Renal Week Flashcards by Andrew Maud

What is the management of hyperkalaemia?

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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What are the biochemical indicators of chronic renal failure?

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

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

Low-pressure chronic UO= not painful

Acute UO= painful

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

High phosphate
Low calcium,
Hyperparathyroidism

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How is renal anaemia managed?

Regular SC Epo

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Signs and symptoms of CKD?

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

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

130/80

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

ACEi given 1st line

regardless of age/ethnicity

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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

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

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Characteristic pain of renal stones

loin to groin

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Clinical picture of patient with renal infarction?

Hx of CVD RFs e.g AF

Flank/chronic abdo pain

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What is identifiable on CT scan of patient with pyelonephritis?

Gas accumulation caused by parenchymal infection

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

Asymmetrical dilation

Also painful

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

Chronic condition,

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

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

Microalbuminuria

serum creatinine is a late marker

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What drug can be prescribed to mx hyperphosphataemia?

Sevelamer
bings to phosphate in gut therefore reducing serum phosphate

Also reduces calcium and cholesterol

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When would you prescribe cinacelet?

Mx of 2nd hyperparathyroidism

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

Renal arteriography

inject a dye and use XR

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Abdominal bruits are strongly suggestive of which renal pathology?

Renovascular compromise

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

anti-neutrophilic cytoplasmic antibodies

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

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

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What are the urinary symptoms of acute tubular necrosis?

Oliguria followed by recovery of renal function

What are some of the causes of acute tubular necrosis?

renal ischaemia

nephrotoxicity, haemorrhage, diuretics, contrast, HF

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

Smoking, rubbery/dye industry chemicals

Painless haematuria + wt loss

What is wolfram syndrome?

Rare genetic disease | Causes DI, DM, optic atrophy and deafness

What is alport syndrome

Genetic defect in type IV collagen synthesis | Hereditary nephritis, sensorineural deafness, (catarct / retinal fleck)

Nephritic syndrome is associated with hyper or hypotension?

Hypertension

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

minimal change disease

3 clear features relating to goodpastures syndrome?

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

One of the commonest causes of asymptomatic haematuria is...

thin basement membrane

What is horseshoe kidney, sx, comps?

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

Describe acute hyperuricaemic nephropathy?

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

What is medullary sponge kidney?

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

What the symptoms of pyelonephritis?

similar to UTI (dysuria, haematuria, loin pain) | systemic= fever/rigors

Renal cysts are usually asymptomatic, true or false?

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

Sx of renal abscess?

insidious, non-specific | abdo pain, wt loss, malaise, fever,

Which gene is involved in PKD?

PKD1 on chromosome 16

PKD cysts are found where?

Renal parenchyma

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

mitral valve prolapse | berry aneurysms

What are the sx of PKD?

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

What is renal failure?

Abrupt, revrsible deterioration of renal function

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

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

What are the 5 main functions of the kidney?

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

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

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

Azothioprine is CI with which drug?

Allopurinol

What is the difference between nephrotic and nephritic syndrome?

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

What is the diagnostic criteria for having an AKI?

Creatining >1.5x baseline | Urine output <0.5ml/kg/hr for >6hrs

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?

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

What are the parameters for the three stages of AKI? | Cr x baselines and UO levels

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

What are the criteria for stage 3 AKI?

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

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

ACEi

What is the first presentation of most patients with PKD?

Hypertension

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

Morphine Should not be prescribed to patients with kidney impairment