CSIM renal medicine Flashcards Preview

4TH YEAR > CSIM renal medicine > Flashcards

Flashcards in CSIM renal medicine Deck (105):
1

what role do the kidneys have in metabolism?

excrete metabolites in urine
metabolise vit. D and some proteins

2

what is nephrotic syndrome and what are the clinical signs

loss of protein through the kidenys

protein urea >3.5g / day
oedem
hypoalbuminaemia
hyperlipidaemia

the 3.5 is arbitrary - it just needs to be enough to make you hypoalbuminaemic

3

what is nephritic syndrome?

inflammation of the kidneys leading to:

haematurea
protein urea
hypertension
oligourea

4

what will the creatinine be like in nephrotic syndrome?

normal

5

what will the urine look like in nephrotic syndrome?

frothy due to the protein

6

in suspected renal disease how should the BP be assessed?

lying and standing

7

causes of AKI

PRE: Secondary to sepsis, low BP, nephrotoxins etc
INTRINSIC: nephritis ( inflammation)
POST- obstruction

8

what are the symptoms of advanced kidney disease

Tiredness (anaemic)
swollen ankles, feet or hands (due to water retention)
shortness of breath
nausea
blood in the urine

9

symptoms of acute glomerular nephritis

AKI ->
Oedema, hypertension
Smoky or coca- cola coloured urine
Hypertension, reduced urine volumes
Systemic symptoms- rash, haemoptysis

could be asymptomatic

10

where does the creatinine in the urine come from?

mostly freely filtered through glomerular
some secreted in proximal tubules

11

what information is used to get eGFR?

creatinine
sex
ethnicity (black or other)
age

12

why dont we measure the actual GFR anymore?

requires 24hr urine collection

13

what kind of kidney injury does proteinurea indicate?

Marker of intrinsic renal disease

14

2 ways of quantifying proteinurea and whats the difference?

albumin : creatinine for small protein urea
protein : creatinine for large protein urea

15

what is a hyaline cast? and what is it dependent on

glycoprotein formed in the renal tubules

seen in small quantities in normal adults

dependent on urine flow and pH

16

what can light microscopy of a MSU tell you

red cell casts : diagnostic of glomerular disease
white cell casts : inflammation or infection
organisms and white cells during a urinary infection
tubular debris : in acute tubular necrosis

17

which scan will most kidney patients get?

USS

18

what does a chronically damaged kidney look like on USS?

shrunken
less well demarcated regions

19

what do the inflammatory cells in the kidney look like?

crescent moons

20

in monitoring urine output, when should you catheterise?

only if they cant collect urine themsleves

21

how small does a molecule have to be to filter through the glomerulus?

<30A

22

why kidney damage in trauma ?

large release of protein is neprotoxic

23

how many red cells is normal in the urine?

1-2 per micro litre

conveniently this is also the cut off for what dipstix can detect

24

causes of haematuria that aren't related to glomerular disease?

renal malignancy
renal stone disease
bladder tumours

25

which protein does the kidney produce and why?

Tamm-Horsfall

thought to protect against infection

26

what is normal protein in urine?

<150mg / day

this is NOT detectable on dipstix

27

what does the amount of protein urea tell you about where the pathology is?

>1 g / day = glomerular disease
<1 g / day = somewhere after the glomerular e.g. tubules, upper/ lower UTI, stones

28

benign causes of proteinurea

exercise
orthostatic

29

two non-renal conditions that cause protein urea?

fever
HF

30

effect of low albumin on lipoprotein level?

increases
liver is trying to make more proteins which includes cholesterol etc

31

effect of nephrotic syndrome on clotting?

pro-thrombotic due to loss of anti-thrombin protein

32

why at risk of infection in nephrotic syndrome?

loose immunoglobulins

33

why do you need to include creatinine when measuring urine protein?

to account for hydration status

34

5 things that effect serum creatinine?

production:
liver function
muscle mass
muscle metabolism


diet (if very malnurished)

RENAL DISEASE

35

the better you filter, the ____ your serum creatinine will be

LOWER

36

two people with the same serum creatinine, one with large muscle mass the other with small muscle mass. which has the lower GFR?

small muscle mass

the large guy/girl has more creatinine due to large amount of muscle

37

3 main causes of nephrotic syndrome?

glomerulonephritis
DM
amyloidosis

38

3 main primary disease of nephrotic syndrome

minimal change
membranous
focal segmental glomerulosclerosis

39

what kind of glomerulonephritis is associated with malignancy?

membranous

40

how to manage persistent low levels of proteinurea?

if all else normal monitor but no need to intervene

41

how can AKI be distinguished from CKD?

previous bloods
repeate creatinine 6 hrs later
USS
Hx

42

how is post-renal AKI diagnosed?

USS: gross dilation downstream of kidneys due to obstruction

43

main causes of post renal AKI?

stones

older patients:
prostate
cancer

44

define azotaemia

appropriate response to reduced renal perfusion:

increased nitrogen

45

causes of pre renal azotaemia?

decreased cardiac output
decreased effective circulating volume:
hypovolaemia (reduced fluid intake etc)
volume redistribution
bleeding
renal vascular disease
drugs

46

definition of AKI we were told to use?

increase in serum creatinine of >0.3mg/dl in 48hrs

47

which drugs can cause pre renal azotaemia?

NSAIDS
ACE i
cyclosporin (immunosuppressant)

48

two types of tubulo-interstital disease?

acute tubular necrosis
acute allergic interstitial necrosis

49

what two things can cause ATN?

toxins e.g. aminoglycosides, radio contrast
ischaemia due to hypo perfusion

50

which drugs commonly cause an acute allergic interstitial necrosis?

NSAIDS
bendrofluazide
frusomide
PPIs
penicillin

51

what Ix distinguishes between glomerular disease and tubulo-intertial disease?

urinalysis

52

what are the features of rapidly progressive GN?

haematuria
proteinurea
oedema
hypertension

53

examples of RPGN

goodpastures syndrome
lupus
post infective
Wegeners
microscopic polyangitis

54

all causes of haematurea

Urinary tract infection
Catheter trauma
Infarction
Stone
Tumour
Glomerulonephritis

55

finding of blood and protein in urine should prompt what?

microscopy and culture

56

how does urine microscopy differentiate between Glomerular versus Tubulo-interstitial causes of AKI?

GN: red cell casts and inflammatory cresents

57

what are the three types of RPGN?

type I - Anti-glomerular basement membrane antibody disease (Goodpastures syndrome)

type II - immune complex
lupus nephritis
post-infectious

type III - pauci immune (pauci as in latin for few)
Wegener’s granulomatosis
Microscopic polyangiitis

58

what is the triad for Goodpastures syndrome?

anti- GBM antibodies
pulmonary haemorrhage
RPGN

59

what organism is responsible for post infectious RPGN?

group A, ß-haemolytic streptococcus

60

what does a low compliment tell you about the cause of RPGN?

likely to be post infectious

61

diagnosis of lupus nephritis?

ANA
renal biopsy
immunoflourescence shows ‘full house’ immune deposits

62

what type of RPGN is SLE?

type II - immune complex

63

what type of RPGN will give systemic symptoms of night sweats, weight loss, fever, lethargy?

type III - pauci immune

64

pANCA is associated with what type of RPGN?

type III - pauci immune - microscopic polyangitis

65

what is Wegeners granulomatosis and what auto-antibody is associated with it?

RPGN
cANCA

66

what auto-antibody is associated with microscopic polyangitis?

pANCA

67

when would you NOT renal biopsy RPGN?

in type II - immune complex if there is sufficient clinical evidence that it is post-infectious (culture, reduced compliment and clinical picture)

68

what % of hypertension is secondary?

10%

69

causes of secondary ht?

CRAP
C onns
C ushings
C oarctation of the aorta
R enal
A cromegaly
P haechromocytoma
P arathyroidism (HYPER)
P ills

70

renal causes of hypertension?

GN
renal artery stenosis
autosomal dom. polycystic KD
pyelonephritis

71

what is the problem is Conns?

too much aldosterone (produced in the adrenals)

72

what is the problem in Cushings?

too much cortisol

73

what is the problem in phaeochromocytoma?

too much catecholamines

74

below what age do you start thinking ht is secondary?

40

75

what is first line imaging if suspecting Conns?

CT adrenals

76

what is the Ix for phaeochromocytoma?

serum catecholamines and serum metanephrines

77

where is renin made?

kidney- juxtaglomerular apparatus

78

what does an ACE i do to the kidneys?

stops all the things angiotensin II would do therefore:
vasodilation
reduced aldosterone production (reduced Na retention)

79

what clinical signs make you think ht is due to coarc1tation of the aorta?

scapular vessels
absent pulses
machinery mummer
radio-radial delay

80

food that can raise BP? other than salt obvs

liquorice

81

what sign of chronic ht is seen in the eyes?

papiloedema

82

what effect on the heart does chronic ht have?

LV hypertrophy

83

how does increased filtration of proteins cause CKD?

nephrotoxc inflammatory process

84

on USS kindey, what would one normal and one small kidney suggest?

renal artery stenosis

85

1st line drug for CKD? why?

ACE-i to reduce proteinuria

86

If you want to increase your dietary protein for gains, what should you do?

Drink the piss of a patient with nephrotic syndrome

87

which of the following are complications of CKD?

Uraemia
Hypokalaemia
Acidaemia
Mineral bone disorder
Dehydration
Anaemia

Uraemia - YES
Hypokalaemia - NO (HYPERKALAEMIA)
Acidaemia - YES
Mineral bone disorder - YES
Dehydration - NO (FLUID OVERLOAD)
Anaemia - YES

88

why anaemia in CKD?

kidneys produce erythropoiten

89

why hyperkalaemia in CKD?

unable to actively remove K

90

effect on pH of CKD?

acidaemia - role in acid base regulation

91

what is the clinical manifestation of high phosphate?

pruitis

92

what is the tx for low erythropoeitin?

EPO and iron

93

what is better transplant or dialysis?

transplant

cheaper
restores all function
knock on effect for the rest of the family

94

what is the hall mark of interstitial nephritis?

white cell cast

need a biopsy to SHOW it's that but you can infer it from the lack of another cause

95

another name for Good pastures syndrome?

anti glomerular basement membrane disease

96

what do crescent cells tell you?

indicate severe aggressive immune damage
guide prognosis (10% good 100% BAD)

97

what first Ix in a women with recurrent UTIs?

US renal tract

98

Mx of recurrent UTIs?

low does prophylactic abx
one off abx after intercourse

99

4 indications for urgent dialysis?

uraemia
severe acidosis
high potassium
refractory pulmonary oedema

100

when do you get re cell casts?

when there is significant haematuria i.e. when there is inflammation in the kidney...

not when there is just a bit of nephropathy

101

effect of CKD on iron metabolism?

inefficient metabolism: iron is less readily available for haemoglobin synthesis

102

calcium in CKD? why?

low
functional vit. D deficiency

103

PTH in CKD? why

high due to low calcium

104

what is the target BP in CKD?

130/80

105

why give drugs to bind phosphate in CKD?

prevent absorption- it will be high :(