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Metabolic > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

Nephrotic Triad

A

Proteinuria, oedema, hypoalbuminemia

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2
Q

Why hypercholesterolemia in nephrotic

A

Hypoalbuminemia -> increased liver production -> secondary effect

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3
Q

Nephrotic at increased risk of

A

Thrombosis

Sepsis

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4
Q

Why thrombosis risk

A

Pee out antithrombin III

Increased fibrinogen production

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5
Q

What is nephrotic syndrome

A

Damage to the podocytes

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6
Q

What are podocytes

A

Third layer of filtration+contain a negative charge to

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7
Q

What is minimal change

A

Loss of foot processes of podocytes

Associated with Hodgkin’s lymphoma, asthma and eczema

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8
Q

Why is it called minimal change

A

Cannot see abnormality on light microscopy

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9
Q

What is membranous

A

Thickened basement membrane - spike/dome appearance

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10
Q

Types of nephrotic (5)

A 
Minimal change
Membranous
Focal segmental
Membranoproliferative
Lupus associated
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11
Q

Most common nephrotic

A

FSGS

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12
Q

What is FSGS

A

Parts of some glomeruli are scarred

IgM associated

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13
Q

Prognosis for membranous

A

1/3 recover, 1/3 relapse, 1/3 end stage

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14
Q

What is mesangiocapillary also known as

A

Membranoproliferative

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15
Q

What is mesangiocapillary?

A

Increase number of cells in glomerulus and alterations in the basement membrane. The deposits in the glomerular mesangium and basement membrane cause complement activation

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16
Q

What nephropathy is hepC associated with

A

Mesangiocapillary

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17
Q

What type of nephropathy can lupus cause

A

All of them

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18
Q

What is nephritic syndrome

A

Haematuria, hypertension, oedema, oliguria

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19
Q

Why do nephritics have oedema

A

Fluid retention

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20
Q

Types of nephritic

A

IgA, post infectious, mesangiocapillary, rapidly progressive

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21
Q

Types of mesangiocapillary GN

A

Type 1 - circulating immune complexes - SLE, Hep B+C

Type 2 - dense deposit disease - excessive activation of the complement system

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22
Q

Types of rapidly progressive GN

A

Type 1 - goodpasture
Type 2 - immune complex mediated e.g. SLE
Type 3 - GPA and eGPA

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23
Q

What is GPA

A

Granulomatosis with polyangitis

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24
Q

What is eGPA

A

eosinophilic granulomatosis with polyangitis

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25
Q

Who is eGPA common in

A

Asthmatics

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26
Q

What is IgA

A

IgA deposits in the space between glomerular capillaries

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27
Q

Most common nephritic

A

IgA

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28
Q

What is Henoch-Schonlein purpora

A

Systemic form of IgA nephropathy, common in children, small bruises affecting the buttocks and lower legs

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29
Q

How long post infection for streptococcal

A

2 weeks

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30
Q

How long post infection for IgA

A

24-48 hours, particularly respiratory infections

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31
Q

What is good pastures

A

anti-GBM disease - antibodies attach the basement membrane in the lungs and kidneys

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32
Q

Basement membrane is

A

Type 4 collagen

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33
Q

How to assess renal plasma flow

A

Para-aminohippurate clearance (PAH)

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34
Q

What HLA antigen is most important in renal transplant

A

DR > B > A

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35
Q

What most likely to die from on dialysis?

A

Ischaemic heart disease

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36
Q

Post op problems with renal transplant?

A 
Acute tubular necrosis
Vascular thrombosis
Urine leakage
UTI
Rejection
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37
Q

What is hyper acute vs acute vs chronic graft failure?

A

Hyperacute - pre-existent antibodies - rare due to HLA
Acute - mismatched HLA, cell mediated, <6 months, reversible
Chronic - both antibody and cell mediated, fibrosis of transplanted kidney, potential recurrence of renal disease (MCGN > IgA > FSGS)

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38
Q

Features of PKD?

A 
Hypertension
Recurrent UTIs
Abdo pain
Renal stones
Haematuria
CKD
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39
Q

Extra renal manifestations of PKD?

A 
Liver cysts (most common)
Berry aneurysms - leading to subarachnoid haemorrhage
Mitral valve prolapse
Mitral/tricuspid incompetence
Aortic root dilation
Aortic dissection
Cysts in other organs
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40
Q

Pattern of inheritance with PKD?

A

Autosomal dominant

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41
Q

What is AKI?

A

Reduction in renal function following an insult to the kidneys

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42
Q

Causes of AKI?

A 
Prerenal:
Hypovolemia
Renal artery stenosis
Intrinsic: 
Glomerulonephritis
Acute tubular necrosis
Acute interstitial nephritis
Rhabdomyolysis
Tumour lysis syndrome
Postrenal:
Kidney stone
BPH
External compression
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43
Q

Risk factors for AKI?

A 
CKD
Significant comorbidities
History of AKI
65+
Contrast exposure
Drugs with nephrotoxic potential:
NSAIDs
Aminoglycosides
ACEi
ARBs
Diuretics
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44
Q

Symptoms of AKI?

A

Reduced urine output
Pulmonary and peripheral oedema
Arrhythmias
Uraemia

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45
Q

Factors affecting eGFR?

A

Pregnancy
Muscle mass
Eating red meat 12 hours prior to sample

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46
Q

What to do for patients at increased risk of contrast-induced AKI?

A

Offer IV hydration before and after contrast infusion

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47
Q

Ascites treatment?

A

Spironolactone

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48
Q

What drugs cause acute interstitial nephritis?

A 
Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide
49
Q

How does interstitial nephritis present?

A

Eosinophilia
Mild renal impairment
Hypertension
Fever, rash, arthralgia

50
Q

Investigation for AKI of unknown aetiology?

A

Renal ultrasound

51
Q

How to calculate anion gap?

A

(Sodium + Potassium) - (Bicarbonate + Chloride)

52
Q

ECG changes in hypokalaemia?

A

U waves
T wave flattening
ST depression
Prolonged PR interval

53
Q

Treatment of mild-moderate hypokalaemia?

A

2.5-3.4 mol/l

Oral potassium

54
Q

Treatment of severe hypokalaemia?

A

<2.5 mmol
Cardiac monitoring
IV fluid therapy
No quicker than 20mmol/hr

55
Q

Symptoms of hypokalaemia?

A

Muscle weakness
Hypotonia
Predisposes to digoxin toxicity

56
Q

Treatment of nephrogenic diabetes insipidus?

A

Inability to respond to vasopressin

Give chlorothiazide

57
Q

What is Alport syndrome?

A

X-linked dominant
Abnormal GBM
Affects males more than females

58
Q

Symptoms of Alport syndrome?

A 
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa
59
Q

What is lenticonus?

A

Protrusion of the lens surface into anterior chamber

60
Q

General management of nephrotic?

A

Sodium restriction
Anticoagulation
Statin
ACEi - reduce proteinuria

61
Q

Why nephrotic at increased sepsis risk?

A

Loss of immunoglobulin in the urine

62
Q

Causes of membranous GN?

A 
Idiopathic - 75%
Panicillamine
NSAIDs
Mercury
Capropril
Autoimmune disease
Hep B
Hep C
Schistosomiasis
Malaria
Malignancy
Sarcoidosis
Kidney transplantation
Sickle cell
63
Q

What is thin glomerular basement membrane disease?

A

Autosomal dominant
Microscopic haematuria
RBC casts

64
Q

HIV FGS?

A

Collapsed appearance of glomeruli

Enlarged podocytes

65
Q

What is renal artery stenosis?

A

Narrowing of the renal artery leading to hypo perfusion and activation of the RAAS

66
Q

Prerenal uraemia

A

Low urine sodium
High urine:plasma osmolality
High specific gravity

67
Q

Symptoms of renal artery stenosis?

A

Abrupt onset hypertension
Treatment resistant hypertension
Unexplained kidney failure

68
Q

Symptoms of renal artery thrombosis?

A 
Sudden onset loin pain
Fever
Haematuria
Nausea + vomiting
Sudden drop in kidney function
Hypertension
69
Q

Symptoms of atheroembolic renal disease?

A 
Skin lesions
Abdo pain
Diarrhoea
Confusion
Weight loss
Fever
Muscle aches
70
Q

Hyponatremia?

A 
<136 mmol/L
Asymptomatic if chronic or only mild
Anorexia
Headache
Nausea
Lethargy
Personality change
Muscle cramps
Weakness
Confusion
Drowsiness
71
Q

Cause of hypovolemic hyponatremia?

A 
Vomiting
Diarrhoea
Skin losses
Renal failure
Diuretics
Adrenocorticoid deficiency
72
Q

Causes of euvolemic hyponatremia?

A 
Acute water load
Psychogenic polydipsia
SIADH
Glucocorticoid deficiency
Severe hypothyroidism
73
Q

Causes of hypervolemic hyponatremia?

A 
CCF
Cirrhosis
Nephrotic syndrome
Primary polydipsia
Renal failure
74
Q

What is SIADH?

A

Excess ADH secretion from posterior pituitary

75
Q

Treatment of hyponatremia?

A

Sodium chloride IV for hypovolemic
Fluid restrict euvolemic
Stop diuretics, SSRIs
Treat underlying cause

76
Q

Rapid overcorrection of hyponatremia?

A

Central pontine myelinolysis

77
Q

What is hypernatremia?

A 
>145 mol/L
Lethargy
Weakness
Confusion
Jerks
Seizures
Dry mouth
Oliguria
Tachycardia
78
Q

Causes of hypernatremia?

A 
Diabetes insipidus
Dementia
Burns
Loop diuretics
Hyperglycemia
Iatrogenic
Excess salt ingestion
79
Q

Treatment of hypernatremia?

A

Correct fluid loss

Treat underlying disorder

80
Q

Hyperkalemia?

A

> 5.5 but severe >6.5
Palpitations
Muscle weakness
Depressions reflexes

81
Q

Causes of hyperkalemia?

A

Decreased excretion
Increased circulation
Extracellular shift
Pseudohyperkalemia

82
Q

ECG of hyperkalemia?

A 
Peaked T waves
Prolonged PR
Widened QRS
Loss of P wave
AV dissociation
83
Q

Hyperkalemia management?

A 
Calcium glutinate
Insulin/dextrose infusion
Salbutamol nebuliser
Calcium resonium
Loop diuretic
Dialysis
84
Q

What is metabolic acidosis?

A

pH <7.35

Bicarbonate <22

85
Q

Causes of normal anion gap metabolic acidosis?

A 
GI bicarb loss
Renal tubular acidosis
Drugs
Addison's disease
Ammonium chloride
86
Q

Causes of raised anion gap metabolic acidosis?

A

Lactate: shock, hypoxia
Ketones: DKA, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol

87
Q

What is a normal anion gap?

A

10-20

88
Q

Symptoms of metabolic acidosis?

A 
No ACID
Nausea
Arrhythmias
Confusion
Increased heart rate + RR
Diarrhoea
89
Q

Treatment of metabolic acidosis?

A

Treat underlying cause

90
Q

Drugs causing minimal change?

A

NSAIDs
Interferon
Lithium

91
Q

Drugs causing FSGS?

A

Bisphosphonates

Heroin

92
Q

Drugs causing membranous?

A

NSAIDs
Gold
Penicillamine

93
Q

Drugs causing acute tubular injury?

A 
NSAIDs
Aminoglycosides
Amphotericin B
Zoledronic acid
IV contrast
94
Q

Drugs causing interstitial nephritis?

A

NSAIDs
Antibiotics
Allopurinol
PPI

95
Q

Drugs causing HUS or TTP?

A

Ciclosporin
Clopidogrel
Gemcitabine
Bevacizumab

96
Q

Drugs causing rhabdomyolysis?

A

Statin

Cocaine

97
Q

Risks of raised creatine?

A

Increased hospital mortality
Risk of CKD
Progression to ESRF

98
Q

Stage 1 AKI?

A

Creatinine 1.5-1.9x baseline

Urine <0.5ml/kg/hr for 6-12 hours

99
Q

Stage 2 AKI?

A

Creatinine 2-2.9x baseline

Urine <0.5ml/kg/hr for >12 hrs

100
Q

Stage 3 AKI?

A

Creatinine 3x baseline

Urine <0.3ml/kg/hr for 24 hrs or anuria >12 hours

101
Q

Investigations for AKI?

A 
Urinalysis
Urine MSC
Blood gases
Renal ultrasound
ECG
Immunology screen
102
Q

Findings of acute tubular necrosis?

A

High urine sodium
Low urine:plasma osmolality
Low specific gravity
Brown granular casts

103
Q

What drugs can worsen AKI?

A 
NSAIDs
Aminoglycosides
ACE inibitors
ARBs
Diuretics
104
Q

Other drugs stopped in AKI?

A

Metformin
Lithium
Digoxin

105
Q

CKD stage one?

A

Kidney disease but normal GFR

106
Q

CKD stage 2?

A

Kidney disease

GFR 60-89

107
Q

CKD stage 3?

A

GFR 30-59

108
Q

CKD stage 4?

A

GFR 15-29

109
Q

CKD stage 5?

A

GFR <15

110
Q

Mainstay of CKD treatment?

A

Prevent loss of kidney function
optimise glycemic control
Blood pressure - ACE
Lipid lowering agent

111
Q

Peritoneal dialysis?

A

Infusion of dialysis fluid into peritoneal cavity
Exchange occurs with highly vascular omentum
Fluid replaced to remove waste

112
Q

Complications of peritoneal dialysis?

A 
Peritonitis
Constipation
Fluid retention
Hernia
Back pain
Malnutrition
Depression
Catheter problems: infection, blockage, kinking, leaks
113
Q

Other management of patients on dialysis?

A

Phosphorus binding agents
Alfacalcidiol
Calcimemetics

114
Q

Haemodialysis?

A

Through a fistula or central line

Ultrafiltration removes waste and adds any necessary products

115
Q

Complications of haemodialysis?

A 
Infection
Hypotension
Cardiac arrhythmias
Nausea vomiting
Fever
Dialyser reactions
Heparin induced thrombocytopenia
Depression
116
Q

Contraindications to transplant?

A 
Cancer
Infection
Uncontrolled ischaemic heart disease
HIV
Viral hepatitis
Extensive peripheral vascular disease
Mental incapacity
117
Q

Pros of transplant?

A

Stop dialysis
Improved quality of life
Normal diet + activity
Reversal of anaemia and bone disease

118
Q

Cons of transplant?

A 
Operative complications
Graft failure
Thrombosis in transplant
Infection
Cancer
Immunosuppression effects

Metabolic (5 decks)

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