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Medicine Year 5 > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

creatinine and urine output for the three stages of AKI

A

1: creatinine 1.5-1.9x & urine output 0.5ml/kg/hr for 6 hrs
2: creatinine 2-2.9x & urine output 0.5 ml/kh/hr for 12 hrs
3: creatinine 3+x & urine output 0.3 ml/kg/hr for 24 hrs

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2
Q

DAMN AKI pneumonic

A

Diuretics / Digoxin
ACEi / ARB
Metformin / Methotrexate
NSAIDs

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3
Q

which medication should you avoid in transplant patients as it is nephrotoxic

A

NSAIDs

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4
Q

metformin and AKI

A

does not worsen AKI but increases the risk of metformin toxicity

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5
Q

marker for AKI induced rhabdomyolysis

A

creatine kinase

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6
Q

how to manage metformin in patients at risk of contrast induced nephropathy

A

withhold for 48 hours and only restart when kidney function is normal

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7
Q

5 stages of eGFR for CKD

A

1: above 90 and signs of kidney damage
2: 60-90 and signs of kidney damage
3a: 45-59 and moderate reduction in function
3b: 30-44 and moderate reduction in function
4: 15-29 and severe reduction in function
5: below 15 and established kidney failure

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8
Q

4 variables measured in CKD

A

creatine
age
gender
ethnicity

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9
Q

eGFR in bodybuilders

A

disproportionally low

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10
Q

does hypocalcaemia indicate chronic or acute kidney disease

A

chronic

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11
Q

eGFR below 30 or eGFR which falls more than 15 in one year

A

refer

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12
Q

how would you correct phosphate levels in CKD mineral bone disease

A

correct with diet
then a phosphate binder e.g. sevelamer

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13
Q

pathophysiology of osteomalacia in CKD

A

high phosphate drags calcium from bones

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14
Q

management of CKD induced anaemia

A

correct iron deficiency THEN EPO stimulating agents

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15
Q

side effects of EPO

A

bone aches, flu sx, HTN, rashes, pure red cell aplasia, encephalopathy

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16
Q

medication to start in all CKD pts

A

statin

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17
Q

liver cysts and subarachnoid haemorrhages with berry aneurysms are found in what condition

A

polycystic kidney disease

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18
Q

inheritance of polycystic kidney disease

A

autosomal dominant

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19
Q

scan to screen for polycystic kidney disease

A

USS

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20
Q

first indicator of diabetic nephropathy

A

microalbuminuria

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21
Q

what do diabetics need annual screening for and why

A

albumin:creatinine ratio (ACR)

more than 3 then start ACEi/ARB

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22
Q

size of kidneys in diabetic nephropathy compared to CKD

A

diabetic: large or normal sized
CKD: small

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23
Q

ABG in DKA and sepsis

A

raised anion gap metabolic acidosis

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24
Q

ABG in addisons and diarrhoea

A

normal anion gap metabolic acidosis
(high K in addisons, low K in diarrhoea)

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25
does vomiting cause acidosis or alkalosis
alkalosis
26
too much 0.9% NaCl on ABG
metabolic acidosis
27
calculation of an anion gap
(+) - (-)
28
maintenance fluid in children
100 ml/kg for the first 10 kg 50 ml/kg for the next 10 kg 20 ml/kg for every 1kg after that
29
contraindication for peritoneal dialysis
crohns
30
most common organism in peritoneal peritonitis
staph epidermidis
31
maturation time for AV fistula
6-8w
32
rare but serious complication of haemodialysis
dialysis equilibration syndrome
33
most likely cause of death in patient with CKD on dialysis
IHD
34
pulmonary oedema with AKI and uraemia causing encephalopathy or pericarditis are indications for what
haemodialysis
35
transplant rejection in minutes to hours due to pre-existing antibodies against ABO/HLA
hyperacute reaction
36
which type of hypersensitivity reaction is a hyperacute reaction
2
37
management of a hyperacute reaction
removal due to thrombosis of vessels causing ischaemia and necrosis of the kidney
38
transplant rejection in under 6m due to mismatched HLA often presents asymptomatically with raised creatinine, urea and protein in urine
acute graft failure
39
most common infection in solid organ transplant recipients which can predispose acute graft failure
cytomegalovirus infection
40
management of acute graft failure
can be reversible in some cases with steroids and immunosuppressants
41
type of immune response in acute graft failure
cell mediated with cytotoxic t cells
42
antibody and cell mediated response causing fibrosis of the kidney in over 6m
chronic graft failure
43
which cancer does renal transplant predispose and why
SCC of the skin immunosuppressants
44
blood on urine dipstick
exercise
45
haematuria in endometriosis
cyclical haematuria
46
which infection can cause haematuria
TB
47
haematuria, loin pain and abdominal mass can present with pyrexia of unknown origin or with a varicocele
renal cell carcinoma
48
paraneoplastic syndromes in renal cell carcinoma
polycythaemia (raised EPO), hypercalcaemia (raised PTH)
49
children under 5 present with unilateral abdominal mass, flank pain, painless haematuria, fever and anorexia
wilms tumour
50
most common metastases for wilms tumour
lung
51
histology of bladder cancer
transitional cell
52
when would you do a 2ww referral for cystoscopy for bladder cancer
2 episodes of painless frank haematuria
53
4 causes of pre-renal disease
dehydration, haemorrhage, heart failure, sepsis all cause reduced perfusion to the kidney
54
urine osmolarity and serum sodium in pre renal
increased urine osmolarity and reduced Na as kidneys concentrate urine and retain sodium
55
most common cause of renal failure causing damage to tubular cells due to ischaemia or toxins results in dark brown urine with muddy brown casts
acute tubular necrosis
56
urine osmolarity and serum sodium in acute tubular necrosis (renal)
reduced urine osmolarity and increased sodium as kidneys cannot concentrate urine or retain sodium
57
which type of renal disease can compartment syndrome cause
acute tubular necrosis due to myoglobin
58
ABG in renal tubular acidosis
normal anion gap acidosis
59
most common nephrotic syndrome in paeds causing foot processes and podocyte fusion on renal biopsy
minimal change disease
60
management of minimal change disease
prednisolone
61
which virus can cause focal segmental glomerulosclerosis
HIV
62
haematuria, proteinuria, oliguria and htn presenting 1-2 WEEKS after URTI
post strep glomerulonephritis
63
1-2 DAYS after URTI
IgA nephropathy
64
oedema, increased protein, thick basement membrane and sub epithelial spikes associated with malignancy and positive PLA2
membranous glomerulonephritis
65
3 causes of rapidly progressive glomerulonephritis
goodpasture SLE wegeners
66
haemoptysis + AKI/proteinuria/haematuria
anti-GBM disease
67
systemic lupus erythematosus and proteinuria
lupus nephritis
68
impaired renal function with an allergic picture of high WCC, IgE and eosinophils in urine
acute interstitial nephritis
69
cause of acute interstitial nephritis
ABX (and other drugs)
70
cause and presentation of post renal
obstruction of urinary tract causing hydronephrosis on USS
71
x linked disease causing haematuria, bilateral sensorineural deafness and eye problems with splitting of the lamina densa on biopsy
alport syndrome
72
cause and management of haemolytic uraemic syndrome
E. Coli supportive therapy
73
abdominal pain, arthritis, haematuria and purpuric rash over buttocks and extensor surfaces of the arms and legs in children after an UTI
henoch schonlein purpura
74
investigation for diabetes insipidus
water deprivation test
75
cause and treatment for nephrogenic diabetes insipidus
lithium thiazides, low salt and protein diet
76
cause and treatment for cranial diabetes insipidus
hereditary hemochromatosis desmopressin
77
MOA of desmopressin
V2 receptor agonist
78
max rate of potassium infusion before cardiac monitoring
10
79
two medications for hyperkalaemia and roles
calcium gluconate: shifts potassium to stabilise the myocardium calcium resonium: removes potassium
80
young female with AKI after ACEi with the renal atereis showing a string of beads
fibromuscular dysplasia
81
medical management of ascites
spironolactone - aldosterone antagonist
82
how does alcohol cause polyuria
reduces ADH in posterior pituitary
83
hyaline casts
loop diuretics
84
how does nephrotic syndrome predispose VTE management
loss of antithrombin III give prophylactic LMWH

Medicine Year 5 (27 decks)

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