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Nephrology Flashcards

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1
Q

What do muscles release when they are dying

A

Myoglobin
Potassium
Creatine Kinase

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2
Q

Elderly man with frequent falls presents with complaints of tea coloured urine and AKI
CK found to be very high
Dx?

A

Rhambdomyolysis

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3
Q

Features of rhabdomyolysis

A

Hematuria- reddish brown or tea coloured urine
=false positive no RBC on dipstick, red because of myoglobin

Hypotension
AKI
Very high CK

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4
Q

Uncommon side effect of statins

A

Rhabdomyolysis

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5
Q

How does myoglobin cause an AKI

How do you manage it ?

A

It is nephrotoxic

Rehydration with IV fluid - essential!

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6
Q

ECG of patient with rhambdomyolysis shows tall tent t waves and wide qrs
Next step of management ?

A

Hyperkalemia

IV calcium gluconate or calcium chloride
Protect the heart!

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7
Q

Initial investigation + management of rhabdomyolysis

To confirm dx?

A

ECG
IV fluids

Dx - CPK level - it indicates muscle necrosis

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8
Q

Hematuria + hemoptysis + impaired RFTs
Initial investigation?
Most accurate investigation?

A

Goodpasture syndrome
Initial - Anti- glomerular basement membrane antibodies

Most accurate - lung or kidney biopsy = crescenteric glomerulonephritis

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9
Q

What is Goodpasture syndrome?

A

Acute rapidly progressive glomerulonephritis +

Pulmonary alveolar hemorrhage

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10
Q

CXR of Goodpasture will show

A

Patchy interstitial infiltration ( intrapulmonary bleeding)

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11
Q

Hemoptysis + hematuria
+ cannot hear (SNHL)
Diagnosis?

A

Alport syndrome

X linked

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12
Q

Jaundice + hemoptysis

Diagnosis?

A

Jaundice - due to the liver being affected

Alpha-antitrypsin deficiency

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13
Q

Antibody in eosinophilia Granulomatosis with polyangiitis

A

Churg Strauss

P - ANCA

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14
Q

Features of Granulomatosis with polyangiitis

Antibody present?

A

Wegener Granulomatosis
URT problems - sinusitis/ nasal septum perforation/ epistaxis
+ hematuria

C-ANCA

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15
Q

Hematuria + diarrhoea
With AKI
Diagnosis?

A

HUS

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16
Q

Pale skin + itching, worse after hot bath + peripheral oedema and increased skin pigmentation
Dx?

A

Chronic renal failure
Itching - due to uraemia seen in late stage renal failure
Pallor due to anemia (decreased erythropoietin)

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17
Q

Features of liver failure

A

Ascites
Jaundice
Bleeding

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18
Q

Red skin*/flushed + itching, worse after hot bath + gout + high hb + burning sensation in fingers and toes
Dx?

A

Polycythemia rubra Vera

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19
Q

Polycythemia rubra Vera vs chronic renal failure

A

PRV - flushed skin vs pallor in CRF, high hb vs anemia in CRF

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20
Q

Itching worse after hot bath + linear tracks/burrows

Dx?

A

Scabies

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21
Q

IV fluid allowed in sepsis

A

RL or NS 0.5% NaCl

= don’t cause dilutional hyponatremia

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22
Q

Commonest renal cause of AKI

A

Acute tubular necrosis

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23
Q

Massive hemorrhage + hypotensive shock + high creatinine

Dx?

A

Acute tubular necrosis

= low perfusion to kidneys due to prolonged ischemia

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24
Q

Drug intake + rash fever + hematuria

Dx?

A

Interstitial nephritis

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25
Where does 25-alpha hydroxylation occur?
Liver
26
Where does 1-alpha hydroxylation occur?
Kidney | Converts 25-hydroxy vitamin D to active form = 1,25 dihyroxyvitamin D
27
What causes vitamin D deficiency in renal failure?
Reduced 1-alpha hydroxylase in kidneys
28
Repeated UTI + hypertension | Possible dx?
Repeated UTI - renal scarring - Chronic pyelonephritis - hypertension
29
Loin/back pain + UTI | Dx?
Acute pyelonephritis
30
Repeated UTI + sudden loin/back pain + fever + rigors Urine = nitrites , leukocyte esterase +ve Dx?
Acute pyelonephritis **chronic has NO active infection
31
Risk factors of pyelonephritis
pregnancy stones VUR DM
32
Treatment of lower UTI
Trimethoprim , nitrofurantoin
33
Treatment of upper UTI
Cipro | Co amoxiclav
34
Investigations of pyelonephritis
Urinalysis Urine c&s - before you start antibiotics Adults , older children - mid stream Young Children - clean catch / catheter/ suprapubic aspirate
35
When should antibiotics be started in acute pyelonephritis
Start empirical ABx immediately
36
Most common causing organism of UTI
E.Coli = gram negative
37
``` Management of pyelonephritis Men Women - pregnant and non pregnant Indwelling catheters Children ```
``` Admission - often Antibiotics = Men, non pregnant women and patients with indwelling Caths === cipro 500 mg bid 7 days === co-amoxiclav 625 mg tid for 14 days ``` Children = 1. Co amoxiclav =2. Cefixime Pregnant women - cefalexin -500mg bid 10- 14 days PO (if not admitted)
38
Small kidneys + HTN | Possible Dx?
Bilateral artery stenosis or | Chronic pyelonephritis
39
What medications are contraindicated in bilateral artery stenosis?
ACEi
40
Normal cause of mild proteinuria
Excercise | +1
41
Proteinuria (mild) + healthy individual | Next step?
Repeat test | If still high protein:creatinine ratio
42
What is nephrotic syndrome | What is the peak incidence in children?
Proteinuria >3g/24hr Hypoalbuminemia <30g/L Oedema 2-5 years old
43
Majority of cases of nephrotic syndrome in children are due to ?
Minimal change glomerulonephritis - microscopic hematuria seen in 10% - good prognosis = 90% respond to steroids (high dose)
44
Features of minimal change disease? | Definitive dx test?
Nephrotic syndrome Normal tension Selective proteinuria Dx - renal biopsy - electron microscopy shows fusion of podocytes
45
What causes hyperlipidemia and hypercoagulable state in nephrotic syndrome
Loss of anti thrombin III
46
What causes liability to infections in nephrotic syndrome
Loss of immunoglobulins
47
Most common cause of AKI | Metabolic imbalances seen
Pre-renal causes - dehydration “hypovolemia” HyperK, raised serum urea and creatinine AKI - decreased eGFR - unable to excrete the above
48
What can be done to reduce the risk of contrast induced nephropathy ?
Drink plenty fluids | IV NS .9% NaCl pre and post procedure esp in high risk pts
49
What medication needs to be stopped before any contrast study?
Metformin | =nephron - harmful
50
HTN + CKD GFR > 30 ACR >30 What meds should be given?
ACEi - prils or. ARBs - sartans They slow progression of CKD ACEi = preferred
51
Situations ACEi and ARBs can be used in renal impairment
ACR = urinary albumin:creatinine >=70 >= 30 if there is HTN >= 3 if there is DM
52
Most common nephrotic syndrome in adults
Caucasian or unspecified ethnicity - membranous African/black/Hispanic = focal segmental GN ** for plab - adult >40 = membranous
53
Causes & | Prognosis of membranous glomerulonephritis
Cause - mainly idiopathic Infections rheumatoid drugs, malignancy Prognosis- 30% remission , 30% partial remission, 30% progress to ESRD
54
Types of glomerulonephritis
2- nephrotic nephritic Nephritic - rapidly progressive - Goodpasture, igA IgA- mesangioproliferative Goodpasture - crescenteric
55
Causes of minimal change disease
Idiopathic mainly Hodgkin NSAIDs
56
Causes of focal segmental glomerulosclerosis
Idiopathic / 2ry to HIV or heroin
57
Anemia + hypocalcemia + small kidneys (<9mm) on US What do you suspect? What is the reason for the hypocalcemia
CKD | HypoCa = decreased 1-alphahydroxylase
58
What causes a dynamic bone disease?
=Reduced bone turnover - causes msk pain and immobility It is due to 1,25 dihydrocycholecalciferol over-replacement There will be hypoca + inappropriately normal PTH
59
Hematuria + HTN + loin/flank pain Suspect? What is an important association
ADPKD Intracranial aneurysm
60
How is the dx of ADPKD made?
Ultrasound
61
What is haemolytic uremic syndrome? (HUS) | Features, organism
Haemolytic anemia Uraemia - low urea and creatinine thrombocytopenia(acute renal failure) *E.Coli Diarrhoea (bloody) + renal failure + anemia
62
Treatment HUS
IV fluids +/- blood transfusion Dialysis if required ABX NEVER GIVEN
63
HUS triad + fever + neurological manifestations | Dx?
thrombotic thrombocytopenic purpura
64
IgA(bergers ) vs post strept glomerulonephritis Organism Treatment
IgA - 1-2 days after URTI with hematuria and usually young males PSGN _ 1-2 weeks, proteinuria +decreased complement C3 Rena; biopsy shows humps on electron microscopy O— group A beta- hemolytic streptococci usually strept pyogenes Tx - supportive mainly (resolves spontaneously)
65
Causes of small kidneys
Chronic glomerulonephritis Chronic pyelonephritis Hypertensive renal disease Bilateral renal artery stenosis
66
Causes of large kidneys
ADPKD Obstructive Uropathy Reflux nephropathy
67
Indications of haemodialysis (5)
``` Persistently high K >6.5 (refractory hyperk) Severe metabolic acidosis Fluid overload with anuria Uremic pericarditis , pulm oedema Uremic encephalopathy ```
68
Treatment of reflux nephropathy
Low dose trimethoprim daily | If fails or there is parenchymal damage - surgery
69
What 4 meds should be stopped if patient presents with diarrhoea/vomiting and there is risk of dehydration/AKI?
``` DAMN Drugs Diuretics ACEi and ARBs Metformin NSAIDs ```
70
Pt with ESRD + MSK pain + hypocalcemia + low vit D+ high PTH | Dx?
2ry hyperparathyroidism or vitamin D deficiency

Revision (31 decks)

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