Renal Flashcards
State 4 or more risk factors for patients getting AKI.
- CKD (especially if eGFR below 60)
- Other chronic disease- heart failure, liver disease, diabetes
- Hypovolaemia
- Age over 65
- Iodine contrast agent in past week
- Drugs- NSAIDs, ACEIs, ARBS, Aminoglycosides
- Neurological or cognitive impairment
- Oliguria (output below 0.5ml/kg/hr)
- Sepsis
- Deteriorating Early Warning Score
- Past history of AKI
What do NICE recommend measuring in patients with a recognised risk factor for AKI?
eGFR
Serum Urea
Serum Creatinine
Urinary Creatinine
Serum creatinine
and compare to baseline
Which of the following increases a patients risk of AKI?
- CT scan with iodine contrast 3 weeks ago
- Gentamicin
- Urine output of 0.6ml/kg/hr
- MEWS score of 3
Gentamicin
Iodine contrast in the past 1 week, urine output below 0.5ml/kg/hr and DETERIORATING Mews score increase risk
Which 2 investigations/ tests are used to detect AKI in adults?
- Serum creatinine and urea
- Serum urea and eGFR
- Serum creatinine and urine output
- Urine output and USS
Serum creatinine
and
Urine output
Name 2 or more complications of AKI.
- Fluid overload (pulomary oedema)
- Hyperkaelamia (arrythmias)
- Metabolic acidosis
- Uraemia (pericarditis and encephalopathy)
Calcium gluconate is used to manage which complication of AKI?
Hyperkalaemia
Sodium bicarbonate is used to manage which complication of AKI?
Metabolic acidosis
What are the 2 most common causes of CKD?
Diabetes
Hypertension
Other than diabetes and hypertension, state 2 or more causes of CKD.
- Polycystic kidney disease
- Glomerulo nephrotic/ nephritic syndromes
- Chronic pyelonephritis
- Long term NSAID use
Which 2 tests should be used to diagnose CKD?
- eGFR and urinalysis
- Serum creatinine and eGFR
- eGFR and urine ACR
- eGFR and urine ACR
Which 4 patient variables are used in calculating eGFR?
- Age
- Gender
- Ethnicity
- Serum creatinine
Which blood tests should be done to investigate a patient with haematuria/ proteinuria, to identify the cause of glomerular/ systemic disease?
- Immunology- ANA, ANCA, Anti GBM, Paraprotein
2. Serology- BBV, blood cultures, ASOT (for Strep)
Name 2 or more classes of drug used for immunosuppression in renal transplant patients.
- Monoclonal antibodies eg. Daclizumab
- Calcineurin inhibitors eg. Tacrolimus, Ciclosporin
- Antimetabolites eg. Mycophenolate, Azathioprine
- Steroids
Acute graft failure occurs within ___ months of renal transplant.
6 months
State 4 or more causes of CKD.
- Diabetes
- Hypertension
- Vasculitis
- SLE
- Glomerulonephritis
- Genetic eg. Alport syndrome, Polycystic kidney disease
- Drugs- NSAIDs, Calcineurin inhibitors
- Obstruction- stones, tumours, BPH, fibrosis
- Infection- HBV, HCV, HIV
- Atherosclerosis
Alport syndrome is an X linked inherited disorder that affects the kidneys and which 2 other organs?
- Ears - sensorineural deafness
2. Eyes- anterior lenticonus and retiniti pigmentosa
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
Tacrolimus
Which of these immunosuppressive drugs can cause side effects including tremor, nephrotoxicity, diabetes and neurotoxicity?
Prednisolone
Mycophenolate
Azathioprine
Tacrolimus
Tacrolimus
Fanconi syndrome is a disorder of which part of the nephron?
Loop of Henle
DCT
PCT
Collecting duct
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.
Type 2 Renal tubular acidosis is a disorder of which part of the nephron?
Loop of Henle
DCT
PCT
Collecting duct
PCT
Which class of diuretics can cause side effects including gynaecomastia, testicular atrophy, metabolic acidosis and hyperkalaemia?
Loop diuretics
Thiazide diuretics
Potassium sparing diuretics
Potassium sparing diuretics eg Spironalactone
Which class of diuretics can cause side effects including metabolic alkalosis, gout and hyperglycaemia?
Loop diuretics
Thiazide diuretics
Potassium sparing diuretics
Thiazide diuretics
Which class of diuretics is used for glaucoma?
Carbonic anhydrase inhibitors
Name 4 or more drugs which are nephrotoxic.
- NSAIDs
- Antimicrobials- Aminoglycosides (Gentamicin), Sulfamethoxazole (in Co-Trimoxazole), Penicillin, Rifampicin
- Anti-epileptics- Phenytoin, Lamotrigine, Sodium Valproate
- Lithium
- PPIs
- Furosemide
- Iron
- Calcineurin inhibitors eg. Tacrolimus, Cyclosporin
- ACEIs, ARBs
Other than drugs, name 2 or more nephrotoxic substances.
- Microbes eg. Bacteria, viruses and parasites
- Radiocontrast dye
- Haemoglobin in haemolysis
- Light chains
- Myoglobin in rhabdomyolysis
- Immunoglobulins in myeloma
- Urate crystals
Name 4 or more causes of HIGH anion gap metabolic acidosis.
Methanol Uraemia (renal failure) Diabetic Ketoacidosis Propylene glycol Iron, Isoniazid Lactic Acidosis Ethanol, Ethylene glycol Salicylates/ aspirin
Name 2 or more causes of NORMAL anion gap metabolic acidosis.
- GI losses- Diarrhoea, Pancreatic fistula, ileostomy, ureterosigmoidostomy
- Addison’s (Hypoaldosteronism)
- Renal tubular acidosis
- Drugs- Acetazolamide
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
Acute interstitial nephritis
Name 2 or more causes of metabolic alkalosis.
- Primary hyperaldosteronism- Conn’s
- Diarrhoea
- Vomitting
- Diuretics- Loop and Thiazide
- Cushing’s syndrome
- Burns
- Hypokalaemia
- Bartter’s syndrome
Which classes of diuretic drug can cause metabolic ACIDOSIS as side effects?
- Carbonic anhydrase inhibitors eg. Acetazolamide
2. Potassium sparing diuretics eg. Spironalactone
Which classes of diuretic drug can cause metabolic ALKALOSIS as side effects?
- Loop diuretics
2. Thiazide diuretics
Which condition may present with muscle pain, AKI, serum hyperkalaemia and hyperphosphataemia?
- Acute tubular necrosis
- Rhabdomyolisis
- Diabetic nephropathy
Rhabdomyolysis
What is tested for on a urine dipstick?
- Leukocytes
- Nitrites
- Urobilinogen
- Protein
- pH
- Blood
- Specific gravity
- Ketones
- Bilirubin
- Glucose
Name 2 or more features of CKD that may be seen in a patient on history/examination?
- Fluid overload- peripheral oedema, pulmonary oedema, raised JVP
- Fatigue
- Anorexia
- Nausea and vomit
- Pruritis
- Bone pain
- Anaemia - conjunctival pallor
- Hypertension
- Amenorrhoea
- Uraemia- flap/ encephalopathy
State 2 or more causes of sterile pyuria (WCC >10 but no UTI).
- Recently treated UTI
- STI eg. Chlamydia
- Polycystic kidney disease
- Endometriosis
- Recent urological procedure
- Balanitis
- Prostatitis
- Renal TB
- Renal calculi
- Pelvic radiotherapy
State 2 or more causes of proteinuria.
- Glomerulonephritis (nephrotic syndrome)
- Diabetes
- Amyloidosis
- Myeloma
- SLE
- Infection- post step GN, HBV, HIV
- Pre-eclampsia
- CKD
What can cause ketonuria?
- DKA
2. Starvation states- low carbohydrate diets, eating disorders
What can cause glucosuria?
- Diabetes
- Pregnancy
- Sepsis
- Proximal renal tubule pathology- Fanconi syndrome, Type 2 renal tubule acidosis
Which antibiotic is recommended 1st line for pregnant women with a UTI?
- Cefalexin 500mg BD 7 days
- Trimethoprim 200mg BD 7 days
- Nitrofurantoin 100mg BD 7 days
- Nitrofurantoin 100BD BD 3 days
- Nitrofurantoin 100mg BD 7 days
Which UTI antibiotic should be avoided in patients with low renal function (eGFR <45)?
Trimethoprim
Cefalexin
Nitrofurantoin
Nitrofurantoin
Which UTI antibiotic is most commonly associated with resistance?
Trimethoprim
Nitrofurantoin
Trimethoprim
How should a child aged <3 months presenting with features of a UTI be managed?
- Trimethoprim 200mg BD
- Nitrofurantoin 100mg BD
- Referral to specialist for IV antibiotics
- Referral to specialist for IV antibiotics
Which antibiotic is recommended as 1st line treatment for pyelonephritis?
- Trimethoprim
- Penicillin
- Cefalexin
Cefalexin
