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Renal Flashcards

1
Q

Define AKI (3)

A
  1. Increase in creat >26 in 24 hours
  2. Increase in creat by 50% over seven days
  3. UO <0.5mls/kg for >6 hours
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2
Q

What would an indication be to do an USS for an AKI

A

No identifiable cause for AKI, USS within 24 hours

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3
Q

Name three drugs that should be stopped due to risk of toxicity in an AKI

A
  1. Lithium
  2. Metformin
  3. Digoxin
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4
Q

Management of hyperkalaemia (7)

A
  1. Calcium gluconate - for cardiac stabilisation
  2. Combined insulin/ dex
  3. Salbutamol nebs
  4. Sodium bicarb
  5. Calcium resonium
  6. Diuretics (loop)
  7. Dialysis
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5
Q

Name five indications for RRT

A
  1. Persistent hyperkalaemia despite medical managment
  2. Refractory pulmonary oedema
  3. Severe metabolic acidosis, pH <7.2/ BE <10
  4. Uraemia complications e.g pericarditis
  5. Drug overdose
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6
Q

Drugs/ factors that can cause acute tubular necrosis (6)

A
  1. Lead
  2. Anti-freeze
  3. Contrast
  4. Uric acid
  5. Aminoglycosides
  6. Myoglobin
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7
Q

Autosomal dominant polycystic kidney disease

Classification

A

Type 1

  1. Chrm 16
  2. More common
  3. Presents earlier with renal failure

Type 2
1. Chrm 4

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8
Q

Autosomal dominant polycystic kidney disease

Diagnostic criteria and investigation of choice

A

USS
Criteria in pts with +ve FH
1. two cysts, unilateral or bilateral, if aged < 30 years
2. two cysts in both kidneys if aged 30-59 years
3. four cysts in both kidneys if aged > 60 years

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9
Q

Autosomal dominant polycystic kidney disease
Mx
Criteria

A 
Tolvaptan 
If
1. Can be at discounted price on pt access scheme
2. Rapidly progressing disease
3. CKD 2 or 3
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10
Q

Name four extra-renal features of ADPKD

A
  1. Liver cysts (most common)
  2. Beri beri aneurysms - can cause SAH
  3. Mitral + aortic valvular issues
  4. Cysts in other organs e.g spleen, pancreas
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11
Q

Features of ADPKD (6)

A
  1. HTN
  2. Renal stones
  3. Recurrent UTIs
  4. AP
  5. Haematuria
  6. CKD
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12
Q

What is Alport’s syndrome?

M/F

A

X linked dominant
Defect in type IV collagen results in abnormal GBM
Common and more severe in men

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13
Q

Name five features of Alport’s syndrome
Think three organs (3)
Biopsy (1)
Typical exam question (1)

A
  1. Failing renal transplant = Goodpasture’s (autoantibodies to GBM)
  2. Microscopic haematuria
  3. Bilateral sensorineural deafness
  4. Longitudinal splitting of lamina densa (basket weave)
  5. Lenticonus: protrusion of the lens surface into the anterior chamber
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14
Q

Which three organs are affected in Alport’s syndrome

Nephritic or nephrotic

A
  1. Kidney
  2. Ears
  3. Eyes
    Nephritic
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15
Q

Difference between nephritic and nephrotic syndrome

A

Nephritic

  1. Haematuria
  2. HTN

Nephrotic

  1. Proteinuria
  2. Normal BP
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16
Q

Dietary advice for CKD (4)

A

Low

  1. Protein
  2. Phosphate
  3. Potassium
  4. Sodium
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17
Q

CKD classification

A 
Needs to have some sort of kidney damage on other tests 
1 eGFR >90 
2 eGFR >60
3a eGFR >45
3b eGFR >30 
4 eGFR >15
5 eGFR <15
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18
Q

MDRD includes which four factors

A
  1. Age
  2. Ethnicity
  3. Gender
  4. Serum creatinine
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19
Q

Name three factors that can affect the MDRD result

A
  1. Pregnancy
  2. Red meat within last 12 hours of sample being taken
  3. Muscle mass
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20
Q

What is an acceptable change in creat/ eGFR once started on ACEi?

A

Fall in eGFR of up to 25%
OR
Rise in creatinine of up to 30%

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21
Q

What eGFR level/ what stage of CKD can furosemide be used as an anti-hypertensive?

A

eGFR <45 aka stage 3b

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22
Q

What is diabetes insipidus and what are the two types?

What is the urine osmolality?

A

Deficiency or failure to respond to ADH

  1. Nephrogenic - ADH acts on collecting ducts, collecting ducts fails to respond
  2. Cranial - hypothalamus doesn’t produce ADH

Failure/ insensitivity of ADH prevents reabsorption of water from the urine. This means in DI –> they have a low urine osmolality (as it is extremely diluted)

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23
Q

Diagnostic test for DI

A

Water deprivation test
Deprived of fluid intake for 8 hours
Urine osmolality checked - it would be expected to be low
Then given desmopressin (which is synthetic ADH)
In cranial DI –> urine osmolality post desmopressin is high
In nephrogenic DI –> urinary osmolality post desmopressin is low

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24
Q

Name four causes of cranial and and three causes of nephrogenic DI

A

Cranial

  1. Brain tumour/ surgery
  2. Wolfram’s syndrome (DIDMOAD)
  3. Idiopathic
  4. Post head injury

Nephrogenic

  1. Drugs e.g lithium, democlocycline
  2. Low K+
  3. High calcium
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25
Q

Two symptoms of DI

A
  1. Polyuria

2. Polydypsia

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26
Q

How does spironolactone work?

Name two SE

A

Aldosterone antagonist
SE
1. Gynaecomastia
2. Hyperkalaemia

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27
Q

Name four features on an ECG with a low K+

A
  1. U waves
  2. Prolonged PR
  3. ST depression
  4. Small or absent T waves
28
Q

Name two signs of low K+

A
  1. Hypotonia
  2. Muscle weakness

Can lead to digoxin toxicity

29
Q

Name four causes of transient non-visible haematuria

A
  1. UTI
  2. Vigorous exercise
  3. Menstruation
  4. Sexual intercourse
30
Q

Name two causes of transient visible heamaturia

A
  1. Diet: beetroot, rhubarb

2. Drugs: rifampicin, doxorubicin

31
Q

Name six causes of persistent non visible haematuria

A
  1. cancer (bladder, renal, prostate)
  2. stones
  3. benign prostatic hyperplasia
  4. prostatitis
  5. urethritis e.g. Chlamydia
  6. renal causes: IgA nephropathy, thin basement membrane disease
32
Q

How do you define persistent non-visible haematuria?

A

Blood being present on dipstick in 2 out of 3 samples tested 2-3 weeks apart

33
Q

Criteria for urgent referral for haematuria

A

> =45yo
unexplained visible haematuria without urinary tract infection OR
visible haematuria that persists or recurs after successful treatment of urinary tract infection

OR
Aged >= 60 years AND
unexplained non-visible haematuria AND
either dysuria OR raised WCC

34
Q

Criteria for non urgent referral for haematuria

A

> = 60 years with recurrent or persistent unexplained urinary tract infection

35
Q

Haemolytic uraemic syndrome

Triad features

A
  1. AKI
  2. haemolytic anaemia
  3. Thrombocytopaenia
36
Q

Haemolytic uraemic syndrome
Which organism?
What do you seen on smear?

A

E coli - shiga toxin producing (0157H7)

Schistocytes

37
Q

Haemolytic uraemic syndrome usually secondary to?

A

Stomach virus - think small child with bloody diarrhoea

38
Q

What is ITP?

A

Immune mediated platelet destruction
Commonly after a virus
Idiopathic
Increased bleeding time

39
Q

What is TTP?
The Terrible Pentad
Thrombotic thrombocytopenic purpura
Name five classic symptoms

A 
Deficiency in ADAMTS-13 --> Increased vWF
1. Low platelets
2. Anaemia
3. Fever
4. Neurological sx 
5. Renal dysfunction 
Cells: schistocytes
40
Q

DIC
What is it caused by?
What are the lab findings?

Damn I’m Clotting

A 
secondary to trauma/ sepsis/ obstetric complications 
D dimer raised
Schistocytes 
Decreased fibrinogen 
Increased bleeding time
41
Q
  1. Low platelets
  2. Anaemia
  3. Fever
  4. Neurological sx
  5. Renal dysfunction
    Cells: schistocytes
    =
42
Q 
Secondary to trauma/ sepsis/ obstetric complications 
D dimer raised
Schistocytes 
Decreased fibrinogen 
= ?
43
Q

What investigations would you do for suspected HUS? (4)

A

FBC - to check for thrombocytopenia
Clotting - increased bleeding time
U&E - AKI
Stool culture - PCR for Ecoli shiga toxin producing

44
Q

Triad of features for RCC

A
  1. Haematuria
  2. Loin pain
  3. Abdominal mass
45
Q

Name three non typical RCC features

A
  1. Dragging feeling in testicle
  2. Left varicocele
  3. Pyrexia of unknown origin
46
Q

Canonball secondaries =

A

RCC - metastases to lung

47
Q

RCC - metastases to lung =

A

canonball secondaries

48
Q

Three features of Churg-Strauss

Antibody

A
  1. Recurrent sinusitis
  2. Asthma (eosinophillia)
  3. Mononeuritis multiplex
    p-ANCA
49
Q

Churg-Strauss + Wegeners

Small/medium/large

A

Small to medium vessel vasculitis

50
Q

Name six features of Wegeners/ granulomatosis with polyangitis

A
  1. Saddle shaped nose
  2. Chronic sinusitis
  3. Nasal crusting
  4. Haemoptysis
  5. Epistaxis
  6. SOB
    c-ANCA
51
Q

Henoch-Schonlein purpura
Features (4)
Age group
Mx

A
  1. Association with IgA nephropathy and its features
  2. Palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
  3. AP
  4. Arthritis
    3-14yo
    Mx self limiting, supportive
52
Q

IgA nephropathy also known as
Features (3)
Age + gender

A 
Berger's 
1. Macroscopic haematuria
2. Current URTI
3. Mesangial hypercellularity 
Young male
53
Q

Post Strep GN

Features (4)

A
  1. 2 weeks post strep infection
  2. Low complement levels
  3. Proteinuria + haematuria + oedema
  4. Smoky/ coca cola urine
54
Q

Minimal change

What is it?

A

Most common cause of nephrotic syndrome

T cell + cytokine mediated damage to GBM

55
Q

FSGS

focal segmental glomerulosclerosis

A

IgM and C3 deposits

Nephrotic syndrome

56
Q

Name three associated conditions with IgA nephoropathy

A
  1. HSP
  2. Alcoholic cirrhosis
  3. Coeliacs/ dermatitis herpetiformis
57
Q

Name five markers of poor prognosis in post strep GN

One marker for good prognosis

A
  1. Male
  2. Proteinuria >2g/day
  3. HTN
  4. Smoking
  5. High cholesterol

Good prognosis
1. Frank haematuria

58
Q

Name five nephritic syndromes

A
  1. Alports
  2. IgA nephropathy
  3. Henoch-Schonlein purpura
  4. Post strep GN
  5. Goodpastures
59
Q

Name two nephrotic syndromes

A
  1. Minimal change

2. FSGS

60
Q

Fusion of podocytes on electron miscroscopy will be seen in which condition?

A

Minimal change

61
Q

Name three causes of minimal change

A
  1. Drugs: rifampacin, NSAIDs
  2. Hodgkins lymphoma, thymoma
  3. Infection mononucleosis
62
Q

Rx minimal change

A
  1. Steroids

2. Cyclophosphamide

63
Q

Immunofluorescence: granular or ‘starry sky’ appearance=

A

post Strep GN

64
Q

Immunosuppresion management following renal transplant
Initial
Maintenance

A

Initial
1. Tacrolimus/ ciclosporin with a monoclonal antibody
Maintenance
2. ciclosporin/tacrolimus with MMF or sirolimus

65
Q

Define contrast media nephrotoxicity

A

Increase in creatinine by 25% within 3 days of contrast

66
Q

Name four RF for contrast media nephrotoxicity

A
  1. Known renal impairment (especially diabetic nephropathy)
  2. > 70yo
  3. Dehydration
  4. Heart failure
  5. Use of nephrotoxic drugs
67
Q

How can you prevent contrast media nephrotoxicity?

A

IV fluids for 12 hours pre- and post- procedure

MSRA (22 decks)

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