximal renal tubule pathology- Fanconi syndrome, Type 2 renal tubule acidosis
39
Q

Which antibiotic is recommended 1st line for pregnant women with a UTI?

  1. Cefalexin 500mg BD 7 days
  2. Trimethoprim 200mg BD 7 days
  3. Nitrofurantoin 100mg BD 7 days
  4. Nitrofurantoin 100BD BD 3 days
A
  1. Nitrofurantoin 100mg BD 7 days
40
Q

Which UTI antibiotic should be avoided in patients with low renal function (eGFR <45)?

Trimethoprim
Cefalexin
Nitrofurantoin

A

Nitrofurantoin

41
Q

Which UTI antibiotic is most commonly associated with resistance?

Trimethoprim
Nitrofurantoin

A

Trimethoprim

42
Q

How should a child aged <3 months presenting with features of a UTI be managed?

  1. Trimethoprim 200mg BD
  2. Nitrofurantoin 100mg BD
  3. Referral to specialist for IV antibiotics
A
  1. Referral to specialist for IV antibiotics
43
Q

Which antibiotic is recommended as 1st line treatment for pyelonephritis?

  1. Trimethoprim
  2. Penicillin
  3. Cefalexin
A

Cefalexin

Medicine (11 decks)

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