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yr 4 - passmed corrections > Renal > Flashcards

Renal Flashcards

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1
Q

What 2 factors can you look at to diagnose AKI?

A

1) Urine output

2) Creatinine

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2
Q

How many AKI grades are there?

A

3

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3
Q

Give the creatinine criteria for each AKI grade

A

1) Rise of >26 umol/L or 1-1.9x baseline

2) Rise of 2.0-2.9x baseline creatine

3)
- > 3.0x baseline creatine or
- > 353.6 umol/L or
-initiation of renal replacement therapy or
- decrease of eGFR to < 35 mL/min

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4
Q

Give the urine output criteria for each AKI grade

A

1) <0.5 ml/kg/hr for 6 hours

2) <0.5 ml/kg/hr for 12 hours

3) <0.3 ml/kg/hr for >24h or anuria for 12h

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5
Q

What should you ALWAYS ask for when interpreting investigations?

A

Previous investigations to compare

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6
Q

What is the earliest clinical marker of a developing AKI?

A

Urine output

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7
Q

Why is creatinine a good marker of renal function?

A

As it is almost 100% filtered by kidney

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8
Q

What renal function changes are acceptable after starting an ACEi?

A

A rise in the creatinine and potassium may be expected after starting ACE inhibitors.

Acceptable changes are an increase in serum creatinine, up to 30%* from baseline and an increase in potassium up to 5.5 mmol/l*.

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9
Q

What rise in serum creatinine is acceptable after starting ACEi?

A

Up to 30% from baseline

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10
Q

What rise in serum potassium is acceptable after starting ACEi?

A

Up to 5.5 mmol/l

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11
Q

What is the most common group of causes of AKI?

A

Pre-renal e.g. 2ary to dehydration or sepsis

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12
Q

ECG signs of hyperkalaemia?

A

1) tall, tented T waves

2) flattened P waves

3) broad bizarre QRS

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13
Q

Emergency management of hyperkalaemia?

A

1) IV calcium gluconate 10%

2) Salbutamol 5mg nebulised

3) Insulin dextrose infusion

4) Dialysis/haemofiltration if not responding

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14
Q

How long should Abx be prescribed for in women >65?

A

3 days (also send a urine culture)

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15
Q

Next steps in suspected UTI if associated with visible or non-visible haematuria?

A

Send an MSU for all women with a suspected UTI if associated with visible or non-visible haematuria

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16
Q

Why are patients with nephrotic syndrome at an increased risk of VTE?

A

Due to loss of antithrombin III

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17
Q

What testicular volume indicates onset of puberty?

A

> 4ml

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18
Q

What is the treatment for acromegaly?

A

Ocreotide

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19
Q

How can the SAAG gradient be calculated?

A

Serum albumin - ascitic albumin = SAAG gradient

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20
Q

What does a high SAAG indicate (i.e. >11 g/L)?

A

Low levels of protein in ascitic fluid e.g. portal HTN, RHF

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21
Q

What cause of nephrotic syndrome is frequently associated with malignancy?

A

Membranous nephropathy

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22
Q

What is SAAG used to determine?

A

Whether ascites has been caused by portal HTN or not.

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23
Q

What is Budd Chiari syndrome?

A

Hepatic vein thrombosis

Can lead to portal HTN

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24
Q

How can rhabdomyolysis cause AKI?

A

Due to acute tubular necrosis –> myoglobin is nephrotoxic.

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25
Q

What condition typically presents with haemoptysis + AKI/proteinuria/haematuria?

A

Anti-GBM disease (Goodpasture’s)

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26
Q

What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?

A

Full recovery but with later recurrent episode

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27
Q

What condition should you consider in a young female patients who develop AKI after the initiation of an ACE inhibitor?

A

Fibromuscular dysplasia

28
Q

What can be seen in urine in AIN?

A

White cell casts & eosinophils

29
Q

Why is nephrotic syndrome associated with a hypercoaguable state?

A

Due to loss of antithrombin III in the kidneys

30
Q

How can hypothyroidism affect sodium?

A

Severe hypothyroidism can result in SIADH.

This dilutes blood conc of Na+ (euvolaemic hyponatraemia).

31
Q

What is the most common cause of AKI?

A

Acute tubular necrosis (intrarenal AKI)

32
Q

Give some causes of ATN

A

1) Ischaemia (e.g. from pre-renal cause)

2) Nephrotoxins:
- aminoglycosides
- myoglobin (from rhabdo)
- uric acid (tumour lysis syndrome)
- IV contrast
- ethylene glycol

33
Q

How do penicillins vs aminoglycosides cause AKI?

A

Penicillin - AIN

Aminoglycosides - ATN

34
Q

What is typically seen in urine in ATN?

A

Muddy brown casts

35
Q

What are the 3 key causes of intrarenal AKI?

A

1) ATN
2) AIN
3) Glomerulonephritis

36
Q

What are some causes of AIN?

A

Drugs - penicillins, NSAIDs, diuretics

37
Q

Features of AIN?

A
  • AKI features
  • eosinophilia
  • fever
  • rash

creates an allergic picture

38
Q

How can ACEi affect creatinine?

What rise is acceptable?

A

Can cause rise in creatinine.

Rise of up to 30% from baseline is acceptable.

39
Q

How can uraemia affect the heart?

A

Can cause pericarditis

40
Q

Urine osmolality in pre-renal azotemia vs ATN?

A

Pre-renal –> high urine osmolality (i.e. very concentrated as the kidneys hold on to sodium and water)

ATN - low urine osmolality (i.e. less concentrated as the kidneys lose sodium and water)

41
Q

Urine sodium in pre-renal azotemia vs ATN?

A

Pre-renal –> low

ATN –> high

42
Q

2 drugs used for proteinuria in CKD?

A

1) ACEi

2) SGLT-2 inhibitors

43
Q

What is the SGLT-2 inhibitor licensed for CKD?

A

Dapagliflozin

44
Q

4 key complications of AKI?

A

1) Hyperkalaemia

2) Uraemia - pericarditis & encephalopathy

3) Metabolic acidosis

4) Fluid overload - pulmonary oedema & HF

45
Q

Via what 2 ways can damage to kidney cells occur in ATN?

A

1) Ischaemia due to hypoperfusion

2) Nephrotoxins

46
Q

How is iron replaced in anaemic patients on haemodialysis?

A

IV iron (instead of oral iron)

47
Q

What is the main class of Abx that should be stopped in AKI?

A

Aminoglycosides

48
Q

What is the threshold for stopping metformin in AKI?

A

eGFR <45

49
Q

Serum urea:creatinine ratio in pre-renal AKI vs ATN?

A

Pre-renal - raised

ATN - normal

50
Q

What murmur can anaemia cause?

A

Aortic flow murmur (ejection systolic)

51
Q

what is taken into account in eGFR calculation?

A

CAGE

Creatinine
Age
Gender
Ethnicity

52
Q

What are the drugs that can cause ED?

A
  • antihypertensives
  • beta blockers
  • diuretics
  • antidepressants
  • antipsychotics
  • alcohol
  • recreational drugs
53
Q

What are 3 key contraindications for PDE-5 inhibitors (sildenafil)?

A

1) Concurrent nitrate use (risk of severe hypotension)

2) Hypotension

3) Recent stroke/MI - wait 6 months

54
Q

What test should all patients with ED have?

A

Serum testosterone

55
Q

What is the most common organic cause of ED?

A

Vascular causes e.g. CVD, diabetes, HTN, smoking

56
Q

What is 1st line for renal colic pain?

A

IM diclofenac

57
Q

What can be given instead of IM diclofenac in renal colic if NSAIDs are contraindicated or not giving sufficiency pain relief?

A

IV paracetamol

58
Q

Cause of periureteric fat stranding vs perinephric fat stranding?

A

Periureteric = passed stones

Perinephric = pyelonephritis

59
Q

What is preferred for the removal of renal stones in pregnancy women?

A

Ureteroscopy

60
Q

What 2 types of renal stones are radiolucent?

A

Urate & xanthine stones

61
Q

Mx of renal stones depends on size.

a) <5mm

b) 5-10mm

c) 10-20mm

d) >20mm

A

a) watchful waiting (if asymptomatic)

b) shockwave lithotripsy

c) shockwave lithotripsy OR ureteroscopy

d) percutaneous nephrolithotomy

62
Q

Mx of ureteric stones?

A

<10 mm –> shockwave lithotripsy +/- alpha blockers

10-20mm –> ureteroscopy

63
Q

1st line imaging in renal stones?

A

Non-contrast CT KUB

64
Q

Infection with which organism is most likely in struvite renal stones?

A

Proteus mirabilis

65
Q
A

yr 4 - passmed corrections (36 decks)

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