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Maud- Phase 3b > Renal Week > Flashcards

Renal Week Flashcards

1
Q

What is the management of hyperkalaemia?

A 
IV calcium gluconate (stabilised myocardium by increasing threshold for depolarisation)
IV insulin and dextrose (move K_ into cells) 
Calcium resonium (stops K+ absorption in gut)

Dialysis (if renal function not restored / K+ >7mmol/L / ptx resistant to tx)

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2
Q

What are the biochemical indicators of chronic renal failure?

A 
Low Hb
Low Ca2+
Raised PO42-
Raised creatinine
ACR >3mg/mmol
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3
Q

Describe the difference between low-pressure chronic urinary obstruction and acute urinary obstruction?

A

Low-pressure chronic UO= not painful

Acute UO= painful

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4
Q

How does a low GFR effect Ca2+, phosphate, PTH?

A

High phosphate
Low calcium,
Hyperparathyroidism

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5
Q

How is renal anaemia managed?

A

Regular SC Epo

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6
Q

Signs and symptoms of CKD?

A 
Pruritis,
loss of appetite, wt loss, 
pleural effusion, impotence 
muscle cramps, 
HTN
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7
Q

A patient has DM and albuminuria, what is their BP target?

A

130/80

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8
Q

Patient has HTN and albuminuria, what drug is given first line to control their BP?

A

ACEi given 1st line

regardless of age/ethnicity

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9
Q

Patient is started on BP controlling medication ____, there is a risk it may cause renal artery stenosis so we check their ______ within 14 days. If creatinine levels rise >____% we should stop the medication

A

ACEi may cause renal artery stenosis
Check U+E within 14 days
If creatinine >20% stop ACEi

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10
Q

Characteristic pain of renal stones

A

loin to groin

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11
Q

Clinical picture of patient with renal infarction?

A

Hx of CVD RFs e.g AF

Flank/chronic abdo pain

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12
Q

What is identifiable on CT scan of patient with pyelonephritis?

A

Gas accumulation caused by parenchymal infection

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13
Q

Do ureteral strictures cause asymmetrical or symmetrical dilation of the kidneys?

A

Asymmetrical dilation

Also painful

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14
Q

Bladder dilation is seen, what does this tell you about the course of the disease?

A

Chronic condition,

Bladder is strong muscular organ, significant build up fof pressure before it becomes dilated

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15
Q

Which biological marker is useful for early detection of renal impairment?

A

Microalbuminuria

serum creatinine is a late marker

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16
Q

What drug can be prescribed to mx hyperphosphataemia?

A

Sevelamer
bings to phosphate in gut therefore reducing serum phosphate

Also reduces calcium and cholesterol

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17
Q

When would you prescribe cinacelet?

A

Mx of 2nd hyperparathyroidism

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18
Q

What investigation is gold standard for identifying an occlusion within renal vasculature?

A

Renal arteriography

inject a dye and use XR

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19
Q

Abdominal bruits are strongly suggestive of which renal pathology?

A

Renovascular compromise

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20
Q

Wegner’s granulomatosis is a condition in which c-ANCA is positive. What does ANCA stand for?

A

anti-neutrophilic cytoplasmic antibodies

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21
Q

In Wegner’s granlomatosis ANCA attack which size blood vessels, what is the result on the kidney? what is seen on biopsy?

A

ANCA attack small-medium blood vessels
Causes necrotising granulomatous inflammation
Biopsy= cresentic necrotising glomerulonephritis + red cell casts

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22
Q

What are the urinary symptoms of acute tubular necrosis?

A

Oliguria followed by recovery of renal function

23
Q

What are some of the causes of acute tubular necrosis?

A

renal ischaemia

nephrotoxicity, haemorrhage, diuretics, contrast, HF

24
Q

What are RFs for bladder CA and what is the key presentation?

A

Smoking, rubbery/dye industry chemicals

Painless haematuria + wt loss

25
Q

What is wolfram syndrome?

A

Rare genetic disease

Causes DI, DM, optic atrophy and deafness

26
Q

What is alport syndrome

A

Genetic defect in type IV collagen synthesis

Hereditary nephritis, sensorineural deafness, (catarct / retinal fleck)

27
Q

Nephritic syndrome is associated with hyper or hypotension?

A

Hypertension

28
Q

The commonest cause of nephrotic syndrome in children / young adults is…

A

minimal change disease

29
Q

3 clear features relating to goodpastures syndrome?

A

Anti-glomerular basement membrane (GBM)
glomerulonephritis
pulmonary damage (haemoptysis)

30
Q

One of the commonest causes of asymptomatic haematuria is…

A

thin basement membrane

31
Q

What is horseshoe kidney, sx, comps?

A

fusion of lower renal poles
usually asymptomatic
increased risk of UTI / renal stones

32
Q

Describe acute hyperuricaemic nephropathy?

A

Occurs following chemotherapy
Uric acid crystallises in renal system,
Causes obstructions which manifest as flank pain, oliguria, HTN, oedema, uraemic sx

33
Q

What is medullary sponge kidney?

A

Congenital disorder
Cystic sacs in papillary zone (sponge-like appearance)
Cysts obstruct urine- predispose to UTI, haematuria, renal calculi
Diagnosis by excretion urography

34
Q

What the symptoms of pyelonephritis?

A

similar to UTI (dysuria, haematuria, loin pain)

systemic= fever/rigors

35
Q

Renal cysts are usually asymptomatic, true or false?

A

True

usually found incidentally on US, only cause pain/haematuria if grow too large in size

36
Q

Sx of renal abscess?

A

insidious, non-specific

abdo pain, wt loss, malaise, fever,

37
Q

Which gene is involved in PKD?

A

PKD1 on chromosome 16

38
Q

PKD cysts are found where?

A

Renal parenchyma

39
Q

PKD is associated with what in the heart? what in the brain?

A

mitral valve prolapse

berry aneurysms

40
Q

What are the sx of PKD?

A

Abdo/loin pain as kidneys hypertrophy
Bleeding/infection of cysts
Sx of renal failure

41
Q

What is renal failure?

A

Abrupt, revrsible deterioration of renal function

42
Q

Renal failure patients often experience N+V, hyperventilation, oedema, lerthargy and easy bruising. Explain the pathophysiology behind each symptom

A

N+V= uraemic
Hyperventilation= failure to excrete H+ causing acidosis
Oedema= lack of diuresis
Lethargy= lack of Epo
Easy bruising= lack of haemostatic function

43
Q

What are the 5 main functions of the kidney?

A 
Fluid management 
Waste excretion 
Vitamin D activation (add the 1, liver adds 25)
Epo 
Acid-base balance
44
Q

What are the 3 main types of medication given in renal transplant?

A

Steroids e.g prednisolone
Anti-metabolites e.g azothioprine
Calcium urine inhibitors e.g cyclosporin

45
Q

Azothioprine is CI with which drug?

A

Allopurinol

46
Q

What is the difference between nephrotic and nephritic syndrome?

A

Nephrotic syndrome characterised by proteinuria whereas nephritic characterised by haematuria (micro//,acro)

Nephrotic= may have normal kidney function, Nephritic=have ow kidney function

Nephritic= caused by conditions which cause inflammation of glomerulus e.g ANCA, anti-GBM, SLE
Nephrotic caused by minimal change disease, mebranous nephropathy

47
Q

What is the diagnostic criteria for having an AKI?

A

Creatining >1.5x baseline

Urine output <0.5ml/kg/hr for >6hrs

48
Q

A patients results indicate a creatinine level 2.5x their normal baseline and urine output <0.5ml/kg/hr for the past 9 hours. What stage AKI are they?

A

Stage 2 AKI

Stage 1= Cr 1.5-2 x baseline, UO <0.5 for >6hrs

Stage 2= Cr 2-3 x baseline, UO<0.5 for >12 hrs

Stage 3= Cr > 3x baseline, UO <0.5 for >24hrs

49
Q

What are the parameters for the three stages of AKI?

Cr x baselines and UO levels

A

Stage 1= Cr 1.5-2 x baseline, UO <0.5 for >6hrs

Stage 2= Cr 2-3 x baseline, UO<0.5 for >12 hrs

Stage 3= Cr > 3x baseline / >354mmol/L or inititation of RRT UO <0.3 for >24hrs

50
Q

What are the criteria for stage 3 AKI?

A

Any of…
Cr >3x baseline
Cr >354
Initiation of RRT

51
Q

A patient with CKD needs their BP managing, which medication is preferable?

A

ACEi

52
Q

What is the first presentation of most patients with PKD?

A

Hypertension

53
Q

Name a painkiller broken down by the kidney and the implication of this?

A

Morphine

Should not be prescribed to patients with kidney impairment

Maud- Phase 3b (14 decks)

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