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Nephrology Flashcards

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1
Q

What is the presentation of lower UTI?

A

*Dysuria
*Suprapubic pain
*Frequency
*Urgency
*Incontinence
*Confusion

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2
Q

What is the presentation of pyelonephritis?

A

*Fever
*Loin, suprapubic or back pain
*Vomiting
*ANorexia
*Haematuria
*Renal angle tenderness

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3
Q

What investigations should be carried out in suspected UTI?

A

*Urine dipstick
*Mid stream urine sample for culture

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4
Q

What will urinalysis show in UTI

A

*Positive for nitrates if gram negative bacteria
*Leukocytes

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5
Q

Name 3 causes of UTI

A

*E.Coli ( gram neg anaerobic rod)
*Kelbsiella pneumoniae (gram neg. anaerobic rod)
*enterococcus

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6
Q

Name a fungal cause of UTI

A

Candida albicans

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7
Q

What is the management for UTI

A

*3 days for simple lower UTI in women
*5-10 for women who are immunocompromised, have abnormal anatomy or impaired kidney function
*7 days for men, pregnant women or catheter associated UTI
*Trimethoprim or nitrofuratoin

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8
Q

When should you avoid using trimethoprim?

A

In the 1st trimester

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9
Q

What is the treatment of pyelonephritis?

A

Cefalexin, trimethoprim or co-amoxiclav for 7-10 days

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10
Q

Diagnosis of AKI

A

*urine output of <0.5ml/kg/hour for >6 hours
*Creatinine rise of ≥26mmol/l within 48 hours
*Creatinine rise to ≥1.5 times the baseline within the past 7 days

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11
Q

What investigations should be carried out in suspected AKI?

A

*Metabolic profile
*UEs
*LFTs
*FBC
*CRP
*Urine dip
*Urine output monitoring

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12
Q

What are the pre renal causes of AKI?

A

*Dehydration
*Hypotension
*Heart failure
Lead to inadequate perfusion of the kidney

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13
Q

What are the renal causes of AKI?

A

-Glomerulonephritis
- Interstitial disease
-Acute tubular necrosis

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14
Q

What are the post renal causes of AKI?

A

-Kidney stones
-Masses
-Ureter or ureteral strictures
-Enlarged prostate or prostate cancer

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15
Q

What is the management of AKI?

A

*IV fluid if pre renal cause
*Stop nephrotoxic medications
*Relieve obstruction if post renal - insert a catheter
*Treat the underlying cause

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16
Q

What are the complications of AKI?

A

*Hyperkalaemia
*Fluid overload, heart failure, pulmonary oedema
*Metabolic acidosis
*Uraemia -> encephalopathy or pericarditis

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17
Q

What are the nephrotoxic drugs?

A

*ACEi
*ARBs
*NSAIDs
*aminoglycosides
*Cyclosporin
*Tacrolimus
*amphotericin B
*Cisplatin
*Acyclovir
*Ampicillin

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18
Q

What are the causes of chronic kidney disease?

A

*Diabetes
*Hypertension
*Age related decline
*Glomerulonephritis
*Polycystic kidney disease
*NSAIDs, PPIs, Lithium

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19
Q

What are the risks for chronic kidney disease?

A

*Age
*Hypertension
*Diabetes
*Smoking

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20
Q

What is the presentation of chronic kidney disease?

A

*Often asymptomatic until the late stages
*Fatigue
*Oedema
*Nausea and/or vomiting
*Pruritis due to build up of waste
*Restless legs (uraemia)
*Anorexia

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21
Q

What investigations should be carried out in suspected chronic kidney disease?

A

*UEs + eGFR
*Serum glucose
*Urinalysis
*Urinary albumin: AER (albumin excretion rate) or ACR (albumin to creatinine ratio)
*Renal ultrasound

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22
Q

What is needed to confirm the diagnosis of chronic kidney disease?

A

eGFR 2 tests 3 months apart

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23
Q

Explain albumin categories of chronic kidney disease

A

A1: AER<30 or ACR <3

A2: AER 30-300 or ACR 3-30

A3: AER >300 or ACR >30

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24
Q

Explain the GFR category of chronic kidney disease

A

G1: GFR>90 + pathological diagnosis or haem/proteinuria or radiological abnormality

G2: GFR 60-89

G3: GFR 45-59

G3b: 30-44

G4: 15-29

G5 <15

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25
What are the complications of CKD?
- anaemia - renal bone disease - cardiovascular disease - peripheral neuropathy - dialysis related problems
26
What is the managment of CKD?
* ACEi, dapagliflozin, statin * If hypertension is not controlled consider addign another agent * monitor K+ * Iron supplements and erythropoietin * vitamin D, low phosphate diet and bisphosphonates if osteoporosis
27
What are the indications of RRT?
* Medically resistant hyperkalaemia * medically resistant fluid overload * Medically resistant acidosis * Uraemic pericarditis * Uraemic encephalopathy * Dialysable toxins (aspirin, lithium, toxic alcohol)
28
How often does haemodialysis take place
4 hours 3 times a week
29
What are the complications of haemodialysis?
* Acute hypotension * Access problems * Cramps due to sodium flux * Fatigue * Hypokalaemia * Blood loss * Air embolism * Dialysis disequilibrium
30
What are the complications of peritoneal dialysis?
* Infection- peritonitis * Glucose load - development or worsening of diabetes * Hypoalbuminaemia * Peritoneal membrane failure * Mechanical: hernia, diaphragmatic leak, dislodged catheter * Encapsulating peritoneal sclerosis
31
What are the pros of renal transplant?
* No dialysis * Improved fertility * Better renal funciton * More independent * Better life expectency * Cost
32
What are the cons of renal transplant?
* Immunosuppression * higher cardiovascular risk * Higher infection risk * Post transplant diabetes * Skin malignancy
33
Nephrotic syndrome
- 3.5g proteinuria for 24 hours (urine PCR>300) - serum albumin<30 - oedema - ± hyperlipidaemia
34
Nephritic syndrome
- Hypertension - Blood and protein in the urine - Declining kidney function
35
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
36
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
37
Presentation of minimal change disease
- nephrotic - acute presentation - idiopathic or secondary to malignancy
38
Treatment of minimal change
High dose prednisolone
39
Presentation of IgA nephropathy
- peak in age 20s - Nephritic syndrome - most common cause of primary glomerulonephritis - following sore throat 1-2 days
40
Histology of Ig A nephropathy
IgA deposits and glomerular mesangial proliferation
41
Presentation of membranous glomerulonephritis
- peak in 20s and 60s - majority are idiopathic - nephrotic syndrome
42
Histology of membranous glomerulonephritis
IgG and complement deposits on the basement membrane
43
Presentation of post streptococcal glomerulonephritis
- 1-3 weeks post strep infection - Nephritic syndrome - usually a full recovery
44
Presentation of Goodpasture syndrome
Glomerulonephritis and pulmonary haemorrhage causing AKI and haemoptysis
45
Diagnosis of adult polycystic kidney disease
Renal ultrasound scan: - Age 15-30: 2 cysts and a family history - Age 30-59: 3 cysts in each kidney and a family history - >60: 4 cysts in each kidney and a family history - if no family history then 10+ cysts
46
What is Alport's?
X linked condition affecting collagen. Causes sensorineuro deafness and renal failure. Can affect other organs including the eyes
47
What is Fabry's disease?
X linked storage disorder. REsults in end stage renal failure and proteinuria. Causes neuropathy, cardiac problems and skin changes
48
What is the pathophysiology of diabetic nephropathy?
hyperglycaemia -> osmotic load -> volume expansion -> intra glomerular HTN -> hyperfiltration -> proteinuria -> HTN and renal failure
49
What is the presentation of diabetic nephropathy?
- protienuria - usually with other diabetic complications - happens after around 20 years of diabetes
50
Presentation of renal artery sclerosis
- hypertension (rapid, resistant to treatment) - CKD - flash oedema - AKI after administration of ACEi/ARB
51
What is amyloidosis?
Deposition of insoluble protienous material in extracellular space
52
What is the presentation of amyloidosis?
- nephrotic syndrome (oedema) - fatigue, weight loss, dyspnoea - periorbital purpura/eyelid petechiae
53
Investigation for amyloidosis
- congo red staining: apple green birefringence - serum/urine immunofixation
54
Causes of nephrotic syndrome
- amyloidosis - membranous glomerulonephritis - focal segmental glomerulosclerosis - minimal change
55
Causes of nephritic syndrome
-IgA - post streptococcal glomerulonephritis
56
What are the indications for circumcision?
- phimosis - recurrent balanitis - paraphimosis
57
What must be excluded before circumcision?
hypospadias
58
risk factors for erectile dysfunction
- beta blockers - SSRI - alcohol - all CVD risk factors
59
What are the causes of a unilateral hydronephrosis?
- pelvic ureteric obstruction - aberrant renal vessels - calculi - tumour
60
What are the causes of bilateral hydronephrosis
- stenosis of the urethra - urethral valve - prostatic enlargement - extensive bladder tumour - retro peritoneal fibrosis
61
Hydronephrosis investigation
USS
62
hydronephrosis acute upper urinary tract
nephrostomy
63
chronic upper tract. obstruction hydronephrosis
ureteric stent/pyeloplasty
64
Investigation prostate cancer
multiparametric MRI
65
Renal stones imaging
non contrast CT-KUB
66
renal stone 5-10mm
shock wave
67
renal stone 10-20mm
shock or ureteroscopy
68
renal stone >20mm
percutaneous nephrolithotomy
69
ureteric stone
shockwaves lithotripsy ± alpha blockers
70
BPH medication to start first
alpha 1 blocker
71
hyperacute renal transplant
- minutes to hours - type II - have to remove
72
acute renal transplant reaction
- less than 6 months - mismatched HLA - asymptomatic, increased creatinine, pyuria and proetinuria - steroids and immunosuppression
73
Acute interstitial glomerulonephritis
- urine WCC and eosinophils - impaired renal function - fever, rash, arthralgia
74
Henoch schonlein purpura
- abdo pain - arthritis - haematuria - purpuric rash
75
Monitoring in henoch schonlein
BP and urinalysis
76
why does nephrotic syndrome result in a pro thrombotic state?
Loss of antithrombin III
77
Causes of acute interstitial necrosis
- penicillin - rifampicin - NSAIDs - allopurinol - furosemide
78
Symtpoms of acute interstitial necrosis
- fever - rash - eosinophilia - HTN - mild renal impairment
79
ADPKD type 1 chromosome
16
80
inheritance of alports
X linked dominant
81
management of anti flomerular basement membrane
- plasma exchange - steroids
82
symptoms of anti glomerular basement membrane
pulmonary haemorrhage and rapidly prgressing glomerulonephritis
83
When should you start an ACEi in diabetic nephropathy?
When the ACR is ≥3
84
features of haemolytic uraemic syndrome
AKI + thrombocytopenia + microangiopathic haemolytic anaemia
85
peritonitis peritoneal dialysis
staphylococcus epidermidis
86
treatment of peritonitis peritoneal dialysis
vanc and ceftazidime
87
jaundice in gilberts
rise in unconjugated bilirubin
88
what HBA1c is diagnostic?
48+
89
Asymptomatic bacteruria in catheterised patients
dont treat
90
variance
square of the standard deviation
91
what does VSD increase the risk of?
Endocarditis
92
Osteomalacia presentation
- bone pain - tenderness - proximal myopathy
93

Finals (37 decks)

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