Brainscape's Knowledge GenomeTM

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


See full index

BPT Clinical Exam > Renal Long > Flashcards

Renal Long Flashcards

1
Q

Causes of CKD

A
  1. DM - 33%
  2. GN - 24%
  3. HTN - 14%
  4. PCKD - 7%
  5. Reflux nephropathy
  6. Analgesic nephropathy
  7. Uncertain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RF for progression of CKD

A
  1. Low birth weight
  2. HTN
  3. AKI
  4. Proteinuria
  5. Smoking
  6. Hyperuricaemia
  7. An increase in glomerular pressure (pregnancy, obesity, diabetes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Early Sx of renal failure

A 
Nocturia
Lethargy
Loss of appetite
Fluid retention
Pruritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sx of Severe CKD

A 
Pericarditis
Serositis
Encephalopathy
GI bleeding 
Uraemic neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Precipitants of AKI

A 
NSAIDS
Contrast
Infection
ACE/ARB
Dehydration
Anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sx/Signs to screen for GN

A 
Proteinuria
Haematuria
Oliguria
Oedema
Sore throat
Sepsis
Rash
Haemoptysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

IgA nephropathy associations

A

HIV
CLD
IBD
Coeliac

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

Causes of membranoproliferative GN

A 
Hep C
Autoimmune disease
Indolent infections (malaria, syphilis)
Essential Cryoglobulinaemia
Malignancies
Drugs - penacillamine, NSAIDS, anti TNF drugs
Mercury/gold poisoning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of FSGS

A 
Primary
Familial
HIV infection
Morbid obesity
Heroin use
Reflux nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCKD Hx Questions

A 
FHx
Haematuria
Polyuria
Loin pain
HTN
Renal calculi
Headache/SAH/visual disturbance
Diverticular disease
Hernias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Principles of Mx of CKD

A
  1. Fluid intake and diet
  2. Anaemia
  3. Acidosis
  4. Phosphate/calcium/bones
  5. CVS risk
  6. Consider vascular access
  7. Consider when to start dialysis
  8. Consider suitability for Tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

General Dialysis questions

A
  • Where is it performed
  • How often
  • How many hours per week
  • Relief of Sx with treatment
  • Complications with dialysis
  • On transplant list
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CKD conservatively managed patients - Sx questions

A 
Anaemia
Bone disease
Secondary gout/pseudogout
Pericarditis
HTN
Cardiac failure
Fluid overload
Peripheral neuropathy
Pruritis
Peptic ulcers
Impaired cognitive function
Poor nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HDx History questions

A

How long have they been on HDx?
Where do they dialyse? - Transport if satellite unit
What is the current dialysis prescription?
-Frequency, duration, dry weight, fluid removed
-Pre and post HDx BP
-Anticoagulation apart from heparin given during HDx
-Recent changes to presciption
What is the patient’s dialysis access Hx?
Any symptoms on or after dialysis?

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

PDx Hx Questions

A

CAPD vs APD?
How long have they been on PD
Infections of PD side or peritonitis
Still passing urine?

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

Renal Tx Questions

A
  • Graft pain or swellin
  • Infections
  • Urine leaks
  • Steroid and immunosuppression side effects
  • Proteinuria and Cr level
  • Avascular necrosis
  • Skin cancer
  • Reflux nephropathy
  • Recurrent GN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CKD causes that have normal or enlarged kidneys

A
  • Early diabetic nephropathy
  • PCKD
  • Obstructive uropathy
  • Acute renal vein thrombosis
  • Amyloidosis
  • Rarely other infiltrative diseases eg. lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CKD Ix

A
  1. Determine renal function
    - egfr
    - Tubular function: electroltes, pH, uric acid, calcium, albumin
    - Urinalysis and PCR
  2. Determine renal structure
    - USS - size and symmetry, signs of obstruction
    - Renal artery doppler
    - CT - RAS, obstruction, CT renal angiography
    - Cystoscopy and retrograde pyelography
  3. Effects of CKD
    - FBE, Iron studies, CMP, PTH
    - Nerve conduction studies
  4. Assess for underlying disease
    - ANA, ANCA, Hepatitis, HIV, complement, SPEP, FLC, urine cytology
    - Renal Bx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Approach to Tx of CKD

A
  1. Treat reversible causes of deterioration
  2. BP and lipid control
  3. Diet: Salt and water restriction
  4. Normalise calcium and phosphate - diet or meds
  5. Treat acidosis if needed
  6. Anaemia Mx
  7. Dialyse when indicated
  8. Consider Tx
20
Q

Common Complications of Dialysis

A

Sudden cardiac death
Vascular disease
Extravascular calcification - AS, calciphylaxis
Amyloidosis

21
Q

Kidney donation options

A

DBD
DCD
Live family donor
Pared kidney exchange

22
Q

Renal Tx Hx

A
  • Cause of original renal failure and duration of transplant in situ
  • Source of transplant
  • Previous rejection episodes and how they were managed
  • Graft Biopsies
  • Immunosuppressive medication changes and side effects
  • Patient and donor CMV status
  • IHD/PVD
  • Infections
  • Malignancy
23
Q

SE of Ciclosporin

A 
Hirsutism
Gingival hypertrophy
Tremor
Diarrhea
Neurotoxicity
Renal impairment
Hypomagnesmia
LFT derrangement
HTN
Chol
Gout
Hyperkalemia
24
Q

SE of everolimus/sirolimus

A 
Proteinuria
Hyperlipidaemia
Pneumonitis
Tendon rupture
oedema
Impaired wound healing
Cytopenias
25
Q

Absolute contraindications to Renal Tx

A
  • Malignant disease (need 2 years of remission after treatment before consideration)
  • Severe IHD
  • Active vasculitis or anti basement membrane disease
  • Occulsive aortoiliac disease
  • Continuing sepsis
26
Q

Relative contraindications to Renal Tx

A

Older than 75 yo
High risk of recurrence in Tx
Ureteric or bladder disease
Other co-morbidities

27
Q

Causes of chronic renal rejection

A
  • Chronic allograft nephropathy
  • Recurrent GN (especially FSGS and membranous)
  • De novo GN
  • Chronic AMR
28
Q

PCKD Diagnostic Criteria

A
  • Diagnostic criteria in those with a family history of PCKD
    ○ At least 3 unilateral or bilateral kidney cysts if age 15-39
    ○ At least 2 cysts in EACH kidney in persons age 40-59
    ○ Four or more cysts in EACH kidney in persons age 60 or older
    • If NO family history
      ○ Need >10 cysts in each kidney and no features to suggest any other cystic disease
      Genetic testing not routinely offered unless atypical case
29
Q

DDx HAematuria

A 
Stones
Infection
GN
Malignancy
Bleeding predisposition
Drugs - cyclophosphamide

In transplant

  • BK virus
  • Disease recurrence
30
Q

Steroid Cx

A 
Diabetes
HTN
Chol
Altered fat distribution
Oedema
Cataracts
Bones
Mood and insomnia
31
Q

MMF SE

A

Diarrhea

Cytopenia

32
Q

Tacrolimus SE

A 
Alopecia
Diarrhea
Neurotoxicity
Tremor
Hypomagnesemia
Hyperkalemia
Gout
Nephrotoxiity
Diabetes
HTN
chol
33
Q

Causes of renal anaemia

A
  1. Decreased EPO production
  2. Iron deficiency
    - Decreased absorption
    - Loss: Dialysis, anticoagulation, reduced RBC life span
    - Increased iron demand with EPO supp
  3. Uraemic inhibitor - Decreased bone marrow function
  4. Inflammation: increased hepcidin
34
Q

Tx of chronic hyperkalemia in CKD

A
  1. Decreased K+ Diet
  2. W/H relevant drugs
  3. Improve glycemic control
  4. Correct acidosis
  5. Resonium
35
Q

Tx of Acidosis in CKD

A

Sodium bicarg
-SE: Hypokalemia and fluid iverload

Dialysis

36
Q

Tx of Uraemia in CKD

A

Itch

  • Emollients
  • Control CKD MBD

Nausea: Antiemetics

Dialysis

37
Q

Tx of CVS risk in CKD

A

BP

  • Target if non proteinuric: <140/90
  • Target if proteinuric: <130/80
  • Life style:
  • -Reduce salt intake <2 grams per day
  • -Exercise
  • -Weight loss
  • Pharm:
  • -ACEi

Statin
-if 50 + yo w/ CKD
if 18-49 yo w/ DM/IHD/Stroke

38
Q

Considerations when choosing a dialysis modality

A
  1. Longevity vs QOL
  2. PAtient lifestyle
  3. Functional ability
  4. Carer availability
  5. Tolerability - cardiac issues
  6. Transport/geographical issues
  7. Home environment
  8. Previous abdo surgery, hernia
39
Q

Mx of acute cell mediated rejection

A
  1. Methlypred

2. Thymoglobulin/ATGAM

40
Q

Mx of AB mediated rejection

A

MEthylpred
PLEX
IVIG

Rarely thymoglobulin/rituximab

41
Q

MX of Chronic rejection

A

Aims:

  1. Early detection
    - Surveillance
  2. Prevention
    - Adherence
    - Drug level monitoring
    - Absorption issues
42
Q

Factors to consider for risk of rejection

A
  1. Graft function - baseline and present
  2. HLA mismatch
  3. DSA, past sensitising Hx
  4. Previous REnal Bx
  5. Adherence/absorption
43
Q

Approach to any issues post transplant

A

Consider:

  • Basics
  • Meds
  • Infection
  • Malignancy
44
Q

Prophylaxis time lines post Tx

A

1-2 months: Nystatin/amphoterecin

3-6 months: Valganciclovir –> if leukopenia, the nvalaciclovir

6 months –>Bactrim (PJP, norcardia, Toxo) —> alternatives: Dapsone, pentamidine

45
Q

Immunosuppression Cx

A
  • CVS risk
  • Cytopenias, drug levels, drug interactions
  • Bone health
  • Infection risk - vaccines
  • Malignancy

BPT Clinical Exam (11 decks)

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