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MEDICINE FINALS > RENAL&GU > Flashcards

RENAL&GU Flashcards

1
Q

What is CKD?

A

Gradual, irreversible reduced kidney function

Reduced kidney function (eGFR <60) for >3 months
(measured on 2 separate occasions) alongside evidence
of kidney damage (structural abnormalities on USS,
persistent sediment (blood/protein) in urine, history of
renal transplant)

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2
Q

What does the kidney do?

A
  • filter and excrete waste products from the blood
  • water and electrolyte balance
  • secretes renin (BP control), EPO (RBC production) and Vit D
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3
Q

What is end stage renal failure?

A

Stage 5 CKD
- insufficient renal function to sustain life
- require haemodialysis

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4
Q

What initial investigations would you do for someone with suspected CKD?

A
  • Serum creatinine and eGFR.
  • Early morning urine sample (ACR).
  • Urine dipstick test (haematuria)
  • Body mass index (BMI), blood pressure, and serum HbA1c and lipid profile (cardiovascular risk factors).
  • A renal tract ultrasound if indicated (such as urinary tract stones or obstruction, or a family history of polycystic kidney disease.)
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5
Q

How would you monitor for disease progression in someone with CKD?

A
  • eGFR and urine ACR
  • FBC (exclude renal anaemia)
  • serum calcium, phosphate, vitamin D, and parathyroid hormone (exclude renal metabolic and bone disorder)
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6
Q

What are the complications of CKD? (7)

A
  • AKI
  • HTN/dyslipidaemia
  • CVD
  • renal anaemia
  • renal mineral and bone disorder
  • peripheral neuropathy
  • pulmonary oedema
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7
Q

Give 5 causes of CKD

A
  • Age
  • glomerulonephritis
  • infections e.g. HIV/TB
  • drugs (NSAIDs, calcineurin inhibitors)
  • obstruction (stones/fibrosis)
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8
Q

How might someone with CKD present?

A

Mostly asymptomatic
- nephrotic/nephritic syndrome
- unexplained haematuria/proteinuria

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9
Q

Give 4 causes of normal anion gap (hyperchloremic) metabolic acidosis

A
  • gastrointestinal bicarbonate loss: diarrhoea, fistula
  • renal tubular acidosis
  • drugs: e.g. acetazolamide
  • Addison’s disease
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10
Q

Give 4 causes of raised anion gap metabolic acidosis

A
  • lactate: shock, hypoxia
  • ketones: diabetic ketoacidosis, alcohol
  • urate: renal failure
  • acid poisoning: salicylates, methanol
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11
Q

What are the stages of hyperkalaemia?

A

mild: 5.5 - 5.9
mod: 6.0 - 6.4
sev: >6.5 (or ECG changes)

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12
Q

How is hyperkalaemia treated?

A

mild/mod: stop causative meds, treat underlying cause, calcium resonium
severe:
1. IV calcium gluconate 10%
2. IV soluble insulin with 50ml glucose 50% over 5-15mins
3. nebulised salbutamol

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13
Q

Give 3 ECG findings you would get in hyperkalaemia

A
  • tall, tented T waves
  • broad QRS complexes
  • loss of P waves
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14
Q

Give 5 possible causes of hyperkalaemia

A
  • renal impairment
  • nephrotoxic drugs
  • DKA
  • Addisons
  • metabolic acidosis
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15
Q

Which pH balance does hypokalaemia tend to be associated with?

A

metabolic alkalosis (H+ is a competitor of K+)

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16
Q

Give 2 causes of hypokalaemia with hypertension

A
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
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17
Q

What symptoms might you get with hypokalaemia?

A
  • muscle cramps
  • weakness
  • arrhythmia
  • ILEUS
18
Q

What ECG changes would you expect to see in someone with hypokalaemia?

A

U waves
absent T waves
prolonged PR interval
ST depression

19
Q

How is hypokalaemia managed?

A

mild = PO K+ supplement
severe (<2.5) = very slow IV infusion

20
Q

What medication should you check for in patients with hypokalaemia to save them from harm?

A

DIGOXIN - exacerbates toxicity

21
Q

Give 3 causes of hypokalaemia without hypertension

A
  • diuretics
  • GI loss (e.g. Diarrhoea, vomiting)
  • renal tubular acidosis (type 1 and 2**)
22
Q

Give 4 S&S you might get with hypocalcaemia

A
  • tetany (muscle cramp, twitch, spasm)
  • perioral paraesthesia

ECG: prolonged QT interval

Trousseau’s sign - wrist flexion with BP cuff
Chvostek’s sign - tapping over parotid causes face twitch

23
Q

Give 2 causes of raised ALP plus raised calcium

A
  • bone mets
  • hyperparathyroidism
24
Q

Give 2 causes of raised ALP plus low calcium

A
  • osteomalacia
  • renal failure
25
Q

What is SIADH?

A

syndrome of inappropriate ADH secretion
- hyponatraemia secondary to the dilutional effects of excessive water retention

26
Q

What is ADH and where is it produced?

A

Vasopressin, stimulates water resorption from collecting ducts
- produced in hypothalamus and secreted by posterior pituitary gland

27
Q

What biochemical/clinical picture do you see in SIADH

A

euvolaemic hyponatraemia

28
Q

What would you expect to see on urine osmolality and urine sodium in SIADH?

A

high urine sodium
high urine osmolality

29
Q

Give 3 examples of voiding LUTS

A

(HIS)
Hesitancy
Incomplete emptying (terminal dribble)
Straining to void

30
Q

Give 3 examples of storage LUTS

A

Frequency
Urgency
Nocturia

31
Q

Give 4 causes of proteinuria

A

1 glomerular disease
2 tubular disease e.g cystic kidney disease
3 overflow in e.g. rhabdomyolysis
4 transient proteinuria in e.g. fever/overexertion

32
Q

Give 3 main causes of bladder outlet obstruction (in men) and an example for each

A

1 Bladder outlet obstruction
- prostate enlargement/cancer

2 - Neurogenic
- causa equina/MS/PD

3 - Iatrogenic
- opiates

33
Q

What is the management for BPH?

A
  1. Conservative management
    - weight loss/exercise/reduced caffeine
  2. Alpha blockers
    - Tamsulosin/doxazosin
  3. 5-alpha reductase inhibitors
    - finasteride
34
Q

How do alpha blockers work and what are side effects?

A
  • decrease small muscle tone
  • work IMMEDIATELY
  • SE: hypotension, drowsiness, DEPRESSION
35
Q

How would renal stones present?

A
  • sudden onset UNILATERAL severe colic pain
  • haematuria
  • no tenderness on palpation
36
Q

How would you managed someone with renal stones?

A

1 - A-E
2 - adequate fluid resuscitation
3 - analgesia
4 - most pass without further intervention

37
Q

How do you manage urge incontinence?

A

1 - treat underlying cause
2 - conservative
3 - BLADDER TRAINING
4 - anti muscarinic e.g. Oxybutynin
5 - MIRABEGRON (no anticholinergic SE)
6 - topical oestrogen in post menopause

38
Q

How do you manage stress incontinence?

A

1 - pelvic floor exercises
2 - conservative
3 - DULOXETINE
4 - surgery

39
Q

What are indications for acute dialysis?

A

AEIOU
A - acidosis (refractory)
E - electrolyte disturbance (refractory hyperkalaemia) I - intoxication
O - oedema (severe/unresponsive pulmonary oedema)
U - uraemia symptoms (seizures/decreased conciousness)

40
Q

How do you treat pyelonephritis?

A

IV co-amoxiclav

41
Q

What are indications for doing a renal biopsy?

A
  • unexplained AKI
  • suspected glomerulonephritis
  • positive nephritic screen
  • persistent acute tubular necrosis
  • suspected interstitial nephritis

MEDICINE FINALS (19 decks)

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