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Year 3 - Medical Block Workbooks > Renal Medicine > Flashcards

Renal Medicine 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
Renal tubular acidosis (RTA) - Four types
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+
26
Hyperkalaemia | - ECG Changes
Hyperkalaemia ECG 1. Tented T 2. Long QRS 3. Slurred ST 4. Loss of P 5. Asystole
27
Hyperkalaemia | - Five management steps
Hyperkalaemia Tx 1. Calcium gluconate 10mls 10% 2. ActRapid 10 units IV dextrose 50 mls 50% 3. NaHCO3 4. Salbutamol 5. Calcium Resonium
28
Hypokalaemia | - Six causes
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
Hypokalaemia | - ECG
Hypokalaemia ECG 1. Small T 2. U wave 3. Increased PR interval
30
Hypokalaemia | - Three steps to management
Hypokalaemia Mx 1. Mg replacement 2. Oral K replacement 3. IV K replacement in saline (no dextrose)
31
Stage 2 AKI 1. Creatinine 2. Urine output
Stage 2 AKI 1. 2-2.9 x baseline Creatinine 2. 12 hours oliguria (<0.5)
32
AKI - Three intrinsic causes
AKI Intrinsic Causes 1. Glomerular (GN) 2. Tubules and interstitium - Ischaemia - Sepsis - Nephrotoxins 3. Vascular - Vasculitis - Malignant HTN - TTP-HUS
33
Malignant hypertension 1. Categories 2. Causes/definitions
Malignant hypertension (Accelerated hypertension) 1. Classed as - Urgency - Emergency 180/120 2. Renal disease Intracranial pressure
34
Malignant hypertension - Treatment
Malignant hypertension Tx 1. Labetalol 2. Nicardipine/nitroprusside 3. Fenoldopam
35
HUS - Triad of symptoms - Common causes
Haemolytic uraemic syndrome 1. Microangiopathic h. anaemia 2. Thrombocytopenia 3. AKI 1. Diarrhoea-associated - Shiga toxin E.c. 2. Shigella, strep pn.
36
TTP 1. Classic pentad 2. Pathology 3. Causes
TTP Classic Pentad (Fat RN): F ever A naemia (haemolytic) T hrombocytopenia R enal failure N eurological changes 2. Pathology (ADAMTS) - Von Willebrand factor cleaving enzyme deficiency - Von W multimers - Aggregation, microthrombi, and thrombocytpoenia 3. Causes - Idiopathic - Congenital - HIV - Pregnancy - Drug - Pancreas - Covid
37
AKI | - Ix
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
AKI | - Mx
AKI Mx 1. Ix and DDx 2. STOP nephrotoxic 3. Fluid balance 4. Glycaemic control 5. RRT/ICU
39
RRT | - Five Indications/Substances
RRT - Indications 1. Intoxication 2. Urea - Pericarditis - Encephalopathy 3. Potassium - Refractory 4. Acid - Refractory metabolic 5. Fluid - Refractory overload
40
Nephrotic syndrome - Triad of symptoms
Nephrotic syndrome triad 1. Oedema 2. Albumin <30 3. PCR>350
41
Nephrotic syndrome | - Four Complications
Nephrotic syndrome complications Protein losses 1. Infection 2. VTE Function 3. CKD 4. HTN
42
Nephrotic syndrome | - Four Causes
Nephrotic syndromes 1. Minimal change 2. FSGS 3. Membranous nephropathy 4. Membranoproliferative glomerulonephritis
43
Nephritic syndrome | - Four Presentations
Nephritic presentation 1. AKI 2. Haematuria (V/NV) 3. HTN 4. Proteinuria
44
Nephritic syndromes | - Six examples
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
Nephritis treatments 1. Post-infectious GN 2. IgA nephropathy
Nephritis treatments 1. Post-infectious GN (3-12 yo) - ACEi/ARB (self-limiting) - RRT (ESRF) 2. IgA Nephropathy (10-30yo) - ACEi/ARB
46
Small vessel vasculitis 1. Types 2. Presentations
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
Nephritis - Presentations and treatments 1. Goodpastures 2. Alports
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
CKD | - KDIGO
KDIGO - CKD 1. Kidney disease, improving global outcomes 2. G1-G5 for staging A1-3 for ACR categories (<3, 3-30, >30)
49
CKD | - Causes
CKD Causes 1. DM 2. HTN 3. GN 4. RVS disease 5. PCKD 6. Uropathology 7. Pyelonephritis
50
CKD | - Management
CKD Mx 1. DM, HTN, Infx 2. Tolvaptan (vasopressin antagonist) 3. Preventative statin 4. ACEi/ARB 5. Supplementation - Haematinics - EPO - Vit D
51
Diabetic nephropathy | - Mx
DM nephropathy Mx 1. ACEi/ARB 2. BP control 3. CVS risk
52
HTN nephropathy | - Ix
HTN nephropathy Ix 1. Metanephrines 2. Aldosterone:renin ratio 3. Cortisol and dexamethasone supression 4. TSH 5. MRAngio
53
PCKD - Mx
PCKD Mx 1. BP 2. CKD Mx 3. Tolvaptan 4. Genetic counselling/testing
54
Anaemia of CKD | - Mx
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
CKD | - MBD pathophysiology
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
CKD | - MBD Suspicion
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
Mineral bone disease | - Turnover abnormalities
MBD Abnormalities 1. Low Turnover - Adynamic bone disease - Osteomalacia 2. High Turnover - Osteitis Fibrosa
58
Effects on Calcium 1. Vitamin D 2. FGF23 3. PTH
Effects on Calcium 1. Vitamin D - Increases gut absorption 2. FGF23 - Increases bone resorption 3. PTH - Increases Calcitriol production
59
Vitamin D3 | - Metabolism and effects
Vitamin D3 Metabolism 0. 7-Dehydrocholestrol - Converted by UVB radiation 1. Vitamin D3 - Cholecalciferol 2. Calcidiol - Produced in liver 3. Calcitriol - Produced in kidney - works in gut
60
CKD MBD | - Mx Aims
Mineral Bone Disease Mx 1. Reduce renal bone disease 2. Reduce CVS morbidity - Calcium overload - High PTH and high phosphate
61
RRT | - Nine forms
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
Kidney transplant | - 3 Induction Dx
Kidney Transplant Induction 1. Methylprednisolone 2. Basiliximab+thymoglobulin 3. Alentuzumab/rituximab
63
Kidney transplant | - 5 Maintenance drugs
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
Kidney transplant | - Long term care
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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