Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 Revision > Renal Investigations and Management > Flashcards

Renal Investigations and Management Flashcards

1
Q

Pre-renal AKI management

A

Assess for hydration:
Clinical observations (BP, HR, UO)
JVP, cap refill, oedema
Pulmonary oedema

Fluid challenge for hypocolaemia:
Crystalloid or colloid
Bolus of fluid, reassess and repeat as necessary
If >1L and no improvement seek help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Renal AKI investigations

A 
U&Es
FBC and coagulation screen (clotting? anaemia?)
Urinalysis (haemoproteinuria)
USS (obstruction? size?)
Immunology (ANA, ANCA, GBM)
Protein electrophoresis and BJP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Further management of AKI

A

Fluid resuscitate (if still not achieving adequate BP then inotropes/vasopressors)
Treat underlying cause (e.g. antibiotics for sepsis)
Stop nephrotoxics
Dialysis if remains anuric and uraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Post renal AKI investigations

A

USS

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Post-renal AKI

A

Relieve obstruction:
Catheter
Nephrostomy
Refer to urology if ureteric stenting is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hyperkalaemia management

A

Cardiac monitor and IV access
10mls 10% calcium gluconate (2-3 mins)
Insulin with 50mls 50% dextrose
Salbutamol nebs

Calcium resonium (prevents absorption, not in acute setting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Urgent indications for haemodialysis

A

Hyperkalaemia (>7 or >6.5 unresponsive to medial therapy)
Severe acidosis (pH<7.15)
Fluid overload
Urea >40 or pericardial rub/effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Target blood pressures for CKD

A

140/90

130/90 if ACR of 70 or more or diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lipid lowering therapy in CKD

A

Atorvastatin 20mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CV risk modification in CKD

A

Lifestyle advice
Control of hypertension
Other prophylaxis (lipid lowering therapy, consider aspirin for secondary prevention)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Managing mineral and bone disease in CKD - lifestyle advice

A 
Dietary advice (phosphate restriction)
Also consider need for salt, potassium, fluid and other dietary restrictions
Correct metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Managing mineral and bone disease in CKD - medications

A 
Alfacalcidol (active vit D)
Phosphate binders (calcium based [adcal/phoslo/osvaren], aluminium [alucaps], non-calcium based [lanthanum, sevelamer])
Calcimimetic (calcinet)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Renal anaemia investigation

A

Exclude other causes of anaemia:
B12 and folate deficiency
Check ferritin and iron stores
Consider haematological causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Renal anaemia management

A

Oral iron
IV iron
EPO injection if no iron or haematinic deficiencies (ESA therapy)

Mild anaemia is okay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vascular access for dialysis steps (in order of efficacy)

A

Tunnelled venous catheter
Arteriovenous graft
Fistula

Can also get HeRO grafts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Starting haemodialysis management

A

Gradual build up (prevents disequilibrium syndrome from too-rapid correction of uraemic toxin levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Starting PD management

A

Training (3-6 weeks)
Build up fill volume size
Regular clinic and nurse follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Glomerulonephritis (GN) blood tests

A 
FBC
U&amp;E
LFT
CRP
Immunoglobulins
Electrophoresis
Complement
Autoantibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Glomerulonephritis investigations

A

Urinalysis (haemo/proteinuria)
Urine microscopy (RBC [dysmorphic], RBC and granular casts, lipiduria)
Urine protein/creatinine ratio/24 hours urine
Kidney biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nephritic syndrome findings

A 
Acute renal failure
Oliguria
Oedema/fluid retention
Hypertension
Active urinary sediment (RBCs, RBC and granular casts)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nephrotic syndrome findings

A 
Proteinuria >3g/day
Hypoalbuminaemia
Oedema
Hypercholesterolaemia
Usually normal renal function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Histological GN investigations

A

Light microscopy
Immunofluorescence
Electron microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Histological GN classification

A

Proliferative or non-proliferative
Focal/diffuse (< or >50% of glomeruli affected)
Global/segmental (all or part of glomerulus affected)
Crescenteric (epithelial extracapillary proliferation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Non-immunosuppressive management of GN

A 
Anti-hypertensives (<120/75 if proteinuria)
ACEI/ARBs
Diuretics
Statins
Maybe anticoagulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Immunosuppressive management of GN

A

Drugs (corticosteroids, azathioprine, alkylating agents [cyclophosphamide/chlorambucil], calcineurin inhibitors, mycophenolate mofetil [MMF])

Plasmapheresis

Antibodies (IV immunoglobulin, monoclonal antibodies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Nephrotic syndrome management

A 
Fluid/salt restriction
Diuretics
ACEI/ARBs
Maybe anticoagulation
IV albumin (only if volume deplete)
Immunosuppression (induce remission - partial=<3g, complete=<300mg/day)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Minimal change nephropathy renal biopsy investigation

A

EM (foot process fusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Minimal change nephropathy management

A

Oral steroids

2nd line cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Focal segmental glomerulosclerosis renal biopsy investigation

A 
Light microscopy (as name suggests)
IF (minimal Ig/complement deposition)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

FSGS management

A

Prolonged steroids (remission in 60%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Membranous nephropathy renal biopsy findings

A

Subepithelial immune complex deposition in the basement membrane

32
Q

Membranous nephropathy management

A

Steroids
Alkylating agents (cyclophosphamide)
B cell monoclonal antibody

33
Q

IgA nephropathy renal biopsy findings

A 
Light microscopy (mesangial cell proliferation and expansion)
IF (IgA deposits in mesangium)
34
Q

IgA nephropathy management

A

BP control
ACEI/ARB
Fish oil

35
Q

Rapidly progressive glomerulonephritis management

A

Prompt with strong immunosuppression:
Steroids
Cytotoxics (cyclophosphamide/mycophenolate/azathioprine)
Plasmapheresis

36
Q

Kidney transplant assessment

A 
Immunology
Virology
Assess cardiorespiratory risk
Assess peripheral vessels/bladder function/mental state
Assess co-morbidities
37
Q

Contraindications to kidney transplant

A 
Malignancy (inc solid tumour in last 2-5 years)
Active HCV/HIV
Untreated TB
Severe IHD
Severe airways disease
Active vasculitis
Severe PVD (unusable vessels)
Hostile bladder
38
Q

How do you desensitise a kidney recipient?

A

Active removal of blood group or donor specific antigen:
Plasma exchange
B-cell antibody (rituximab)

39
Q

Immunosuppression during transplant operation

A

Prednisolone IV

40
Q

Maintenance treatment after transplant operation

A

Prednisolone, tacrolimus, MMF

Prednisolone, ciclosporin, azathioprine

41
Q

Anti-rejection treatments

A 
Pulsed IV methyprednisolone
Anti-thymocyte globulin
IV Ig
Plasma exchange
Rituximab, bortezimab, eculizumab
Immunosuppression intensification
42
Q

Infection prophylaxis after transplant

A

Prophylaxis for PJP for first 3 months

43
Q

Investigation for CMV disease after transplant

A

IgM and PCR

44
Q

CMV disease management

A

Propylactic PO valganciclovir in higher risk patients

IV ganciclovir if evidence of infection

45
Q

BK virus nephropathy management

A

No effective anti-viral therapy
Treat by reducing immunotherapy

Monitor blood viral load by PCR

46
Q

Management of post-transplant lymphoproliferative disease (lymphoma, usually related to EBV infection)

A

Reduce immunosuppression
Chemotherapy
No role for antivirals

47
Q

ADPKD investigations

A

USS (cysts, renal enlargement)
CT/MRI (when unclear on USS)

Genetic: linkage analysis, mutation analysis

48
Q

ADPKD management

A

Rigorous control of hypertension
Hydration
Proteinuria reduction
Cyst haemorrhage and infection management
Tolvaptan (reduces cyst volume and progression)

Renal failure: dialysis, transplant

49
Q

What findings would suggest ARPKD?

A

Children
Fibrotic liver cysts
Cysts appearing from collecting duct system

50
Q

Alports syndrome investigation

A

Haematuria and hearing loss

Renal biopsy - variable thickness GBM

51
Q

Alports management

A

No specific treatment
Standard aggressive treatment of BP and proteinuria
Dialysis/transplantation

52
Q

Anderson Fabry’s disease investigations

A

PLasma/leukocyte alpha-galactosidase
Renal bipsy (shows concentric lamellar inclusions within lysosomes)
Skin biopsy

53
Q

Anderson Fabrys disease management

A 
Enzyme replacement (fabryzyme)
Management of complications
54
Q

Medullary cystic kidney investigation

A

Family history

CT

55
Q

Medullary cystic kidney management

A

Renal transplant

56
Q

Medullary sponge kidney investigation

A

Excretion urography (to demarcate calculi)

57
Q

What are urinary casts formed from?

A

Precipitation of Tamm-Horsfall mucoprotein

58
Q

What are the 4 types of urinary cast and what do they mean?

A

Hyaline (usually benign)
Red cell (always pathological, nephritic syndrome)
Leucocyte (infection/inflammation)
Granular (chronic disease)

59
Q

Myeloma investigations

A 
Bloods (serum protein electrophoresis, serum free light chains)
Urine bence jones protein
Bone marrow biopsy
Skeletal survey
Renal biopsy
60
Q

Myeloma management

A 
Stop nephrotoxics
Manage hypercalcaemia
Chemotherapy
Stem cell transplant
Plasma exchange (to remove light chains)
Supportive - dialysis
61
Q

Amyloidosis renal investigation

A 
Urinalysis and uPCR
Blood tests (renal function, inflammatory markers, protein electrophoresis, SFLC)
Renal biopsy (congo red staining, apple green under polarised light)

SAP scan shows extent of disease

62
Q

AA amyloidosis management

A

Treat underlying condition

Refer to UCL national amyloidosis centre

63
Q

AL amyloidosis management

A

Immunosuppression (steroids, chemo, stem cell transplant)

Refer to UCL national amyloidosis centre

64
Q

AAV affecting kidney investgiation

A

Urinalysis (blood and protein)
Bloods (inflammatory markers, AKI, anaemia)
Immunology (ANCA, MPO, PR3)
Renal biopsy

65
Q

AAV affecting kidney management

A

Immunosuppresion (steroids, cyclophosphamide, rituximab)
Plasma exchange
Supportive (dialysis, ventilation)

66
Q

What is the name of the classification of lupus nephritis?

A

ISN classification

67
Q

Describe the ISN classification of lupus nephritis

A 
Class I: minimal mesangial
Class II: mesangial proliferative
Class III: focal proliferative
Class IV: diffuse proliferative
Class V: membranous
Class VI: advanced sclerosing
68
Q

Lupus nephritis management

A

Progressive immunosuppression increase as classes increase

69
Q

UTI investigation

A

Mid stream specimen of urine

70
Q

Cut offs for specific bacteriuria

A

> 10^5= significant, probably UTI
10^4= contaminated maybe, need to repeat
<10^3= not significant
For women of child bearing age

71
Q

Management of abacterial cysitis/urethral syndrome

A

Alkalinising the urine

72
Q

Asymptomatic bacteriuria in pregnancy management

A

Antibiotics

73
Q

Female lower UTI management

A

Nitrofurantoin or trimethoprim (3 days)

74
Q

Uncatheterised male UTI management

A

Nitrofurantoin or trimethoprim (7 days)

75
Q

Complicated UTI or pylonephritis (GP) management

A

Co-amoxiclav or co-trimoxazole (14 days)

76
Q

Complicated UTI or pyelonephritis (hospital) management

A

Amoxicillin and gentamicin IV (3 days)
Co-trim and gent if pen allergic
Co-trim step down

Year 2 Revision (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions