Brainscape's Knowledge GenomeTM

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


See full index

Medicine > Renal medicine > Flashcards

Renal medicine Flashcards

1
Q

Definition of AKI

A

Creatinine: Rise >26 umol in 48h OR >1.5x baseline in 7d

Urine output: <0.5ml/kg/hr for >6h

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

Pre-renal causes of AKI

A

Urea often disproportionately high

  • Reduced vascular volume: D&V, pancreatitis, burns, haemmorhage, rapid diuresis after relieving obstruction
  • Reduced CO: Cardiogenic shock, MI
  • Systemic vasodilation: Sepsis, anaphylaxis, anti-HTNs
  • Drugs: Diuretics, ACEi, NSAIDs, angiotensin receptor blockers
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Renal causes of AKI

A

Creatinine:urea approx 10 (proportional rise)

  • Glomerulonephritis:
  • Interstitial nephritis​
  • Tubular necrosis​
  • Vascular:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Post-renal causes of AKI

A
  • Intrarenal:
    • LC preceipitation (myeloma)
    • Urate crystals (tumour lysis syndrome)
    • Drugs (causing crystalluria): Acyclovir, sulphanomides, NSAIDs
  • Upper tract obstruction:
    • Renal calculi (stones): e.g. hypercalcaemia
    • Carcinoma of bladder, colon, renal tract
    • Retro-peritoneal fibrosis
    • Acute pyelonephritis (esp. in DM)
  • Urethral obstruction:
    • Urethral strictures
    • Prostatic hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs and symptoms of AKI

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Definitions of CKD

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Staging CKD

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

Symptoms of AKI

A

REDUCED URINE OUTPUT

Nausea, vomiting, hiccups

Fatigue, malaise

Breathlessness (acidosis/pulmonary oedema)

Peripheral oedema

Haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Emergency scenarios with AKI/ARF (what will kill patients)

A
  • Hyperkalaemia (K > 6.5)
  • Pulmonary oedema
  • Metabolic acidosis
  • Hypertensive encephalopathy (fundi, coma score, reflexes)
  • Uraemic encephalopathy (asterixis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of hyperkalaemia

A

Calcium gluconate

Dextrose (50%) + insulin

ECG monitor + IV access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of pulmonary oedema

A

Sit upright

High-flow oxygen

Furosemide IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Distinguishing features of CKD vs AKI

A

Anaemia

Osteodystrophy/VitD/Ca deficiencies

Small, scarred kidneys on CKD

Timescale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Features of post-renal AKI

A

Complete anuria

Dysuria, poor stream beforehand

Distended bladder

Constipation, prostate hypertrophy

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

Criteria for renal team referral

A
  • AKI not responding to treatment
  • Complications: ↑k+, acidosis, fluid overload
  • stage 3 aki (>3x baseline, Cr >350)
  • Difficult fluid balance (eg hypoalbuminaemia, heart failure, pregnancy)
  • Possible intrinsic renal disease (table 7.4)
  • Hypertensive encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for AKI

A
  • B: U+E, VBG, FBC
  • O: Urine dipstick (pre-catheter), urine output monitorin
  • X: USS KUB
  • E: ECG monitoring if hyperkalaemic
  • S: Intrinsic renal disease if indicated (Abs, myeloma, etc…)
17
Q

Management

A

Fluid resuscitation

Catheterisation/(?nephrostomy for higher-level obstruction)

Stop nephrotoxic medications

Change medication doses for renal impairment

Biopsy if intrinsic renal disease

18
Q

Signs of hypovolaemia

A

Low BP (NB: compare to baseline)

Low skin turgor

Dry mucous membranes

Low urine output

Weight loss

Tachycardia

Low CRT

19
Q

Signs of fluid overload

A

High BP

Bilateral crepitations/breathlessness

Raised JVP (NB: Not valid in RHF)

Gallop heart rhythm

Peripheral oedema

20
Q

Vascular causes of renal AKI

A

Vasculitis

DIC

TTP

HUS

21
Q

Causes of acute tubular necrosis

A
  • ​Ischaemia (prolonged renal hypo-perfusion, acute thrombotic event)
  • Toxins/pigments
  • Rhabdomyolysis/hypercalcaemia
  • Drugs:
    • Gentamicin, penicillins
    • Diuretics, ACEi
    • NSAIDs, cyclosporin
    • Contrast agents, anaesthetics
22
Q

Causes of interstitial nephritis

A

​Drugs (allergic-type reaction): Penicillins, cephalosporins, rifampicin, NSAIDs

Infection

Infiltration (e.g. sarcoid)

23
Q

Common causes of CKD

A

Diabetes

Hypertension

Glomerulonephritis

24
Q

Definition of CKD

A

Abnormal renal structure/function for >3mo

Criteria: Albuminuria, low eGFR

25
Q

HOPC questions for CKD

A

Recent/recurrent UTI

Lower UT symptoms

Oedema: SOB, swelling

N+V, anorexia, restless legs

Autoimmune: Eyes, skins, joints

Myeloma/malignancy: Bone pain, B-symptoms, anaemia

When did you last feel well?

26
Q

Peripheral examination in CKD

A

Peripheral oedema

Vasculitic rash/pruritus scratch-marks

Signs of peripheral vascular disease

Uraemic flap

27
Q

Facial examination in CKD

A

Anaemia

Xanthalesama

Gum hypertrophy (ciclosporin)

Cushingoid (steroids)

Periorbital oedema (nephrotic syndrome)

Telangiectasia (scleroderma)

Facial lipodystrophy (glomerulonephritis)

28
Q

Neck/chest examination of CKD

A

JVP

Central line scars

Pulmonary oedema/pleural effusion

Sternotomy scars

Cardiomegaly

29
Q

Bone profile results of CKD

A

Hypocalcaemia

Hyperphosphataemia

Hyper-PTH

Vit D deficiency

30
Q

Indications for long-term dialysis

A

Inability to control symptomss:

  • Fluid status (oedema)
  • Electrolye/acid-base disturbances
  • N+V/nutrition
  • Pruritus
  • Inability to control BP
  • Cognitive impairment
31
Q

Complications of A-V fistulae

A

Thrombosis

Stenosis

Vascular steal syndrome (distal blood flow)

32
Q

Complications of central venous catheter

A

Infection

Blockage

Blood recirculation

33
Q

Complications of peritoneal dialysis

A

Catheter site infection

PD peritonitis

Hernias

Loss of membrane f(x) with time

34
Q

General complications for dialysis patients

A

Haemodynamic instability/hypotension (c.f. not on haemofiltration)

Dialysis dysequilibrium (imbalance between cerebral and vascular solutes –> oedema –> need gradual start)

High mortality from CV disease (poor BP control, deranged Ca/phosphate, oxidative stress/inflammation)

Uraemia –> granulocyte/T-cell dysfunction –> > sepsis mortality

Renal osteodystrophy

35
Q

What to ask about/check for dialysis patients?

A

K+ and fluid status

Normal urine output and target weight

Next scheduled dialysis

Dose-adjustments

IV access considerations w/ fistulas

Troponin has low Sp in ESRF

36
Q

Contraindications to renal transplant

A

Absolute: Cancer w/ mets

Temporary: Active infection, unstable CVD

Relative: CHF, CVD

37
Q

Immunosuppressive medications for transplant patients

A
  • Monoclonal antibodies
  • Calcineurin inhibitors (e.g. tacrolimus)
  • Glucocorticosteroids
  • Antimetabolites (e.g. azathioprine, mycophenolic acid)
38
Q

Questions for renal transplant presentation

A

eGFR/creatinine + comparison to baseline

Check for macrolide/calcineurin interactions

Adjust doses to renal function

Correct AKI promptly

Consider opportunistic infection

Discess VTE prophylaxis w/ transplant unit

Ensure immunosupression even if need to give IV/NG

Medicine (8 decks)

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