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Year 6 > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

Indications for dialysis

A

Hyperkalaemia
Fluid overload
Metabolic acidosis
Uraemic
CKD stage 5
Drugs intoxication

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2
Q

Types of RRT and when they are used

A

Haemofiltrations- AV fistula made
Used in IBD and ITU

Peritoneal- 1st

Transplant- 3rd

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3
Q

Causes of ARF

A

Pre- sepsis or hypovolaemia

Renal- vasculitides, glomerulnephritis, ATN, AIN

Post renal- stones

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4
Q

Types of intrinsic renal failure and sx

A

Vasculitis- HUS, TTP, DIC, GPA, eGPA

GLN- minimal, membranous- nephrotic syndrome

ATN- hypo perfusion, rhabdo- high urine sodium, low urine osmolarity

AIN- drugs- systemic symptoms

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5
Q

Hypovolaemia vs ATN

A

Urine sodium- low in hypo, high in ATN

Urine osmolarity- high in hypo, low in ATN

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6
Q

Drugs to stop in AKI

A

DAMN

Diuretics
ACEi/ARB- these are ok in CKD
Metformin
NSAIDs

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7
Q

Stages of AKI

A

1- increase of creatinine by 1.5-1.9
Or 0.5ml/kg/hr for 6hrs

2- 2-2.9
For 12 hrs

3- >3
For 0.3 24 hours

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8
Q

Stages of CKD

A

1>90
2 60-90
3 30-60
4 15-30
5 <15

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9
Q

When to refer to nephrologist in CKD

A

GFR <30
Decrease >25% or by 15 in 12 months

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10
Q

Medical management of CKD

A

Phosphate binders- sevelamar

Vit D

IM erythropoietin

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11
Q

Consequences of CKD

A

Acidosis, hyperkalaemia
Anaemia, bone disease
CVD
Uraemia

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12
Q

Non proliferative GLN

A

Nephrotic syndrome

Membranous- adults- SLE or drugs
Minimal- children
Focal segmenting- secondary to obesity to HIV

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13
Q

Proliferative GLN

A

Nephritic

IgA- 2-3d after URTI

Post infection- weeks

Rapid progressing
Vasculitis- GPA, eGPA
Anti-GBM- goodpastures- haemoptysis, nephritic

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14
Q

Differentiating RPGLN

A

Saddle nose, epistaxis, haemoptysis, haematuria, cANCA- GPA

Asthma, eosinophils, nephritic- eGPA

Haemoptysis, haematuria, GBM AB

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15
Q

IgA nephropathy sx

A

Purpuric rash
Arthralgia
Abdo pain
GLN

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16
Q

Brown cells in urine

A

ATN

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17
Q

Red cast cells in urine

A

Nephritic

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18
Q

Mx of AD PKD

A

Tolvaptan

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19
Q

Features of AD PKD

A

Renal cysts
Liver cysts- hepatomegaly
Berry aneurysm
Mitral valve prolapse
Renal failure signs

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20
Q

Sx of renal cell carcinoma

A

Loin pain, mass and blood

Left varicocele

EPO- PC, PTHrP- hyper cal, renin, ACTH- Cushing

Cannon ball mets

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21
Q

Mx of renal cell carcinoma

A

Nephrectomy

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22
Q

ATN vs AIN vs GLN

A

Urine drip

Blood- GLN

AIN- higher white cells because inflammatory process- allergic response

ATN- no cellular content- caused by ischaemia or nephrotoxic drugs- gentamicin
Poor response to fluid challenge

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23
Q

Alports syndrome sx

A

Haematuria
Deafness
Progressive renal failure

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24
Q

Causes of AIN

A

PANDA
Allergic response to drugs:
PPI
ABx
NSAIDs
Diuretics
Allopurinol

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25
Causes of renal artery stenosis
Old- atherosclerosis Young- fibromuscular dysplasia
26
Fibromuscular dysplasia sx
String of beads on MR angiography HTN CKD- or acute after ACEi
27
Diagnosis of CKD
Reduced eGFR and markers of kidney disease Proteinuria, haematuria, electrolyte abnormalities
28
Which antigen is most important for renal transplant
HLA DR
29
How to tell CKD vs AKI on imagine
CKD- small Apart from PKD, diabetic nephropathy early, amyloidosis
30
Organism associated with peritonitis secondary to peritoneal dialysis
Coagulase negative staph Staph epididimis
31
Monitoring of those with renal transplants
Malignancy- skin- sun exposure Renal failure CVD
32
How to tell if pre renal or renal from bloods
If Urea more than creatinine raise- pre renal
33
Tx of ACR >3 in CKD and DM
ACEi
34
Tx of ACR >3 in CKD and DM
ACEi
35
Types of tubule renal acidosis
All cause hyperchloraemic metabolic acidosis Type 1- unable to secrete H+- distal Hypokalaemia Causes renal stones Type 2- proximal Hypokalaemia Osteomalacia Type 3- rare Type4- Hyperkalaemia Low aldosterone 214- low low more
36
AKI but with unknown aetiology and normal bloods Ix
Renal USS
37
What should all patients with CKD be started on
Statin
38
Mx of AKI
Fluid assess Bloods- set up ECG Assess medication Urinalysis Imaging for post renal Correct the cause
39
Tx of hyperkalaemia
10% 10ml Calcium gluconate 10 U Insulin/dextrose neb salbutamol Calcium resonium Dialysis
40
If CKD and need contrast what do you give
IV fluids to dilate and reduce nephropathy
41
How to tell if rhabdo caused AKI
If CK >10,000 Tea coloured urine
42
What should be monitored with a patient With IgA neph
Blood pressure Urinalysis
43
Sx of IgA neph
After illness Abdo pain Arthritis Rash
44
Minimal change tx
Prednisolone
45
Biopsy of membranous nephropathy
Thick BM Sub epithelial spikes on silver staining
46
Biopsy of focal segmenting
Focal and segmental sclerosis on light microscopy and foot effacement on EM
47
Anti GBM biopsy
IgG along BM linear deposition
48
CI to transplant
Cancer Active infection Severe Co morbidity
49
Sx of urea build up
Grey tinge Vomitting Confusion Seizure Coma
50
Pt with pain in hips after transplant
Avascular necrosis
51
Why do those with replacing minimal change disease get repeated infections
Loss of IG in the urine
52
If CKD and normocitic anaemia what is tx
SC erythropoietin only if no IDA
53
What solution is use in peritoneal dialysis
1.5% glucose
54
Dx of IgA nephropathy
Urinalysis, MCS Biopsy
55
Kidney stones order of Ix
Urine dip then CT
56
Which drug can cause a rise in creatinine without affecting kidneys
Trimethoprim
57
Types of chronic urinary retention
High pressure- if impaired renal function and bilateral hydronephrosis Outflow obstruction Low pressure- normal
58
If proteinuria and diabetic what drugs can you give
ACEi SGLT2 Better to catch at microalbuminuria as it is reversible
59
Inheritance and chromosomes of PKD
AD 16 + 4- better
60
Drug that reduces CKD progression in ADPKD
Tolvaptan
61
If CKD post menopausal
Vit D- calcitriol and BP
62
Early testing for CKD in DM
Early morning ACR
63
What can cause FSG
HIV
64
DVT with low albumin dx and reasoning
Nephrotic syndrome Allows loss of antithrombin 3 and plasminogen
65
Outcome for those with minimal change
1/3 never again 2/3 later reoccurrence
66
Types of hepatorenal sx
1- acute <2 weeks 2- slow
67
Excretion of DOACs
Dab- renal Rivaroxaban- liver livarox Apixiban- faecal - good if renal impaired
68
Large kidneys in chronic kidney disease
HIV induced PKD Early diabetic Amyloid
69
Anaemia in CKD tx
Correct IDA first with supplements then EPO
70
Ix of PKD
Ultrasound
71
High phosphate in CKD
Diet mod 1st then binders 2nd
72
How long does it take for AV fistula to be ready
6-8 weeks
73
Which murmur is heard in PKD
Mitral valve prolapse Click and regurg
74
Tx of hyper acute rejection
Remove kidney
75
Which medications do not worsen AKI but have to be stopped due to toxicity
Metformin Digoxin Lithium
76
SE of calcium acetate
Calcium binders- cause hypercalcaemia and vascular calcification Used to reduce phosphate
77
Selevemer moa
Phosphate binder- used in CKD
78
What is indicative that the patient has nephrogenic DI instead of cranial from history
Kindey damage ie low GFR
79
Investigating diabetic nephropathy
Measure ACR- can be spot test which if abnormal- >2.5 First pass- if + in 2/3 specimens with absence of infection
80
Loss of vision after renal transplant
CMV retinitis
81
Tx of rhabdo
Iv saline
82
eGFR variables
CAGE Creatinine Age Gender Ethnicity
83
Indication for dialysis
K >6.5 Fluid overload <7.1 pH Uraemia CKD 5
84
Dx of post strep glomerulonephritis
Anti strep O titre
85
If AKI what ix do you have to do
US renal tract
86
Acute vs chronic graft rejection
Acute <6 month - rising pyuria, proteinuria and creatine Confirmed with biopsy
87
Rhabdo features
Tea coloured urine High K Low Ca
88
What test can determine ATN
Poor response to fluid challenge
89
SE of EPO
Flu like HTN Encephalopathy pure red cell aplasia
90
What should all CKD patients be on
Statin
91
What scan should CKD patients have
DEXA

Year 6 (28 decks)

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