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Medical School Finals > Speciality: Renal > Flashcards

Speciality: Renal Flashcards

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USMLE® Step 1 flashcards
1
Q

Cranial Diabetes Insipidus

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Idiopathic, post head injury, Pit surgery, craniopharyngioma, DIDMOAD, Hereditary Haemochromotosis.
  2. Polyuria. Polydipsia
  3. High plasma osmolality and low urine osmolality
    - Water deprivation test
  4. Desmopressin
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2
Q

Nephrogenic Diabetes insipidus

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Genetics, hypercalcaemia, hypokalaemia, drugs (lithium), tubulo-interstitial disease
  2. Polyuria, Polydipsia
  3. High plasma osmolality and low urine osmolality, water deprivation test
  4. Thiazide diuretics and low salt/protein diet.
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3
Q

Alport syndrome

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. X linked
    - Defect in collagen gene, abnormal GBM.
  2. Microscopic haematuria, renal failure, BL sensorineural deafness, Eye problems.
  3. Genetic testing, renal biopsy.
  4. Nil
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4
Q

Daily glucose requirement

A
  • 50-100g/day

- Regardless of weight

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5
Q

Fluid requirements

  • water
  • Potassium, sodium and chloride
A
  • 25-30/ml/kg/day

- Potassium, Na and CL = 1mmol/kg/day

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6
Q

Metabolic acidosis

  1. Normal anion gap
  2. Raised anion gap
A
  1. Hyperchloraemic metabolic acidosis; GI bicarb loss due to diarrhoea, renal tubular acidosis, Addison’s disease.
  2. Lactic acidosis; shock, sepsis and hypoxia.
    - Ketones
    - Renal failure.
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7
Q

CKD EGFR ranges

A

Normal = Patients w/ EGFR >60ml/min/1.73m2 with NO markers of renal disease.

CKD1 = EGFR >90ml/min + evidence of kidney disease

CKD 2 = EGFR 60-90ml/min + reduced renal function + evidence of renal disease

CKD 3a = EGFR 45-59ml/min
CKD 3b = EGFR 30-44ml/min

CKD 4 = EGFR 15-29ml/min

CKD 5 (ESRD) = EGFR <15ml/min

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8
Q

Anion gap

A

(na + k) - (cl + hco3)

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9
Q

AKI

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Pre-renal = Ischaemia, hypovolaemia, renal artery stenosis.
    Renal = Glomerulonephritis, Acute tubular necrosis, Rhabdomyolysis, Tumour lysis syndrome.
    Post-renal = Kidney stone, BPH.
    Risk factors - Emergency surgery, Intraperitoneal surgery, CKD, DM, HF, age, liver disease, nephrotoxic drugs.
  2. Rise in creatinine of 26mmol/L in 48hrs OR 50% rise in 7 days OR fall in urine output.
    - Oedema
    - Arrhythmia
    - Uraemia
  3. U&E
    - Urine output.
  4. Stop NSAIDS, aminoglycosides, ACEI, ARB, Diuretics.
    - Treat electrolytes issues
    - Refer to nephrologist
    - Correct underlying cause.
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10
Q

Acute interstitial nephritis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Drugs - penicillin, rifampicin, NSAID’s, allopurinol, furosemide.
    - Systemic disease - SLE, sarcoidosis.
    - Infection
    - Marked interstitial oedema, and infiltrate between tubules.
  2. Fever
    - Rash
    - Arthralgia
    - Eosinophilia
    - Mild renal impairment
    - HTN
    - Proximity of Sx to drugs.
  3. Urinalysis; sterile pyuria and white cell casts.
  4. Remove offending agent and support.
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11
Q

Potassium sparing diuretics

A
  • Spironolactone
  • Eplerenone
  • Amiloride
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12
Q

Hyperkalaemia Management

A

1) Remove precipitants
2) Stabilise cardiac membrane w/ Calcium Gluconate (doesn’t alter electrolytes)
3) IV insulin/dextrose - moves K intracellularly.
4) Nebulised salbutamol.
5) Calcium resonium removes K from the body. PO or via enema.
6) Diuretics
7) Dialysis

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13
Q

Maintenance fluid requirements in kids

A

100ml/kg for the 1st 10kg
50ml/kg for the 2nd 10kg
20ml/kg for the remainder.

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14
Q

Haematuria

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Transient haematuria = UTI, periods, exercise, sex.
    Constant = Cancer (painless haematuria = bladder Ca until proven otherwise), stones, BPH, prostatitis, Chlamydia.
  2. Can be macro or microscopic
  3. Urine dip.
    - Further Rx = cystoscopy, U&E etc.
  4. Urgent referral = >45 + non-explained visibe haematuria w/o infection OR that persist or recurs following UTI Rx.
    Urgent referral = >60 + unexplained nonvisible haematuria + dysuria and raised WCC.
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15
Q

Rhabdomyolysis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Skeletal muscle is damaged and breaksdown, resulting in myoglobin release.
    - Results in AKI.
    - Consider in long-lie.
    - Prolonged seizure.
    - Crush injury
    - Statins (especially when prescribed w/ Clarithromycin)
  2. Tea-coloured urine due to myoglobin.
    - AKI + CK
    - Myoglobinuria
    - Elevated phosphate
    - Hyperkalaemia
    - Metabolic acidosis.
  3. U&E
    - CK
    - Urinalysis
    - ABG
  4. IV fluids to maintain urine output + Supportive care.
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16
Q

Preventing nephrotoxicity due to contrast media.

A
  • IV NACL for 12 hours pre and post procedure.
17
Q

Nephrotic syndrome Triad

A
  1. Proteinuria >3g/24hr
  2. Hypoalbuminaemia
  3. Odema

Other features include low total T4 levels.

18
Q

Nephrotic syndrome Causes

A
  • Minimal change disease
  • Membranous GN
  • FSGS
  • Amyloidosis
  • DM
19
Q

Persistent pyuria + negative urine culture and screen

A

Renal TB

20
Q

Goodpasture’s syndrome

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Pulmonary haemorrhage and rapidly progressive glomerulonephritis.
    - Anti-GBM against collagen.
    - More common in men.
    - Associated w/ HLA DR2
  2. Pulmonary haemorrhage
    - Rapidly progressive GN
  3. Renal biopsy - linear IgG deposits along the GBM
    - Raised transfer factor due to pulmonary haemorrhages
  4. Plasma exchange
    - Steroids
    - Cyclophosphamide
21
Q

Nephritis syndrome causes

A
  • Post strep GN -often GAS URTI

- LSE, Goodpasture’s syn, IgA nephropthy.

22
Q

Post streptococcal GN

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. 1-2 weeks following a URTI.
    - Often GAS - strep pyogenes
    - Immune complex deposition in the glomeruli (IgG, IgM and C3)
  2. General headaches, malaise
    - Haematuria
    - Proteinuria
    - HTN
    - Low C3
  3. Clinical
    - renal biopsy; diffuse proliferative GN
    - Neutrophils in the endothelium.
  4. Supportive
    - Carries a good prognosis.
23
Q

Acute tubular necrosis

A
  • Nephrotoxic stimuli; aminoglycosides, contrast media, myoglobin and haemolysis results in necrosis.
  • Muddy brown casts
24
Q

Interstitial Nephritis

  1. Causes
  2. Pathology
  3. presentation
  4. Ix
  5. Rx
A
  1. Drugs !!! NSAIDs, penicillin, rifampicin
    - SLE, Sarcoid
    - Infection
  2. Histology, marked oedema and interstitial infiltrate
  3. Fever, rash, joint pain
    - Eosinophilia
    - Mild renal impairment
    - HTN
  4. Sterile pyuria
    - White cell casts
25
Q

Primary Vs secondary aldosterone’s

A
  • Secondary = high renin
    Cause - renal artery stenosis.
  • Primary = normal renin

Medical School Finals (24 decks)

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