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MED4 CPY > Renal > Flashcards

Renal Flashcards

1
Q

3 equations for eGFR

A
  1. Cockcroft-Gault equation (tend to overestimate patients)
  2. MDRD equation (tend to underestimate normal subjects)
  3. CKD-EPI (recommended)
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1
Q

Reference interval of GFR

A

90~120 ml/min/1.73m^2

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2
Q

Cockcroft-Gault equation

A

(140 - age) ⨉ weight / (P_Cr ⨉ 72) , times 0.85 for female

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3
Q

Parameters in CKD-EPI

A

Cr, age, gender, race

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4
Q

Reference interval of creatinine

A

70~150 µmol/L

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5
Q

creatinine clearance equation

A

Clearance ⨉ P_Cr = U_Cr ⨉ V_U
(ml/min)

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6
Q

Limitation of creatinine

A

FP: drugs
FN: lower muscle mass

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7
Q

FP & FN of urea (4+4)

A

FP: high protein diet, catabolic state, GI bleed, dehydration
FN: low protein diet, fasting, liver disease, over-hydration

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8
Q

Urea:Creatinine ratio range indicating pre-renal failure

A

> 80:1

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9
Q

Oliguric definition

A

urine output <400 ml/day
OR <0.5 ml/kg/hr

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10
Q

Anuric definition

A

urine output <50 ml/day

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11
Q

Acute kidney injury definition in KDIGO definition

A

(any one of the following)
a. Urine output <0.5 ml/kg/h for 6h
b. Serum Cr ↑ 1.5x baseline in 7d
c. Serum Cr ↑ >26.5 µmol/L in 48h

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12
Q

Clinical staging of acute kidney injury

A

Stage 1: serum Cr ↑ 1.5~2x, oliguric for 6h
Stage 2: serum Cr ↑ 2~3x, oliguric for 12h
Stage 3: serum Cr ↑ >3x, anuric for 12h

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13
Q

Causes of pre-renal failure

A

↓ ECV: dehydration, GI bleed, third spacing…
↓ cardiac output: CHF, MI…
Shock
Renal vascular disease: RAS, MAHA
Drugs: NSAID, ACEI

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14
Q

Which region is most vulnerable in acute tubular necrosis?

A

proximal convoluted tubule

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15
Q

Causes of acute tubular necrosis

A

ischaemia / toxins

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16
Q

Nephrotoxins that cause acute tubular necrosis (8)

A

Iatrogenic: aminoglycosides, amphotericin B, cisplatin, contrast
Metabolic: haemoglobin, myoglobin, urate
heavy metal

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17
Q

Natural history of acute tubular necrosis

A

oliguric phase –> anuric phase –> recovery phase, each lasts for one week

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18
Q

How to differentiate pre-renal injury and acute tubular necrosis with urine electrolyte?

A

FENa: (<1%; >2%)
Urine Na: (<20; >40)
Urine:plasma Cr ratio: (>40; <20)
Urine osmolality: (>500; <350)
Plasma UCR: (>80;<80)

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19
Q

Equation for fraction of Na excretion

A

(U_Na/P_Na) ➗ (U_Cr/P_Cr) ⨉ 100%

20
Q

Definition of chronic kidney disease

A

progressive irreversible impairment of renal function >3m, as evidenced by
a. eGFR <60 ml/min/1.73m^2
b. albuminuria
i. albumin excretion rate >30 mg/day, or
ii. urine albumin: creatinine ratio >3 mg/mmol

21
Q

Aetiology of chronic kidney disease (4)

A
  1. DM nephropathy (30%)
  2. Hypertension (25%)
  3. Glomerulonephritis (15%)
  4. Polycystic kidney disease (5%)
    …
22
Q

What is secreted in adaptation in chronic kidney disease to ↑ phosphate secretion?

A

FGF23 (fibroblast growth factor 23)

23
Q

Pathogenesis for impaired concentrating ability in chronic kidney disease (3)

A
  1. ↓ medullary hypertonicity
  2. medullary fibrosis
  3. collecting duct resistance to ADH
24
Q

Renal osteodystrophy (3)

A

Osteomalacia
Osteitis fibrosa cystica
Osteosclerosis

25
Q

Renal replacement therapy indications

A
  • eGFR <5 ml/min; or <10ml/min with ESRF s/s
  • ## uraemic encephalopathy
  • declining nutritional status
  • persistent volume overload
  • refractory acidosis / hyperkalaemia / hyperphosphataemia
26
Q

Advantages of haemodialysis compared with peritoneal dialysis

A
  • more efficient in small molecules
  • much shorter period of dialysis
  • lower dextrose & osmolality required
27
Q

Proteinuria definition

A

> 0.15 g/day
(Nephrotic range: >3.5g/day)

28
Q

Microalbuminruia deinition

A

30~300mg /day or ACR 3~30mg/mmol

29
Q

Macroalbuminuria definition

A

> 300 mg/day

30
Q

Pathological proteinuria exclusion criteria (4)

A

UTI, fever, heavy exercise in 24h, menstruation

31
Q

Aetiology of proteinuria

A
  1. Orthostatic proteinuria
  2. Transient proteinuria
  3. Overflow proteinuria
  4. Glomerular proteinuria
  5. Tubular proteinuria
32
Q

Size of protein that are not filtered through glomerular ultrafiltration

A

> 40kDa

33
Q

MC isolated proteinuria in teenagers

A

Orthostatic proteinuria

34
Q

MC proteinuria cause

A

Glomerular proteinuria

35
Q

Limitations of urine dipstick for detecting proteinuria

A
  1. only detect >300mg protein
  2. only detect albumin
    (do two times)
36
Q

Compare severity of acidaemia of 3 types of RTA

A

type 1 > type 2 > type 4

37
Q

Which type of RTA gives hypercalciuria, nephrolithiasis, and osteomalacia? What is the pathogenesis?

A

type 1
Severe acidaemia —> buffering of H+ from bones

38
Q

Which type of RTA gives hypoK and hyperK?

A

hypoK: type 1, 2
hyperK: type 4

39
Q

Which type of RTA gives -ve UAG?

A

type 2

40
Q

Pathogenesis of type 1 RTA (relation to K)

A

impaired distal tubule to secrete H+

⨉ secrete H+ –> K+ is secreted in compensation

41
Q

Management of type 1 RTA

A

Oral NaHCO3

42
Q

Pathogenesis of type 2 RTA (relation to K)

A

↓ proximal HCO3- reabsorption

↑ HCO3 loss –> ↑ Na loss –> ↑ aldosterone & distal flow –> ↑ K secretion

43
Q

Which RTA is associated to Fanconi syndrome?

A

type 2

44
Q

Diagnosis of type 2 RTA

A

HCO3- loading test
FE of >15% HCO3

45
Q

Management of type 2 RTA

A

IV NaHCO3 + K supplements

46
Q

Pathogenesis of type 4 RTA

A

mieralocorticoid deficiency / resistance

47
Q

Which 2 ions have serum concentrations normal until GFR <50% of normal in CKD patient?

A

H, phosphate

48
Q

Effect of CKD on Ca metabolism

A

↓ phosphate excretion –> ↑ phosphate concentration –> hypocalcaemia –> secondary hyperPTH –> tertiary hyperPTH

↓ 1α-hydroxylation –> vitamin D resistance

MED4 CPY (14 decks)

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