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Year 3 > FFCP Renal and urology > Flashcards

FFCP Renal and urology Flashcards

(106 cards)

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1
Q

What are symptoms and signs of nephritic disease?

A

High BP, mild oedema, positive for blood and protein on urine dip

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2
Q

What will you see on urine microscopy for nephritic syndome?

A

Red Cell casts

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3
Q

When might you get false positive for ANCA?

A

In infections eg endocarditis

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4
Q

Low c3 and c4 with renal disease suggests what?

A

Immune complex disease

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5
Q

What’s the diagnostic criteria for nephrotic syndrome?

A

Proteinuria >3g a day
Hypoalbuminaemia <30g/dL (due to the massive loss of protein)
Oedema
Raised cholestrol

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6
Q

What are some causes of nephrotic syndrome?

A

minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy

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7
Q

Main difference between nephritic and nephrotic syndome?

A

nephritic - glomeruli doesnt properly filter RBCs, nephrotic - doesnt properly filter albumin

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8
Q

What defines CKD?

A

An eGFR of less than 60 for more than three months

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9
Q

What values define stage 3, 4 and 5 CKD?

A

3 - eGFR between 30 and 60
4- eGFR between 15 and 30
5- eGFR less than 15

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10
Q

What medications do you need to stop in AKI?

A

NSAIDS, ACE, ARB, metformin, potassium sparing diuretcis

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11
Q

How does hyperkalemia present on ECG?

A

Peaked T waves, P wave flattening/PR prolongation, QRS widening

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12
Q

How do you manage ECG changes of K>6.5mmol/L?

A

Calcium gluconate to stabilise cardiac cells, insulin dextrose to encourage K+ into cells. If bicarb<22mmol and not overloaded give 1.26% bicarbonate IV 500ml

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13
Q

What is a benefit of APD over CAPD?

A

APD- dialysis usually takes place over night (around eight hours). CAPD - around 4-5 exchanges a day

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14
Q

What should you give any patient with CKD and a raised ACR?

A

SGLT-2 inhibitor

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15
Q

Problems with SGLT-2 inhibitors?

A

They increase risk of UTI

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16
Q

What’s the sepsis six?

A

Take blood cultures
Measure lactate and FBC
Monitor urine output
Start IV fluid resus
administer empiric antibiotics
Give oxygen sat target 94%

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17
Q

What else can you give for hyperkalaemia besides calcium gluconate and iv dex/insulin?

A

nebulised salbutamol and potassium binders

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18
Q

Why do CKD patients often have hypocalcaemia and hypophophatemia?

A

Absence of 1 alpha hydroxylase due to kidney condition
(give 1-alpha calcidol)

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19
Q

What should you give for normocytic anaemia in CKD?

A

Epo (+/- iron)

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20
Q

What defines acute kidneyy injury?

A

Rise in serum creatinine of >26 umol/L within 48 hours
or 1.5x increase in serum creatinine known or presumed to have occured within last 7 days
or 6 hours oliguria (output <0.5ml/kg/ hour)

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21
Q

If someone with AKI is euvolaemic and passing urine as usual how much fluid should be given?

A

Maintenance fluid which is estimated daily output + 500l

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22
Q

What are Bence Jones proteins?

A

If seen in urine, indicative of myeloma. B cell proliferation

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23
Q

What drugs need to be stopped in AKI?

A

NSAIDS, ACE, ARBs, metformin, potassium sparing diuretics

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24
Q

How to manage hyperkalaemia as a complication of AKI?

A

If ECG changes calcium gluconate. If potassium >6.5 as well then insulin dextrose
If low bicarbonate and not overloaded, give 1.26% bicarbonate IV 500ml 1-4 hours

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25
How to manage pulmonary oedema as a result of AKI?
Sit up, oxygen, GTN infusion, furosemide >80mg bolus then further boluses or infusion of 10mg/hour
26
When can sodium bicarbonate be used in AKI?
For reversing hyperkalaemia, correction of acidosis is by recovery of renal function
27
What are red cell casts indicative of?
Glomerulonephritis
28
Why is presentation of nephrotic syndrome often missed?
Bc the blood pressure presents as low/ normal so people often forget to do urine dip
29
What do you see when you try to visualise minimal change disease?
Normal features on light microscopy, and fusion of podocytes on EM
30
What can membranous nephropathy occur secondary to?
SLE/ Lupus nephritis, Drugs such as penicillamine, gold, anti TNF, Malignancy, Infections such as Hep B, Hep C, HIV, malaria, syphilis and sarcoidosis
31
What are causes of pre renal AKI?
Sepsis, hypovolaemia, cardiac failure, hypotension
32
Causes of intrinsic AKI?
Acute tubular injury, glomerulonephritis, myeloma, vasculitis
33
Causes of post renal AKI?
Kidney stones, prostatic hypertrophy, tumors, retroperitoneal fibrosis
34
Why should you check calcium and phosphate in AKI?
Could be a sign of myeloma
35
What symptom of CKD is an indication for dialysis?
Pruritus (itching)
36
Why can you get high cholesterol in nephrotic syndrome?
Bc lipoproteins are lost in the urine so lots of free cholesterol
37
What do red cell casts mean?
glomerulnephritis
38
What is ANCA associated with?
small vessel vasculitis eg: miscroscopic polyangitis (often kidney), Wegener's - often lungs and sinuses, Churg-Strauss
39
What's the most common cause of nephrotic syndrome in adults?
focal segmental glomerulosclerosis
40
What can cause focal segmental glomerulosclerosis?
HIV, lupus, reflux nephropathy etc
41
What would you see on biopsy of membranous glomerulonephritis?
thickened glomerular basement membrane, immunoflorescence - diffuse uptake of IgG
42
How does IgA/Berger's disease nephropathy typically present?
nephritic syndrome 24-48 hours after an upper resp tract infection
43
What is post-infectios glomerulonephritis?
glomerular injury triggered by infection - post commonly post streptococcal infections. Presents with nephritic syndrome about 2 weeks after infection
44
What can anti-glomerular basement membrane antibody disease affect?
the kidneys (nephritic syndrome) as well as lungs (alveolar haemorrhage with hemoptysis) - if they are both involved condition is known as Goodpasture's syndrome
45
What are the ACR categories?
<3 is normal to mildly increased, 3-30 is moderately increased and >30 is severely increased
46
What drug should everyone with CKD and proteinuria be started on? (whether they have diabetes or not)
SGLT2
47
If potassium is in the ranger 6-6.4 (moderate hyperkalemia), how can you treat?
glucose (25g over 15 min) with insulin and salbutamol
48
If hyperkalemia is severe (>6.5) how to treat?
calcium gluconate
49
What symptoms of CKD are indications for dialysis?
pruritus, encephalopathy or pericarditis
50
How is proteinuria best qualified?
protein/ creatinine ratio
51
What types of ANCA are associated with granulomatosis with polyangiitis ?
cANCA -also called proteinase 3
52
What types of ANCA are associated with microscopic polyangititis or eosionophilic granulomatosis with polyangiitis?
perinuclear pANCA also called myeloperoxidase
53
How is vasculitis treated?
high dose glucocorticoids, cytotoxic agents - cyclophosphamide, plasma exchange to remove ANCA
54
What is the inheritance of adult polycystic kidney disease?
autosomal dominant
55
Sudden onset headache in someone with polycystic kidney disease?
subarachnoid haemorrhage (bc berry aneurysm associated with polycystic kidney disease)
56
What defines chronic kidney disease?
A GFR less than 60 for more than three months
57
What do you use in proteinuric CKD?
ACE-I or ARB at biggest dose you can as they improve protienuria
58
How soon should an ultrasound be done in AKI?
less than 24 hours and less than 6 is pyonephrosis is suspected
59
How to manage AKI complication of pulmonary oedema?
Sit up, O2, GTN infusion, furosemide >80mg bolus
60
Whereabouts do loop diuretics work?
Thick ascending limb - binds to sodium potassium chloride transporter preventing reabsorption of sodium
61
How do thiazide diuretics work?
They block sodium chloride transporter in the distal convulted tubule
62
Why is acetazolamide contraindicated in CKD?
It blocks bicarbonate reabsorption so it is contra indicated in CKD
63
Side effects of loop diuretics?
hypokalaemia, dehydration, kidney stones, deafness
64
Indications for aldosterone inhibitors?
hyperaldosteronism, heart failure, hypokalaemia from other diuretics, cirrhosis
65
Stages of kidney failure?
1- EGFR greater than 90 with sign of damage on other test 2- 60-90 with damage on other tests 3a- 45-59 3b 30-44 4-15-29 5 - less than 15 = established kidney failure
66
What type of anaemia in chronic kidney disease and at what point does it tend to become apparant?
normochromic normocytic and tends to become apparant when GFR is less than 35
67
Target haemoglobin for CKD patients?
10-12 g/dl
68
What are first line antihypertensives in CKD? and what problem do they come with?
ACE inhibitors - but they reduce filtration pressure so a small fall in GFR and rise in creatine to be expected
69
What antihypertensive can be useful in CKD patients when GFR falls below 45?
furosemide - also has added benefit of lowering serum potassium
70
What kind of dialysis does 4-5 exchanges per day?
CAPD (As opposed to APD which dialysis typically takes place in the 8 hours overnight)
71
If you do an ACR and it is between 3 and 70 what should you do?
Repeat sample (repeat sample not needed if greater than 70)
72
What difference would you see on a dipstick between glomerulonephritis and acute interstitial nephritis?
glomerulonephritis = haematuria and leucocytes acute interstitial nephritis= leuocytes by themselves
73
How can urine sodium help determine between pre-renal uraemia and acute tubular necrosis?
ATN sodium in urine will be high >30, whereas pre-renal will be <20 as kidneys hold on to sodium to preserve volume
74
Is aspirin safe to continue in AKI?
Usually safe to continue at the cardioprotective dose of 75mg OD
75
AKI staging in terms of urine output?
urine output less than 0.5mL/kg/hour for 6 hours = stage 1 less than the above for 12 hours = stage 2 less than 0.3ml/kg/hour for 24 hours or anuria for 12 hours = stage 3
76
What pH in AKI prompts a critical care referral?
a pH of less than 7.15
77
Indications for haemodyalsis for kidney injury?
pul oedema, hyperkalaemia, severe uraemia, severe acidosis, insufficient urine output
78
If patient experiencing symptoms of BPH but not affecting qual of life what should be done?
lifestyle changes - avoiding cluids before bed, coffee, double voiding etc
79
What kind of drug is tamsulosin?
alpha blocker - reduces smooth muscle tone to improve urine flow in BPH
80
What would next step for BPH be if tamsulosin doesn't work or bad side effects?
a 5alpha-reductase inhibitor such as finasteride. Reduce conversion of testosterone to DHT but take 6-12 months to work
81
Side effects of tamsulosin?
dizziness, postural hypotension, dry mouth, depression, drowsiness
82
Side effects of finasteride/
impotence and reduced interest in sex
83
Classifications of BPH severity based on IPSS score?
mild 0-7, moderate 8-19, severe 20-35
84
If a patient has lUTS and a prostate larger than 30g or PSA greater than 1.4 ng/ml what should be given?
5 alpha reductase inhibitor
85
If a man has storage symptoms as well as voiding symptoms that persist after treatment with alpha blocker, what should be given?
anti-muscarinic drug eg oxybutynin, tolterodine or darifenacin
86
Most significant risk factor for bladder cancer?
tobacco spoke
87
What is the most common type of bladder cancer?
Transitional cell carcinoma
88
Most common presentation of bladder cancer?
painless haematuria
89
What is often given post TURBT in non-muscle invasive bladder cancer to reduce risk of recurrence?
intravesical therapy with BCG or chemo such as mitomycin C
90
What is the standard treatment for muscle-invasive bladder cancer?
radical cystectomy with bilateral pelvic lymph node dissection, with neoadjuvant cisplatin chemo priot to surgery
91
What ACR value is regarded as clinically important proteinuria?
An ACR of 3mg/mmol
92
What variables are included when estimating GFR?
Serum creatine, age, gender, ethnicity
93
What factors might effect gfr result?
pregnancy, muscle mass, eating red meat prior to sample being taken
94
What should target haemoglobin be for CKD patients?
10-12 g/dl
95
What should be done before using erythripoiesesis stimulating agents in CKD patients?
Optimise iron status - eg IV iron
96
What anti-hypetensive drugs are useful in CKD patients?
ACE inhibitors first-line - but they reduce filtration pressure so egfr will decrease (acceptable by up to 25%), furosemide also useful, lowers serum potassium as well
97
What substance is implicated in diabetes insipidus?
ADH
98
Difference between central and nephrogenic DI?
Central body doesnt produce ADH, nephrogenic the kidneys stop respoding to ADH
99
What drug can lead to acquired nephrogenic DI?
lithium
100
What acid base problems can lead to acquired nephrogenic DI?
hypercalcaemia, hypokalaemia, also CKD
101
how can urine and serum osmolality help in diagnosing DI?
If the U:P ratio is greater than 2:1, DI is unlikely, if U:P is less than 2:1 it confirms dilute urine
102
How does water deprivation test work for DI?
empty bladder, no fluids take urine and serum osmolality throughout. Then adminster desmopressin and allow water consumption.
103
What is dipsogenic DI?
When there is a problem with the thirst centre, not ADH levels
104
How can you differentiate between cranial DI and nephrogenic DI when administering desmopressin?
Cranial - following desmopressin urine concentrates, Nephrogenic - no change following desmopressin
105
What is copeptin and how can it be used?
It derives from the precursor of ADH, so testing serum levels can suggest the levels of ADH present in blood
106
How can nephrogenic DI be treated medically?
Thiazide diuretics -they decrease urine volume

Year 3 (14 decks)

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