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Finals > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is Dialysis disequilibrium syndrome?

A

A rare complication and usually affects those who have recently started renal replacement therapy. It is caused by cerebral oedema, but the exact mechanism is unclear. Therefore this is a diagnosis of exclusion.

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2
Q

Causes of normal anion gap metabolic acidosis

A
  • GI bicarb loss (diarrhoea, fistula)
  • renal tubular acidosis
  • drugs (acetazolamide)
  • Addison’s
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3
Q

Causes of a raised anion gap metabolic acidosis

A
  • lactate (shock, hypoxia)
  • ketones (DKA, alcohol)
  • urate (renal failure)
  • acid poisoning (salicylates)
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4
Q

Causes of metabolic alkalosis

A

(loss of H+ or gain of bicarb)

  • vomiting/aspiration
  • diuretics
  • hypokal
  • 1’ hyperaldosteronism
  • Cushing’s
  • Bartter’s
  • congenital adrenal hyperplasia
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5
Q

Causes of resp acidosis

A

COPD
Decompensation in other resp conditions (life-threatening asthma/pul oedema)
Sedative drugs (BZDs, opiate OD)

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6
Q

Causes of resp alkalosis

A 
Anxiety (hypervent)
PE
Salicylate poisoning
CNS disorders - stroke, SAH, encephalitis
Altitude
Pregnancy
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7
Q

Visible haematuria occurring after URTI

A

IgA nephropathy

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8
Q

Causes of bilaterally enlarged kidneys

A

Adult PKD
Bilateral hydronephrosis
Amyloidosis

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9
Q

Causes of unilateral enlargement of kidneys

A

Hydronephrosis
Renal cancer
Renal cyst

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10
Q

Indications for dialysis in chronic renal failure

A

Progressive decline in renal function (CKD stage 5, or GFR<15)
Symptomatic uraemia despite conservative Rx
Renal bone disease
Pericarditis
Volume O/L despite fluid restriction and diuretics
Hyperkalaemia despite Rx

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11
Q

Complications of haemodialysis

A 
Hypotension
Hypovolaemia
Hypokalaemia
Disequilibration syndrome
Amyloidosis
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12
Q

Prognosis for Henloch-schonlein purpura

A

Full renal recovery

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13
Q

Conditions associated with adult PKD

A

Liver cysts
Berry aneurysms
Pancreatic cysts

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14
Q

ACEi in CKD

A

Should generally be continued/initiated as they’re renoprotective.
Acceptable changes:
- eGFR dec of <25%
- rise in creatinine <30%

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15
Q

After an US confirms renal stone, what is the next step with respect to imaging?

A

Non-contrast CT

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16
Q

Repeated UTIs, bubbly urine

A

Enterovesical fistula

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17
Q

Why is nephrotic syndrome a pro-thrombotic state?

A

Loss of antithrombin III

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18
Q

Which medications can aid passage of renal stones?

A

Alpha blocker

CCB

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19
Q

Frank haematuria and polycythaemia

A

Adenocarcinoma of the kidney

20
Q

Most likely GN associated with streptococcal infection in children

A

Diffuse proliferative GN

21
Q

Pt takes ramipril, amlodipine and indapamide. BP is 158/95 and K is 4. What do you do?

A

Since K <4.5, add spironolactone

If K >4.5, add a higher-dose thiazide-like diuretic

22
Q

Variables involves in eGFR calculation

A

Creatinine
Age
Gender
Ethnicity

23
Q

Causes of AKI

A

Pre-renal: low BP (sepsis, heart failure, cirrhosis), RAS, NSAIDs/ACEi

Intrinsic: pre-renal leading to ischaemia, nephrotoxins, cancer (tumour lysis), GN (nephrotic/nephritic)

Post-renal: obstruction (malignancy, BPH, strictures, stones, clots)

24
Q

Causes of CKD

A

Renal - ADPKD, GN, chronic pyelonephritis
Systemic - DM, HTN
Idiopathic
Rare - AKI leading to CKD, chronic interstitial nephritis

25
Q

Outline the classification of CKD based on eGFR

A

Stage 1: >90 (with other signs of kidney disease)
Stage 2: 60-90 (with other signs of kidney disease)
Stage 3a: 45-59
Stage 3b: 30-44
Stage 4: 15-29
Stage 5/ESRD: <15

26
Q

Complications of AKI and their management

A

Hyperkalaemia - IV calc gluconate, dex/ins, dialysis
Pulmonary oedema - O2, furosemide
Uraemia - RRT

27
Q

Management of AKI

A

General - monitor, fluid status
Treat cause
If severe, RRT

28
Q

Complications of CKD

A

HTN - target BP <140, give ACEi
2’ hyperparathyroidism
CVD risk

29
Q

How does CKD lead to 2’ hyperparathyroidism?

A

Loss of 2nd hydroxylation of vit D -> hypocalcaemia -> hyperPTH

30
Q

Management of lower UTI in women

A

Nitrofurantoin/Trimethoprim for 3d (5-10d if complicated)

31
Q

Risk factors for lower UTI

A

Demographics: Inc age
GUM/OBGYN: Sexually active, use of spermicide, pregnancy, atrophic vaginitis
Reduced voiding e.g. catheter, neuropathic bladder
PMH: DM, immunocompromised, prev. UT surgery

32
Q

Prevention of UTIs

A

Reduce risk factors
If recurrent - 6m low dose Trimeth/Nitro

No evidence for cranberry juice, inc fluids, hygiene

33
Q

Management of pyelonephritis

A 
MSU MC+S
Ciprofloxacin 7d (or co-amox for 14d)
34
Q

Signs and symptoms of ADPKD

A

Renal - abdo pain, haematuria, renal stones, HTN, recurrent UTI
Extra-renal - liver cysts, berry aneurysm (SAH), MVP

35
Q

Diagnosis of ADPKD

A

Abdo USS

36
Q

Treatment of ADPKD

A

Supportive - BP <130, infections, stones etc
SAH screening - MR angiography
If ESRF, RRT

37
Q

Causes of nephrotic syndrome

A

1’:

  • MCGN (commonest in kids)
  • FSGS (commonest in adults)
  • Membranous GN

2’:

  • DM (commonest overall)
  • Amyloidosis
  • AI (SLE)
38
Q

Causes of nephritic syndrome

A 
1' - IgA Nephropathy
2':
- post-strep
- vasculitis
- SLE
- Goodpasture's
- Alport's
39
Q

Which drugs would you hold if a pt had a low GFR?

A

Heparin
Opiates
Lithium
Digoxin

40
Q

Give some examples of nephrotoxic drugs

A 
MANAC
Metformin
Abx (esp aminoglycosides, tetracycline)
NSAIDs
Anti-HTNs (ACEi, ARB, diuretics)
Contrast dye
41
Q

Outline the method of haemodialysis, and its potential problems

A

Blood taken from AV fistula and surrounded by dialysate solution within a PPM, then pumped back through fistula (heparin is cont given)

Problems:

  • physical = infections, allergy, hypotension, disequilibrium syndrome
  • psychosocial = depression common
42
Q

When would you recommend PD over HD?

A

<2yo
Better renal function
Fewer co-morbidities

43
Q

Outline the method and potential complications of PD

A

Dialysate solution is infused into peritoneal cavity, interacts with blood in peritoneal capillaries, and is then removed.

Complications - peritonitis (staph), sclerosing peritonitis

44
Q

C/I for receiving a kidney transplant

A

Major - prev Ca, HIV/AIDs, irreversible severe liver/heart/lung disease
Minor - obese, smoker

45
Q

Outline the immunosuppression that may be commenced before and after a renal transplant

A

Pre-op: Anti IL-2 Monoclonal antibodies

Post-op: Ciclosporin/Tacrolimus + Monoclonal ABs/MMF

46
Q

Outline the four types of graft rejection seen in renal transplant

A

Hyper acute (mins) - ABO mismatch
Accelerated (few ds) - T-cell mediated (fever, fall in GFR)
Acute (<6m) - HLA mismatch
Chronic - interstitial fibrosis, gradual drop in GFR

47
Q

Potential complications of RRT

A

Graft rejection
Infection
Cancer
CVD

Finals (25 decks)

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