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Year 3 Medicine > Renal > Flashcards

Renal Flashcards

1
Q

What is Hypernatraemia usually caused by?

A

Water Deficit

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2
Q

What can Hypernatraemia lead to?

A

Cellular dehydration
Bleeding
Thrombosis

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3
Q

What are some symptoms of Hypernatraemia?

A 
Thirst
Apathy
Irritability
Weakness
Confusion
Reduced Consciousness
Seizures
Hyperreflexia
Spasticity
Coma
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4
Q

What are the three types of Hypernatraemia?

A

Hypovolaemic Hypernatraemia
Euvolaemic Hypernatraemia
Hypervolaemic Hypernatraemia

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5
Q

What are some renal causes of Hypovolaemic Hypernatraemia?

A

Osmotic Diuresis
Loop diuretics
Renal disease

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6
Q

What are some non-renal causes of Hypovolaemic Hypernatraemia?

A

Sweating
Burns
Diarrhoea
Fistulas

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7
Q

What are some renal causes of Euvolaemic Hypernatraemia?

A

Diabetes Insipidus

Hypodypsia

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8
Q

What are some non-renal causes of Euvolaemic Hypernatraemia?

A

Respiratory losses

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9
Q

What are some causes of Hypernatraemic Hyponatraemia?

A 
Primary Hyperaldosteronism
Cushings
Hypertonic Dialysis
Hypertonic Sodium Bicarbonate
NaCl tablets
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10
Q

What is Diabetes Insipidus?

A

A condition characterised by the production of excessive dilute urine throughout the day

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11
Q

What is the physiological cause of Diabetes Insipidus?

A

Underproduction/Inaction of ADH in the DCT/Collecting Ducts leading to excessive diuresis

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12
Q

What are the two primary causes of Diabetes Insipidus?

A

Neurogenic

Nephrogenic

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13
Q

What are some causes of Neurogenic Diabetes Insipidus?

A

Pituitary Tumours

Head Trauma

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14
Q

What are some causes of Nephrogenic Diabetes Insipidus?

A

Polycystic Kidney disease
Hypokalaemia
Hypercalcaemia

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15
Q

What is a non-physiological cause of Diabetes Insipidus?

A

Psychogenic Polydypsia as a result of mental illness

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16
Q

What are the symptoms of Diabetes Insipidus?

A

Polyuria

Polydypsia

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17
Q

What is the treatment for Hypernatraemia?

A

Free water

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18
Q

What are some symptoms of Hyponatraemia?

A 
Decreased perception and gait disturbance
Yawning
Nausea
Reversible ataxia
Headache
Apathy
Confusion
Seizures
Coma
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19
Q

What are some appropriate investigations for Hyponatraemia?

A 
Plasma osmolality
Urine Sodium 
TSH
Cortisol
Calcium
Albumin
Glucose
LFTs
CT Head/Chest if ?SIADH
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20
Q

What values of Urine Sodium are diagnostically relevant in Hyponatraemia?

A 
<20mmol/L = Non-renal salt losses
>40mmol/L = SIADH
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21
Q

What are some renal causes of Hypovolaemic Hyponatraemia?

A

Diuretics
Osmotic diuresis
Addisons

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22
Q

What are some non-renal causes of Hypovolaemic Hyponatraemia?

A

Diarrhoea
Vomiting
Third space losses

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23
Q

What is the treatment for Hypovolaemic Hyponatraemia?

A 
IV Fluids (0.9% NaCl)
Additional K+ if required
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24
Q

What are some causes of Euvolaemic Hyponatraemia?

A

Hypothyroidism
Primary Polydypsia
Glucocorticoid deficiency
SIADH

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25
Q

How does SIADH present?

A 
Reduced serum osmolality
Inappropriately concentrated urine
Urine Na+ >20mmol/L
Clinical euvolaemia
Not on Diuretics
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26
Q

What is the reccommended management of SIADH?

A

Fluid restriction <800ml/day
PO NaCl
Furosemide if required

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27
Q

What are some causes of Hypervolaemic Hyponatraemia?

A

CCF
Nephrotic syndrome
Liver cirrhosis

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28
Q

What is the management for Hypervolaemic Hyponatraemia?

A

Fluid restriction

Consider furosemide

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29
Q

What can rapid correction of hyponatraemia lead to?

A

Pontine/Osmotic myelinosis

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30
Q

What is the recommended treatment for Acute Hyponatraemia?

A

3% Hypertonic Saline +/- Furosemide

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31
Q

What is the recommended treatment for Chronic Hyponatraemia?

A

Hypertonic saline boluses if having seizures

Isotonic saline and Furosemide if not

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32
Q

What value of serum potassium is considered Hyperkalaemia?

A

K+ >5.5mmol/L

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33
Q

What are some causes of Hyperkalaemia?

A 
CKD with/without Potassium rich diet
Drugs
Hypoaldosteronism
Addison's Disease
Rhabdomyolysis
Tumour lysis
Massive haemolysis
Succinylcholine use
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34
Q

Which drugs are known to cause Hyperkalaemia?

A 
ACE Inhibitors
ARBs
Spironolactone
Amiloride
NSAIDs
LMWH/Heparin
Ciclosporin
High dose Trimethoprim
Digoxin
Beta Blockers
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35
Q

What ECG changes can be seen with Hyperkalaemia?

A 
Tented T Waves
Prolonged QRS
Slurring of ST Segment
Loss of P waves
Asystole
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36
Q

What are the generalised treatment points for Hyperkalaemia?

A
  1. Stabilisation of Myocardium to prevent arrythmias
  2. Movement of Potassium intracellularly
  3. Removal of Potassium from body
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37
Q

How is the myocardium stabilised in Hyperkalaemia?

A

10mls of IV Calcium Gluconate over 5-10 minutes

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38
Q

How does Calcium Gluconate stabilise the myocardium in Hyperkalaemia?

A

Calcium antagonises the effects of Potassium on cardiac cells, reducing the risk of arrhythmia

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39
Q

What is given to move Potassium intracellular in Hyperkalaemia?

A

IV Fast-Acting Insulin (actrapid)
Sodium Bicarbonate if Acidotic
Salbutamol if Insulin is ineffective

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40
Q

How does Insulin drive Potassium intracellularly?

A

Increases activity of Na+-K+-ATPase channels, leading to increased movement of Potassium intracellular.

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41
Q

What is the risk associated with using insulin to treat Hyperkalaemia?

A

Hypoglycaemia

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42
Q

How is the risk of hypoglycaemia when using insulin to treat Hyperkalaemia minimised?

A

Giving Insulin with IV Glucose/Dextrose

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43
Q

How is Potassium removed from the body in Hyperkalaemia treatment?

A

Calcium Resonium - 15-45g PO
Furosemide 20-80mg
Dialysis if unsuccessful

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44
Q

How does Calcium Resonium remove Potassium from the body?

A

Provides Ca2+ ions that are exchanged with intracellular Potassium

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45
Q

What value of Serum Potassium is defined as Hypokalaemia?

A

K+ <3.5mmol/L

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46
Q

What are some causes of Hypokalaemia?

A 
Pseudohypokalaemia - Leukaemia
Extra-Renal losses
Redistribution - Insulin, caffeine
Refeeding syndrome
Alkalosis
Vigorous exercise
Glue sniffing
Conn's Syndrome
Cushing's 
Renal Losses
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47
Q

What are some extra-renal sources of Potassium loss in Hypokalaemia?

A

Inadequate intake

GI losses

48
Q

What are some renal sources of Potassium loss in Hypokalaemia?

A

Diuretics
Tubulopathies
Liquorice
Glucocorticoids

49
Q

What are some symptoms of Hypokalaemia?

A 
Fatigue
Constipation
Proximal muscle weakness
Paralysis
Cardiac arrhythmias
Worsened Glucose control in diabetics
Hypertension
50
Q

What ECG changes can be seen in Hypokalaemia?

A

Small T Waves
U waves after R
Increased PR interval

51
Q

What is the recommended treatment for Hypokalaemia?

A

Replace Magnesium
Oral K+ Replacement
IV K+ Replacement - Added to 0.9% NaCl not Dextrose

52
Q

What is AKI?

A

Clinical syndrome that presents with an abrupt decline in GFR

53
Q

What are some risk factors for AKI?

A 
Diabetes
CKD
IHD/CCF
Age >75
Sepsis
Medications
54
Q

Which medications carry a risk of AKI?

A

ACE Inhibitors
ARBs
NSAIDs
Abx

55
Q

What defines Stage 1 AKI?

A

Serum Creatinine 1.5-1.9x baseline

Urine Output <0.5ml/kg/h for 6-12h

56
Q

What defines Stage 2 AKI?

A

Serum Creatinine 2.0-2.9x baseline

Urine Output <0.5ml/kg/h for >12h

57
Q

What defines Stage 3 AKI?

A

Serum Creatinine 3x baseline

Urine Output <0.3ml/kg/h for >24h or Anuria >12h

58
Q

How can causes of AKI be classified?

A

Pre-Renal
Renal
Post-Renal

59
Q

What are some Pre-Renal causes of AKI?

A

Hypovolaemia
Reduced CO
Reduced Circulating Volume
Impaired Renal Autoregulation

60
Q

What are some Renal causes of AKI?

A 
Glomerular Pathologies
Vascular pathologies
Ischaemia
Sepsis
Infections
Nephrotoxins
61
Q

What are some Post-Renal causes of AKI?

A

Bladder Outlet Obstruction

Pelvicoureteral Obstruction

62
Q

What investigations are appropriate with AKI?

A 
Dipstick - ?Haematuria/Proteinuria
Daily FBC, U+E,LFT,Bone Profile, CRP
CK if ?Rhabdomyolysis
Urine MSU
USS KUB
63
Q

If the Dipstick for AKI is +ve for Haematuria/Proteinuria, which extra tests may be appropriate?

A

cANCA and pANCA - ?Vasculitis
anti-GBM, ANA, C3, C4 - ?Lupus
Serum Immunoglobulins - ?Myeloma

64
Q

What are some appropriate management steps with AKI?

A 
Ensure volume status and perfusion pressure
Fluids if depleted, diuretics if overloaded
Consider third space losses
Consider a CVP line
Monitor input/output
Treat underlying cause
Refer for ?Renal Replacement Therapy
Consider ICU Admission
65
Q

What are indications for renal replacement therapy in AKI?

A 
Hyperkalaemia after therapy
Metabolic acidosis after therapy
Fluid overload after diuretics
Uraemic Pericarditis
Uraemic Encephalopathy
Signs of intoxication
66
Q

What causes Nephrotic Syndromes?

A

Damage to glomeruli

67
Q

How do Nephrotic Syndromes present?

A

Oedema
Proteinuria >3.5g/day
Hypoalbuminaemia <30
Hypercholesterolaemia

68
Q

What are some causes of Nephrotic Syndromes?

A

Minimal Change Disease
Focal Segmental Glomerulosclerosis
Membranous Nephropathy

69
Q

What is Minimal Change Disease?

A

A disease most common in children
Fusion of Podocytes
Can be idiopathic, or caused by drugs e.g. NSAIDs, Abx

70
Q

What is Focal Segmental Glomerulosclerosis?

A

A circulating factor increases glomerular permeability

Can be second to drugs, infection, malignancy

71
Q

What is Membranous Nephropathy?

A

Immune complexes form in the Glomerulus.
Primarily idiopathic
Can be second to infection, malignancy, drugs

72
Q

What are some common complications of Nephrotic syndromes?

A 
Higher risk of infection
VTE
Progression to CKD
Hypertension
Hyperlipidaemia
73
Q

What are Nephritic Syndromes?

A

Collection of signs and symptoms seen due to inflammation of the kidneys

74
Q

How do Nephritic Syndromes present?

A

AKI
Visible Haematuria
Oedema
Hypertension

75
Q

What are some causes of Nephritic Syndrome?

A 
Post-Infectious Glomerulonephritis
IgA Nephropathy
Small Vessel Vasculitis (ANCA)
Anti-GBM Disease (Goodpastures)
Thin Basement Membrane Disease
Alport Syndrome
Lupus Nephritis
76
Q

What is Post-Infectious Glomerulonephritis?

A

Immune complex deposition in glomerulus leading to haematuria weeks after a Group A Strep infection.

Treat through supportive management

77
Q

What is IgA Nephropathy?

A

Most common idiopathic glomerulonephritis

Presents with Mesangial immune complex depositions in glomerulus

78
Q

What is Small Vessel (ANCA) Vasculitis?

A

Glomerulonephritis that presents systemically with some respiratory symptoms.

Treat through immunosuppression

79
Q

What is Anti-GBM (Goodpastures) Disease?

A

Glomerulonephritis due to production of Anti-GBM antibodies.

Treat through immunosuppression

80
Q

What is Thin Basement Membrane disease?

A

Glomerulonephritis due to hereditary abnormalities of Type IV Collagen.

81
Q

What is Alport Syndrome?

A

Glomerulonephritis due to an X-linked mutation in Type V Collagen

82
Q

What are generalised management points for confirmed Glomerulonephritis?

A 
Discuss with Renal
ACEi/ARB for Proteinuria
Control BP
Salt/Water restriction
Diuretics if overloaded
Statins for Hypercholesterolaemia
83
Q

What is Peritoneal Dialysis?

A

Home-based dialysis which uses the patients’ peritoneal membrane as the dialysis machine

84
Q

How does Peritoneal Dialysis work?

A

Solutes move from the patients’ blood across the peritoneal membrane down the concentration gradient into the dialysate fluid.

85
Q

How is the Osmotic Gradient created in Peritoneal Dialysis?

A

Due to the high Glucose content of the Dialysate fluid

86
Q

What are some advantages to Peritoneal Dialysis?

A

Quality of Life
Excellent first choice for patients starting dialysis
Individualised treatment

87
Q

What are some disadvantages to Peritoneal Dialysis?

A

Pts must manage technical aspects
Unsuitable if previous stoma/abdo surgery
Carries risk of PD Peritonitis

88
Q

What are some potential complications of Peritoneal Dialysis?

A

Leaks
Herniae
Hydrocoele

89
Q

What options are there for Peritoneal Dialysis?

A

Automated
Continuous Ambulatory
Assisted Automated

90
Q

How does Automated Peritoneal Dialysis work?

A

Automated cycler machine exchanges 10-12L overnight, leaving daytime free

91
Q

How does Continuous Ambulatory Peritoneal Dialysis work?

A

4-5 Dialysis exchanges a day

92
Q

How does Assisted Automated Peritoneal Dialysis work?

A

Healthcare assistants visit the patient at home to assist with setup

93
Q

How does Haemodialysis work?

A

Dialysis machine pumps blood from the patient through a dialyser (artificial kidney)

Waste solute, salt and excess fluid is removed from the blood

94
Q

What are some advantages of Haemodialysis?

A

Efficient

Able to offer unit-based support

95
Q

What are some disadvantages of Haemodialysis?

A 
Needs access
Risk of infection/bacteraemia
Haemodynamic instability
Risk of bleeding
Risk of anaemia
96
Q

What options are available for Haemodialysis?

A

Home HD
Nocturnal HD
Continous Renal Replacement Therapy - Primarily HDU/ITU

97
Q

When should patients with ESRD not be offered renal replacement therapy?

A

If they are aged 80 or over

OR

WHO Performance score >3

98
Q

What is Chronic Kidney disease?

A

The presence of kidney damage, manifested by abnormal albumin excretion or decreased kidney function, quantified by measured or estimated GFR that persists for more than 3 months

99
Q

What are some causes of CKD?

A 
Diabetes
Hypertension
Glomerulonephritis
Renovascular disease
Polycystic Kidney disease
Obstructive Nephropathy 
Chronic/Recurrent Pyeloneprhitis
100
Q

What are some complications of CKD?

A 
Anaemia of CKD
Mineral Bone Disease
Secondary and Tertiary Hyperparathyroidism
Hypertension
CV Disease
Malnutrition
Dyslipidaemia
101
Q

As CKD progresses, what can it lead to?

A 
Electrolyte disturbances
Fluid overload
Metabolic acidosis
Uraemic Pericarditis
Uraemic Encephalopathy
102
Q

What are some generalised treatment options for CKD?

A 
Treat underlying disease (cause)
Reduce CV risk
Reduce Progression of CKD
Treat Complications
Plan for the Future
103
Q

How is Diabetic Nephropathy diagnosed?

A

Raised Urine Albumine:Creatinine ratio
Evidence of long standing/poorly controlled DM
Evidence of other Microvascular disease

104
Q

What is the treatment for Diabetic Nephropathy?

A

ACE/ARB for Proteinuria
Antihypertensive for BP Control
CV Risk reduction

105
Q

What is Hypertensive Nephropathy?

A

Chronic hypertension leads to Nephrosclerosis, giving CKD

106
Q

What investigations are appropriate with suspected Hypertensive Nephropathy?

A 
24h Urinary Metanephrines
Aldosterone:Renin ratio
Cortisol and Dexamethasone suppression
TSH
MRI - ?Renal artery stenosis
107
Q

What management is recommended for Hypertensive Nephropathy?`

A

Anti-hypertensives

108
Q

What causes Type 1 Polycystic Kidney Disease?

A

PKD1 Mutation on Chromosome 16

109
Q

What causes Type 2 Polycystic Kidney Disease?

A

PKD2 Mutation on Chromosome 4

110
Q

How is Polycystic Kidney disease diagnosed?

A

USS

Family Hx

111
Q

Why does CKD lead to anaemia?

A 
Decreased EPO production by kidney
Absolute/Functional iron deficiency
Blood loss
Shortened RBC survival
Bone marrow suppression due to uraemia
Deficiency of B12/Folate
112
Q

What should be measured in anaemia due to CKD?

A 
Haematinics:
B12
Folate
Ferritin
Iron
Transferrin saturation
113
Q

What are some contra-indications for a Kidney Transplant?

A 
Active infection/malignancy
Severe heart/lung disease
Reversible renal disease
Uncontrolled substance abuse
Psychiatric illness
Ongoing treatment non-adherence
Short life expectancy
114
Q

What are the possible sources of donor Kidneys?

A

Living Related Donor
Living Unrelated Donor
Deceased Donor

115
Q

Which immunosuppressants are required once Kidney Transplantation is complete?

A

Induction - Methylprednisolone, Basiluximab, Thymoglobulin

Maintenance - Steroids, Calcineurin Inhibitors, Antimetabolites, Rapamycin inhibitors

116
Q

What long-term care is appropriate with Kidney transplants?

A

Initial regular F/U
Monitor GFR, Proteinuria, Ca,Phosphate and PTH
Screen for infections
Vaccinate
Monitor CV
Screen for malignancies
Contraception is mandatory for first year post transplant

Year 3 Medicine (8 decks)

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