Week 227 - Acute Renal Failure Flashcards
Name some drugs that can cause HYPOKALAEMIA
Thiazide diuretics Loop diuretics
Name some drugs that can cause HYPERKALAEMIA
ACE Inhibitors Angiotensin receptor blockers Spironolactone
What drug can cause a falsely elevated serum creatinine?
Trimethoprim
Long term of which drugs can cause irreversible renal damage?
Aminoglycosides (e.g. gentamycin) NSAIDs
What drugs can cause high serum uric acid/urate stones?
Chemotherapy for bulky tumours
What drugs can cause rhabdomyolysis/High CK?
Statins Calcineurin inhibitors (Cyclosporin, tacrolimus)
What is the most appropriate investigation that will help determine the cause of renal disease in a patient presented with ARF, chest symptoms, urine dipstick showed blood +++& protein+++
Renal Biopsy
What is the most appropriate investigation that will help determine the cause of renal disease in a patient presented with ARF, fever, night sweats, dysuria, & loin pain
Urine microscopy looking for white cell casts, urine culture
What is the most appropriate investigation that will help determine the cause of renal disease in an elderly patient developing ARF 4 days after hip surgery
Urinary Na
What is the most appropriate investigation that will help determine the cause of renal disease in a patient with symptoms of polyuria, nocturia, hesitancy developing a gradual rise of serum urea & creatinine
Physical examination & bladder scan
What electrolyte abnormality likely to be associated with Ingestion of MDMA (Ecstasy)
Hyponatraemia
What electrolyte abnormality likely to be associated with ARF after strenuous exercise
Hypocalcaemia
What electrolyte abnormality likely to be associated with Recovery phase of ARF due to rhabdomyolysis
HYPERcalcaemia
What electrolyte abnormality likely to be associated with ARF after introduction of ACEI in a patient with chronic heart failure
Hyperkalaemia
What electrolyte abnormality likely to be associated with Chronic Laxative Abuse
Hypokalaemia
In what pathological conditions are you likely to see RBC Casts?
Glomerulonephritis
In what pathological conditions are you likely to see WBC Casts?
Pyelonephritis
In what pathological conditions are you likely to see Fatty Casts?
Nephrotic Syndrome
In what pathological conditions are you likely to see Pigmented Casts?
Rhabdomyolysis
What biochemical abnormality is most likely to be associated with An athlete participating in a marathon tournament for the first time?
High Creatinine Kinase
What biochemical abnormality is most likely to be associated with The use of Angiotensin receptor blocker (ARB) for treatment of hypertension?
Hyperkalaemia
What biochemical abnormality is most likely to be associated with Ecstasy use?
Hyponatraemia
What biochemical abnormality is most likely to be associated with Prostatic carcinoma?
Metabolic acidosis
What biochemical abnormality is most likely to be associated with Chemotherapy for a bulky sarcoma of right thigh?
Hyperuricaemia
What drugs would be associated with AKI with Hypercalcaemia?
Vitamin D and Oral Calcium
What drugs would be associated with AKI with high CK?
Statin and Cyclosporin
What histopathological findings would you expect to find in Rapidly Progressive GN?
Crescentic Change in the Bowman’s Space
What histopathological findings would you expect to find in Acute Interstitial nephritis?
Eosinophils in the interstitium
What histopathological findings would you expect to find in Acute Tubular necrosis?
Mitotic Figures in the tubular epithelial Nuclei
What histopathological findings would you expect to find in Obstructive Uropathy?
Tubular Dilation
What test would you choose for A 24-yr-old construction worker has sustained a construction accident. His thighs have been trapped under a pile of rubble for several hours. He arrived to the A& E with AKI & swollen right thigh
Plasma Creatitine Phosphokinase
What test would you choose for A 39-yr-old woman with advanced ovarian carcinoma with bulky pelvic and retroperitoneal disease is admitted with high serum creatinine. Urinary catheter produced 75 mls in 6 hours. Urinalysis showed macroscopic haematuria
Renal Ultrasound Scan
What test would you choose for A 63 yrs male, with normal serum creatinine, started on lisinopril 20 mg/day for treatment of hypertension. 4 weeks later, routine tests showed serum creatinine 330, K 5.8
MRA of the Renal Arteries
What test would you choose for A 41 yrs male treated with amoxicillin for chest infection, two weeks later developed poor appetite & weight loss. Blood tests showed a serum creatinine of 250umol/l
Mesangial leucocytes & eosinophil infiltration on renal biopsy
What is the aetiology of acute kidney injury in A 71 yrs male with a permanent ileostomy following pan colectomy (1999) for UC is being investigated for a recent onset weight loss. Following an oral barium study, he reported increased stoma output (>3 litres/ day), a previously normal s. creatinine was found to be 220 umol/l.
Pre-renal Failure
What is the aetiology of acute kidney injury in A 76 yrs old female developed AKI post elective hip replacement. Preoperatively she was treated with normal saline (1 litre/12hrs), and a single dose of genatmicin 240mg.
Acute Tubular Necrosis
What is the aetiology of acute kidney injury in A 55 yrs female has completed a course of pelvic readiotherapy for the treatment of advance cervical cancer. Two weeks later, she developed oliguria, urine test showed hematuria, S creatinine 350umol/l.
Obstructive Uropathy
What is the aetiology of acute kidney injury in A 28year old male develops AKI with haematuria two weeks after a sore throat
Glomerulonephritis
What is the most likely cause of hypertension if there are Normal sized kidneys on renal US
Essential hypertension
What is the most likely cause of hypertension if there are Asymetrical kidneys with acute rise in serum creatinine after introduction of ACEI
Bilateral renal artery stenosis
What is the most likely cause of hypertension if there are Asymetrical kidneys with minimal/no change in serum creatinine after introduction of ACEI
Unilateral renal artery stenosis
What is the most likely cause of hypertension if there are Normal sized kidneys on USS, micro-aneurysms on fundoscopy
Diabetic nephropathy
What is the most useful marker in differentiating renal from pre-renal failure?
Urinary Na
What cardiac procedure could cause AKI in patients with renal disease?
Coronary Angiogram
What type of renal injury will result from Laxative Abuse?
Volume Depletion (pre-renal)
What type of renal injury will ACE inhibitors result in?
Dilation of efferent arteriole
What type of renal injury can NSAIDs result in?
Reduction of vasodilatory prostaglandins
What type of renal injury will Radiocontrast agents give?
Afferent arteriolar vasoconstriction/renal ischaemia
What drug can cause acute rhabdomyolysis?
Statins
The dose of which painkiller needs to be reduced in patients with chronic kidney disease?
Gabapentin
Which drug can cause post renal failure by inducing retroperitoneal fibrosis?
Bromocryptin (used in treatment of Parkinson’s, Diabetes, pituitary tumours)
Which drug can cause urteric calcium stone formation?
Large doses of Vitamin D
What is the diagnosis?
Unilateral Renal Hydronephrosis
What is the Diagnosis?
? Bilateral Polycystic Kidneys
What is the Diagnosis?
Unilateral Renal Cell Carcinoma
What is the Diagnosis?
Unilateral Renal Stone
What is the Diagnosis?
Soft Tissue Shadow in the renal pelvis with hydronephrosis
What is the Diagnosis?
Normal Kidney Apperance
Describe what frothy (foamy) urine could suggest?
Nephrotic Syndrome
What could Cloudy Urine Suggest?
Acute Pyelonephritis
What does dark urine with red cell casts suggest?
Acute glomerulonephritis
What does Dark urine with no RBCs/RBC casts suggest?
Rhabdomyolysis
What does Macroscopic Haematuria with no RBC casts suggest?
Transitional Cell Carcinoma of Bladder
What are the clinical limitations of Plasma Urea Investigation?
Dispropotionately LOW in pts with liver disease
Disporoportionately HIGH in pts with dehydration
What are the clinical limitations of Serum Creatinine Investigation?
Undergoes tubular secretion
Increased in those with high muscle mass
Used as a variable MDRD eGFR equation
What are the clinical limitations of a Intravenous Urogram?
Useful in investigating renal stone disease (? not a limitation though)
What are the clinical limitations of Urinary Sodium Investigation?
Invalid in patients on diuretics
