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Acute Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Define AKI

A

rise in serum creatinine >50% in 7 days
Rise in serum creatinine >25micromol/l in 48hrs
urine output <0.5ml/kg/hr for >6hrs

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2
Q

Risk factors for AKI

A 
CKD
Heart failure 
diabetes 
liver disease 
over 65
NSAIDs, ACEI
contrast medium
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3
Q

pre-renal AKI

A

inadequate blood supply

  • dehydration
  • shock
  • heart failure
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4
Q

renal causes of AKI

A

Glomerulonephritis
interstitial nephritis
ATN

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5
Q

post-renal AKI

A

obstruction to outflow of urine

  • calculi
  • masses, strictures, BPH
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6
Q

Investigating AKI

A

urinalysis - blood, leucocytes, nitrites and glucose

USS

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7
Q

treating AKI

A

stop nephrotoxic medication
Fluid rehydration
catheter if obstruction

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8
Q

DAMN drugs

A

diuretics
ACEI/ARB
metformin - lactic acidosis
NSAIDs

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9
Q

preventing contrast induced nephropathy

A

pre and post contrast IV 0.9% saline

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10
Q

complications of AKI

A

hyperkalaemia
fluid overload, pulmonary oedema
metabolic acidosis
uraemia

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11
Q

what can uraemia lead to?

A

encephalopathy or pericarditis

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12
Q

treating hyperkalaemia

A

IV calcium gluconate
insulin/dextrose
salbutamol
calcium resonium/dialysis

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13
Q

hyperkalaemia is

A

K > 5.5

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14
Q

first thing to do in hyperkalaemia

A

ecg

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15
Q

ecg findings hyperkalaemia

A

tall tented t waves
wide QRS
absent p waves

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16
Q

K requirements per day

A

1mmol/kg/day

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17
Q

what fluid to avoid in hyperkalaemia

A

hartmanns

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18
Q

how long for AV fistula to mature?

A

6-8 weeks

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19
Q

differentiate between AIN and ATN

A

AIN has raised WCC (eosinophils) on urine dip

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20
Q

alport syndrome

A

renal failure, sensorineural hearing loss and ocular abnormalities

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21
Q

nephrotic syndrome criteria

A

proteinuria >3g/24 hour
oedema
hypoalbuminaemia <30g/l

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22
Q

findings in diabetes insipidus

A

high serum osmolality, low urine osmolality

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23
Q

treating cranial and nephrogenic diabetes insipidus

A 
cranial = desmopressin
nephrogenic = TZD
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24
Q

cancer risk in transplant patients

A

SCC - skin cancer

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25
Q

immunosuppression following transplant

A

ciclosporin/tacrolimus with monoclonal antibody

add steroids >1 rejection episode

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26
Q

detecting diabetic nephropathy

A

ACR in early morning urine annually

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27
Q

when to start ACEI in CKD

A

if ACR >70mg/mmol

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28
Q

medication used for spironolactone gynaecomastia

A

epleranone

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29
Q

goodpastures investigation

A

anti-GBM antibodies

30
Q

how many stages for AKI?

A

3

31
Q

what can saline cause?

A

hyperchloraemic acidosis

32
Q

resus fluids

A

500ml 0.9% saline over 15 mins/STAT

33
Q

define CKD

A

abnormal kidney structure or function >3 months

34
Q

eGFR and CKD

A 
1 = >90
2= 60-90
3a = 45-59
3b = 30-44
4 = 15-30
5 = <15
35
Q

ACR and CKD

A 
A1 = <3
A2 = 3-30
A3 = >30
36
Q

causes of CKD

A 
diabetes 
glomerulonephritis
PKD
drugs and toxins
heart failure
37
Q

kidneys in CKD

A

bilaterally small

38
Q

Why is it important not to combine ACEI and ARB?

A

risk of hyperkalaemia

39
Q

management of CKD

A 
DM, bp, weight control
ACEI/ARB
fluid and diet restriction
EPO - anaemia
phosphate binders
vit D supplement
sodium bicarbonate
20mg atorvostatin 
RRT
40
Q

presentation of CKD

A 
asymptomatic 
pruritus
loss of appetite
nausea
oedema
peripheral neuropathy 
hypertension
41
Q

using eGFR to diagnose CKD

A

2 tests 3 months apart

42
Q

complications of CKD

A 
acidosis
electrolyte imbalance
renal bone disease
CVD
dialysis
uraemia
43
Q

When to refer CKD to a specialist

A

eGFR <30ml/min
ACR >70mg/mmol
accelerated decline
uncontrolled HTN 4 anti-hypertensives

44
Q

CKD - hyperparathyroidism

A

secondary due to high serum phosphate
low active vitamin D
high PTH

45
Q

most common nephropathy in children

A

minimal change disease

46
Q

underlying causes of nephrotic syndrome

A

HSP
diabetes
HIV
FSGS

47
Q

urinalysis - minimal change

A

small molecular weight proteins

hyaline casts

48
Q

treating minimal change

A

CCS high dose 4 weeks

low salt diet, diuretics, albumin infusions

49
Q

presentation of minimal change

A

oedema (periorbital and peripheral), frothy urine, proteinuria and low albumin

50
Q

treating steroid resistant minimal change

A

ACEI

cyclosporine, tacrolimus, rituximab

51
Q

complications of nephrotic syndrome

A 
hypovolaemia 
thrombosis 
infection 
renal failure 
relapse
52
Q

indications for acute dialysis

A 
acidosis
hyperkalaemia
uraemia - seizures
intoxication 
oedema
53
Q

indications for long term dialysis

A

ESRF = CKD5

54
Q

3 main options for maintenance dialysis

A

continuous ambulatory peritoneal dialysis
automated peritoneal dialysis
haemodialysis

55
Q

catheter used in peritoneal dialysis

A

tenckhoff

56
Q

how does peritoneal dialysis work?

A

filtration membrane = peritoneal membrane
dialysis solution with dextrose added to peritoneal cavity
ultrafiltration from blood to dialysis solution

57
Q

complications of peritoneal dialysis

A

SBP
peritoneal sclerosis
ultrafiltration failure
weight gain

58
Q

typical haemodialysis regime

A

4 hours a day, 3 days a week

59
Q

2 options for haemodialysis

A

tunnelled cuffed catheter

AV fistula

60
Q

tunnelled cuff catheter

A

subclavian or jugular vein into SVC or right atrium
2 lumens - blood exits and blood enters
dacron cuff provide barrier to infection

61
Q

which vessels for AV fistula

A

radio-cephalic
brachio-cephalic
brachio-basilic

62
Q

examining AV fistula

A

skin integrity
aneurysms
palpable thrill
machinery murmur

63
Q

AV fistula complications

A 
aneurysm
infection 
thrombosis
stenosis
STEAL syndrome
high output heart failure
64
Q

STEAL syndrome

A

inadequate blood flow distal to AV fistula

distal ischaemia

65
Q

is it ok to take blood from AV fistula?

A

NO

66
Q

matching renal donor

A

HLA type A, B and C on chromosome 6

67
Q

what vessels are used in transplant?

A

external iliac

68
Q

transplant rejection

A

hyperacute = remove graft
acute <6 months
chronic

69
Q

cause of hyperacute rejection

A

HLA or ABO antibodies

70
Q

complications related to immunosuppressants

A 
IHD
T2DM
infections - PCP, CMV, TB
Non-hodgkin lymphoma
SCC - skin cancer

Acute Medicine (2 decks)

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