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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
How does SIADH present?
``` Reduced serum osmolality Inappropriately concentrated urine Urine Na+ >20mmol/L Clinical euvolaemia Not on Diuretics ```
26
What is the reccommended management of SIADH?
Fluid restriction <800ml/day PO NaCl Furosemide if required
27
What are some causes of Hypervolaemic Hyponatraemia?
CCF Nephrotic syndrome Liver cirrhosis
28
What is the management for Hypervolaemic Hyponatraemia?
Fluid restriction | Consider furosemide
29
What can rapid correction of hyponatraemia lead to?
Pontine/Osmotic myelinosis
30
What is the recommended treatment for Acute Hyponatraemia?
3% Hypertonic Saline +/- Furosemide
31
What is the recommended treatment for Chronic Hyponatraemia?
Hypertonic saline boluses if having seizures | Isotonic saline and Furosemide if not
32
What value of serum potassium is considered Hyperkalaemia?
K+ >5.5mmol/L
33
What are some causes of Hyperkalaemia?
``` CKD with/without Potassium rich diet Drugs Hypoaldosteronism Addison's Disease Rhabdomyolysis Tumour lysis Massive haemolysis Succinylcholine use ```
34
Which drugs are known to cause Hyperkalaemia?
``` ACE Inhibitors ARBs Spironolactone Amiloride NSAIDs LMWH/Heparin Ciclosporin High dose Trimethoprim Digoxin Beta Blockers ```
35
What ECG changes can be seen with Hyperkalaemia?
``` Tented T Waves Prolonged QRS Slurring of ST Segment Loss of P waves Asystole ```
36
What are the generalised treatment points for Hyperkalaemia?
1. Stabilisation of Myocardium to prevent arrythmias 2. Movement of Potassium intracellularly 3. Removal of Potassium from body
37
How is the myocardium stabilised in Hyperkalaemia?
10mls of IV Calcium Gluconate over 5-10 minutes
38
How does Calcium Gluconate stabilise the myocardium in Hyperkalaemia?
Calcium antagonises the effects of Potassium on cardiac cells, reducing the risk of arrhythmia
39
What is given to move Potassium intracellular in Hyperkalaemia?
IV Fast-Acting Insulin (actrapid) Sodium Bicarbonate if Acidotic Salbutamol if Insulin is ineffective
40
How does Insulin drive Potassium intracellularly?
Increases activity of Na+-K+-ATPase channels, leading to increased movement of Potassium intracellular.
41
What is the risk associated with using insulin to treat Hyperkalaemia?
Hypoglycaemia
42
How is the risk of hypoglycaemia when using insulin to treat Hyperkalaemia minimised?
Giving Insulin with IV Glucose/Dextrose
43
How is Potassium removed from the body in Hyperkalaemia treatment?
Calcium Resonium - 15-45g PO Furosemide 20-80mg Dialysis if unsuccessful
44
How does Calcium Resonium remove Potassium from the body?
Provides Ca2+ ions that are exchanged with intracellular Potassium
45
What value of Serum Potassium is defined as Hypokalaemia?
K+ <3.5mmol/L
46
What are some causes of Hypokalaemia?
``` Pseudohypokalaemia - Leukaemia Extra-Renal losses Redistribution - Insulin, caffeine Refeeding syndrome Alkalosis Vigorous exercise Glue sniffing Conn's Syndrome Cushing's Renal Losses ```
47
What are some extra-renal sources of Potassium loss in Hypokalaemia?
Inadequate intake | GI losses
48
What are some renal sources of Potassium loss in Hypokalaemia?
Diuretics Tubulopathies Liquorice Glucocorticoids
49
What are some symptoms of Hypokalaemia?
``` Fatigue Constipation Proximal muscle weakness Paralysis Cardiac arrhythmias Worsened Glucose control in diabetics Hypertension ```
50
What ECG changes can be seen in Hypokalaemia?
Small T Waves U waves after R Increased PR interval
51
What is the recommended treatment for Hypokalaemia?
Replace Magnesium Oral K+ Replacement IV K+ Replacement - Added to 0.9% NaCl not Dextrose
52
What is AKI?
Clinical syndrome that presents with an abrupt decline in GFR
53
What are some risk factors for AKI?
``` Diabetes CKD IHD/CCF Age >75 Sepsis Medications ```
54
Which medications carry a risk of AKI?
ACE Inhibitors ARBs NSAIDs Abx
55
What defines Stage 1 AKI?
Serum Creatinine 1.5-1.9x baseline | Urine Output <0.5ml/kg/h for 6-12h
56
What defines Stage 2 AKI?
Serum Creatinine 2.0-2.9x baseline | Urine Output <0.5ml/kg/h for >12h
57
What defines Stage 3 AKI?
Serum Creatinine 3x baseline | Urine Output <0.3ml/kg/h for >24h or Anuria >12h
58
How can causes of AKI be classified?
Pre-Renal Renal Post-Renal
59
What are some Pre-Renal causes of AKI?
Hypovolaemia Reduced CO Reduced Circulating Volume Impaired Renal Autoregulation
60
What are some Renal causes of AKI?
``` Glomerular Pathologies Vascular pathologies Ischaemia Sepsis Infections Nephrotoxins ```
61
What are some Post-Renal causes of AKI?
Bladder Outlet Obstruction | Pelvicoureteral Obstruction
62
What investigations are appropriate with AKI?
``` Dipstick - ?Haematuria/Proteinuria Daily FBC, U+E,LFT,Bone Profile, CRP CK if ?Rhabdomyolysis Urine MSU USS KUB ```
63
If the Dipstick for AKI is +ve for Haematuria/Proteinuria, which extra tests may be appropriate?
cANCA and pANCA - ?Vasculitis anti-GBM, ANA, C3, C4 - ?Lupus Serum Immunoglobulins - ?Myeloma
64
What are some appropriate management steps with AKI?
``` 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
What are indications for renal replacement therapy in AKI?
``` Hyperkalaemia after therapy Metabolic acidosis after therapy Fluid overload after diuretics Uraemic Pericarditis Uraemic Encephalopathy Signs of intoxication ```
66
What causes Nephrotic Syndromes?
Damage to glomeruli
67
How do Nephrotic Syndromes present?
Oedema Proteinuria >3.5g/day Hypoalbuminaemia <30 Hypercholesterolaemia
68
What are some causes of Nephrotic Syndromes?
Minimal Change Disease Focal Segmental Glomerulosclerosis Membranous Nephropathy
69
What is Minimal Change Disease?
A disease most common in children Fusion of Podocytes Can be idiopathic, or caused by drugs e.g. NSAIDs, Abx
70
What is Focal Segmental Glomerulosclerosis?
A circulating factor increases glomerular permeability | Can be second to drugs, infection, malignancy
71
What is Membranous Nephropathy?
Immune complexes form in the Glomerulus. Primarily idiopathic Can be second to infection, malignancy, drugs
72
What are some common complications of Nephrotic syndromes?
``` Higher risk of infection VTE Progression to CKD Hypertension Hyperlipidaemia ```
73
What are Nephritic Syndromes?
Collection of signs and symptoms seen due to inflammation of the kidneys
74
How do Nephritic Syndromes present?
AKI Visible Haematuria Oedema Hypertension
75
What are some causes of Nephritic Syndrome?
``` Post-Infectious Glomerulonephritis IgA Nephropathy Small Vessel Vasculitis (ANCA) Anti-GBM Disease (Goodpastures) Thin Basement Membrane Disease Alport Syndrome Lupus Nephritis ```
76
What is Post-Infectious Glomerulonephritis?
Immune complex deposition in glomerulus leading to haematuria weeks after a Group A Strep infection. Treat through supportive management
77
What is IgA Nephropathy?
Most common idiopathic glomerulonephritis Presents with Mesangial immune complex depositions in glomerulus
78
What is Small Vessel (ANCA) Vasculitis?
Glomerulonephritis that presents systemically with some respiratory symptoms. Treat through immunosuppression
79
What is Anti-GBM (Goodpastures) Disease?
Glomerulonephritis due to production of Anti-GBM antibodies. Treat through immunosuppression
80
What is Thin Basement Membrane disease?
Glomerulonephritis due to hereditary abnormalities of Type IV Collagen.
81
What is Alport Syndrome?
Glomerulonephritis due to an X-linked mutation in Type V Collagen
82
What are generalised management points for confirmed Glomerulonephritis?
``` Discuss with Renal ACEi/ARB for Proteinuria Control BP Salt/Water restriction Diuretics if overloaded Statins for Hypercholesterolaemia ```
83
What is Peritoneal Dialysis?
Home-based dialysis which uses the patients' peritoneal membrane as the dialysis machine
84
How does Peritoneal Dialysis work?
Solutes move from the patients' blood across the peritoneal membrane down the concentration gradient into the dialysate fluid.
85
How is the Osmotic Gradient created in Peritoneal Dialysis?
Due to the high Glucose content of the Dialysate fluid
86
What are some advantages to Peritoneal Dialysis?
Quality of Life Excellent first choice for patients starting dialysis Individualised treatment
87
What are some disadvantages to Peritoneal Dialysis?
Pts must manage technical aspects Unsuitable if previous stoma/abdo surgery Carries risk of PD Peritonitis
88
What are some potential complications of Peritoneal Dialysis?
Leaks Herniae Hydrocoele
89
What options are there for Peritoneal Dialysis?
Automated Continuous Ambulatory Assisted Automated
90
How does Automated Peritoneal Dialysis work?
Automated cycler machine exchanges 10-12L overnight, leaving daytime free
91
How does Continuous Ambulatory Peritoneal Dialysis work?
4-5 Dialysis exchanges a day
92
How does Assisted Automated Peritoneal Dialysis work?
Healthcare assistants visit the patient at home to assist with setup
93
How does Haemodialysis work?
Dialysis machine pumps blood from the patient through a dialyser (artificial kidney) Waste solute, salt and excess fluid is removed from the blood
94
What are some advantages of Haemodialysis?
Efficient | Able to offer unit-based support
95
What are some disadvantages of Haemodialysis?
``` Needs access Risk of infection/bacteraemia Haemodynamic instability Risk of bleeding Risk of anaemia ```
96
What options are available for Haemodialysis?
Home HD Nocturnal HD Continous Renal Replacement Therapy - Primarily HDU/ITU
97
When should patients with ESRD not be offered renal replacement therapy?
If they are aged 80 or over OR WHO Performance score >3
98
What is Chronic Kidney disease?
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
What are some causes of CKD?
``` Diabetes Hypertension Glomerulonephritis Renovascular disease Polycystic Kidney disease Obstructive Nephropathy Chronic/Recurrent Pyeloneprhitis ```
100
What are some complications of CKD?
``` Anaemia of CKD Mineral Bone Disease Secondary and Tertiary Hyperparathyroidism Hypertension CV Disease Malnutrition Dyslipidaemia ```
101
As CKD progresses, what can it lead to?
``` Electrolyte disturbances Fluid overload Metabolic acidosis Uraemic Pericarditis Uraemic Encephalopathy ```
102
What are some generalised treatment options for CKD?
``` Treat underlying disease (cause) Reduce CV risk Reduce Progression of CKD Treat Complications Plan for the Future ```
103
How is Diabetic Nephropathy diagnosed?
Raised Urine Albumine:Creatinine ratio Evidence of long standing/poorly controlled DM Evidence of other Microvascular disease
104
What is the treatment for Diabetic Nephropathy?
ACE/ARB for Proteinuria Antihypertensive for BP Control CV Risk reduction
105
What is Hypertensive Nephropathy?
Chronic hypertension leads to Nephrosclerosis, giving CKD
106
What investigations are appropriate with suspected Hypertensive Nephropathy?
``` 24h Urinary Metanephrines Aldosterone:Renin ratio Cortisol and Dexamethasone suppression TSH MRI - ?Renal artery stenosis ```
107
What management is recommended for Hypertensive Nephropathy?`
Anti-hypertensives
108
What causes Type 1 Polycystic Kidney Disease?
PKD1 Mutation on Chromosome 16
109
What causes Type 2 Polycystic Kidney Disease?
PKD2 Mutation on Chromosome 4
110
How is Polycystic Kidney disease diagnosed?
USS | Family Hx
111
Why does CKD lead to anaemia?
``` 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
What should be measured in anaemia due to CKD?
``` Haematinics: B12 Folate Ferritin Iron Transferrin saturation ```
113
What are some contra-indications for a Kidney Transplant?
``` Active infection/malignancy Severe heart/lung disease Reversible renal disease Uncontrolled substance abuse Psychiatric illness Ongoing treatment non-adherence Short life expectancy ```
114
What are the possible sources of donor Kidneys?
Living Related Donor Living Unrelated Donor Deceased Donor
115
Which immunosuppressants are required once Kidney Transplantation is complete?
Induction - Methylprednisolone, Basiluximab, Thymoglobulin | Maintenance - Steroids, Calcineurin Inhibitors, Antimetabolites, Rapamycin inhibitors
116
What long-term care is appropriate with Kidney transplants?
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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