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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

What does the PCT reabsorb (6 things)

A 
Glucose
Amino acids
Water
Bicarbonate ions
Na ions
Cl ions
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2
Q

Thin Descending loop of Henle reabsorbs

A

Water only

IMPERMEABLE to Na+

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3
Q

Thick Ascending loop of Henle reabsorbs

A

PERMEABLE to Na+
- Contains Na/K/2Cl transporter

IMPERMEABLE to water

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4
Q

DCT reabsorbs

A

Na and Cl

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5
Q

Collecting duct 2 facts

A

Aldosterone increases number of Na+ channels in collecting duct

ADH binds to V2 receptors to increase AQUAPORINS

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6
Q

4 ways ANGIOTENSIN II increases blood pressure

A
  • vasoconstriction of smooth muscle
  • stimulating ALDOSTERONE to increase Na and H2O retention
  • stimulating ADH to increase H2O reabsorption
  • Increase thirst by stimulating hypothalamus
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7
Q

3 things stimulating RENIN secretion

A
  • Decreased BP

—> Decreased Na and H2O delivery to MACULA DENSA

  • INCREASED sympathetic activity
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8
Q

Where are RENIN and ACE produced?

A

Renin- kidney

ACE- LUNGS

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9
Q

Side effects of THIAZIDE DIURETICS (6 things)

A

Low Na/ K

High Ca/ glucose/ uric acid/ lipid

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10
Q

3 Contraindications of THIAZIDE DIURETICS

A

GOUT (raised uric acid)

Liver/ Kidney Failure (same as sulphonylureas and meglitinides (-pregnancy))

May worsen DIABETES (cos of increased glucose)

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11
Q

Effect of Hypokalaemia on Digoxin

A

Increases risk of digoxin toxicity

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12
Q

The only diuretic that doesn’t decrease lithium excretion

A

Osmotic diuretic

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13
Q

Contraindication of LOOP DIURETIC

A

Renal failure

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14
Q

2 contraindications of K+ sparing diuretic

A

Hyperkalaemia

ADDISON’s DISEASE

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15
Q

Contraindication for osmotic diuretic

A

Heart failure

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16
Q

3 side effects of Loop diuretics

A

Low Na/ Ca

OTOTOXICITY

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17
Q

2 side effects of K+ sparing diuretic

A

Hyperkalaemia

Gynaecomastia

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18
Q

2 side effects of osmotic diuretic

A

Low Na

FEVER

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19
Q

3 indications for Thiazide Diuretics

A

Hypertension

Heart Failure

Ascites

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20
Q

2 indications for Loop Diuretics

A

Heart Failure

Severe hypercalcaemia

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21
Q

5 indications for K+ sparing diuretics

A

—>Heart Failure

—>Ascites

—>Refactory Hypotension

OEDEMA

CONN’s SYNDROME

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22
Q

3 indications for Osmotic Diuretics

A

CEREBRAL OEDEMA

—>HAEMOLYSIS

Rhabdomyolysis

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23
Q

Drug interactions of Osmotic Diuretic

A

Increases levels of TOBRAMYCIN

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24
Q

Types of stones in Renal Calculi

A

Calcium (radiopaque)- COMMON

Struvite (staghorn calculus) (associated with PROTEUS MIRABILIS)

Uric acid crystals (radiolucent)

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25
Q

Signs and Symptoms of Renal Calculi (4 things)

A

Suprapubic/ loin pain- may radiate to genital region

Dysuria

UTI

Haematuria

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26
Q

Causes of Renal Calculi (6 things)

A

HIGH calcium
HIGH urea
HIGH oxalate

Recurrent UTI

  • –>Drugs (LOOP)
  • –>Hereditary conditions (Polycystic Kidney Disease)
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27
Q

Investigations of Renal Calculi

A

24 hr urine analysis

CT scan KUB- Kidney/ Ureters/ Bladder

Ultrasound may also be used

Chemical analysis of stones

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28
Q

6 steps of Treatment for Renal Calculi

A

Pain- Analgesia and TAMSULOSIN

Dehydration- IV and ORAL FLUIDS

Nausea/ Vomiting- Antiemetics

Hypercalcaemia- Low Calcium Diet/ Stop THIAZIDE DIURETICS

Hyperoxaluria- Low Oxalate Diet

Hyperuricaemia- Allopurinol

29
Q

4 complications of Renal Calculi

A

Recurrent UTI

Recurrent Calculi

Obstruction

Trauma to Ureter/ Ureteric Stricture

30
Q

2 types of UTI

A

Lower UTI

Upper (PYELONEPHRITIS) UTI (E.Coli likely)

31
Q

3 Signs and Symptoms of LOWER UTI

A

Dysuria
Frequency/ Urgency
SUPRAPUBIC PAIN

32
Q

3 Signs and Symptoms of UPPER UTI

A

Haematuria
Fever/ Chills
FLANK PAIN

33
Q

9 RISK FACTORS for UTI

A

Female
Menopause
Sexual intercourse
Pregnancy

Catheterisation
Urinary tract obstructions (like stones)

Genitourinary malformation

Diabetes
Immunosuppression

34
Q

6 Causative organisms of UTI

A

E.Coli most common (METALLIC SHEEN)

Staph. Saprophyticus

Kleb. Pneumoniae

Proteus Mirabilis (produces UREASE)

Pseudonomas Aeruginosa (BLUE-GREEN information and FRUITY ODOR)

BK and JC viruses (associated with GRAFT FAILURE after transplant)

35
Q

4 defences against UTIs

A

MICTURITION (urination)

Urine: osmolarity, pH, organic acids

Secreted Factors:

1) Tam- Horsfall protein
2) IgA
3) LACTOFERRIN- hoovers up free iron

Mucosal defences- mucopolysaccharides coat bladder

36
Q

3 investigations for UTI

A

Urine dipstick- POSITIVE FOR LEUCOCYTES and NITRITES

Urine culture- to identify causative organisms

Radiology- consider US or cytoscopy if in CHILDREN OR recurs in MEN

37
Q

Treatment for UTI

A

Trimethoprim (twice daily)
Prophylactic antibiotics if it is recurrent

If recurrent more than 4 a year- exclude anatomical variant or abnormality of renal tract

38
Q

3 COMPLICATIONS of UTI

A
  • Pyelonephritis
  • Renal failure
  • SEPSIS
39
Q

Renal Cell Carcinoma definition

A

Adenocarcinoma originating from PCT

40
Q

5 risk factors for Renal Cell Carcinoma

A 
Male
50-70 years old
Smoking
Obesity
---> Mutation of Von Hippel Lindau Tumor suppressor gene
41
Q

Signs and Symptoms of Renal Cell Carcinoma (5 things)

A 
LOIN pain with palpable mass
FEVER
Haematuria
Unintentional weight loss
---> HYPERTENSION
42
Q

2 paraneoplastic syndromes involved in Renal Cell Carcinoma

A

Secretion of ACTH- produces symptoms of HYPERCALCAEMIA

Secretion of ERYTHROPOETIN- produces symptoms of POLYCYTHAEMIA

43
Q

Treatment for Renal Cell Carcinoma

4 medical treatments

A

Refer to Macmillan Nurses
Monitor Psychological Wellbeing

  • –> Medical-
  • Interferon ALPHA
  • Sunitinib
  • Sorafenib
  • Bevacozumab

Surgical-

  • Partial or total NEPHRECTOMY
  • Radiofrequency ablation
44
Q

4 complications of Renal Cell Carcinoma

A

METASTASIS
—> Hypertension

Hypercalcaemia
Polycythaemia

45
Q

Where does Transitional Cell Carcinoma arise from?

A

The Transitional Urothelium

46
Q

Risk factors of Transitional Cell Carcinoma

A

—> CAPS

Cyclophosphamide
—> Aniline dyes
—> Phenacetin
Smoking

47
Q

Signs of Transitional Cell Carcinoma

A

Lower UTI symptoms (frequency/ urgency)
PAINLESS HAEMATURIA

—> PAINLESS

48
Q

Investigations for Transitional Cell Carcinoma

A

Cytoscopy and Ureteroscopy with biopsy
—> Retrograde pyelography
CT/ MRI

49
Q

Treatment for Transitional Cell Carcinoma

A

Refer to Macmillan Nurses
Monitor Psychological Wellbeing

Medical:

  • –> MITOMYCIN
  • –> GC regimen (gemcitabine and cisplatin)
  • –> MVAC regimen (methotrexate, vinblastine, adriamycin, cisplatin)

Surgery:

  • Nephroureterectomy
  • Cystectomy
  • Radiofrequency ablation
50
Q

Complication of Transitional Cell Carcinoma

A

Metastases- usually to bone

51
Q

3 main characteristics of Acute Kidney Injury

A
  • rapid fall in GFR

- increase in CREATININE and UREA

52
Q

Pre renal causes of AKI (4 things)

A

Hypovolaemia-

  • Haemorrhage
  • DIURETICS
  • Burns

Shock (SEPIS or CARDIOGENIC)

Hypoperfusion-

  • NSAIDs
  • ACE inhibitor

Oedematous conditions-

  • Heart failure
  • NEPHROTIC SYNDROME
53
Q

Intrinsic causes of AKI (3 things)

A

Glomerular diseases-

  • Immune complex diseases (SLE)
  • Glomerulonephritis
  • Vasculitis

Vascular lesions-

  • BILATERAL RENAL STENOSIS
  • Malignant hypertension
  • Microangiopathy

Tubulointerstitial disease-

  • Acute tubular necrosis
  • MULTIPLE MYELOMA
  • Acute tubulointerstitial nephritis
  • NEPHROTOXIC drugs
54
Q

Post renal causes of AKI (3 things)

A

Obstructions-

  • STONES
  • Tumors (including BENIGN PROSTATE HYPERTROPHY)
  • STRICTURES
55
Q

Signs and Symptoms of AKI (6 things)

A

Oliguria/ Anuria

Nausea/ vomiting

Confusion

Hypertension

Abdominal/ flank pain

Signs of fluid overload (high JVP)

56
Q

Investigations of AKI

A

GFR

Urinalysis-

  • BENCE JONES protein to exclude multiple myeloma
  • Leucocytes and Nitrites to exclude UTI

Bloods

57
Q

Treatment for AKI

A

Maintain renal blood flow and fluid balance

Monitor ELECTROLYTES

Treat UNDERLYING CAUSE

Stop all NEPHROTOXIC DRUGS

58
Q

4 complications of AKI

A
  • Metabolic acidosis
  • Hyperkalaemia
  • HYPERPHOSPHATAEMIA
  • PULMONARY OEDEMA
59
Q

Without treatment, CKI develops into…

A

End stage Kidney disease

60
Q

7 causes of CKI

A
  • Hereditary disease (polycystic kidney disease)
  • Anatomical abnormality of renal tract
  • Hypertension
  • Diabetes
  • Malignancy
  • Glomerulonephritis
  • ANY KIDNEY DISEASE tbh
61
Q

Signs and Symptoms of CKI

A

Oliguria/ Anuria

Nausea/ vomiting

Confusion

Hypertension

OEDEMA (peripheral/ pulmonary)

KUSSMAUL BREATHING (sign of metabolic acidosis)

ANAEMIA

Metallic taste in mouth

62
Q

Investigations for CKI

A

GFR

Urinalysis-

  • BENCE JONES protein to exclude multiple myeloma
  • Leucocytes and Nitrites to exclude UTI

Bloods

63
Q

Treatment for CKI (6 things ish)

A

LOW SALT diet, maintain psychological wellbeing

Treat underlying cause

Control blood pressure

TREAT-

  • Anaemia
  • Acidosis (with sodium bicarbonate)
  • Hyperphosphataemia (with phosphate binders)

DIALYSIS

Renal Transplant

64
Q

9 Complications of CKI

A
  • Metabolic ACIDOSIS
  • ANAEMIA
  • Hypertension
  • Carpal Tunnel Syndrome
  • Renal bone disease
  • Depression
  • Stroke
  • Peripheral nerve disease
  • OEDAMATOUS STATES
65
Q

4 Signs of Nephrotic Syndrome

A

PHOH

  • Proteinuria (>3g daily)
  • Hypoalbuminaemia (<30g/L)
  • Oedema
  • Hyperlipidaemia occurs because-
    1) Hypoproteinaemia stimulates production of more proteins from the live- so synthesis of more lipoproteins
66
Q

7 causes of NEPHROTIC SYNDROME

A
  • Minimal change disease
  • Diabetic nephropathy
  • Amyloidosis
  • SLE
  • Mesangial proliferative glomerulonephritis
  • Membranous glomerulonephritis
  • Focal segmental glomerulosclerosis
67
Q

Investigations for Nephrotic Syndrome

A

Bloods

Urinalysis

NEPHRITIC SCREENING-

  • C3/ C4
  • ANA, dsDNA, ANCA, anti-glomerular basement membrane antibody
  • HIV/ HBV. HCV serology
  • Venereal Disease Research Laboratory for Syphilis
68
Q

Treatment for NEPHROTIC SYNDROME

A 
Low Salt Diet
Depends on cause-
- Hypertension
- Proteinuria
- Hypercholestrolaemia
- Prophylactic anticoagulation therapy
- Immunotherapy regimen- PREDNISOLONE/ CYCLOPHOSPHAMIDE/ AZATHIOPRINE
-Dialysis if severe

Medicine (15 decks)

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