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Medicine > Renal > Flashcards

Renal Flashcards

0
Q

Non-drug causes of ATN

A
  1. Infections: “BLeSS”
    Brucella, leptospirosis, staph, strep
  2. Immune: SLE and Glomerulonephrites
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1
Q

Drug causes of Acute Tubulointerstitial NEPHRITIS

A
  1. NSAIDs
  2. Antibiotics: “CRPS” =
    Cephalosporins, Rifampicin, Penicillin, Sulphonamides (?via formation of crystals and block the tubules)
  3. Diuretics: furosemide and thiazides.
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2
Q

Acute Tubulointerstitial Nephritis (acute TIN)

  1. Clinical features
  2. Management
A
  1. Rash, fever, systemic illnesses. EOSINOPHILIA and raised IgE. Also eosinophils in the urine
  2. Prednisolone
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3
Q

Commonest organism in UTI:

  1. Generally - multi organism or not?
  2. Post-instrumentation
  3. Honeymoon UTI
A
  1. E.coli
  2. Proteus spp
  3. Staph. Saprophyticus
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4
Q

DVT management

A

5/7 of LMWH subcutaneously, and introduce warfarin during this time.
Maintain LMWH until INR is >2..

If severe renal failure, use unfractionated heparin (UFH) IV for better control of plasma levels.

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5
Q

What to give to reverse unfractionated heparin

A

Protamine sulphate

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6
Q

Renal vein thrombosis

  1. Causes
  2. Symptoms
  3. Investigation
  4. Management
A
  1. Usually post-nephrotic syndrome (due to hypercoagulable state), especially Membranous Glomerulonephritis
    Renal Cell Carcinoma
  2. Sudden onset loin pain and renal function deterioration, may get PE, Haematuria, (palpable kidney)
  3. CT or MR. (Venography less sensitive)
  4. Anticoagulate with warfarin for 3-6/12
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7
Q

Renal artery stenosis

  1. Clinical features
  2. Investigations
  3. Management
A
  1. Uncontrollable HTN, worsened renal function with ACEi and ARBs.
    Flash pulmonary oedemaS, normal LVF on echo.
    Small kidney
    Weak other pulses (+bruit)
  2. Renal angio is gold standard, if nothing shows up on CT/MR. Also Doppler.
  3. Comprehensive drug regimens…
    Angioplasty
    Stent
    Revascularisation surgery
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8
Q

Complications of nephrotic syndrome

A

“LIT”

Lipids high
Infections
Thrombi

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9
Q

Management of Membranous glomerulonephropathy

A

Fluid restrict…

Steroids and cyclophosphamide

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10
Q

Causes of Membranous Glomerulonephritis

A

Malignancies
Drugs (gold, penicillamine, captopril)
Infections: HEPATITIS B, Syphilis,
Autoimmune: rheumatoid arthritis, SLE, thyroid disease

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11
Q

Management of Nephrotic Syndrome

A
  1. Fluid restrict
  2. Diuretic (furosemide, can also give spironolactone)
  3. ACEI or A2A reduces proteinuria (? Reduces GFR)
  4. Treat underlying cause
  5. Maintain normal nutrition
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12
Q

Acute renal failure management

A
  1. ABC approach, and correct the pre- and post-renal problems, as well treat exacerbating factors
  2. Arrange urgent USS and senior help
  3. Stop nephrotoxic drugs, and Metformin
  4. Complications
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13
Q

Indications for acute dialysis

A
  1. Pulmonary oedema refractory to medical treatment
  2. Uraemic pericarditis or encephalopathy
  3. Severe acidosis (metabolic)
  4. Hyperkalaemia
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14
Q

Complications of peritoneal dialysis

A

Peritonitis (>60% Staph infection, then G-ves)
Port exit site infection

OBESITY - raises lipids in patients already hyperlipidaemia

Catheter malfunction
Membrane dysfunction

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15
Q

Complications of Dialysis

A

Cardiovascular:
- IHD/heart failure/strokes etc. - Main cause of mortality
- Anaemia
- Bleeding tendency (give desmopressin in acute setting)
Malnutrition
Renal bone disease in CRF

Infection (granulocyte dysfunction due to uraemia)

AMYLOIDOSIS (beta-microglobulin), causing CTS, arthralgia etc.

Acquired renal cysts
Malignancies

16
Q

Acute rejection features and Treatment

A

<6/12 after transplant
Rising creatinine
Fever, graft site pain
(Tubular damage)

Mx= methylprednisolone

17
Q

Chronic rejection features and treatment

A

> 6/12 “interstitial fibrosis plus tubular atrophy” (IFTA, vascular changes also seen)
Gradual increase creatinine and proteinuria.

Unresponsive to increased immunosuppression

18
Q

Alpert syndrome

  1. Aetiology
  2. Clinical features
  3. Management
A
  1. X-linked condition, missing goodpastures antigen
  2. Haematuria, proteinuria, progressive renal failure
    Extra-renal manifestations: sensorineural hearing loss, ocular defects (lenticonus - bulging of lens capsule on slit-lamp)
  3. Treat as for CRF
    ACEi can slow renal progression

Medicine (20 decks)

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