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Year 3 - Medical Block Workbooks > Renal Medicine > Flashcards

Renal Medicine Flashcards

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USMLE® Step 1 flashcards
1
Q

Renal Hx

- Seven Sx

A

Renal Hx Sx

  1. Dyspnoea
  2. Leg swelling
  3. LUTS
  4. Flank pain
  5. N&V
  6. ENT
  7. Constitutional
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2
Q

Dialysis

- Five modes

A

Dialysis Modes

  1. APD (automated)
  2. CAPD (continuous ambulatory)
  3. Assisted PD
  4. UHD (Unit-based haemodialysis)
  5. HHM (?)
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3
Q

Renal FHx

- Five questions

A

Renal FHx

  1. Renal disease
  2. Cardiac disease
  3. Diabetes
  4. HTN
  5. Genetic conditions
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4
Q

Renal Ex

- Three face signs

A

Renal Ex; face:

  1. Aneamia (of CKD)
  2. Rash (SLE)
  3. Swelling (HD-> SVCO)
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5
Q

Renal Ex

- Neck Sx

A

Renal Ex Neck

  1. JVP
  2. Tunneled/HD line
  3. Scars
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6
Q

Haematinics

- Three examples

A

Haematinics

  1. Iron
  2. B12
  3. Folate
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7
Q

Anion gap

  1. Calculation
  2. Normal range
A

Anion gap

  1. Na - (Cl + HCO3)
  2. 8-12
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8
Q

High anion gap

- Four causes

A

High anion gap

  1. Lactic acidosis
  2. Ketoacidosis
  3. Toxins (ethylene glycol, methanol, isoniazid, salicylate)
  4. Renal failure
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9
Q

Normal anion gap acidosis

- Three causes

A

Normal anion gap acidosis

  1. GI losses of bicarb
  2. Renal losses of bicarb
  3. Toxins (ammonium chloride, acetazolamide)
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10
Q

Hypernatraemia

Four hypovolaemic causes (dehydration)

A

Hypovolaemic hypernatraemia (dehydration)

  1. Renal loss
    - Loop diuretics
    - Osmotic eg NG tube
  2. Non-renal loss
    - Sweating/burns
    - Diarrhoea/fistula
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11
Q

Hypernatraemia

Four euvolaemic causes

A

Euvolaemic hypernatraemia

  1. Renal loss
    - DI/Hypodipsia
  2. Non-renal
    - Insensible
    - Respiratory
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12
Q

Hypernatramia

Four Hypervolaemic causes

A

Hypervolaemic hypernatraemia

Non-renal
1. NaCl Tablets

Renal

  1. Hyperaldosteronism
  2. Cushing’s
  3. Dialysis
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13
Q

Diabetes insipidus

-	Four causes
A

DI causes

1. Trauma
2. Tumours
3. Cerebral sarcoid/TB
4. Cerebral inflammation
infection/vasculitis

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14
Q

Hyponatraemia

Four hypovolaemic causes

A

Hypovolaemic hyponatraemia

  1. Renal
    - Thiazides
    - Addison’s
  2. Non-renal
    - D+V
    - Sweating/burns
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15
Q

Hypovolaemic hyponatraemia

-	Mx
A

Hypovolaemic hyponatraemia Mx

  1. Fluids (0.9% saline)
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16
Q

Euvolaemic hyponatraemia

- Four causes

A

Euvolaemic hyponatraemia causes

  1. Hypothyroidism
  2. Primary poydipsia
  3. Adrenal insufficiency
  4. SIADH
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17
Q

Pseudo-hyponatraemia
(Hypervolaemic)
- Four causes

A

Pseudo-hyponatramia
(hypervolaemic)

  1. Hyperglycaemia
  2. High lipids
  3. Uraemia
  4. Myeloma
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18
Q

Hypervolaemic hyponatraemia

-	Three causes
A

Hypervolaemic hyponatraemia causes

  1. CCF
  2. Nephrotic syndrome
  3. Liver cirrhosis
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19
Q

Hypervolaemic hyponatraemia

  1. Treatment
  2. Risk of treatment
A

Hypervolaemic hyponatraemia

  1. Fluid restrict (+ furosemide)
  2. Risk of CPM/OM
    - Central pontine myelinosis
    - Osmotic myelinosis
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20
Q

Acute hyponatraemia

- Mx

A

Acute hyponatraemia Mx

  1. 3% hypertonic saline IV boluses
  2. +/- Furosemide
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21
Q

Chronic hyponatraemia

- Mx

A

Chronic hyponatraemia

  1. If seizures - hypertonic saline boluses
  2. Symptomatic, non-seizing
    - Isotonic saline + Furosemide
  3. Asymptomatic
    - Water restriction
    - Stop drug causes
    - Restore volume
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22
Q

Hyperkalaemia

- Five causes

A

Hyperkalaemia causes

  1. CKD (with K rich diet eg. dried fruit, potatoes)
  2. Drugs
  3. Hyperaldosteronism
  4. Rhabdomyolysis, tumour lysis, haemolysis
  5. Artifact hyperkalemia
    - Haemolysis, leucocytosis, thrombocytosis
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23
Q

Hyperkalaemia

- Six drug causes

A

Hyperkalaemia drug causes

  1. Spironolactone/Amilioride
  2. ACEi/ARB
  3. NSAIDs
  4. Betablockers/Digoxin
  5. Heparin/LMWH
  6. Trimethoprim
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24
Q

Hypo-renin-aemic hypoaldosteronism

  1. Class of acidosis
  2. Presentation
  3. RFs
A

Hyporeninaemic hypoaldosteronism

  1. Type IV RTA
  2. Presents with:
    - Hypochloraemic acidosis
    - Hyperkalaemia
  3. RFs
    - Increased age
    - Reduced eGFR
    - DM, acute G.nephritis, TI.nephritis, sickle, NSAIDs
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25
Q

Renal tubular acidosis (RTA)

-	Four types
A

RTA

Type 1: Distal (dRTA)

  • Failure of H+ secretion into lumen
  • Alkaline urine and hypokalaemia

Type 2: Proximal (pRTA)
- Failure of tubular bicarb reabsorption

Type 3: Combined P&D
- Rare

Type 4: Absolute hypoaldosteronism/aldosterone insensitivity
- Physiological reduction in ammonium excretion 2º to low K+

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26
Q

Hyperkalaemia

- ECG Changes

A

Hyperkalaemia ECG

  1. Tented T
  2. Long QRS
  3. Slurred ST
  4. Loss of P
  5. Asystole
27
Q

Hyperkalaemia

- Five management steps

A

Hyperkalaemia Tx

  1. Calcium gluconate 10mls 10%
  2. ActRapid 10 units
    IV dextrose 50 mls 50%
  3. NaHCO3
  4. Salbutamol
  5. Calcium Resonium
28
Q

Hypokalaemia

- Six causes

A

Hypokalaemia causes

  1. Pseudohypokalaemia
    - Acute leukaemia
  2. Extra-renal losses
    - Intake, D/V/Stoma
  3. Redistribution
    - DTs, Beta agonist, insulin, caffeine
  4. Refeeding syndrome, exercise
  5. Conn’s/Cushing’s
  6. Renal loss
    - Diuretics, RTA, liquorice
29
Q

Hypokalaemia

- ECG

A

Hypokalaemia ECG

  1. Small T
  2. U wave
  3. Increased PR interval
30
Q

Hypokalaemia

- Three steps to management

A

Hypokalaemia Mx

  1. Mg replacement
  2. Oral K replacement
  3. IV K replacement in saline (no dextrose)
31
Q

Stage 2 AKI

  1. Creatinine
  2. Urine output
A

Stage 2 AKI

  1. 2-2.9 x baseline Creatinine
  2. 12 hours oliguria (<0.5)
32
Q

AKI

-	Three intrinsic causes
A

AKI Intrinsic Causes

  1. Glomerular (GN)
  2. Tubules and interstitium
    - Ischaemia
    - Sepsis
    - Nephrotoxins
  3. Vascular
    - Vasculitis
    - Malignant HTN
    - TTP-HUS
33
Q

Malignant hypertension

  1. Categories
  2. Causes/definitions
A

Malignant hypertension
(Accelerated hypertension)

  1. Classed as
    - Urgency
    - Emergency 180/120
  2. Renal disease
    Intracranial pressure
34
Q

Malignant hypertension

-	Treatment
A

Malignant hypertension
Tx

  1. Labetalol
  2. Nicardipine/nitroprusside
  3. Fenoldopam
35
Q

HUS

  • Triad of symptoms
  • Common causes
A

Haemolytic uraemic syndrome

  1. Microangiopathic h. anaemia
  2. Thrombocytopenia
  3. AKI
  4. Diarrhoea-associated
    - Shiga toxin E.c.
  5. Shigella, strep pn.
36
Q

TTP

  1. Classic pentad
  2. Pathology
  3. Causes
A

TTP

Classic Pentad (Fat RN):

F ever
A naemia (haemolytic)
T hrombocytopenia

R enal failure
N eurological changes

  1. Pathology (ADAMTS)
    - Von Willebrand factor cleaving enzyme deficiency
    - Von W multimers
    - Aggregation, microthrombi, and thrombocytpoenia
  2. Causes
    - Idiopathic
    - Congenital
    - HIV
    - Pregnancy
    - Drug
    - Pancreas
    - Covid
37
Q

AKI

- Ix

A

AKI Ix

Bedside

  1. Urine dip
    - Protein/blood
  2. Urine MSC

Bloods

  1. FBC, LFT, CRP
  2. U&E, Serology
  3. Haemolysis screen/film

Imaging
1. USS KUB

38
Q

AKI

- Mx

A

AKI Mx

  1. Ix and DDx
  2. STOP nephrotoxic
  3. Fluid balance
  4. Glycaemic control
  5. RRT/ICU
39
Q

RRT

- Five Indications/Substances

A

RRT - Indications

  1. Intoxication
  2. Urea
    - Pericarditis
    - Encephalopathy
  3. Potassium
    - Refractory
  4. Acid
    - Refractory metabolic
  5. Fluid
    - Refractory overload
40
Q

Nephrotic syndrome

-	Triad of symptoms
A

Nephrotic syndrome triad

  1. Oedema
  2. Albumin <30
  3. PCR>350
41
Q

Nephrotic syndrome

- Four Complications

A

Nephrotic syndrome complications

Protein losses

  1. Infection
  2. VTE

Function

  1. CKD
  2. HTN
42
Q

Nephrotic syndrome

- Four Causes

A

Nephrotic syndromes

  1. Minimal change
  2. FSGS
  3. Membranous nephropathy
  4. Membranoproliferative glomerulonephritis
43
Q

Nephritic syndrome

- Four Presentations

A

Nephritic presentation

  1. AKI
  2. Haematuria (V/NV)
  3. HTN
  4. Proteinuria
44
Q

Nephritic syndromes

- Six examples

A

Five nephritic syndromes

  1. Post-infectious GN
    - Weeks after group A strep
  2. IgA nephropathy
    - Idiopathic and episodic
  3. Small vessel vasculitis (ANCA)
  4. Goodpastures and Alport’s
  5. Thin basement
  6. Lupus
45
Q

Nephritis treatments

  1. Post-infectious GN
  2. IgA nephropathy
A

Nephritis treatments

  1. Post-infectious GN (3-12 yo)
  • ACEi/ARB (self-limiting)
  • RRT (ESRF)
  1. IgA Nephropathy (10-30yo)
    - ACEi/ARB
46
Q

Small vessel vasculitis

  1. Types
  2. Presentations
A

Small vessel vasculitis
- Immunosupression therapy

  1. GPA (granulomatosis with polyangitis)
    - Nasal ulcers/polyps
    - Haemoptysis
  2. MPA (microscopic polyangitis)
    - Mild resp symptoms
  3. Churg-Strauss (Eosinophillic granulomatosis with PA)
    - Asthma, rhinitis
    - Purpura, peripheral neuropathy
47
Q

Nephritis

  • Presentations and treatments
  1. Goodpastures
  2. Alports
A

Nephritis

  • Goodpastures
    1. Pulmonary infiltrates on CXR
  • IgG along basement membrane (Type 4 HS)
    2. Plasma exchange and immunosupression
  • Alports
  1. Haematuria
    - Sensorineural hearing loss
    - GBM irregularity
  2. Supportive treatment
    RRT
48
Q

CKD

- KDIGO

A

KDIGO - CKD

  1. Kidney disease, improving global outcomes
  2. G1-G5 for staging
    A1-3 for ACR categories (<3, 3-30, >30)
49
Q

CKD

- Causes

A

CKD Causes

  1. DM
  2. HTN
  3. GN
  4. RVS disease
  5. PCKD
  6. Uropathology
  7. Pyelonephritis
50
Q

CKD

- Management

A

CKD Mx

  1. DM, HTN, Infx
  2. Tolvaptan
    (vasopressin antagonist)
  3. Preventative statin
  4. ACEi/ARB
  5. Supplementation
    - Haematinics
    - EPO
    - Vit D
51
Q

Diabetic nephropathy

- Mx

A

DM nephropathy Mx

  1. ACEi/ARB
  2. BP control
  3. CVS risk
52
Q

HTN nephropathy

- Ix

A

HTN nephropathy Ix

  1. Metanephrines
  2. Aldosterone:renin ratio
  3. Cortisol and dexamethasone supression
  4. TSH
  5. MRAngio
53
Q

PCKD

-	Mx
A

PCKD Mx

  1. BP
  2. CKD Mx
  3. Tolvaptan
  4. Genetic counselling/testing
54
Q

Anaemia of CKD

- Mx

A

Anaemia of CK Mx

  1. Haematinic measurement
  2. Replace IV iron and haematinics
  3. Discussing starting ESA (erythropoiesis stimulating agents)
  4. Aim for Hb 100-120
55
Q

CKD

- MBD pathophysiology

A

Mineral bone disease

  1. Increased fibroblast GF-23
  2. Increased ALP and PTH
  3. Increased phosphate
    decreased Ca
  4. Decreased 1,25-Vit D
56
Q

CKD

- MBD Suspicion

A

Mineral Bone Disease Suspicion

  1. Mineral Abnormalities:
    - Ca/PO4
    - ALP
    - PTH, D metabolism
  2. Calcification
    - Soft tissue/vasculature
  3. Bone abnormalities
    - Turnover/metabolism
    - Volume/linear growth/strenght
57
Q

Mineral bone disease

- Turnover abnormalities

A

MBD Abnormalities

  1. Low Turnover
    - Adynamic bone disease
    - Osteomalacia
  2. High Turnover
    - Osteitis Fibrosa
58
Q

Effects on Calcium

  1. Vitamin D
  2. FGF23
  3. PTH
A

Effects on Calcium

  1. Vitamin D
    - Increases gut absorption
  2. FGF23
    - Increases bone resorption
  3. PTH
    - Increases Calcitriol production
59
Q

Vitamin D3

- Metabolism and effects

A

Vitamin D3 Metabolism

  1. 7-Dehydrocholestrol
    - Converted by UVB radiation
  2. Vitamin D3
    - Cholecalciferol
  3. Calcidiol
    - Produced in liver
  4. Calcitriol
    - Produced in kidney
    - works in gut
60
Q

CKD MBD

- Mx Aims

A

Mineral Bone Disease Mx

  1. Reduce renal bone disease
  2. Reduce CVS morbidity
    - Calcium overload
    - High PTH and high phosphate
61
Q

RRT

- Nine forms

A

RRT

  1. A-PD
    - 8-10 hours at night
  2. CAPD
    - Regular througout day and night
  3. AAPD
    - Assistants help with APD
  4. HHD
    - Home HD for frequent use
  5. NHD
    - Nocturnal long HD
  6. CCRT
    - Continuous RRT in acute setting (ITU/HDU)
  7. Related donor
  8. Unrelated donor
    - Paired/chain/altruistic
  9. Deceased donor
    - 60%
62
Q

Kidney transplant

- 3 Induction Dx

A

Kidney Transplant Induction

  1. Methylprednisolone
  2. Basiliximab+thymoglobulin
  3. Alentuzumab/rituximab
63
Q

Kidney transplant

- 5 Maintenance drugs

A

Kidney transplant maintenance

  1. Prednisolone
  2. CNIIs
    - Tacrolimus
    - Cyclosporine
    - Voclosporine
  3. Antimetabolites
    - Mycophenolate
    - Azathioprine
  4. Rapamycin inhibitors
    - Sirolimus
  5. T-cell regulation
    - Belatecept + belimumab
64
Q

Kidney transplant

- Long term care

A

Kidney transplant L-T Care

  1. Bloods
    - GFR
    - CNI
    - Protein
    - Ca, phosphate, PTH
    - Lipids, glucose
  2. Vaccination and Infx screen
  3. CVS, MBD monitoring
  4. Malignancy monitoring
    - SC
  5. Contraception

Year 3 - Medical Block Workbooks (7 decks)

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