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Year 3 Medicine > Renal > Flashcards

Renal Flashcards

1
Q

What is the normal anion gap?

A

8-12mmol/l

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2
Q

Give 3 symptoms of HYPERnatraemia

A

Thirst
Irritability
Weakness

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3
Q

Give two causes of HYPOvolaemic HYPERnatraemia

A 
Loop Diuresis (Renal Loss)
Burns (Non Renal Loss)
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4
Q

Give two causes of EUvolaemic HYPERnatraemia

A

Diabetes Insipidus

Hypodipsia

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5
Q

Give two causes of HYPERvolaemic HYPERnatraemia

A

Hypertonic Dialysis

Cushings

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6
Q

What is the triad of Diabetes Insipidus?

A

Polydipsia, Polyuria, Dilute Urine

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7
Q

Give two causes of Central DI

A

TB

Sarcoidosis

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8
Q

Give two causes of Nephrogenic DI

A

Congenital

Drugs (Lithium, Amphoterecin, Demeclocycline)

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9
Q

What three investigation results would prove DI

A

Serum Osmolality>295
Urine Osmolality<300
Water Deprivation test causes weight loss

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10
Q

Using the mnemonic SALT LOSS, what are the features of HYPOnatraemia?

A

Stupor, Anorexia, Lethargy, Tendon reflexes decreased, Limp muscles, Orthostatic hypotension, Seizures, Stomach cramping

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11
Q

What are two causes of HYPOvolaemic HYPOnatraemia? How would you differentiate between them?

A

Addisons (renal)
Burns (non renal)
Differentiated by urinary sodium

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12
Q

What are two causes of EUvolaemic HYPOnatraemia?

A

Primary Polydipsia
SIADH
Differentiated by urinary concentration

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13
Q

What are two causes of HYPERvolaemic HYPOnatraemia

A

CCF

Liver Failure

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14
Q

Name three drugs you could use to treat SIADH (by inducing DI)?

A

Lithium
Amphoterecin
Demeclocycline

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15
Q

How would you treat HYPER and HYPOvolaemic HYPOnatraemia respectively?

A

HYPO- IV 0.9% saline

HYPER - Fluid restrict and consider furosemide

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16
Q

Give 4 causes of HYPERkalaemia

A

CKD
Rhabdomyolysis
Addisons
Drugs

Emergency if K+>7mmol/l
OR
K+>5.3mmol/l with ECG changes

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17
Q

Using the mnemonic THANKS CYCLE, what drugs contribute to HYPERkalaemia?

A 
Trimethoprim
Heparin
ACEI
NSAIDs
K+ Sparing DIuretics
Succinyl Choline
Cyclosporine
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18
Q

What is Type 4 RTA?

A

Occurs when there is low aldosterone activity

May be Hypertensive, Hyperkalaemic, Hyperchloraemic

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19
Q

Give 4 possible ECG changes for HYPERkalaemia

A

Flattened P waves
Tented T waves
Prolonged QRS complex
Asystole

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20
Q

What are three possible presentations of HYPERkalaemia?

A

Fatigue
Paraesthesia
Chest Pain

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21
Q

Give a four step management plan for HYPERkalaemia

A

1) 10mls 10% Calcium Gluconate over 10 mins
2) Actrapid+IV dextrose/glucose solution
3) Nebulised Salbutamol
4) Calcium Resonium

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22
Q

What are three possible presentations of HYPOkalaemia?

A

Fatigue
Constipation
Proximal Muscle Weakness

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23
Q

Give three drugs which could cause HYPOkalaemia

A

Doxazosin
Salbutamol
Insulin

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24
Q

Apart from drugs and N and V, give 3 other causes of HYPOkalaemia

A

Refeeding Syndrome
Conns Syndrome
Liquorice

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25
Q

Give 3 ECG changes of HYPOkalaemia

A

Low T waves
High U waves
Prolonged PR interval

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26
Q

Apart from replacing Potassium in HYPOkalaemia, what other electrolyte would you consider replacing?

A

Magnesium

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27
Q

Define AKI

A

Reduced renal function occurring over hours to days

A rise in creatinine more than 50% in the last 7 days

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28
Q

Give two broad causes of PRE RENAL AKI

A

Reduced cardiac output

Reduced circulating volume

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29
Q

Give a tubular, glomerular and vascular cause of INTRARENAL AKI

A

Glomerular - Acute Glomerulonephritis
Tubular - Toxins (endo - myoglobin, exo - aminoglycosides)
Vascular - Vasculitis

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30
Q

Give two causes of POSTRENAL AKI

A

BPH

Bladder Outflow Obstruction

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31
Q

If you thought the AKI might be due due to Post Streptococcal Glomerulonephritis, what investigation would you do?

A

Anti Streptolysins Titre

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32
Q

Name 4 Investigations for AKI

A

Urine Dipstick
Daily Bloods (Inc CK- Rhabdomyolysis, LFTs - Hepatorenal)
Urine PCR, M, C, S
USS KUB

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33
Q

How do you calculate IV flow rate?

A

IV Flow Rate = (drop factor * vol)/time

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34
Q

What Nephrotoxic agents should you discontinue in an AKI? Give 4

A

Aminoglycosides
Vancomycin
Acyclovir
NSAIDs

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35
Q

Give 3 indications for Renal Replacement Therapy in an AKI

A

Refractory Hyperkalaemia
Uraemic Encephalopathy
Uraemic Pericarditis

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36
Q

What are the four characteristics of Nephrotic Syndrome?

A

Oedema
Proteinuria (>3.5g in 24 hours) (Frothy Urine)
Hypoalbuminaemia (<30)
Hypercholesterolaemia

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37
Q

Give the four main causes of Nephrotic Syndrome

A

Minimal Change Disease
Membranous Nephropathy
Focal Segmental GlomeruloSclerosis
Diabetes

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38
Q

Give the four main presenting features of Nephritic Syndrome

A

Haematuria
Hypertension
Hardly any urine
Proteinuria

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39
Q

Describe the pathophysiology of Post Streptococcal GN

A

Occurs weeks after Group A/B Strep Infection
1-2 weeks post tonsillitis
3-4 weeks post impetigo/cellulitis
Normally affects children aged 3-12

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40
Q

What would a serum sample of Post Streptococcal GN show?

A

Low C3

Anti Strep Antibodies

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41
Q

How would you manage Post Streptococcal GN?

A

Self Limiting

ACEI/ARB for proteinuria

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42
Q

Describe the pathophysiology of IgA Nephropathy

A

Haematuria after an URTI, GI Infection

Peak incidence in 20-30 y/o

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43
Q

Describe the findings in a serum/urine/biopsy of IgA Nephropathy

A

Serum - High IgA, Normal C3/C4
Urine - Asymptomatic microhaematuria with intermittent visible
Biopsy - Mesangial Immune Complexes

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44
Q

State the three different types of ANCA/Small Vessel Vasculitis

A

Granulomatosis with Polyangitis
Microscopic Polangitis
Churg Strauss

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45
Q

Describe the features of Granulomatosis with Polyangitis

A

C-ANCA

Pulmonary and Nasopharyngeal involvement (haemoptysis and nasal polyps)

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46
Q

Describe the features of Microscopic Polyangitis

A

P-ANCA

Mild Respiratory Symptoms

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47
Q

Describe the features of Churg Strauss

A

P-ANCA

Asthma, Allergic Rhinitis, Peripheral Neuropathy

48
Q

Describe the pathophysiology of Anti GBM disease

A

Antibodies against type 4 collagen

Type 4 collagen also lies in Respiratory System therefore haemoptysis

49
Q

What would serum sample/CXR/biopsy of Anti GBM show?

A

Serum - Anti GBM Antibodies
CXR - Pulmonary Infiltrates
Biopsy - Deposition of IgG along basement membrane

50
Q

How would you treat Anti GBM disease?

A

Plasma Exchange and Immunosupression

51
Q

Describe the pathophysiology of Thin Basement Membrane Disease

A

Hereditary Abnormalities of Type 4 collagen cauisng microscopic haematuria
Biopsy shows diffuse thinning of GBM

52
Q

What is Alport Syndrome?

A

X linked abnormalities in Type 4 collagen, also causing hearing loss and eye abnormalities

53
Q

How does the biopsy of Alport and Thin Basement Membrane disease differ

A

Thin Basement Membrane - Diffuse thinning

Alport - Alternate thinning and thickening

54
Q

Why should you give LMWH prophylactically in Nephrotic Syndrome?

A

Low albumin increases VTE risk

It is an acute phase reactant normally with anticoag properties

55
Q

Define CKD

A

Presence of kidney damage with abnormal albumin excretion/decreased function, persisting more than 3 months

56
Q

Describe the classifications of CKD in term of GFR, from G1-G5

A 
G1 - >90
G2 - 60-89
G3a - 45-59
G3b - 30 - 44
G4 - 15-29
G5 - <15
57
Q

How could you classify the Albumin Creatinine Ratio in CKD?

A

A1 - <3
A2 - 3-30
A3 - >30

58
Q

What drug could cause hypertrophy of the gums? What would this indicate?

A

Cyclosporin

Renal Transplant

59
Q

Give four complications of CKD

A

Anaemia of Chronic Disease
Mineral Bone Disease
Hyperparathyroidism
Hypertension

60
Q

What is the link between Hypertension and CKD?

A

Chronic raised BP causes Nephrosclerosis

Renal Artery Stenosis causes Hypertension (investigate with Magnetic Resonant Angiogram)

61
Q

Describe the genetics of APCKD

A 
Autosomal Dominant
Type 1 (85%) - Mutation on Chromosome 16
Type 2  (15%)  - Mutation on Chromosome 4, slower course, reaches end stage renal failure sooner
62
Q

Give 4 clinical presentations of APCKD

A

Loin Pain
Visible Haematuria
Renal Calculi
High BP

63
Q

Name three disease associations of APCKD

A

Mitral Valve Prolapse
Ovarian Cysts
SAH

64
Q

How would you diagnose APCKD?

A

Family History and USS (although cysts aren’t usually visible until after the age of 30)

65
Q

How would you treat APCKD?

A 
Controlling BP (NOT with CCB though)
Tolvaptan (ADH antagonist) may slow growth
66
Q

Describe four reasons why someone may have Anaemia of Chronic Disease in CKD

A

Reduced Erythropoietin production
Absolute Iron Deficiency (Malnutrition)
Functional Iron Deficiency (Inflammation)
Bone Marrow Supression from Uraemia

67
Q

How would you manage ACD in CKD?

A 
Replace any Haematinics that need replacing
Give ESA (Erythropoietin Stimulating Agent)
68
Q

Give two causes of CKD Mineral Bone Disease with LOW turnover

A

Osteomalacia (Vit D Deficiency)

Adynamic Bone Disease (low osteoclasts and osteoblasts)

69
Q

Give one cause of CKD Mineral Bone Disease with HIGH turnover

A

Osteitis FIbrosa (complication of hyperparathyroidism - soft areas of bone with no calcium)

70
Q

Give a brief description of Vit D Metabolism

A

Cholecalciferol is converted to calcidiol in the liver
Calcidiol is converted to Calcitriol by 1a Hydroxylase in Kidneys
1a Hydroxylase is upregulated by PTH

71
Q

What is Tertiary Hyperparathyroidism?

A

Persistent high PTH despite high calcium

72
Q

Give two advantage and two disadvantages to Peritoneal Dialysis

A

Advantages - Good QoL, More individualised

Disadvantages - Risk of Infection, Unsuitable for previous abdo surgeries

73
Q

Give three complications of Peritoneal Dialysis

A

Peritonitis
Hernia
Leak

74
Q

What are the three subtypes of Peritoneal Dialysis?

A

Automated - overnight exchange 10-12L over 8-10 hours leaving daytime free
Continuous Ambulatory - 4-5 exchanges throughout the day at regular intervals
Assisted Automated

75
Q

Give 4 disadvantages of Haemodialysis

A

Bacteraemia
Haemodynamic Instability
Cramps
SVCO

76
Q

What is AV Fistula Steal Syndrome?

A

Reduced oxygenation of tissue distal to the fistula due ot mixing of oxygenated and deoxygenated blood

77
Q

What is Active Conservative Management, and who recieves it?

A

When Renal Replacement Therapy offers no survival benefit

If over 80 or if WHO Performance Score>3

78
Q

When is Renal Transplant contraindicated?

A 
Active infection/malignancy
Severe heart/lung disease
Reversible renal disease 
Uncontrolled substance abuse
Psychiatric Illness
Short life expectancy
79
Q

Living related donor is the best option for transplant, what are the four types of Living UNrelated donor?

A 
Living Donor Paired Exchange
Living Donor Deceased Exchange
Live Donor Chain
Altruisic Donation (donated into pool)
80
Q

What is the Induction treatment for a Kidney Transplant?

A

Methylprednisolone usually in combination with basiliximab and thymoglobulin
less common = Rituximab and alentuzumab

81
Q

What is the Maintenance treatment for a Kidney Transplant?

A

used immediately after transplantation and for long term to prevent acute or chronic rejection
Prednisolone
Calcineurin Inhibitors - Tacrolimus/Cyclosporine
Antimetabolite medications: mycophenolate, azathioprine
Rapamycin Inhibitors - Everolimus
T-cell regulation: belatacept and belimumab

82
Q

What is Polyomavirus?

A

Childhood infection of flu like symptoms which stay latent forever
Can become reactivated post transplant, causing renal infection and rejection
Look out for changes in vision/urination

83
Q

What is Myeloma?

A

Abnormal proliferation of single clone of Plasma Cells leading to secretion of Immunoglobulins

84
Q

Give 3 systemic complications of Myeloma

A

Osteolytic Bone Lesions (Backache)
Hypercalcaemia (myeloma cells increase signalling of osteoclasts)
Recurrent bacterial infection

85
Q

How does Myeloma affect the Kidneys?

A

Deposition of IgG/Light Chains in glomerulus causing Tubular Obsttruction/Proteinuria

86
Q

What is Radiocontrast Nephropathy and how can you prevent it?

A

AKI 48-72 hours after IV contrast
Prevented with pre hydration with IV Crystalloid and the discontinuation of Nephrotoxic drugs 24h pre and post procedure

87
Q

What is Urate Nephropathy?

A

Uric acid crystals precipitate in the tubule interstitium

Decreases GFR and causes inflammation

88
Q

How would Urate Nephropathy present?

A

Mild Proteinuria

Slight increase in serum creatinine

89
Q

How would you manage Urate Nephropathy?

A

Tumour Lysis - Excessive Hydration

Allopurinol/Febuxostat

90
Q

What is a Phakomatose?

A

Neurocutaneous syndromes arising from embryonic ectoderm causing systemic hamartomas
An example is Tuberous Sclerosis - can cause Renal Angiomyolipomas

91
Q

Name the two types of Phakomatoses affecting the Kidney

A

Tuberous Sclerosis Complex (Pringle’s Disease)

Vin Hippel Lindau Syndrome

92
Q

What is the main complication of Von Hippel Lindau Syndrome?

A

Renal Cysts and Clear Cell Renal Carcinoma by the age of 40

93
Q

What are the three types of Membranoproliferative Syndrome? How would it appear microscopically?

A

Type 1 - Hep C
Type 2 - Caused by persistent activation of compliment pathway, low circulating levels of C3
Type 3 - Hep B and Hep C
‘Tram Tracks’

94
Q

What are the two types of Nodular Glomeulonephritis? How would you differentiate between them?

A

Diabetic and Amyloid Nephropathy
Diabetic - Congo red negative
Amyloid - Congo positive and apple green bifringence

95
Q

Name 3 ANCA -ve small vessel vasculitis

A

HSP (Henoch-Schonlein purpura)
Behcets
Goodpastures

96
Q

What glomerulonephropathies will ONLY present as crescenteric/RPGN?

A

ANCA +ve

Goodpastures

97
Q

If the cause of the nephropathy is Drug Induced Lupus, what is the drug?

A

TNF Inhibitor such as Infliximab

98
Q

It can be hard to differentiate between Post IgA nephropathy and Post Strep Nephropathy, what is the difference in timescales of renal manifestations?

A 
IgA = 2-3 days
Strep = 2-3 weeks
99
Q

Give 3 causes of Membranous Nephropathy

A

Lupus
Malignancy (Lung, Colon, Haematological)
Hep B/C

100
Q

Give two secondary causes of FSGS

A

Heroin

HIV

101
Q

Describe the stages of AKI in terms of Serum Creatinine

A

Stage 1: 1.5-1.9 x baseline
Stage 2: 2-2.9 x baseline
Stage 3: 3 x baseline

102
Q

Describe the stages of AKI in terms of Urine Output

A

Stage 1: <0.5ml/kg/h for 6-12hrs
Stage 2: <0.5ml/kg/h for atleast 12hrs
Stage 3: <0.3ml/kg/h for atleast 24hrs

103
Q

Using the STOP mnemonic, how would you acutely manage an AKI?

A

Sepsis - Appropriate Abx
Toxins - Stop any nephrotoxic medications
Optimising Fluids - Likely to be dehydrated
Prevent Harm

104
Q

Name five drugs that are safe to continue in an AKI

A

Paracetamol, Warfarin, Statins, Beta Agonists, Asparin

105
Q

What are patients and donors matched by for a renal transplant?

A

human leukocyte antigen (HLA) type A, B and C on chromosome 6

106
Q

Why is living donor transplantation better than deceased donor transplantation?

A

living can happen within months
elective procedures
deceased - 60% of all transplants in uk
little time for preparation, often happens in years

107
Q

describe the long term care of a transplant patient

A

1st few months - follow up several times a month
after 6 its less
monitor - GFR, CNI levels, proteinuria, Ca, phosphate, PTH, lipids and glucose
vaccinations - except live or attenuated viral vaccines
monitor and control cardiovascular disease, bone and mineral metabolism
screen for malignancies
contraception obligatory for 1st year

108
Q

what is mortality mostly related to in transplant patients?

A

cardiovascular disease, infections, malignancies

109
Q

what are some complications of transplant?

A

acute - first month - related to surgery or infections (consider time frame - <4 = hospital acquired or related to donor, 1-12 months = activation of latent infections, relapsed, residual or opportunistic, >12 community acquired

110
Q

what are some important infections to consider in renal transplant patients?

A

CMV, hep B, herpes simplex virus, varicella zoster, EBV, BK, aspergillus, pneumocystis jirovecii, listeria, mycobacterium tuberculosis, toxoplasma gondii

111
Q

what cancers are associated with kidney transplants?

A

SCC - squamous cell carcinoma
Non-Hodgkin lymphoma

important to screen for cancers - skin, cervix, breast, prostate, renal & urothelial, liver, colorectal, lymphoproliferative

112
Q

can patients be re-transplanted?

A

yes

113
Q

what is NODAT?

A

new-onset diabetes after transplant - associated with the use of anti-rejection medications

114
Q

advantages of renal transplant

A

near normal lifestyle

better mortality/morbidity

115
Q

disadvantages of renal transplant

A

criteria to meet to undergo surgery
compliance with medication is lifelong
risk of rejection, malignancy, infection
long waiting times

116
Q

what does active conservative management of ERSF involve?

A 
symptoms control to enhance life
respect pt preferred place of care 
advance care plan 
MDT approach 
support for pt and family

Year 3 Medicine (15 decks)

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