renal medicine Flashcards
usual first line option for independent patients for renal replacement is??
peritoneal dialysis
usual first line option for patients with Chron’s disease for renal replacement is?
haemodialysis
the insertion of a peritoneal dialysis catheter dangerous as well as the infusion and drainage of fluid.
CKD: only diagnose stages 1&2 if???
supporting evidence to accompany eGFR
for egfr The most commonly used formula is the Modification of Diet in Renal Disease (MDRD) equation, which uses the following variables:? (CAGE)
serum creatinine
age
gender
ethnicity
CKD1:
gfr>90
CKD2:
gfr 60-90
CKD3a:
gfr45-59
CKD3b:
gfr 30-44
CKD4:
15-29
CKD 5:
<15
most common cause of peritonitis secondary to peritoneal dialysis????
staph epidermis
coag negative staph
post strep glomerulonephritis occurs??
1-2 weeks after URTI
IgA nephropathy occurs?
1-2 days after URTI
aka berger’s
post-strep glomerulonephritis pathology?
delayed antibody-mediated disease following infection of the pharynx or skin causing nephritic syndrome.
what is Alport’s syndrome characterised by?
haematuria, sensory hearing loss and ocular disturbances
which drugs should be stopped in AKI?
NSAIDs, aminoglycosides, ACE inhibitors, angiotensin II receptor antagonists [ARBs] and diuretics) within the past week, digoxin (levels)
screening test for PKD?
USS abdo
how is PKD transmitted?
Autosomal dominant
ADPKD1 which chromosome?
16
85% cases
ADPKD2 which chromosome?
4
15% cases
Hyperacute transplant rejection is suspected.
Which of the following is the best treatment for this patient?
removal of graft
nephrotic syndrome - what is a recognised cx? why?
high risk of VTE disease (eg renal vein thrombosis)
Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels
Increased risk of VTE in patients with nephrotic syndrome - mx?
LMWH
triad of nephrotic syndrome?
- Proteinuria (> 3g/24hr) causing
- Hypoalbuminaemia (< 30g/L) and
- Oedema
Addison’s disease/adrenal insufficiency can cause which metabolic abnormality?
hyperkalaemic metabolic acidosis
HSP features:
palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
abdominal pain
polyarthritis
features of IgA nephropathy may occur e.g. haematuria, renal failure
ADPKD is associated with????
berry aneurysms - SAH
commonest extra-renal manifestation of ADPKD?
liver cysts - 70%
could present as hepatomegaly
metabolic acidosis with normal anion gap?
addison's GI losses (diarrhoea) renal tubular acidosis
low thyroxine but normal free thyroxine levels in which disease?
nephrotic syndrome
can aspirin be continued in aki?
yes at cardio-protective dose
what ix indicates that kidney disease is chronic and not acute?
hypocalcaemia
81-year-old woman is due to have a contrast-enhanced CT scan to investigate suspected lung cancer. She suffers from chronic kidney disease, due to a history of hypertension.Her most recent eGFR is 50ml/min/1.73m2. Due to the increased risk of contrast-induced acute kidney injury in this patient, which of the following would be most appropriate?
offer Iv fluid infusion before and after contrast
NICE guidelines suggest referring to a nephrologist from primary care if eGFR ????
falls to below 30 or progressively by >15 a year
In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked and which tx started?
check iron studies FIRST!!!
start epo
patients who are IDA don’t respond to EPO
Hyaline casts may be seen in the urine of patients ????
taking loop diuretics like furosemide
DKA: what ABG finding and what anion gap?
metabolic acidosis and raised anion gap
causes of rapidly progressing glomerulonephritis?
goodpastures
wegners
SLE, microscopic polyarteritis
what expecting on renal biopsy from canca positive (PR3)?
cresentic glomerulonephritis
When prescribing fluids, the potassium requirement per day is?
1mmol/kg/day
nice recommends how much fluids per day?
20-30ml/kg/day of water
nice recommends how much glucose per day to stop starvation ketosis?
50-100g/day
who shouldn’t have hartmann’s ??
patients with hyperkalaemia
it contains potassium
problem with increased saline: sfx?
risk of hyperchloraemic metabolic acidosis
63-year-old man attends for a GP appointment and states that he has had two episodes of visible blood in his urine. One episode occurred last week and the other this morning. There was not any pain. He denies any lower urinary tract symptoms. A urinalysis shows +++ blood and is negative for all other markers. What investigation should be requested?
cystoscopy
13-year-old girl presents to her GP with her father as she is concerned about recently gaining weight. She feels that her hands and feet have got ‘fatter’ in the last few weeks and she has had to buy larger shoes as her old ones no longer fit. She also says that her face looks rounder and puffier than it used to. A routine review of symptoms reveals no other problems except when passing urine, she has noticed her urine looks very frothy. dx?
nephrotic syndrome
minimal change disease
mx of minimal change nephropathy?
PO pred and urgent outpt referral to paeds
what is second line tx in minimal change disease?
when pred not working (do renal biopsy)
use cyclophosphamide
Sterile pyuria and white cell casts in the setting of rash and fever should raise the suspicion of ??
acute interstitial nephritis
common cause of acute interstitial nephritis?
abx therapy
what typically presents with haemoptysis and haematuria?
goodpastures syndrome
path: goodpastures?
(anti-GBM disease) is a rare type of small-vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen. Goodpasture’s syndrome is more common in men (sex ratio 2:1) and has a bimodal age distribution (peaks in 20-30 and 60-70 age bracket). It is associated with HLA DR2.
pre-renal causes of AKI?
(main 2, and FIRST mnemonic)
ix: high serum urea:creatinine ratio
sepsis, dehydration (hypoperfusion) Failures - HF, RF Infection RBC haemorrhage Stenosis Thrombosis
renal causes of AKI?
nephotoxics mainly
acute tubular necrosis
sx of hypokalaemia:
Asymptomatic Weakness Leg cramps Respiratory issues Paralysis Arrythmias
causes of hypokalaemia:
Drugs: diuretics, laxatives, steroids, abx
GI losses
Renal failure
post-renal causes of AKI:
retention
obstruction
(stones)
what is an effective form of analgesia for renal stones?
rectal diclofenac