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FLASH FINALS > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Causes of RAISED anion gap metabolic acidosis:

A 
'LUKA'
Lactate: Shock, hypoxia 
Ketones: DKA, alcohol 
Urate: Renal failure
Acid poisoning: salicylates, methanol
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2
Q

Metabolic acidosis with NORMAL anion gap:

A 
'BRAAD"
Bicarbonate loss (diarrhoea, fistula) 
Renal tubular acidosis
Ammonium chloride injection
Addison's disease
Drugs (acetazolamide)
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3
Q 
Vomiting/aspiration 
Diuretics
Hypokalaemia 
Primary hyperaldosteronism 
Cushing's syndrome 
Congenital adrenal hyperplasia

Cause which biochemical imbalance?:

A

Metabolic alkalosis

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4
Q

Acute interstitial nephritis:

Drug causes:

A

ANTIBIOTICS -> Penicillin, rifampicin, NSAIDs, Allopurinol, furosemide

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5
Q

Acute intersitital nephritis presentation

A

AKI w/ fever, rash, arthralgia with eosinophilia and mild renal impairment:

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6
Q

Feature of CKD less likely to be seen in AKI?

A

Hypocalcaemia

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7
Q

Bilateral small kidneys:

A

CKD

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8
Q

Oligruria output:

A

Less than 0.5 ml/kg/hour

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9
Q

AKI criteria:

A

Rise in SERUM CREATININE of 26mmol/l within 48 hours

50% or greater rise in serum creatinine in the last 7 days

Fall in urine output to <0.5 ml/kg/hour in 6 hours

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10
Q

What test should all pts. with suspected AKI have:

A

Urinalysis

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11
Q

Drugs to stop in AKI:

A

the DAAMN drugs

Diuretics
ACEis/ARBS
Aminoglycosides
Metformin (Maybe) - doesn’t contribute to toxicity itself but may worsen AKI
NSAIDS (except asprin at cardioprotective dose)

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12
Q

Hyperkalaemia tx:

A

Calcium cluconate (stabilise cardiac membrane)
Insuline/dextrose infusion
Nebulised salbutamol
Calcium resonium, loop diuretics, dialysis (to remove)

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13
Q

Indications for dialaysis in AKI/hyperkalaemia

A

Tx. not working resulting in

Pulmonary oedema, acidosis, uraemia or refractory hyperkalaemia

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14
Q

What do the kidneys attempt to do to preserve volume in PRE-renal AKI -

A

Keep sodium

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15
Q

KDIGO criteria for staging AKI

A

Stage 1: 1.5-2 times baseline increase in CREATININE
Urine output reduced to <0.5mL/kg/hour > 6 hours

Stage 2: 2 to 3 times CREATININE
Urine output reduced to <0.5mL/kg/hour > 12 hours

Stage 3: Greater than 3 times CREATININE or to 353.6 umol/L
Urine output reduced to <0.3mL/kg/hour > 24 hours

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16
Q

Mx. ADPKD

A

Select patients: Tolvaptan (vasopressin receptor 2 antagonist)

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17
Q

Hypertension with recurrent UTIs, haematuria

A

ADPKD

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18
Q

Cardiovascular features of ADPKD

A

Mitral valve prolapse
Mitral/tricuspid incompetence
Aortic root dilation

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19
Q

Alport’s inheritance:

Type of collagen affected:

A

X-linked dominant

Type IV

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20
Q

Bilateral sensorineural deafness plus microscopic haematuria and renal failure:

A

Alport’s disease

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21
Q

Diagnostic test for Alport’s

A

Renal biopsy and genetic testing

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22
Q

Congo red staining: apple-green birefringence

A

Amyloidosis

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23
Q

Anti-GBM disease mx:

A

Plasma exchange (plasmapharesis)
Steroids
cyclophosphamide

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24
Q

CKD anaemia classification

A

Usually a normocytic normochromic anaemia

due to reduced EPO levels

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25
Q

CKD: calcium and phosphate levels:

A

Low calcium high phosphate

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26
Q

CKD stages

A

1) GFR >90 w/ other abnormal kidney tests
2) GFR 60-90 w/ other abnormal kidney tests
3a) 45-60
3b) 30-45
4) 15-29 - severe functional impairment
5) <15

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27
Q

First line antihypertensive in pts. w/ CKD

What effect on eGFR/Cr is acceptable

A

ACEIs

eGFR reduction of 25% or rise in Cr of 30% deemed acceptable

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28
Q

First line antihypertensive in pts. w/ CKD

What effect on eGFR/Cr is acceptable

A

ACEIs

eGFR reduction of 25% or rise in Cr of 30% deemed acceptable

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29
Q

CKD: Mineral bone disease management

A

Aim is to to reduce phosphate and parathyroid hormones
1st line: REDUCE intake of dietary phosphate.
Phosphate binders
Vit D: alfacalcidol
May require parathyroidectomy

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30
Q

ACR of 30 mg/mmol is equivalent to:
PCR ->
Urinary protein excretion

A

50

0.5 g/day

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31
Q

ACR indicating clinically significant proteinuria?

A

3 mg/mmol

32
Q

ACR indicating clinically significant proteinuria?

A

> 3 mg/mmol

33
Q

Which psych drug can desensitize the kidneys ability to response to ADH resulting nephrogenic diabetes insipidus:

A

LITHIUM

34
Q

Management of nephrogenic diabetes insipidus:

A

Thiazides with low salt/protein diet

35
Q

Mx. Central (cranial) DI

A

Desmopressin

36
Q

What screening should diabetics receive for nephropathy

A

ACR - early mornign specimen

37
Q

What screening should diabetics receive for nephropathy

A

ACR - early morning specimen

38
Q

Side effects of EPO

A

Accelerated hypertension
bone aches
Flu-like symptoms
Pure red cell aplasia

39
Q

Which condition may initiation of ACEis actually result in a worsening renal function?

A

Fibromuscular dysplasia - due to renal artery stenosis

40
Q

Maintenance fluids:

A

25-30 ml/kg/day WATER
1 mmol/kg/day potassium, sodium and chloride
50-100g/day of glucose

41
Q

Hartmann’s should not be used in patients with which electrolyte disturbance:

A

Hyperkalaemia

42
Q

Nephrotic syndrome caused by:

HIV, Heroin, Alport’s, sickle-cell and can follow on from other renal pathologies

A

Focal segmental glomerulosclerosis

43
Q

Mx. FSGS

A

Steroids +/- immunosuppression

44
Q

Haematuria: what two other investigations should be done as standard:

A

Albumin:creatinine ratio (ACR) and blood pressure

45
Q

Haematuria: for urgent referral:

A

> 45 yrs w/ VISIBLE haematuria w/out UTI or haematuria that persists after UTI resolution

> 60 years w/ non-visible haematuria and either dysuria or raised WCC

46
Q

HSP rash:

Mx.

A

Extensor surfaces of arms and legs and over the buttocks

Supportive for arthralgia
supportive for nephropathy

47
Q

Hypokalamia features:

ECG features:

A

Muscle weakness, hypotonia.
Hypokalaemia -> digoxin toxicity

ECG - U waves, small or absent T waves, prolonged PR, ST depression

48
Q

Differentiating between IgA Nephropathy and Post-strep nephropathy:

A

1) PSGN = LOW complement
2) PSGN = mostly PROTEINURIA, IgA = Commonest cause of HAEMATURIA
3) longer interval between URTI and nephro symptoms in PSGN (7-14 days)

49
Q

IgA nephropathy tx. :

A

if isolated haematuria - supportive
If persistent proteinuria -> ACEi
If active disease and failure of ACEi -> STEROIDS

50
Q

Minimal change disease on renal biopsy electron microscopy:

A

Fusion of podocytes and effacement of foot processes

51
Q

Nephrotic syndrome triad:

A

Proteinuria (3g/24hr)
Hypoalbuminaemia (<30g/L)
Oedema

52
Q

Nephritic syndromes:

A

Rapidly progressive GN
Alport’s
IgA nephropathy

53
Q

Nephrotic syndromes:

A 
Minimal change disease 
Membranous GN 
FSGS 
Amyloidosis 
Diabetic nephropathy
54
Q

Nephrotoxicity due to contrast media tx.:

A

0.9% Nacl 1ml/kg/hour for 12 hours PRE and POST procedure

Metformin should be withheld if high risk. (Lactic acidosis)

55
Q

Peritoneal dialysis peritonitis m/c organism:

A

Staph EPIDERMIDIS

56
Q

Post-streptococcal GN renal biopsy features:

A

Subepithelial ‘humps’ caused by lumpy immune complexes

immunofluorescence shows : Granular/starry sky appearance

57
Q

Rapidly progressive GN what appears in glomeruli?

A

Epithelial CRESCENTS

58
Q

Causes of RPGN

A

Goodpasture’s syndrome
Wegener’s
SLE, MPA

59
Q

Most common cause of renal artery stenosis

A

Atherosclerosis (90%)

60
Q

Features RAS -

A

Flash pulmonary oedema
CKD
Hypertension.

61
Q

Renal papillary necrosis can result from:

A

severe acute pyelonephritis
diabetic nephropathy
obstructive nephropathy

62
Q 
Renal transplant: Hyperacute rejection
Time:
Type of hypersensitivity: 
Due to:
Salvageable:
A

Minutes to hours

Type 2

Pre-existing antibodies against ABO or HLA

No, must be removed

63
Q

Renal transplant: Acute graft failure

Time:
Findings:
Due to:
Salvageable?:

A

<6 months

asymptomatic picked up by rising Cr, pyuria and proteinuria

Mismatched HLA

May be reversible with steroids and immunosuppressants

64
Q

Renal transplant: Chronic graft failure

Time:
Due to:

A

> 6 months

both antibody and cell-mediated mechanisms cause fibrosis

65
Q

Renal transplant: immunosuppression - systemic monitoring:

A

CV disease - Tacrolimus and ciclosporin can cause hypertension and hyperglycaemia

Renal failure - due to nephrotoxic effects of tacrolimus

Malignancy - squamous cell carcinomas and BCC

66
Q

Rhabdomyolysis mx.

A

IV fluids to maintain good urine output

Urinary alkalinization

67
Q

What is sterile pyuria:

A

Increased WCC in urine without organism

68
Q

Causes of sterile pyuria:

A

Partially treated UTI
Urethritis - chlamydia
Renal TB, stones, cancer

69
Q

Urine - hyaline casts -

A

Seen in normal urine, after exercise, during fever or with loop diuretics

70
Q

ATN urine

A

Brown casts

71
Q

Red cell casts in urine:

A

Nephritic syndrome

72
Q

What is seen in urine in prerenal uraemia

A

Bland urinary sediment

73
Q

Membranous nephropathy treatment:

A

ACEi

Steroids
Consider anticoagulation, statin

74
Q

Renal stones on X-ray which are radiolucent:

A

Urate and Xanthine stones

75
Q

Renal stones on X-ray which are semi-opaque

A

Cysteine stones

FLASH FINALS (34 decks)

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