Kidney conditions Flashcards
(160 cards)
1
Q
drug history questions for kidneys (6)
A
gentamicin vancomycin beta blockers ACE inhibitors/ARBs diuretics NSAIDs
2
Q
arrhythmia associated wit hyperkalaemia (significant in renal disease)
A
peaked T waves
3
Q
classic presentation of nephritic syndrome (4)
A
hypertension
oliguria
oedema (not periorbital)
haematuria
4
Q
classic presentation of nephrotic syndrome (4)
A
Oedema (periOrbital) = nephrOtic
prOteinuria
hypoalbuminaemia
hypercholesterolaemia
5
Q
aetiology of most nephrotic syndrome
A
glomerulonephritis (glomerular damage)
6
Q
what investigation would you do for someone presenting with nephrotic syndrome
(think about likely cause)
A
renal biopsy
7
Q
most common cause of chronic kidney disease (CKD)
A
diabetic nephropathy
8
Q
aetiology of chronic kidney disease (CKD)
A
basically anything that affects the kidneys for a long time
9
Q
definition of chronic kidney disease (CKD)
A
reduced kidney function and/or evidence of kidney damage >3months
10
Q
what colour of skin may someone have with chronic kidney disease (CKD)
why
A
lemon yellow
from urea
11
Q
common presentation of chronic kidney disease (CKD) (3)
A
fatigue
weight loss
nocturia
loads of things
12
Q
G1 stage CKD criteria
A
GFR >90 but evidence of kidney damage
13
Q
G2 stage CKD criteria
A
GFR 60-89
14
Q
G3a stage CKD criteria
A
GFR 45-59
15
Q
G3b stage CKD criteria
A
GFR 30-44
16
Q
G4 stage CKD criteria
A
GFR 15-29
17
Q
G5 stage CKD criteria
A
GFR <15 established renal failure
18
Q
how many measurements how far apart of GFR do you need for chronic kidney disease (CKD)
A
2 measurements 90 days apart
19
Q
what 3 things on urinalysis would you do/look for for someone with CKD
why
A
proteinuria
haematuria
albumin creatinine ratio (ACR)
find out cause of CKD
20
Q
investigations for CKD (3)
A
creatinine/GFR
urinalysis
imaging (US if renal, MR angiogram if prerenal, CT if post renal)
21
Q
at what stage should you refer CKD to renal specialist (probs for dialysis)
A
G3 - if progression (25% drop in GFR) or young
G4
G5
22
Q
definitive treatment for CKD G5
A
renal replacement therapy (haemodialysis, peritoneal dialysis, transplant)
23
Q
contraindication of ACE inhibitors in renal disease
A
bilateral renal artery stenosis
24
Q
conservative treatment of CKD if G1-G4 (4)
A
ACE inhibitors/ARBs to reduce BP
statins for CVD
fluid restriction/diuretics
lifestyle modification - reduce K, PO4, salt
25
BP target in CKD
<130/80mmHg
26
what happens to vitamin D in CKD (chronic kidney disease)
what does this cause
vit D is not hydroxylated = so is inactive
CKD mineral bone disease
27
if vit D is not hydroxylated in CKD, what happens to Ca
what does this result in (hormones)
reduced Ca absorption in bones
high serum Ca binds with high serum phosphate
= calcium phosphate = serum Ca decreases
secondary (also tertiary from high PO4 bc bone doesnt excrete it as normal) HYPERparathyroidism
28
presentation of mineral bone disease in CKD (4)
fractures
bone pain
osteomalacia
vascular/soft tissue/bone calcification
29
treatment of mineral bone disease in CKD (3)
think about the 2 problems
decrease PO4 in diet (chocolate)
alfacalcidol (already hydroxylated vit D)
phosphate binders eg calcium carbonate
30
why may someone with CKD present with anaemia
kidneys produce EPO (erythropoietin) so in CKD = decreased EPO = decreased RBC = anaemia
31
definition of acute kidney injury (AKI) (4)
include creatinine and urine (and 2 other)
abrupt (<48 hours) reduction in kidney function
increase in creatinine >50%
reduction in urine <0.5ml/kg/hour
no response to fluid resus
32
is acute kidney injury (AKI) common
very
33
what are the 3 categories of causes of acute kidney injury
prerenal
renal
postrenal
34
description of prerenal AKI
aetiologies (4)
hypoperfusion to kidneys
drugs - ACE inhibitor, NSAIDs
sepsis
renal artery stenosis
diarrhoea/vomiting/haemorrhage
35
treatment of someone with prerenal AKI
| think about it
bloods
fluids
the problem is hypoperfusion!
36
complication of untreated prerenal AKI
acute tubular necrosis
37
what is acute tubular necrosis
what is it caused by
death of tubular epithelial cells = renal cause of AKI
bc of hypoperfusion (untreated prerenal AKI)
38
'muddy brown casts of epithelial cells'
acute tubular necrosis
39
treatment of acute tubular necrosis
| think about the aetiology
fluids
40
drugs that can cause renal damage = AKI
gentamicin
| PPI eg omeprazole
41
in old people/alcoholics what is a likely cause of AKI
rhabdomyolysis from collapse
42
apart from drugs and rhabdomyolysis, what is another major cause of renal AKI
glomerulonephritis
43
description of post renal AKI
examples (3)
obstruction of urine outflow = back pressure of urine into kidneys = AKI
prostate enlargement
kidney stones
tumours
44
treatment of post renal AKI (3)
catheter
stent
nephrostomy (surgery)
to relieve obstruction
45
general presentation of AKI (non specific to aetiology)
oliguria (decreased urine output) <0.5ml/kg/hour
rest of symptoms depends on cause
46
what is the creatinine and oliguria like in the 3 different stages of AKI
stage 1 - x1-1.9 of normal, oliguria <0.5ml/kg/hour for 6 hours
stage 2 - x2-2.9 of normal, oliguria <0.5ml/kg/hour for 12 hours
stage 3 - x3 of normal, oliguria <0.3ml/kg/hour for 24 hours
47
in an old lady who fell 2 nights ago and lay on the floor until being found and has been producing low conc brown urine ('coca cola urine'), what investigation would you do (specific to this case)
what are you trying to confirm
CK
rhabdomyolysis causing renal AKI
48
if you suspect glomerulonephritis causing renal AKI, what blood tests do you want to do (specific to glomerulonephritis)
ANCA for vasculitis
anti-dsDNA for lupus
anti-GBM for goodpastures
49
when might you do a biopsy in AKI
| think about it
if ?renal cause, eg glomerulonephritis
50
is AKI an emergency or routine situation
emergency!
high mortality rates
51
if someone has stage 3 AKI and uraemia, what else will you do apart from fix the cause
dialysis to clear toxins
52
life threatening complication of AKI
hyperkalaemia!
53
what ion do you need to monitor in AKI to prevent complications
significant findings of this
K+ (otherwise hyperkalaemia)
K >5.5 (K >6.5 is life threatening)
54
what may hyperkalaemia present with
test for this
findings of test
arrhythmias
ECG - tall/prominent T waves
55
hypontraemia and hyperkalaemia
addisonian crisis
56
treatment of hyperkalaemia (4)
calcium gluconate
insulin dextrose
salbutamol nebulised
dialysis if K>7
57
what does calcium gluconate do when you give it for hyperkalaemia
protects your myocardium from high K
58
what does insulin dextrose do when you give it for hyperkalaemia
lowers K
59
is glomerulonephritis usually chronic or acute
chronic
60
which type of glomerulonephritis is acute
acute rapidly progressive glomerulonephritis
61
3 categories of aetiology of glomerulonephritis
idiopathic
drugs
immune
62
drugs that cause glomerulonephritis (4)
gold
penicillin
heroin
NSAIDs
63
immune causes of glomerulonephritis(5)
```
lupus
ANCA vasculitis (GPA, MPA)
goodpastures
diabetes
hepB/C
```
64
is glomerulonephritis an infection
no
65
if there is endothelium damage in glomerulonephritis (eg vasculitis) how does this present
haematuria
podocytes can still catch the proteins
66
if there is mesangial damage in glomerulonephritis how does this present
haematuria
mesangial damage causes inflammation in capillary = endothelium damage
67
if there is podocyte damage in glomerulonephritis how does this present
proteinuria (bc podocytes filter out proteins normally in the glomerulus)
68
apart from haematuria and proteinuria, how else does glomerulonephritis typically present
hypertension
69
investigations for glomerulonephritis (4)
autoantibodies - cANCA for GPA, pANCA for MPA, anti-GBM for goodpastures, anti-dsDNA for lupus
renal biopsy
urinalysis - for proteinuria and haematuria
urine microscopy
70
which group of people get minimal change nephropathy
kids
71
do you biopsy kids with ?glomerulonephritis
no bc they probs have 'minimal change nephropathy' so wont see anything anyway
72
treatment of glomerulonephritis (2)
ACEi/ARB to decrease bp
| steroids (prednisolone PO 40-60mg OD)
73
most common nephrotic syndrome in the UK
focal segmental glomerulonephritis
74
glomerulonephritis type with small Ig/complement deposition, podocyte damage, mesangial collapse, <50% of glomeruli are affected, only part of the glomerulus is affected (not the whole thing), small areas of sclerosis
focal segmental glomerulonephritis
<50% affected = focal only part of glomerulus affects = segmental
75
glomerulonephritis type with immune complex deposition in the basement membrane = thick basement membrane
membranous glomerulonephritis
76
glomerulonephritis type with immune complex deposition in the basement membrane = thickened membrane and extra cells there
membranoproliferative
77
```
glomerulonephritis type
recent URTI/gastroenteritis
haematuria (mesangial damage)
most common world wide
HSP purpuric skin rash on extensor surfaces
```
treatment
IgA nephropathy
ACEi/ARB asap (no steroids)
78
biopsy finding in acute progressive glomerulonephritis
glomerular crescents (bowmans space)
79
when do people present with acute rapidly progressive glomerulonephritis
how do they present
(classic presentation)
hameturia/rusty coloured urine/proteinuria 1-3 weeks after infection eg tonsillitis
80
if you dont biopsy a kid with ?glomerulonephritis bc you probs wont find anything on biopsy, what do you do instead
give steroids (prednisolone) and wait and see if they respond
81
which aetiology of glomerulonephritis present with pulmonary emboli too
goodpastures
82
what is dilation of the pelvicalyceal system bc of presence of water called
hydronephrosis
83
where is the obstruction in bilateral hydronephrosis (2)
urethra
| both ureters
84
where is the obstruction in unilateral hydronephrosis (2)
ureter
| kidney
85
what is LARGE pelvicalyceal system dilatation indicated of
chronic problem (only a partial obstruction = patient hasn't present earlier)
86
most common cause of hydronephrosis
kidney stones
87
treatment of hydronephrosis (2)
```
remove obstruction (nephrostomy if kidney stones)
drain accumulated fluid (eg catheter)
```
88
kimmelsteil Wilson lesions
diabetic nephropathy
89
which type of vasculitis may present in the kidneys
small vessel/ANCA positive (bc the arteries inside the kidney (afferent arterioles etc) are small!)
90
which drug is contraindicated in bilateral renal artery stenosis
ACE inhibitors
91
flash pulmonary oedema
| accelerated malignant hypertension - severe headache, blurred vision
renovascular disease (eg renal artery stenosis)
92
investigations for renovascular disease (3)
US
angiogram
renal artery duplex
93
treatment of renovascular disease if not too bad
stent = make it reversible
94
treatment of renovascular disease if bad (majority of people) (3)
ACE inhibitor
antiplatelet
statin
95
what is fibromuscular dysplasia
abnormal growth within artery = artery stenosis = beading of renal artery
96
beading of renal artery
fibromuscular dysplasia
97
what is deposited in the kidneys in multiple myeloma that causes renal failure
amyloid
98
bone destruction and renal failure
multiple myeloma
99
apple green birefringence on congo red stain
multiple myeloma with kidney involvement
100
most common inherited kidney disease
polycystic kidney disease (PCK)
101
is polycystic kidney disease that presents in adults autosomal dominant or autosomal recessive
autosomal dominant
102
which chromosome has the mutation in autosomal dominant polycystic kidney disease
PKD1 on chromosome 16
| or PKD2 on chromosome 4 though more rare
103
if polycystic kidneys metastasise what type of tumour do they typically turn into
benign adenoma
104
which age group present with autosomal dominant polycystic kidneys
middle age adults
105
chronic flank pain
hypertension!!
renal failure
palpable kidneys (abdo mass)
polycystic kidney disease
106
diagnostic investigation for polycystic kidney disease (autosomal dominant (adults) and autosomal recessive (kids))
US
| CT/MRI if unclear
107
what is the chance of someone with autosomal dominant polycystic disease passing it onto their kids
why is this important
50% (bc its autosomal dominant)
need genetic counselling
108
treatment of polycystic kidney disease with no renal failure (2)
(think about what they present with)
ACE inhibitor/ARB
| tolvaptan (carbonic anhydrase inhibitor - causes diuresis = cyst doesnt get any larger)
109
treatment of polycystic kidney disease with renal failure
renal replacement therapy
110
if you have polycystic kidneys, where else may you end up with cysts (3)
liver (hepatic cysts) - common!
pancreas
lung
111
complication of polycystic kidney disease in the brain
intra cranial aneurysm (berry aneurysm)
112
who present with autosomal recessive polycystic kidney disease
young children
113
what do kids with autosomal recessive polycystic kidney disease also present with
hepatic lesions/fibrosis
114
is autosomal recessive polycystic kidney disease common or rare
rare
115
how does autosomal recessive polycystic kidney disease present
hypertension
abdo mass (palpable kidneys)
renal failure
(same as autosomal dominant)
116
whats the prognosis of autosomal recessive polycystic kidney disease (presents in kids)
mortality in first year
bad - 25% mortality in first year
117
which chromosome has the mutation in autosomal recessive polycystic kidney disease
PKDH1 mutation on chromosome 6
118
which inherited kidney condition is associated with goodpastures
alports
119
sensorineural hearing loss
haematuria
bulging of lens in eye
alports syndrome
120
aetiology of alports syndrome
who is it more common in (males or females)
genetic - x linked
| males bc its x linked
121
what type of collagen disorder is present in alports that causes a thickened glomerular basement membrane
type IV collagen
122
what does alports syndrome look like on renal biopsy
thickened glomerular basement membrane
123
treatment for alports syndrome (2)
ACE inhibitor/ARB
| dialysis/transplant
124
inherited kidney disease
lysosomal storage disease = increase in glycosphinogolipids in lots of places (skin, kidneys, blood cells, brain lung, liver, eyes)
renal failure + lots of unspecific symptoms
Anderson fabrys disease
125
cutaneous manifestation of Anderson fabrys disease
angiokeratomas (deposition of lysosomes in the skin = blue dots in the umbilical area)
126
which cell is strongly associated with andersons fabrys disease
LYSOSOMES!
127
treatment of andersons fabrys disease
fabryzyme enzyme replacement
| for the disease with lysosomal involvement!
128
congenital disorder causing shrunken kidneys
medullary cystic kidney
129
what does medullary cystic kidney (genetic condition with cysts in the medulla) cause the kidney to do
how does this present
shrunken kidney
reduced renal function - polyuria, polydipsia, enuresis (cant concentrate urine)
130
investigation for medullary cystic kidney disease (inherited condition)
CT (probs wont see on ultrasound bc too small)
131
treatment of medullary cystic kidney disease (inherited condition)
transplant (bc young) bc their kidneys will never regain function
132
which age do medullary cystic kidney disease (inherited condition) present in
20 y/o
133
pathophysiology of medullary sponge kidney (inherited condition)
dilation of collecting ducts = urinary stasis = medulla looks like a sponge
134
where is an ectopic kidney located
pelvis (think of embryology)
135
what is the name of a kidney that is made of the left and right kidneys joined together
horseshoe kidney
136
what investigation do you always do for a renal mass
why
CT
look for malignancy
137
renal tumour filled with FAT, smooth muscle, blood vessels
is it malignant or benign
angiomyolipoma
benign
138
which genetic condition is associated with angiomyolipoma
how does this present (derm)
tuberose sclerosis
shagreen patches
periungal fibromas
café au lait macules
infantile seizures
139
complication of angiomyolipoma
massive haemorrhage if >4cm (wunderlichs syndrome)
bc its filled with fat and BLOOD VESSELS
140
what does a juxtamedullary cell tumour produce
what does this cause
is it benign or malignant
renin
secondary hypertension
benign
141
which benign renal tumour looks very similar to a renal cell carcinoma
how do you treat it
oncocytoma
nephrectomy - need to remove it to rule out renal cell carcinoma, biopsy not diagnostic
142
renal tumour with 'central scar on CT'
oncocytoma
143
when do people present with a renal cyst
incidental finding on CT/US
144
treatment of renal cyst
nothing - reassure patient they are fine!
145
most common abdo mass in kids
is it benign or malignant
nephroblastoma (wilms tumour)
malignant
146
most common renal tumour in adults
is it benign or malignant
renal cell carcinoma
malignant
147
another name for renal cell carcinoma
grawitz tumour
148
where is a renal cell carcinoma
in the tubules
149
risk factors for renal cell carcinoma (grawitz tumour)
males
60 y/o
obesity (waist size)
150
most common type of renal cell carcinoma on histology
what does it contain that it looks like this
clear cell
glycogen and lipids
151
where can renal cell carcinomas extend into
renal vein
152
which genetic condition is associated with renal tumours and phaeochromocytomas in young people
von hippel lindau
153
classic triad of renal cell carcinoma presentation
haematuria
abdo mass
flank pain
154
investigation for renal cell carcinoma
greater than what size is probs malignant
what dont you bother doing
why
CT, >3cm is probs malignant
renal biopsy - bc it can just looking like an oncocytoma
155
treatment options for renal cell carcinoma (4)
```
???? chekc this
full nephrectomy - rare, if big
PARTIAL NEPHRECTOMY - to retain some GFR
radio ablation - if small
tyrosinekinase inhibitors
```
156
how does spread of renal cell carcinoma present in the lungs on CXR
how does it spread
cannonball metastasis
haematogenous (blood)
157
prognosis of renal cell carcinoma
bad if late stage (stage 4)
158
when does contrast induced nephropathy present
3-4 days after contrast
159
most common imaging of kidneys
CT
160
what is US good for in kidneys
renal size, distension (fluid filled)
