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Renal disease Flashcards

1
Q

how do most renal patients present?

A

asymptomatic- through blood tests

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2
Q

how do most renal patients present?

A

asymptomatic- through blood tests

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3
Q

what would lots of proteinuria look like in urine?

A

frothy

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4
Q

what are the functions of the kidney

A

excretes fluid, maintains acid base and electrolytes, vitamin D metabolism, excretion of urea

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5
Q

what type of breathing is associated with metallic acidosis

A

kussmals breathing

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6
Q

are renal disease patients likely to present with dyspepsia?

A

yes- can die from it

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7
Q

what drugs are renal consultants most concerned a out

A 
ACEI- prevent renal failure BUT
 dehydrating effect
Gentamicin- nephrotoxic
PPI- acute kidney injury
contrast nephropathy- after radiology with contrast (dehydrated/ renal impairment problem)
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8
Q

what sign is a medical emergency

A

pericardial rub- uraemia

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9
Q

where are palpable kidneys found

A

autosomal dominant kidney disease

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10
Q

what is an important measurement in renal disease

A

blood pressure (

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11
Q

what is accelerated hypertension

A

a medical emergency- diastolic BP >120, papilloedema, end organ decompensation (fits, heart failure, acute renal failure)

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12
Q

what nail findings are common in acute illness or hypoalbuminaemia

A

leukonychia, splinter haemorrhages (nephritits, vasculitis)

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13
Q

what do scratch lesions that do not blanche represent?

A

vasculitis, acute glomerulonephritis

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14
Q

what is a smokey urine likely to be caused by

A

acute kidney injury requiring dialysis- muscle breakdown, dehydration, injury which occurs during earthquakes

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15
Q

what does specific gravity show?

A

urine concentration

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16
Q

what does leukocyte/ nitrates tell us on urinalysisi

A

UTI

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17
Q

how do you determine urine protein quantification

A

24 hour collection (

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18
Q

when do we worry about proteinurea

A

> 0.5g per day

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19
Q

what is seen by hyperkalaemia on an ECG

A

tall tented T waves

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20
Q

what GFR is classed as renal failure

A
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21
Q

what is acute kidney injury

A

decline in GFR over hours/ days/ weeks, with/without oliguria, in a patient with normal or impaired renal function

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22
Q

what is a classic presentation in nephrotic syndrome

A

proteinuria >3g per day, hypoalbuminaemia, oedema- periorbital (which is not present in heart failure)

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23
Q

what is nephritis syndrome

A

patient has nephritis- AKI, oliguria, oedema/ fluid retention, hypertension active urinary sediment

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24
Q

what is nephritis syndrome

A

patient has nephritis- AKI, oliguria, oedema/ fluid retention, hypertension active urinary sediment

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25
what would lots of proteinuria look like in urine?
frothy
26
what are the functions of the kidney
excretes fluid, maintains acid base and electrolytes, vitamin D metabolism, excretion of urea
27
what type of breathing is associated with metallic acidosis
kussmals breathing
28
are renal disease patients likely to present with dyspepsia?
yes- can die from it
29
what drugs are renal consultants most concerned a out
``` ACEI- prevent renal failure BUT dehydrating effect Gentamicin- nephrotoxic PPI- acute kidney injury contrast nephropathy- after radiology with contrast (dehydrated/ renal impairment problem) ```
30
what sign is a medical emergency
pericardial rub- uraemia
31
where are palpable kidneys found
autosomal dominant kidney disease
32
what is an important measurement in renal disease
blood pressure (
33
what is accelerated hypertension
a medical emergency- diastolic BP >120, papilloedema, end organ decompensation (fits, heart failure, acute renal failure)
34
what nail findings are common in acute illness or hypoalbuminaemia
leukonychia, splinter haemorrhages (nephritits, vasculitis)
35
what do scratch lesions that do not blanche represent?
vasculitis, acute glomerulonephritis
36
what is a smokey urine likely to be caused by
acute kidney injury requiring dialysis- muscle breakdown, dehydration, injury which occurs during earthquakes
37
what does specific gravity show?
urine concentration
38
what does leukocyte/ nitrates tell us on urinalysisi
UTI
39
how do you determine urine protein quantification
24 hour collection (
40
when do we worry about proteinurea
>0.5g per day
41
what is seen by hyperkalaemia on an ECG
tall tented T waves
42
what GFR is classed as renal failure
43
what is acute kidney injury
decline in GFR over hours/ days/ weeks, with/without oliguria, in a patient with normal or impaired renal function
44
what is a classic presentation in nephrotic syndrome
proteinuria >3g per day, hypoalbuminaemia, oedema- periorbital (which is not present in heart failure)
45
what is nephrotic syndrome caused by
diabetes, glomerulonephritis- immunosuppression
46
what is nephritis syndrome
patient has nephritis- AKI, oliguria, oedema/ fluid retention, hypertension active urinary sediment
47
what is chronic kidney disease
reduced GFR and or evidence of kidney damage and must be seen to be chronic
48
how do we assess GFR
measured through nuclear medicine, estimated by creatinine clearance (neither reabsorbed or secreted at glomerulus)- by 24 hour urine sample- inaccurate Can be estimated by age, sex, race, Creatinine
49
what is creatinine a measurement of
muscle breakdown
50
what is the average eGFR for most people,
51
what is stage 1 of CKD
GFR >90ml/min and evidence of kidney damage
52
what is stage 2
GFR 60-90 with evidence of kidney damage- proteinuria, haematuria and abnormal imaging
53
how are stages 3-5 defined?>
only by GFR
54
is severe kidney disease common?
rare- 0.1%
55
what does CKD increase the risk of
cardiovascular problems
56
what symptom suggests that patients are more likely to progress
proteinuria
57
what are common causes of CKD
Diabetes, hypertension, vascular disease, chronic glomerulonephritis, reflux nephropathy- pyelonephritis, polycystic kidneys, cause may not be known
58
what symptoms do people present with CKD
tiredness, loss of appetite, itch, sleep disturbance, nocturia
59
how do you manage CKD
slow decline in GFR, reduce cardiovascular risk, identify and treat complications of CKD, prepare for renal replacement therapy
60
how do you slow progression of CKD
control BP, reduce proteinuria, ACEI reduce BP and proteinuria-> reduce glomerular pressure so may cause hyperkalaemia so have blood test after 10 days. Control diabetes and stop smoking
61
how do you reduce cardiovascular risk
stop smoking, statins, control BP and proteinuria
62
what are complications of CKD
anaemia- Erythropoietin (bone marrow to producee RBC) declines in CKD. Check B12 and folate levels, may be from other cause Bone disease- Vit D impaired in kidneys- reduced calcium absorption and causes secondary hyperparathyroidism, in advanced disease increases PTH secretion
63
how do you fix anaemia
IV iron, EPO by subcutaneously,
64
what is hyperparathyroidism
can lead to hypercalcaemia
65
what can bone disease actually have an effect on?
cardiovascular- calcification of vessels and heart valves
66
how do we fix bone disease
alfacalcidol- hydroxylated Vit D, phosphate or phosphate binders to reduce absorption including sevelamer, calcium carbonate
67
what are some renal replacement therapy
haemodialysis, peritoneal dialysis, transplantation, conservative management
68
when would a patient be on dialysis according to their GFR
20ml/min
69
what do you need for haemodialysis
Arteriovenous fistula for easy access- when GFR 15ml/min
70
what is needed for peritoneal dialysis
catheter
71
when can patients go on transplant list
when within 6 months of dialysis
72
who goes for conservative management
multiple co morbidities, old people

Renal (18 decks)

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