Renal/ Endocrinology Flashcards
In prerenal disease: what would the serum urea:creatinine ratio be?
What will urine sodium be?
what would the urine osmolality be?
Raised
Sodium <20
Osmolaltiy >500
In prerenal uraemia, think of the kidneys holding on to sodium to preserve volume
What factors may affect eGFR result?
Pregnancy, muscle mass, eating red meat 12 hours prior
Wegner’s: what would autoantibody?
What symptoms
can lead to what condition?
cANCA
chronic sinusitis, cough, caved nose, cresenteric glomerulonephritis
- rapidly progressive glomerulonephritis
What is the triad for haemolytic uraemic syndrome?
Most likely caused by?
1) Acute kidney injury
2) Microangiopathic haemolytic anaemia
3) Thrombocytopenia
E.coli - following diarrhoeal illness
What is the most common viral infection in solid organ transplant patients?
Tx?
cytomegalovirus
ganciclovir
Get symptoms such as: anorexia, fatigue, arthralgia, jaundice, lymphadenopathy, hepatomegaly
Treatment for NEPHROGENIC diabetes insipidus?
Thiazide
What drugs have nephrotoxic potential?
DAAMN
Diuretics ACE inhibitors ARBs Metformin NSAIDs
NSAIDs, aminoglycosides, ACE inhibitors, Angiotensin II receptor antagonists, diuretics
how many months up to is acute graft rejection classified as?
6 months
Features of renal cell carcinoma
classical triad: haematuria, loin pain, abdominal mass pyrexia of unknown origin left varicocele (due to occlusion of left testicular vein) endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
help prevent the formation of ascites in patients with chronic liver disease - what drug would you use?
spironolactone
In Cushing’s do you get high or low potassium?
Metabolic acidosis or alkalosis?
hypokalaemic metabolic alkalosis
History of what condition is pioglitazone contraindicated in?
Pioglitazone is contraindicated by his history of bladder cancer
Management of Addison’s disease
glucocorticoid and mineralocorticoid replacement therapy.
hydrocortisone + fludrocortisone
Primary hyperaldosteronism can present with …
Ix?
Tx?
Primary hyperaldosteronism can present with hypertension, hypernatraemia, and hypokalemia (e.g. muscle weakness)
aldosterone/renin ratio is the first-line investigation –> high resolution CT abdo and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess
adrenal adenoma: surgery
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
Electrolyte features of an addisonian crisis
Features of an addisonian crisis:
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Treatment of phaeochromotoma
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers
then definitive managment is surgery
Investigation for Subacute (De Quervain’s) thyroiditis
thyroid scintigraphy: globally reduced uptake of iodine-131
Pioglitazone side effect
It is a Thiazolidinediones
Side effect is fluid retention
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be…
a basal–bolus using twice‑daily insulin detemir
Addisonian crisis management
hydrocortisone 100 mg im or iv
1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
MODY autosomal?
dominant
What causes
Higher-than-expected levels of HbA1c (due to increased red blood cell lifespan)
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
best test to diagnose Addison’s disease
short synacthen (ACTH) test
Treatment for bilateral adrenocortical hyperplasia
Treatment for adrenal adenoma
Aldosterone antagonist
Surgery
What is myxoedemic coma features?
Hypothermia, hyporeflexia, bradycardia, seizures, thin & brittle hair, periorbital oedema, reduced reflexes
The standard HbA1c target in type 2 diabetes mellitus…
is 48 mmol/mol
What is Pseudo-Cushing’s? What causes it?
mimics Cushing’s
often due to alcohol excess or severe depression
causes false positive dexamethasone suppression test or 24 hr urinary free cortisol
insulin stress test may be used to differentiate
What are the features of insulinoma?
- Symptoms and signs of hypoglycaemia
- Plasma glucose <2.5 mmol/L
- Reversibility of symptoms on the administration of glucose
- C-peptide production does not fall on exogenous insulin injection in patients with an insulinioma
If a postmenopausal woman has a fracture she should be put on
bisphosphonates (Risedronate and calcium supplements)
Thiazide can cause…
hypercalcaemia
Pepperpot skull is a characteristic X-ray showing…
hyperparathyroidism
First line test for acromegaly
Serum IGF-1
Hyperpigmentation is caused by…
Increase in ACTH (from pituitary) as it is also a precursor for POMC which is a precursor for MST. MST stimulates melanocytes giving the hyperpigmentation that is seen in primary adrenal failure
What diabetes medication has an increased risk of osteoporosis and consequently fractures?
Thiazolidinediones
IN the acute management of DKA
Insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
What drugs causes gynaecomastia?
Spironolactone
Long-term corticosteroid use can cause what bone issue?
Osteopaenia & osteoporosis
What cardiac problem can you get in thyrotoxicosis?
High-output cardiac failure may occur in elderly patients
Palpitations
Tachycardia
What is the treatment of choice for toxic multinodular goitre?
Radioiodine therapy
Which thyroid carcinoma presents with phaeochromocytoma?
Medullary carcinoma
What condition presents with thyrotoxicosis and hot solitary nodule?
Toxic adenoma
What’ is the most common type of thyroid cancer?
Papillary carcinoma
What neurological condition can you get from corticosteroid therapy?
steroid psychosis
What’s MEN type 1
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Most common presentation = hypercalcaemia
What’s MEN Type IIA?
- Medullary thyroid cancer
Parathyroid (60%)
Phaeochromocytoma
What’s MEN Type IIB?
- Medullary thyroid cancer
Phaeochromocytoma
Marfanoid body habitus
Neuromas
For MEDULLARY thyroid cancer, what do you use to screen for disease recurrence?
What about for Papillary and Follicular?
Medullary thyroid cancers often secrete calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence.
Papillary and follicular thyroid cancer are monitored with thyroglobulin
Which diabetic drugs causes weight gain?
Insulin
Sulfonylureas
Glitazones
What important blood test needs to be performed for patients taking Carbimazole?
FBC - Agranulocytosis is associated with carbimazole use
What does orlistat do?
Orlistat works by inhibiting gastric and pancreatic lipase to reduce the digestion of fat
Example of sulfonylureas
Gliclazide
How to treat thyroid toxic storm
Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone
First line treatment for most patients with a pituitary tumour causing acromegaly
Trans-sphenoidal surgery
What is the optimal treatment for maturity onset diabetes of the young (MODY) (type Hepatic Nuclear Factor 1 Alpha (HNF1A))
Sulfonylureas (e.g. gliclazide)
What happens to phosphate in hyperparathyroidism
PTH - phosphate trashing hormone
Makes phosphate low
How many units is there in 1ml?
1ml = 100Units
Management of hypercalcaemia
IV 0.9% N saline [1st]
Bisphosphonates [2nd]
What is labetalol’s role
Labetalol blocks both alpha and beta receptors
- lABetalol
How to define Impaired glucose tolerance (IGT)
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
How to define impaired fasting glucose (IFG)
A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l
What neuropathy drug do you avoid in benign prostatic hyperplasia?
Amitriptyline
