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General Med > Renal Medicine > Flashcards

Renal Medicine Flashcards

1
Q

Most likely cause of death with CKD on dialysis

A

Ischaemic heart disease (50%)

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2
Q

Variables to consider when measuring eGFR

A

Serum creatinine
Age
geneder
ethnicity

Pregnancy
Muscle mass
eating red meat 2 hours prior

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3
Q

Causes of haematuria

A

Transient/spurious non-visible:

  • UTI
  • menstruation
  • vigorous exercise
  • sex

Persistent non-visible:

  • Cancer (bladder, renal, prostate)
  • Stones
  • BPH
  • Prostatis
  • Urethritis (chlamydia)
  • Intrinsic renal causes (IgA nephropathy, thine basement membrane disease)

Spurious causes:

  • foots (beetroot, rhubarb)
  • drugs (rifampicin, doxorubricin)
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4
Q

Drugs causing haematuria

A

rifampicin, doxorubricin

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5
Q

Alports features

A

X-lined dominant pattern - gene that codes for Type IV collagen

Features:

  • microscopic haematuria
  • progressive renal failure
  • bilateral sensorineural deafness
  • lenticonus (protrusion of the lens surface into the anterior chamber)
  • retinitis pigmentosa
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6
Q

Nephrotic syndrome causes

A

Primary glomerulonephritis (80%):

  • minimal change glomerulonephritis
  • membranous
  • FSGS
  • membranoproliferative glomerulonephritis

Systemic disease:

  • Diabetes mellitus
  • SLE
  • Amyloidosis

Drugs:

  • Gold
  • penicillamine

Other:

  • congenital
  • neoplastic
  • infection (IE, hep B, malaria)
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7
Q

Peritoneal dialysis

A

4x2litre exchanges per day

Complications:

  • peritonitis (Staph epidermidis, aureus)
  • sclerosing peritonitis
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8
Q

CKD stages

A 
1 >90
2 60-90
3a 45-59 + moderate KD
3b 30-44 + moderate KD
4 15-29 + severe KD
5 <15 + KF

eGFR ml/min

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9
Q

metformin and CT scans

A

Discontinue for 48 hours following CT with contrast

Also stop metformin if eGFR <30 ml/min

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10
Q

CT nephrotoxicity RF and prevention

A

RF:

  • known renal impairment
  • > 70 years
  • dehydration
  • cardiac failure
  • nephrotoxic drugs (NSAIDs, metformin)

Prevention:
- IV 0.9% NaCl 1ml/kg/hour for 12 hours pre and post

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11
Q

Metabolic acidosis with raised anion gap

A

Lactic acidosis (sepsis, tissue ischaemia)
Urate (renal failure)
Ketones (DKA)
Drugs/toxins (salicylates, methanol, ethylene glycol)

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12
Q

Metabolic acidosis with out raised anion gap

A

Due to loss of bicarbonate or:

  • Renal tubular acidosis
  • Diarrhoea
  • Addinsons disease
  • pancreatic fistulae
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13
Q

AKI staging 1-3

A 
1:
 - ↑ 1.5-1.9x creatinine 
 - <0.5ml/kg/hr for >6 hours 
2:
 - ↑2-2.9x creatinine 
 - <0.5ml/kg/hr for >12 hours

3:

  • ↑ >3x creatinine or >354 micromol/l
  • <0.3ml/kg/hr for >24 hours or anuric for 12 hrs
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14
Q

Nephrotic syndrome in children/young adult

A

minimal change disease

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15
Q

Minimal change disease

A

Generally idiopathic but can be:
drugs: NSAIDs, rifampicin
Neoplastic: hodgkins, thymoma
Infectious mononucleosis

Pathophysiology:
T-cell and cytokine mediated damage to GBM leads to polyanion loss and the resultant loss of electriostatic charge causes increased glomerular permeability to serum albumin

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16
Q

Features and management of minimal change disease

A

Nephrotic syndrome

Mx: 80% steroid responsive
cyclophosphamide for steroid resistant cases

1/3 just one episode
1/3 infrequent relapses
1/3 frequent relapses

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17
Q

Henoch-schonlein pupura features

A

Palpable purpuric rash over buttocks and extensor surfaces of arms and legs
Abdominal pain
polyarthritis
features of IgA nephropathy (haematuria, renal failure)

Mx: analgesia and supportive
Inconsistent evidence for steroids

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18
Q

Causes of sterile pyuria

A 
TB
Poorly treated UTI
UTI treated 2 weeks pior 
Appendicitis
Calculi
Prostatos
Bladder tumour
Papillary necrosis
Tubulointerstitial nephritis
Polycystic kidneys
chemical cystitis
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19
Q

UTI RF

A 
Woman
Sex
exposure to spermicide
pregnancy
menopause
Immunosuppresion
Stones
Tract abnormalities
Catheter obstruction
20
Q

UTI bacteria

A

E. Coli
Proteus mirabilis
Klebsiella
Staph saprophyticus

21
Q

Indications for RRT in AKI

A 
Refractory pulomary oedema
persistent hyper K
sever metabolic acidosis (<7.2)
Uraemic complications
uraemic pericarditis
Drug overdose
22
Q

Immediate AKI with Hyperkalaemia Mx

A

10mL of 10% calcium gluconate

10 units actrapidin 50mL 20% glucose

23
Q

Causes of chronic kidney disease

A
  1. Diabetes
  2. Glomerulonephritis
  3. Idiopathic
  4. HTN and renovascular disease
  5. pyelonephritis and reflux nephropathy
24
Q

Examination of CKD/ESRF

A

Aim of exam:

  1. find cause
  2. type of RRT?

Peripheral: HTN, AV fistulae, bruising (steroids), skin malignancy (immunosuppression)

Face: anaemia, yellow tinge (uraemia), gum hypertrophy (ciclosporin), cushingoid appearance

Neck: tunnelled line inserition

Abdomen: PD catheter, transplant scar, ballotable kidneys/liver, nephrectomy scar

Elsewhere: diabetic neuropathy, retinopathy, cardiovascular or peripheral vascular disease

25
Mx of chronic renal disease
Limit progression/complications - BP - ACEI/ARB - Renal bone disease - Restrict PO4 diet and give binders, Vit D and Ca supplements - CVD Risk modify - statins, aspirin (low dose) - diet - restirict K and PO4 Symptom control: - Anaemia: replace iron, B12, folate, EPO (consider red cell aplasia - anti-EPO antibodies) - Acidosis: consider bicarbonate - Oedema: High dose loop diuretics, restrict fluid and sodium intake Restless legs/cramps: check ferritin, clonazepam or gabapentine RRT
26
Complications of RRT
Annual mortality 20% ``` CVD Protein-calorie malnutrition Renal bone disease Infection Amyloid Malignancy ```
27
Renal transplant absolute contraindications
Active infection Cancer severe co-morbidity
28
Immunosupression for renal transplant
INDUCTION: - basiliximab (anti-iL-2R) - alemtuzumab MAINTENANCE: - calcineurin inhibitor (CNI, tacrolimus, ciclosporin) - antimetabolite (azathioprine, mycophenolate - prednisolone
29
Complications of renal transplant
SURGICAL - bleeding, thrombosis, infection, urinary leaks, lymphocele, hernia DELAYED GRAFT FUNCTION - 40% REJECTION - acute (antibody mediated or cellular) or chronic - mx: intense immunosup. +/- plasmapheresis - chronic - sirolimus DRUG TOXICITY - tremor, new onset DM, gum hypertrophy, hirsuitism, agranulocytosis, hepatitis INFECTION - HSV, candida, PCP, CMV MALIGNANCY - skin and viral associated cancers CVD
30
Types of glomerulonephritis
``` IgA Henoch-Schonlein Purpura SLE Anti-glomerular basement membrane disease (Goodpastures) Post-Strep GN Rapidly progressive GN ```
31
Nephritic syndrome
HTN Haematuria moderate to severe loss of eGFR
32
Causes of nephritic syndrome
PRIMARY: - IgA nephropathy - Mesangiocapillary GN SECONDARY: - Post strep - Vasculitis - SLE - Anti-GBM - Cryoglobulinaemia
33
Nephrotic syndrome
Hypoalbuminaemia Oedema proteinuria Hyperlipidaemia
34
Causes of nephrotic syndrome
PRIMARY: - Minimal change - membranous - FSGS - Mesangiocapillary GN (apparently does both) SECONDARY: - Hep B/C - SLE - Diabetic nephropathy - amyloidosis - paraneoplastic syndrome - drug related (NSAIDs, anti-TNF, gold)
35
Management of nephrotic syndrome
1 - Reduce oedema (loop diuretics) 2 - Reduce proteinuria (ACEI) 3 - Reduce risk of complications (Anticoagulate?, Statin, infections and vaccinations) 4 - Treat underlying cause
36
Loop diuretics MoA
Block Na/K/2Cl triple transporter | - thick ascending limb of loop of henle
37
Thiazide diuretics MoA
Inhibit NaCl transporter in DCT
38
Potassium sparing diuretics MoA
Spirolactone and eplerenone - aldosterone antagonists - inhibit Na retention of aldosterone Amiloride and triamterene - block sodium channels of collecting tubules
39
Osmotic diuretics MoA
Mannitol is a solute that is freely filtered at the glomerulus but poorly reabsorbed at tubule Therefore remains in tubule and holds onto water through osmotic effect Used to Decrease ICP
40
Carbonic anhydrase inhibitors MoA
Acetazolamide act on proximal tubule to increase excretion of bicarbonate and consequently sodium, potassium and water. Causes alkalinization of the urine and slight metabolic acidosis Used in glaucoma Sometimes used to prevent altitude sickness
41
PCT reabsorption
``` Amino acids Glucose Cations 60-70% Na Bicarbonate ```
42
Thick ascending loop of henle reabsorption
Na/K/2Cl transporter Mg Ca 20-30% Na
43
DCT reabsorption
5-8% Na | Ca (under PTH control)
44
Cortical collecting tubule reabsorption
Na Excretion of K + H
45
Nephrotoxins (massive list)
Analgesics (NSAIDs) Antimicrobials (gentamicin, sulfonamides, penicillin, rifapicin, amphotericin, acyclovir) Anticonvulsants (Lamotrigine, valproate, phenytoin) Others (omeprazole, furosemide, thiazides, ACEI/ARB, cimetidine, lithium, iron, calcineurin inhibitors, cisplatin) Anaesthetic: methoxyflurane, enflurane Radiocontrast urate crystals Toxins: aristolochia, cadmium, lead, arsenic, ethylene glycol Haemaglobin (haemolysis, myoglobins) Proteins (myeloma, light chain disease) Bacteria: strep, legionella, Brucella, Mycoplasma, chlamydia, TB, salmonella, campylobacter Viruses: EBV, CMV, HIV, adenovirus, measles, polyoma virus Other: leptospirosis, syphilis, toxoplasma, leishmania

General Med (17 decks)

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