Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RACP Written 2018 > Written Prep - Renal > Flashcards

Written Prep - Renal Flashcards

1
Q

Dialysis

What are the causes of ESRF

A
  • Diabetic nephropathy (85%)
  • Glomerulonephritis (20%)
    (IgA nephropathy is MOST COMMON GN)
  • Hypertension
  • PCKD
  • Reflux nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dialysis

- Indications for dialysis

A
  • Pericarditis (STRONGEST INDICATION due to risk of tamponade)
  • Uraemic SYMPTOMS
    (IDEAL Study 2010: NO BENEFIT to early vs late if asymptomatic)
  • Refractory hyperkalaemia
  • Refractory fluid overload
  • Bleeding diathesis
  • Refractory metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dialysis

- Markers of Effective Dialysis

A

Urea Reduction Ratio is the PRIMARY marker of adequacy
(Aim for URR >70%)

Other Markers:
- beta2 microglobulin
(Marker of ‘middle molecule’ clearance)
(Removal enhanced with LONGER and HAEMO filtration)

  • Phosphate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dialysis

- HIGHER FREQUENCY of haemodialysis is associated with: (4)

A
  • Improved hypertension control
  • Hyperphosphataemia
  • Reduced LV mass
  • Improved self-reported health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dialysis:

- Complications of HDx (4)

A

1) Hypotension
2) High output HF (**may need AV ligation)
3) Muscle cramps during dialysis
4) Anaphylactoid reaction to dialyser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dialysis:

- Risk Factors for HYPOTENSION during HDx (3)

A

1) Excessive ultrafiltration with inadequate compensating vascular filling or impaired vasoactive or autonomic response
2) Overzealous antihypertensives
3) Reduced cardiac reserve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dialysis:

What drives solute/fluid removal?

A

PD: hypertonicity
HDx: concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dialysis:

Complications of peritoneal dialysis (4)

A

1) PD peritonitis
2) Non-peritonitis catheter associated infections (“tunnel infection”)
3) Hypoproteinaemia
4) Hyperglycaemia and Weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dialysis:

PD Peritonitis - diagnosis and micro

A

= peritoneal leukocytes with >50% neutrophils

50% gram positive
15% gram negative
20% culture negative 
4% polymocrobial
2% fungal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dialysis:

PD Peritonitis Treatment

A

If polymicrobial or fungal: URGENT TENKHOFF REMOVAL OR LAPAROTOMY

Intraperitoneal ABx to cover gram pos and neg
- 1st and 4th gen cephs +/- vanc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dialysis:

What does recurrent PD Peritonitis lead to?

A

Sclerosing peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CKD:

Pathophysiology

A

1st: Hyperfiltration and Hypertrophy

–> increased pressure and flow

THEN:

  • glom architecture distortion
  • Abnormal podocyte function
  • Disruption of filtration barrier

EVENTUALLY:
Sclerosis and loss of nephron mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CKD:

Over time kidneys become shrunk EXCEPT IN:

A

Norma size:

  • Diabetes in EARLY STAGE
  • Amyloidosis
  • HIV

Bigger size:
PCKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk Factors for CKD:
Childhood (2)
Genetic (4)
Personal (6)

A

CHILDHOOD:

  • small for gestational birth weight
  • childhood obesity

GENETIC:

  • African
  • FHx of CKD
  • APOL1 gene for NONDIABETIC CKD

PERSONAL:

  • Hx AKI
  • Hypertension
  • Diabetes
  • Autoimmune disease
  • Advanced age
  • Abnormal genitourinary anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CKD:

Is Hypertension or Sugar control more important as a risk factor?

A

Hypertension

Bakris 2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CKD:

What is the normal GFR decline?

A

GFR peaks at 120mL/min in 3rd decade

Declines at 1mL/year

At age 70 = 70mL/min

17
Q

CKD:

Value of MDRD and CKD-EPI calculations for GFR

A
  • validated in CKD ONLY
  • validated in Caucasians ONLY
  • NOT validated in pregnancy or BMI extremes

At GFR >60mL it UNDERESTIMATES

18
Q

CKD:

Variables included in MDRD

A

Serum Cr
Age
Ethnicity
Gender

Sometimes included:
Urea
Albumin

19
Q

CKD:

Use of eGFR for prognosis:

A

CANUSA Study: for every 250mL decrease in urine output –> 36% mortality

NECOSAD Study: for every 0.5mL/min decrease in GFR –> 12% mortality

20
Q

What is the most common complication of ESSENTIAL Hypertension?

A

Reduced nephron mass

21
Q

CKD:

Mech for Metabolic Acidosis

A

CKD can usually still acidity urine BUT with LESS AMMONIA PRODUCTION
(So cannot excrete the same amount of H+)

Also, hyperkalaemia reduces ammonia production

22
Q

CKD:

Role of Oral Bicarbonate for Metabolic Acidosis

A
  • corrects acidosis
  • recommended if bicarb <20
  • SOME evidence it slows CKD progression

RACP Written 2018 (167 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions