Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Priority 1 > Renal > Flashcards

Renal Flashcards

1
Q

What are diabetics annually screened for?

A

Microalbuminuria + urine dip at every appointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Complications of renal replacement therapy

A 
CVD- MI and stroke
Malnutrition
Renal bone disease
Infection
Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cardiac complications in hyperkalaemia

A

ECG changes:
Tall tented T waves, broad QRS, prolonged PR, flat P wave

Arrhythmias:
Asystole, VF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of hypercalcaemia

A 
Hyperparathyroidism
Thiazide diuretics
Malignant disease
Sarcoidosis
Thyrotoxicosis
Vit D intoxication
Cortisol deficiency
Familial hypocalciuric hypercalcaemia 
Acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology of CKD

A

Primary kidney injury:
Diabetes, glomerulonephritis, HTN/reno-vascular disease, pyelonephritis and reflux nephropathy

Nephron loss

Hyperfiltration and hypertrophy of residual nephrons (compensating to maintain GFR), increased glomerular capillary pressure

Sclerosis of hyper-filtering nephrons

Nephrotoxins, decreased perfusion (dehydration, shock), proteinuria, hyperlipidaemia, hyperphospatemia, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define CKD

A 
Sustained, irreversible decrease in GFR 
<60ml/min/1.73, for >3months
Equations to calculate
OR
Persistent haematuria/proteinuria/structural abnormalities of the kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define hypocalcaemia

A

<2.1mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indications for dialysis in CKD

A

Metabolic acidosis
Hyperkalaemia after 3x rounds of treatment
Anuria/uraemia
BLAST drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define end stage renal disease

A

<15 GFR

Need for renal replacement therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nephritic syndrome

A

Haematuria
Oliguria
Proetinuria
Fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common cause of glomerular pathology and CKD?

A

Diabetic nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors for pyelonephritis

A

Female
Structural urological abnormalities
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of pyeloneprhitis

A

High fever and rigors
Loin to groin pain
Dysuria and urinary frequency
Haematuria
Other non-specific symptoms (e.g. vomiting)
Pain on bimanual palpation of renal angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Investigations of CKD

A

Determine aetiology
Evaluate complications
Bloods (FBC, ESR, U&E, glucose, low Ca, high phosphate, high ALP, high PTH)
Urine (dip, MC&S, albumin:creatinine ratio)
USS kidney (small in CKD) and bladder (obstruction)
Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 types of fluid replacement

A

5% glucose:
Method for administering IV water, not bulk blood volume
Only 5% stays in IV space
Distribution as for water

0.9% saline:
Better for resuscitating blood volume
33% stays in IV space
Distribution as for ECF

Colloid:
5% human albumin
Best for resuscitating blood volume in very haemodynamically compromised patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Metabolic alkalosis characteristics on ABG

A

↑ pH
↑ HCO3-
↑ BE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of metabolic alkalosis

A

Gastrointestinal loss of H+ ions (e.g. vomiting, diarrhoea)

Renal loss of H+ ions (e.g. loop and thiazide diuretics, heart failure, nephrotic syndrome, cirrhosis, Conn’s syndrome)

Iatrogenic (e.g. addition of excess alkali such as milk-alkali syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Presentation of CKD at different stages

A

1-3
Frequently asymptomatic
Via screening of at risk pts

4-5
Endocrine/metabolic/water/electrolyte disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prevention of diabetic nephropathy

A

Blood pressure control
Glycaemic control
CVS risk control (stop smoking, reduce cholesterol, consider aspirin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define hypercalcaemia

A

> 2.6mmol/L corrected calcium

> 3mmol/L severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 mechanisms, their effects and their management of lack of 1,25 vitamin D production in CKD

A

Hypocalaemia:
Causes bone pain
Managed with vit D and calcium supplementation

Raised PTH:
Causes fractures, osteomalacia, ostetitis fibrosa
Managed by phosphate binders, vit D/analogues, calcimimetics, 1-alpha calcitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of UTI

A

Trimethoprim/nitrofurantoin

3 days:
For simple lower urinary tract infection in women

5-10 days:
For women that are immunosuppressed, have abnormal anatomy or impaired kidney function

7 days:
For men, pregnant women or catheter-related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of lower UTI

A

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Confusion commonly the only symptom in older/frail patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bacterial causes of UTI

A 
E. coli
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
Staph saprophyticus
Candida albicans (fungal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Metabolic acidosis characteristics on ABG

A

↓ pH
↓ HCO3-
↓ BE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of metabolic acidosis

A

Increased acid production or acid ingestion

Decreased acid excretion or rate of gastrointestinal and renal HCO3– loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define nephritis

A

Inflammation of the kidneys

Non-specific and not a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Progression of diabetic nephropathy

A 
GFR elevated (glomerular and tubular hypertrophy)
Glomerular hyperfiltration (mesangial expansion due to ongoing damage)
Microalbuminuria (30-300mg albumin/24hrs) - early warning of renal problems and risk factor for CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Causes of hypertension

A 
Essential (95%) - no identifiable cause
Secondary (5%)
Chronic renal disease
Coartication of aorta
Endocrine disease (Cushings, conns, phaeochromocytoma, acromegaly
Raised ICP
Pre-eclampsia
Drugs (steroids, COCP, NSAIDs)
30
Q

Causes of hypokalaemia

A

Excessive renal loss:
Drugs (thiazides, loop)
Endocrine (aldosterone excess)
Inherited defects

Magnesium deficiency (Na/K/ATPase)

Process driving K+ into cells:
Acute alkalosis
Insulin
Thyrotoxicosis

GI losses:
Diarrhoea
Vomiting
Low dietary K

31
Q

Cardiac complications in hypercalcaemia

A

ECG changes:
Short QT

Arrythmias uncommon

32
Q

Causes of hypocalcaemia

A 
Alkalosis
Hypoparathyroidism
Renal failure
Vit D deficiency
Malabsorption
Acute pancreatitis
Rhabdomyolsis
Sepsis
Low Mg
33
Q

Causes of hyponatraemia

A

Excess intake/water retention:
SIADH, drugs, CCF, cirrhosis, CKD/nephrotic syndrome, hypothyroidism, pregnancy

Renal Na loss:
Diuretics, mineralocorticoid deficiency, tubular disorders, SIADH, cerebral salt wasting

Other Na loss:
Vomiting, diarrhoea, burns

Pseudo-hyponatraemia:
Hyperproteinaemia, hyperlipidaemia

34
Q

Define glomerulonephritis

A

Umbrella term applied to conditions causing inflammation of or around the glomerulus

35
Q

Causes of UTI

A

Bacteria from faeces
Spread through sexual activity
Incontinence/hygiene issues
Urinary catheters

36
Q

Management of 3 mechanisms of abnormal kidney excretion in CKD

A

Fluid retention:
Leads to HTN
Managed by salt and fluid restriction, loop diuretics

Potassium retention:
Leads to hyperkalaemia (muscle weakness, arrhythmias)
Managed with low K diets, correction of acidosis

Acid retention:
Caused by metabolic acidosis
Managed by sodium bicarbonate therapy

37
Q

Management of CKD

A

Identify and treat reversible causes (relieve obstruction, avoid nephrotoxins)
Delay or halt progression of CKD (BP management)
Manage CVD risk (lifestyle, BP, lipid and glycaemic control)
Diagnose and treat pathologic manifestations of CKD (anaemia, mineral and bone disorders, treat acidosis and oedema, restless legs and cramps)

38
Q

Causes of hyperkalaemia

A 
Reduced renal loss:
Low GFR
K-sparing diuretics
Trimethoprim
RAAS inhibiting drugs
ACE inhibitors 
Addisons
Dietary excess
K+ release from cells:
Acidosis
Tumour lysis
Insulin deficiency
Depolarising muscle paralysis
39
Q

Definition and stages of hypertension

A

Raised blood pressure in the systemic vascular bed >140/90mmHg

Normal <120/<80
Pre-HTN 120-139/80-89
Stage 1 40-159/90-99
Stage 2 >160/>100

40
Q

Define hyponatraemia

A

<135mmol/L sodium

Clinical consequences at <125mmol/L

41
Q

Define pyelonephritis

A

Infection in the renal pelvis

42
Q

Treatment of hypernatraemia

A

Stop water loss (antiemetic, stop diuretic, treat diarrhoea)

Aim to replace water (orally or 5% glucose)

43
Q

Define hyperkalaemia

A

> 4.7mmol/L

Clinical consequences >6moml/L

44
Q

Urethral syndrome

A 
Lower urinary tract syndromes:
Urinary frequency
Urgency
Dysuria
Suprapubic discomfort

With no recognised urinary pathogen/abnormality

45
Q

Define hypokalaemia

A

<3.5mmol/L potassium

46
Q

Renal consequences of hypertension

hypertensive renal disease

A

Hyaline arteriosclerosis in renal arterioles
Chronic and progressive renal ischaemia
Tubular atrophy, intestinal fibrosis and progressive glomerular sclerosis
Progressive CKD (small atrophied and fibrosed kidneys)
Vicious cycle of worsening HTN and CKD

47
Q

Causes of hypernatraemia

A 
Water loss
Blunted thirst with age
Diabetes insipidus
Diabetes mellitus
Diuretic use
Iatrogenic (excess saline)
48
Q

ADH

Where does it act?

What does it do?

What increases/decreases secretion?

A

Acts on renal collecting ducts

Increases permeability to water (aquaporin channels) to increase water absorption

Raised secretion: 
Increase in plasma osmolality,
Pain, stress, nausea
Drugs
Lung and CNS lesions
Ectopic pregnancy
Decreased plasma volume

Decreased secretion:
Decrease in plasma osmolality
Increase in plasma volume
Ethanol

49
Q

Mechanism of metabolic alkalosis

A

Decreased hydrogen ion concentration
Leading to increased bicarbonate
Alternatively a direct result of increased bicarbonate concentrations

50
Q

What is CKD associated with?

A 
HTN
Anaemia
Mineral and bone disorders
CVS complications 
More common >65
51
Q

Define cystitis

A

Inflammation of the bladder

Normally caused by UTIs

52
Q

Mechanism, effect and management of lack of erythropoietin production in CKD

A

Mechanism: Anaemia

Effect: Tiredness, LVH

Management: Epoetin, iron and ferritin collection

53
Q

UTI in pregnancy increases risk of

A

Pyelonephritis
Premature rupture of membranes
Pre-term labour

54
Q

Signs and symptoms of uraemia

A

CNS:
Encephalopathy, fits, twitch or tremor, tiredness
Peripheral neuropathy

GI:
Anorexia (loss of appetite & weight), N&V, colitis, metallic taste, halitosis

Resp:
Pleuritis, pleural effusion

Cardio:
Pericarditis

Endocrine:
Growth retardation, sexual dysfunction

Skin:
Pruritus, “half-and-half” nails

Pro-haemorrhagic uraemia - impaired platelet function

55
Q

Effects of CKD on CVS health

A

RAAS activation:
Leads to LVH
Managed by ACE inhibitors, angiotensin receptor blockers,

Microinflammation and HTN:
Lead to CAD, CHF, arrhythmias
Managed by BP control <130/80

56
Q

Investigations of UTI

A

Urine dip:
Nitrites
Leukocytes

57
Q

Investigations for pyelonephritis

A

Urine dip:
Bood, protein, leukocyte esterase, nitrite

CT
USS
DMSA scan (recurrent pyelonephritis)

58
Q

Management of diabetic nephropathy

A

Optimising blood glucose levels and BP

ACE inhibitors (even if BP normal)

59
Q

Cardiac complications in hypocalcaemia

A

ECG changes:
Long QT

Arrhythmias:
VT, heart block

60
Q

Nephrotic syndrome

A

Peripheral oedema
Proteinuria
Serum albumin (<25g)
Hypercholesterolaemia

61
Q

Chronic pyelonephritis

A

Recurrent kidney infections
Leads to scarring of the renal parenchyma
Can result in chronic kidney disease
Can result in abscess and/or pus in or around the kidney
May be a role for prophylactic antibiotics

62
Q

Management of pyelonephritis

A

Blood and urinary cultures
Broad spectrum antibiotics (e.g. co-amoxiclav) until culture and sensitivities are available
Admission if systemically unwell or complicated
IV rehydration
Analgesia
Antipyretics

63
Q

Cardiac complications in hypokalaemia

A

ECG changes:
ST depression, flat T waves, U wave, extra systoles

Arrhythmias:
AF, SVT, VT

64
Q

Define metabolic acidosis/alkalosis

A

Imbalance in production of acids or bases and their excretion by the kidneys

65
Q

Common organisms causing pyelonephritis

A

E. coli most common
Klebsiella
Enterococcus
Pseudomonas

66
Q

Causes of uraemia

A

Pre-renal:
Raised hepatic production of urea
Increased renal reabsorption
Iatrogenic

Renal:
Renal failure

Post-renal:
Urinary outflow obstruction

67
Q

Define hypernatraemia

A

> 145mmol/L sodium

Clinical consequences at >155mmol/L

68
Q

What findings are needed to confirm stage 1 or 2 CKD?

other than GFR

A

Albuminuria
Urine sediment abnormalities
Electrolyte and other abnormalities due to tubular disorders
Histological abnormalities
Structural abnormalities detected by imagine
History of kidney transplantation

69
Q

Causes of end stage renal disease

A

Hypertension
Diabetes mellitus
Glomerulonephritis

70
Q

How does diabetes affect the kidney?

A

Chronic high level of glucose passing through glomerulus causes scarring

Glomerulosclerosis

71
Q

Management of UTI in pregnancy

A

7 days of antibiotics (even with asymptomatic bacteruria)
Urine for culture and sensitivities
First line: nitrofurantoin (avoid in 3rd T)
Second line: cefalexin or amoxicillin

Priority 1 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions