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renal > renal conditions > Flashcards

renal conditions Flashcards

1
Q

criteria for AKI

A

<48hrs reduction in kidney function -
increase in creatinine >26.4
or increase in creatinine by >50%
or reduction in urine output

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2
Q

cause of prerenal AKI

A 
inadequate blood supply to kidneys reducing filtration of blood
hypovolaemia
dehydration
hypotension
heart failure
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3
Q

causes of prerenal AKI

A 
inadequate blood supply 
hypovolaemia - haemorrhage, burns
renal hypoperfusions - NSAIDs
dehydration - D+V
hypotension (shock)
heart failure
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4
Q

renal causes of AKI

A 
vasculitis
glomerulonephritis
infection
systemic conditions
acute tubular necrosis
gentamicin
rhabdomyloysis
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5
Q

post renal AKI causes

A

obstruction to outflow, back pressure to kidney reducing function
kidney stones
ureter strictures

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6
Q

medication to avoid in patients with AKI

A 
NSAIDs
ACEi/ARB
diuretics
gentamicin
contrast
trimethoprim
potassium sparing diuretic
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7
Q

acute tubular necrosis

A

damage + death to epithelial cells of renal tubules
–> damage occurs due to ischaemia or toxins

commonest cause of AKI

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8
Q

is acute tubular necrosis reversible

A

yes, epithelial cells have the ability to regenerate

takes approx 7-21 days to recover

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9
Q

muddy brown casts on urinalysis

A

acute tubular necrosis

–>renal tubular epithelial cells in urine

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10
Q

complications of acute tubular necrosis

A

hyperkalaemia !!
fluid overload - heart failure, pulmonary oedema
metabolic acidosis pH<7.15

uraemia >40 - can lead to encephalopathy or pericarditis

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11
Q

causes of hyperkalaemia

A

AKI, CKD
rhabdomyolysis
adrenal insufficiency - addisons

spironolactone
ACEi/ARB
NSAIDs

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12
Q

hyperkalaemia ECG

A

tall, tented T waces
flattening or absence of P waves
broad QRS complex

higher it gets progressively bradycardic

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13
Q

effect of hyperkalaemia on muscles

A

muscle weakness - patient complains of jelly legs

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14
Q

immediate management of hyperkalaemia

A

10mls of 10% calcium gluconate (wont lower potassium but will normalise ECG)

insulin with 50mls 50% dextrose
nebulised salbutamol

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15
Q

what would you give a acidotic hyperkalaemic patient

A

sodium bicarbonate (on top of hyperkal tx)

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16
Q

urgent indications for haemodialysis

A

hyperkalaemia - 7/>6.5 unresponsive to treatment
severe acidosis <7.15
fluid overload
urea >40 - pericardialrub/effusion

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17
Q

rhabdomyolysis

A

skeletal muscle tissue breaks down + releases breakdown products into the blood
usually triggered by an event that causes muscle to break down
–> extreme underuse, overuse or traumatic injury

18
Q

presentation of rhabdomyolysis

A 
muscle aches + pain
oedema
fatigue
confusion - elderly frail patients
red brown urine
19
Q

rhabdomyolysis investigation

A

creatine kinase high
myoglobin in urine - gives red-brown colour
hyperkalaemia
–> ECG

20
Q

rhabdomylosis management

A

IV fluids
IV sodium bicarbonate
IV mannitol - increases GFR

21
Q

loss of which hormone in CKD leads to anaemia

A

erythropioetin = hormone that produces RBC

22
Q

management of anaemia of CKD

A 
exogenous eythropoietin
blood transfusion (allosensitisation)
23
Q

Xray changes seen in renal bone disease

A

sclerosis at both ends of vertebrae (denser white)
osteomalacia in centre (less white)

“ruger jersey” appearance (stripes found on rugby top)

24
Q

management of renal bone disease

A

alfacalcidol/calcitriol = active forms of vit D

low phosphate diet
bisphosphonates for osteoporosis

25
Q

diagnosis of polycystic kidney disease

A

US of kidney + genetic testing

–> bilateral cysts

26
Q

genes involved in autosomal dominant PKD

A

PKD-1 - chromosome 16 (85%)

PKD-2 - chromosome 4 (15%)

27
Q

extrarenal manifestations of polycystic kidney disease

A

cerebral (intracranial) aneurysms
hepatic, splenic cysts
cardiac valve disease - mitral/aorta regurgitation

colonic diverticula
aortic root dilatation
hernias

28
Q

management of ADPKD

A

tolvaptain - vasopressin receptor antagonist
–> slows development of cysts + progression to renal failure

(ESRF mean age = 50yrs)
cysts may rupture -> haematuria, resolves

29
Q

classic presentation of autosomal recessive PKD

A 
young kids, assoc with hepatic lesions
presents in pregnancy as oligohydramnios (low amniotics fluid during pregnancy, fetus not producing enough urine)
resp failure at birth
underdeveloped ear cartilage
low set ears
flat nasal bridge
30
Q

amyloidosis

A

deposition of extracellular amyloid (insoluble protein fibrils) in tissues or organs

occurs due to abnormal folding of proteins which then aggregate + become insoluble

31
Q

diagnosis of renal amyloidosis

A

renal biopsy = congo red staining, apple green birefringence under polarised light

serum amyloid precursor (SAP) scan (PET scan vibes)

32
Q

types of amyloidosis

A

AL = production of abnormal immunoglobulin light chains from plasma cells

AM = production of acute phase protein (serum amyloid A protein (SAA))
–> assoc with systemic inflammation

33
Q

amyloidosis treatment

A

AL = immunosuppresion - steriods, stem cell transplant

AA = treat underlying condition

34
Q

what are the diffrent types of ANCA + what conditions they indicate?

A

p-ANCA (MPO) = microscopic polyangiitis + churg-strauss (eosinophilic)

c-ANCA(PR3) = granulomatosis with polyangitis (wegners)

35
Q

henoch-schonlein purpura

A

IgA vasculitis
kids
purpuric rash on bum + legs
post URT 1-3 weeks

IgA nephritis in 50%

36
Q

granulomatosis with polyangiitis (Wegners)

A

nose bleeds, crusty nasal secretions, HEARING LOSS, sinusitis
haemoptysis
cough, wheeze
saddle shaped nose

rapidly progressing glomerulonephritis

37
Q

types of kiney stones

A

calcium based - oxalte, phosphate

uric acid - no on XRay
struvite - bacteria, stag horn
cystine - autosomal recessive disease

38
Q

stone responsible for staghorn calculus

A

struvite

recurrent UTIs, bacteria can hydrolyse urea to ammonia

39
Q

kidney stone investigation of choice

A

CT KUB

abdo xray shows calcium

40
Q

pharmacological management of kidney stones

A

tamsulosin

alpha blocker, aids spontaneous passage

41
Q

key difference between haemodialysis + haemodiafiltration

A

replacement of extra-convective ultrafiltrate throught the dialysis period in HDF

42
Q

gold standard dialysis vascular access

A

arteriovenous fistula

artery + vein surgically connected - bypass capillary system, flows high pressure from artery to vein

renal (15 decks)

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