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JG Year 2 > 227 AKI > Flashcards

227 AKI Flashcards

1
Q

What is the effect of renal failure on the drug action of teicoplanin?

A

Has a prolonged half life in renal failure

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2
Q

What is the effect of renal failure on the drug action of teicoplanin?

A

Has a prolonged half life in renal failure

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3
Q

At which level of creatinine clearance is nitrofurantoin contra-indicated for treatment of UTIs?

A
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4
Q

Where does bendroflumethiazide act in the renal system?

A

At the beginning of the distal convoluted tubules - inhibits water and salt absorption

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5
Q

Name 2 types drugs which can cause pre-renal AKI

5 types listed

A 
NSAIDs
Loop diuretics e.g. furosemide and bumetanide
Laxatives e.g. bisacodyl/ senna
ACEI - ramipril/ lisinopril
ARBs - losartan/ candesartan
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6
Q

Name 2 drugs which can cause pre-renal AKI

A

NSAIDs
Loop diuretics e.g. furosemide and bumetanide
Laxatives e.g. bisacodyl/ senna

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7
Q

What do NSAIDs inhibit the production of in the kidney which are potent vasodilators?

A

Prostaglandin E2, I2 and D2 - maintain renal circulation

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8
Q

What do NSAIDs inhibit the production of in the kidney which are potent vasodilators?

A

Prostaglandin E2, I2 and D2 - maintain renal circulation

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9
Q

At which level of creatinine clearance is nitrofurantoin contra-indicated for treatment of UTIs?

A
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10
Q

Where does bendroflumethiazide act in the renal system?

A

At the beginning of the distal convoluted tubules - inhibits water and salt absorption

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11
Q

Below which GFR are thiazide diuretics unlikely to be of use?

A

GFR

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12
Q

Name 2 drugs which can cause pre-renal AKI

A

NSAIDs
Loop diuretics e.g. furosemide and bumetanide
Laxatives e.g. bisacodyl/ senna

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13
Q

Name a type of drug which can cause hypokalaemia

A

Loop diuretics e..g. furosemide, bumetanide

Thiazide diuretics e.g. bendroflumethazide

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14
Q

What do NSAIDs inhibit the production of in the kidney which are potent vasodilators?

A

Prostaglandin E2, I2 and D2 - maintain renal circulation

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15
Q

Which anti rejection meds are used in renal transplant? What is their effect?

A

Ciclosporin and tacrolimus - causes intense vasoconstriciton of the microvasculature of the kidney

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16
Q

Where in the kidney do ACEIs exert their effects?

A

Efferent arteriole

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17
Q

What is released from the adrenal cortex in response to increased potassium in the extracellular fluid of the cortex?

A

Aldosterone

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18
Q

Give 2 e.g’s of what can cause an increase in serum urea

3 listed

A

Corticosteroid treatment
Tetracycline treatment
GIT bleed

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19
Q

Name 3 types of drug which can cause hyperkalaemia

6 listed

A 
ACEI
ARBs
Spironolactone
Amiloride
NSAIDs
Potassium supplements
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20
Q

Name a type of drug which can cause hypokalaemia

A

Loop diuretics e..g. furosemide, bumetanide

Thiazide diuretics e.g. bendroflumethazide

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21
Q

How does metformin cause lactic acidosis?

A

Decreases gluconeogenesis - from lactate in the liver + promotes conversion of glucose to lactate which results in additional lactate in the blood.
Can happen in diabetic patients with renal impairment - metformin renally excreted - will accumulate.

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22
Q

Which anti rejection meds are used in renal transplant? What is their effect?

A

Ciclosporin and tacrolimus - causes intense vasoconstriciton of the microvasculature of the kidney

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23
Q

At what level of serum creatinine is severe AKI considered?

A

> 500umol/L

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24
Q

What is the RIFLE classification of AKI?

A

Risk - SCr x1.5 within 48 hours UO 3 months

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25
Q

Give 1 eg of what can cause a decrease in serum urea

3 listed

A

Decrease protein intake
Liver failure
Sodium valporate

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26
Q

What is the most common cause of intrinsic injury to kidneys?

A

Renal ischaemia causing acute tubular necrosis

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27
Q

Name 2 causes of increased serum creatinine

A

Increased muscle mass
Ingestion of red meat
Rhabdomyolysis
Decreased tubular secretion eg trimethoprim

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28
Q

What are the S&S of pre-renal injury - uraemia?

A

Hypotension
Weak and rapid pulse
Decreased JVP

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29
Q

Which markers on urinalysis differentiates between a pre-renal injury and an intrinsic injury?

A

SG
Osmolality
Sodium

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30
Q

Where is the injury (pre-renal/intrinsic) here:
SG >1.020
Osmolality >500
Na

A

Pre-renal

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31
Q

Where is the injury here (pre-renal/intrinsic) here:
SG 40
Ratio >1%

A

Intrinsic

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32
Q

What is the most common cause of intrinsic injury to kidneys?

A

Acute tubular necrosis

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33
Q

Which 2 types of drugs can cause rhabdomyolysis?

A

Statins

Calcineurin inhibs - ciclosporin

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34
Q

Name 2 types of drugs which can cause hyperkalaemia

A

ACEI
ARBs
Spironolactone

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35
Q

Which drug can cause increased serum creat?

A

Trimethoprim

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36
Q

Name 2 drugs which can cause irreversible renal damage

A

Gentamicin

Ibuprofen

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37
Q

Name a drug which can cause hypercalcaemia, increased Ca excretion in urine/renal stones

A

Calcium preps

Vit D

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38
Q

Which drugs can cause high serum uric acid/urate stones

A

Chemo

39
Q

Which 2 types of drugs can cause rhabdomyolysis?

A

Statins

Calcineurin inhibs - ciclosporin

40
Q

What investigation should be performed to identify the cause of renal disease in:
ARF, chest symptoms, +++haematuria, +++proteinuria

A

Kidney Bx

41
Q

What investigation should be performed to identify the cause of renal disease in:
ARF, fever, night sweats, dysutia, loin pain

A

MC&S looking for white cell casts

42
Q

What investigation should be performed to identify the cause of renal disease in:
Elderly patient developing ARF 4 days after elective knee replacement

A

Urinary Na

43
Q

What investigation should be performed to identify the cause of renal disease in:
Pt with poor stream, dribbling, hesitancy and nocturia + increasing serum urea and creatinine

A

Physical examination and bladder scan

44
Q

Which electrolyte abnormality is likely to be associated with:
ARF post marathon

A

Hyponatraemia

45
Q

Which electrolyte abnormality is likely to be associated with:
Recovery phase of ARF due to rhabdomyolysis

A

Hypocalcaemia

46
Q

Which electrolyte abnormality is likely to be associated with:
ARF after introduction of ACEI in a patient with CHF

A

Hypercalcaemia

47
Q

Which electrolyte abnormality is likely to be associated with:
Chronic use of thiazide diuretics

A

Hyperkalaemia

48
Q

Which electrolyte abnormality is likely to be associated with:
Chronic laxative abuse

A

Hypokalaemia

49
Q

Which pathological condition is associated with:

RBC casts

A

Glomerulonephritis

50
Q

Which biochemical abnormality is associated with:

Chemo for bulky sarcoma of R thigh

A

Hyperuricaemia

51
Q

Which pathological condition is associated with:

Fatty casts

A

Nephrotic syndrome

52
Q

Which pathological condition is associated with:

Pigmented casts

A

Rhabdomyolysis

53
Q

Which biochemical abnormality is associated with:

ARB use for HTN

A

High CK

54
Q

Which biochemical abnormality is associated with:

Ecstasy use

A

Hyponatraemia

55
Q

Which biochemical abnormality is associated with:

prostatic carcinoma

A

Metabolic acidosis

56
Q

Which biochemical abnormality is associated with:

Chemo for bulky sarcoma of R thigh

A

Hyperuricaemia

57
Q

Which drugs can cause:

AKI with hyperkalaemia

A

Spironolactone and ACEI

58
Q

What histopathological changes are seen in:

Obstructive uropathy

A

Tubular dilatation

59
Q

Which drugs can cause:

AKI with high CK

A

Statin and ciclosporin

60
Q

Which drugs can cause:

AKI with hyponatraemia

A

Loop diuretic and thiazide

61
Q

What histopathological changes are seen in:

Rapidly progressive glomerulonephritis

A

Crescenteric change in Bowman’s space

62
Q

What histopathological changes are seen in:

Acute interstitial nephritis

A

Eosinophils in the interstitium

63
Q

What histopathological changes are seen in:

Acute tubular necrosis

A

Mitotic figures in tubular epithelial nuclei

64
Q

What histopathological changes are seen in:

Obstructive uropathy

A

Tubular dilatation

65
Q

What test could establish the cause of:
24 yo construction worker in an accident - thighs have been trapped under rubble for hours - in A&E with swollen right thigh and AKI

A

Plasma creatinine phosphokinase

66
Q

Aetiology of AKI in:

28yo male develops AKI with haematuria after 2 weeks of sore throat

A

Glomerulonephritis

67
Q

What test could establish the cause of:
63 yo male with normal serum creat, started on lisinopril 20mg/day for HTN, routine test 4 weeks later = serum creat 330and K 5.8

A

MRA renal arteries

68
Q

What test could establish the cause of:
41yo male treated with amoxicillin for chest infection. 2 weeks later developed poor appetite and W/L - serum creat of 250umol/l

A

Renal Bx - mesangial leucocytes and eosinophil infiltration

69
Q

Aetiology of AKI in:
71yo male + permanent ileostomy following pan colecomy for UC, investigated for recent onset W/L. Barium swallow showed increased stoma output >3L/day and serum creat was normal, now 220umol/l

A

Pre-renal failure

70
Q

Aetiology of AKI in:

76 yo female with AKI post elective hip replacement, treated with normal saline pre op and gent

A

Acute tubular necrosis

71
Q

Aetiology of AKI in:

55yo female completed course of RTx for treatment of advanced cervical cancer

A

Obstructive uropathy

72
Q

Aetiology of AKI in:

28yo male develops AKI with haematuria after 2 weeks of sore throat

A

Glomerulonephritis

73
Q

What is the most likely cause of HTN in:

Normal sized kidneys on renal USS

A

Essential HTN

74
Q

What is the most likely cause of HTN in:

Asymmetrical kidneys with acute rise in serum creat after introduction of ACEI

A

Bilateral renal artery stenosis

75
Q

What is the most likely cause of HTN in:

Asymmetrical kidneys with minimal/no change in serum creat after introduction of ACEI

A

Unilateral renal artery stenosis

76
Q

What is the most likely cause of HTN in:

Normal sized kidneys on USS, micro aneurysms on fundoscopy

A

Diabetic neuropathy

77
Q

Which investigation:

Useful in differentiating renal from pre-renal failure

A

Urinary Na

78
Q

Which investigation?

May cause AKI in patients with renal disease

A

Coronary angiogram

79
Q

Which investigation:

Safe to perform in patients with renal impairment to investigate obstruction

A

Renal USS

80
Q

Which investigation:

Values may be falsely low in patients with decreased muscle mass

A

eGFR

81
Q

Cause of renal injury?

Laxative abuse

A

Vol depletion

82
Q

Which drug…?

May cause ureteric calcium stone formation

A

Large doses of vit D

83
Q

Cause of renal injury?

NSAIDs

A

Reduction of vasodilatory prostaglandins

84
Q

Cause of renal injury?

Radiocontrast agents

A

Afferent arteriolar vasoconstriction/ renal ischaemia

85
Q

Which drug…?

Can cause rhabdomyolysis

A

Statins

86
Q

Which drug…?

Dose reduction is needed in patients with chronic kidney disease

A

Gabapentin

87
Q

What are the clinical limitations of plasma urea?

A

Disproportionately high in patients with dehydration

Disproportionately low in patients with liver disease

88
Q

Which drug…?

May cause ureteric calcium stone formation

A

Large doses of vit D

89
Q

What is the clinical diagnosis if the urine is:

Frothy

A

Nephrotic syndrome

90
Q

What is the clinical diagnosis if the urine is:

Cloudy with red cell casts

A

Acute post streptococcal glomerulonephritis

91
Q

What is the clinical diagnosis if the urine is:

Dark with no red cells/red cell casts

A

Rhabdomyolysis

92
Q

What is the clinical diagnosis if the urine has:

Macroscopic haematuria with no red cell casts

A

Transitional cell carcinoma of the bladder

93
Q

What is the clinical limitations of serum creatinine?

A

Undergoes tubular secretion
Increased in those with high muscle mass
Used as a variable in MDRD eGFR equation

94
Q

What is the clinical limitation of urinary sodium?

A

Invalid in patients on diuretics

JG Year 2 (28 decks)

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