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FINALS: PASSMED/QUESMED > Renal Medicine > Flashcards

Renal Medicine Flashcards

1
Q

How do you tell the difference between AKI and dehydration on bloods?

A

AKI - creatinine will be much higher than urea
Dehydration - urea will be much higher than creatinine

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2
Q

How do you tell the difference between AKI and CKD?

A

CKD patients will have bilateral small kidneys except those with:
- ADPKD
- Early diabetic nephropathy
- Amyloidosis
- HIV nephropathy

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3
Q

What is a common cause of fragility fractures?

A

CKD induced secondary hyperparathyroidism

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4
Q

What is a common cause of drug-induced AKI?

A

Acute interstitial nephritis

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5
Q

What drugs cause acute interstitial nephritis?

A
  • Antibiotics including penicillin, rifampicin
  • NSAIDs
  • Allopurinol
  • Furosemide
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6
Q

How are diabetic patients screened for diabetic nephropathy?

A

albumin:creatinine ratio (ACR) in early morning specimens

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7
Q

What are the ECG changes of hypokalaemia?

A

U waves
T wave flattening
ST segment changes

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8
Q

What is the most common cause of nephrotic syndrome with malignancy?

A

Membranous nephropathy

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9
Q

What would biopsy show for someone with membranous nephropathy?

A

subepithelial immune complex deposits

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10
Q

What drugs should be withheld with AKi?

A
  • Diuretics
  • Aminoglycosides (gentamicin) and ACE/ARB
  • Metformin
  • NSAIDs
    DAMN AKI
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11
Q

What drug is most commonly used to decrease phosphate levels?

A

Sevelamer - a non calcium based binder which binds to dietary phosphate and prevents it being absorbed

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12
Q

How can stages 1 and 2 of CKD be diagnosed?

A

GFR range PLUS if kidney tests must be abnormal

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13
Q

What are causes of focal segmental gomerulosclerosis?

A

idiopathic
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport’s syndrome
sickle-cell

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14
Q

What is the risk of using 0.9% NaCl fluid therpay in patients who need large volumes?

A

Hyperchloremic metabolic acidosis

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15
Q

What can alcohol bingeing lead to?

A

ADH suppression in the posterior pituitary leading to polyuria as well as hypernatremia

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16
Q

What is the classic triad for HUS?

A
  • AKI
  • Haemolytic anaemia
  • Thrombocytopenia
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17
Q

What organism typically causes HUS?

A

E coli

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18
Q

What medication should be used as an alternative to spironolactone for patients with gynaecomastia?

A

Eplerenone

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19
Q

How does membranous glomerulonephritis present on histology?

A

basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2

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20
Q

What is hyperacute transplant rejection?

A

Rejection within minutes to hours

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21
Q

What is the cause of hyper acute transplant rejection?

A

pre-existing antibodies against ABO or HLA antigens

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22
Q

What type of hypersensitivity reaction of hyper acute transplant rejection?

A

Type 2

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23
Q

Why does rhabdomyolysis cause renal failure?

A

Tubular cell necrosis

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24
Q

What is the prognosis for HSP?

A

Full renal recovery

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25
Q

What is the diuretic of choice in ascites?

A

Spironolactone

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26
Q

When is a renal biopsy indicated for those with minimal change disease?

A

If the response to steroids is poor

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27
Q

What HLA subtype is the most important for transplants?

A

HLA-DR

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28
Q

What are the side effects of EPO?

A
  • Accelerated hypertension
  • Bone aches
  • Flu like symptoms
  • Skin rash
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29
Q

What medication can be used for recurrence of hyperkalaemia?

A

Calcium resonium

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30
Q

How does acute tubular necrosis respond to fluid challenge?

A

Poorly

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31
Q

What is prerenal uraemia?

A

Where the kidneys hold onto sodium to preserve volume

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32
Q

Prerenal uraemia vs ATN?

A
  • Prerenal responds well to fluid challenge
  • Urine osmlaitity will be raised
  • Urine sodium will be low
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33
Q

Why should metformin be stopped in AKI?

A

Due to increased risk of toxicity

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34
Q

How does anti-GBM disease present?

A
  • Haemoptysis
  • AKI/proteinuria/haematuria
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35
Q

What is the most common cause of refractory HTN?

A

Renal artery stenosis secondary to atherosclerosis

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36
Q

eGFR is an inaccurate in which patients?

A

Those with extreme muscle mass

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37
Q

What investigation is needed for patients with AKI of unknown aetiology?

A

US

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38
Q

Patients with HSP require what to monitor for renal involvement?

A

BP and urinalysis

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39
Q

Patient presents with grey/brown tinge to the skin along with history of CKD?

A

Urea build up within the blood

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40
Q

Management of lupus nephritis?

A

Cyclophosphamide and methylprednisolone

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41
Q

What are the indications for acute haemodyialysis?

A

AEIOU
Acidosis
Electrolyte disturbance e.g. hyperkalaemia
Intoxication i.e. drug overdose
Oedema
Uraemia symptoms e.g encephalopathy

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42
Q

What is causes of sterile pyuria (white cells in urine with negative culture)

A
  • Renal TB
  • Partially treated UTI
  • Drugs including NSAIDs, Abx
  • Urinary tract stones
  • Papillary necrosis
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43
Q

Schisotchtes on blood film?

A

Microangiopathic haemolytic anaemia -> HUS

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44
Q

Epithelial crescents in the glomeruli?

A

Rapidly progressing glomerulonephritis

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45
Q

What investigation should be done with all patients with AKI of unknown aetiology?

A

Renal US within 24 hours

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46
Q

Management of low urine output post surgery?

A

Fluid challenge - give bolus of NaCl

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47
Q

How should severe hyperkalaemia be managed?

A

Urgent discussion with nephrology/critical care

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48
Q

Pulmonary oedema with AKI needs what?

A

Haemodialysis

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49
Q

Cause of normal anion gap metabolic acidosis

A

Renal tubular acidosis

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50
Q

Causes of CKD

A

DM, Hypertension , glomerulonephritis, renovascular disease,
pyelonephritis, polycystic kidney disease, obstructive uropathy.

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51
Q

Signs of CKD on examination

A

purpura, bruising, brown discolouration of
nails, evidence of excoriation, peripheral oedema, hypertension,
pericardial rub, evidence o f pleural effusions, proximal myopathy,evidence of preparation for renal replacement therapy

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52
Q

How does haemodialysis work?

A

Blood and dialysis fluid flow either side of a semipermeable
membrane, molecules diffuse down their concentration gradients, plasma biochemistry changes to become more like the dialysis fluid.

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53
Q

What is the management of renal stones?

A

<5mm - wait and watch if asymptomatic
5mm - 10mm - Shockwave lithotripsy
10mm-20mm - Lithrotripsy / Ureteroscopy
>20mm - percutaneous nephrolithotomy

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54
Q

What is the management of ureteric stones?

A

If <10mm - shockwave lithotripsy +/- alpha blockers
If >10mm - Ureteroscopy

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55
Q

Which chromosome is affected in ADPKD?

A

16

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56
Q

Full house immunoflueoresence pattern on renal biopsy?

A

Lupus nephritis

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57
Q

How would Goodpastures present on biopsy?

A

Crescent formation and linear deposition of IgG antibodies across the glomerular basement membrane (anti-GBM antibodies)

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58
Q

What are C/I to renal biopsy?

A
  • HTN
  • CKD wit small kidneys
  • Abnormal coagulation studies
59
Q

Dietary advice for nephrotic syndrome

A

Restrict salt intake, normal protein intake

60
Q

AKI + Haemoptysis + Lung changes?

A

Think Goodpastures

61
Q

What are causes of rhabdomyolysis?

A
  • Prolonged immobilisation
  • Crush injuries
  • Seizures
  • Post surgery
  • Medications such as statins
62
Q

Period of hypotension followed by renal impairment with urinary casts

A

Acute tubular necrosis

63
Q

How to calculate anion gap?

A

(sodium + potassium) - (bicarbonate + chloride)
Normal = 8-14

64
Q

What are causes of normal anion gap metabolic acidosis?

A
  • Diarrhoea
  • Renal tubular acidosis
  • Addisons
65
Q

What are causes of raised anion gap metabolic acidosis?

A
  • Shock
  • DKA/Alcohol
  • Acid poisoning e.g salicylates
66
Q

How to work out pre, renal and post renal cause of AKI?

A

Urea / (creatinine(umol)/1000
Pre renal - >100
Renal/Normal - 40 - 100
Post renal - <40

67
Q

What is in indication for chronic kidney disease over acute?

A

Hypocalcaemia

68
Q

Acute interstitial nephritis vs acute tubular necrosis?

A

AIN is an inflammatory process so white cells will be in the urine whereas ATN is not therefore no white cells in urine

69
Q

Diarrhoea causes what?

A

Hypokalaemia metabolic acidosis

70
Q

Eosinophilic casts are an indication of what?

A

Acute interstitial nephritis

71
Q

What does proteinuria indicate in the context of AKI?

A

Intrinsic renal AKI cause

72
Q

Anyone with severe hyperkalaemia / ECG changes for hyperkalaemia?

A

IV 10mls of 10% Calcium Gluconate
Insulin/Dextrose

73
Q

What must be assessed in someone with bilateral calculi?

A

Renal function

74
Q

HIV nephropathy causes what?

A

Focal segmental glomerulosclerosis -> causes nephrotic syndrome

75
Q

Rapidly progressing glomerulonephritis is associated with what?

A

Goodpasture’s
GPA

76
Q

What can invalidate an EGR?

A

Eating red meat

77
Q

AKI values

A

Creatinine
Stage 1 - 1.5-1.9x baseline / Increased by 26 umol / urine output <0.5mls/kg >6 hours
Stage 2 - 2 - 2.9x baseline / urine output <0.5mls/kg >12 hours
Stage 3 - 3x baseline / urine output <0.3mls/kg >24 hours

78
Q

What are the 4 variables in the MDRD equation to work out estimated EGFR in patients with CKD?

A

Creatinine
Age
Gender
Ethnicity

79
Q

Addisons causes what?

A

Hyperkalaemic metabolic acidosis

80
Q

Patients with CKD and ACR >30 should be started on what?

A

ACE + Statin

81
Q

Hereditary haemochromatosis can cause what?

A

Cranial diabetes insipidus

82
Q

fever + rash + renal dysfunction

A

Acute interstitial nephritis

83
Q

Urine osmolality >500 + urine sodium < 20

A

Pre renal uraemia

84
Q

Urine osmolality < 350 + urine sodium > 40

A

Acute tubular necrosis

85
Q

Brown granular casts are a sign of what?

A

Acute tubular necrosis

86
Q

What is the most common viral infection in solid organ transplant patients?

A

CMV

87
Q

What is the treatment for acute clot retention in urethra?

A

Continuous bladder irrigation via a 3 way urethral catheter

88
Q

What is a drug cause of nephrogenic diabetes insipidus?

A

Lithium - desensitizes the kidneys ability to respond to ADH in the collecting ducts

89
Q

Granulomatosis with polyangiitis is associated with what?

A

Rapidly progressing glomerulonephritis

90
Q

Young female patient with AKI after starting ACE?

A

Fibromuscular dysplasia

91
Q

What is the daily maintenance fluids requirement?

A

25-30ml/kg/day

92
Q

Haemodialysis can cause what?

A

A falsely low HbA1c

93
Q

What is monitoring for ACE inhibitors?

A

Increase in creatinine up to 30% is acceptable
If K+ > 6 - stop ACE and switch to alternative

94
Q

Why do you get kidney stones in PKD?

A

Cysts block collecting ducts leading to urinary stasis and stone formation

95
Q

What part of nephron does RCC affect?

A

PCT

96
Q

What are risk factors for RCC?

A
  • Smoking
  • Male
  • Increasing age
  • HTN
  • FH
  • Obesity
97
Q

Symptoms of chronic renal failure?

A
  • Anaemia
  • Fatigue
  • Vomiting
  • Bone pain
  • SOB
  • Fluid overload
98
Q

Complications of haemodialysis?

A
  • Hypotension
  • Thrombosis
  • Infection
  • Blockage
99
Q

Complication of peritoneal dialysis?

A
  • Peritonitis
  • Obesity
  • Hernias
  • Loss of membrane function
100
Q

Where does sodium reabsorption take place?

A

PCT

101
Q

Anti-GBM has antibody against which type of collagen?

A

Type 4

102
Q

What kind of reaction is IgA nephropathy?

A

Type 3

103
Q

What can be given for calcium stones due to hypercalcicuria?

A
  • Potassium citrate
  • Thiazide diuretics (increase distal tubular reabsorption)
104
Q

Most common cause of death in patients with CKD on harm-dialysis?

A

IHD

105
Q

What is a complication UTI?

A

UTI in the presence of an abnormal urinary tract

106
Q

What is the pathophysiology of IgA nephropathy?

A

IgA immune complex deposit in the mesangial cells

107
Q

haemoptysis + haematuria

A

Think Good pastures

108
Q

Sickness, headache, vomiting and drowsiness after haemodialysis?

A

Disequilibrium syndrome caused by rapid changes in plasma osmolality and cerebral oedema

109
Q

Causes of raised CK?

A
  • Burns
  • Myositis
  • Seizures
  • Influenza
  • Duchennes muscular dystrophy
110
Q

What gene is responsible for PKD?

A

PKD1

111
Q

What are complications of PKD?

A
  • Renal failure
  • HTN
  • Renal calculi
  • Cyst infection
  • Hepatic cysts
112
Q

What is screening of ADKPD for relatives?

A

Abdo US scan for first degree relatives

113
Q

subepithelial ‘humps’ on electron microscopy

A

Post strep glomerulonephritis

114
Q

A high urea can indicate what gastro pathology?

A

Upper GI bleed

115
Q

What is a classic sign of renal artery stenosis?

A
  • Worsening renal function after starting an ACE
  • Refractory HTN
116
Q

Which UTI medication can cause rise in creatinine?

A

Trimethoprim

117
Q

What is a good marker prognosis in IgA nephropathy?

A

Macroscopic haematuria

118
Q

Muddy brown casts

A

ATN

119
Q

rash, eosinophilia and acute renal impairment

A

AIN

120
Q

Most common component of renal stones?

A

Calcium oxalate

121
Q

What is the most common cause of AKI?

A

Pre-renal causes

122
Q

Management of acute upper urinary tract obstruction

A

Nephrostomy

123
Q

fever, rash and eosinophilia in a setting of decreased renal function

A

Acute interstitial nephritis

124
Q

When can a diagnosis of CKD be made?

A

When EGFR <60 on 2 tests which are 3 months apart

125
Q

UTI + haematuria?

A

Must send MSU

126
Q

Trimethoprim can cause a falsely low what?

A

eGFR

127
Q

thickened glomerular basement membrane with IgG and C3 subepithelial deposits

A

Membranous nephropathy

128
Q

Treatment of HTN in someone with IgA nephropathy?

A

ACE inhibitors

129
Q

Headache and tremor can be signs of what?

A

Calcineurin inhibitors (tacrolimus) toxicity

130
Q

Why are patients with nephrotic syndrome susceptible to clots?

A

Loss of antithrombin III and plasminogen via the kidneys

131
Q

Periureteric fat stranding on CT KUB can indicate what?

A

Spontaneously passed calculus

132
Q

Stag horn calculi are made of what?

A

Struvite (magnesium ammonium phosphate)

133
Q

What is a vitamin D supplement which is used in end stage renal disease?

A

Alfacalcidol -> does not require activation in the kidneys

134
Q

anti-MPO antibodies are indicative of what?

A

Microscopic polyangiitis

135
Q

What are the types of renal tubular acidosis?

A

1 - inability to generate acid urine causing hypokalaemia (causes include RA, Sjogrens, SLE)
2 - decreased bicarb resorption causing hypokalaemia (causes include Wilsons)
4 - reduced aldosterone causing hyperkalaemia (causes include diabetes)

136
Q

Crescent formation on biopsy with rapid decrease in EGFR?

A

Membranoproliferative glomerulonephritis

137
Q

When is acute vs chronic rejection following transplant?

A

Acute - within first 6 months
Chronic - >6 months

138
Q

Gold standard imaging for suspected renal cancer?

A

CT Abdo with contrast

139
Q

Abx for UTI in egfr <45

A

Trimethoprim

140
Q

What is the most common complication of haemodialysis?

A

Dialysis-induced hypotension

141
Q

Worsening renal function with dark brown urine

A

ATN

142
Q

Gentamicin can cause what?

A

ATN

143
Q

What is calcitriol?

A

Active form of Vit D

144
Q
A

FINALS: PASSMED/QUESMED (22 decks)

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