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Year 6 - MBBS COPY > Passmed: Renal > Flashcards

Passmed: Renal Flashcards

(49 cards)

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1
Q

How do you calculate the anion gap?

A

(Na+K) - (Cl+HCO3)

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2
Q

What is the anion gap normal range?

A

10-18mmol/L

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3
Q

What are causes of met acidosis w raised anion gap? (4)

A

KULT ACEGIFTS:
Ketoacidosis
Uraemia
Lactate
Toxins

Aminoglycosides
Carbon Monoxide
mEthanol
Glycols
Isoniazid
Ferrous
Theophyllines
Salicylates

CAT MUDPILES:
Carbon Monoxide
Aminoglycosides
Theophyllines

Methanol
Uraemia
DKA
Paracetamol
Propylene Glycol
Isoniazid
Iron
Lactate
Ethanol
Ethylene Glycol
Salicylates

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4
Q

What are the two types of lactic acidosis?

A

A: sepsis, shock, hypoxia

B: metformin + NO hypo

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5
Q

What are causes of met acidosis w normal anion gap? (4)

A

HARD:
Hypoaldosteronism
Acetazolamide
Renal Tubular Acidosis
Diarrhoea

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6
Q

What are causes of met alkalosis? (4)

A

Hyperaldosteronism
Diuretics
HypoK
Vomiting

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7
Q

What are biochem problems in CKD?

A

Dec phosphate excretion + 1α hydroxylation

The high phosphate leads to low calcium and thus osteomalacia

The high PO4, low Ca, low vit D leads to 2° hyperPTH

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8
Q

What are the mx principles of CKD?

A

Aim to reduce the PO4/PTH and inc the Ca/vit D: dietary, phosphate binders, calcitriol

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9
Q

Give two phosphate binders used in CKD mx

A

Calcium Acetate: calcium based ie sx of hyperCa bones stones groans moans

Sevelamer: non-calcium based ie just sx of GI discomfort

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10
Q

What is 1° + 3° hyperPTH?

A

Both have high Ca and low PO4

1°: parathyroid adenoma a/w MEN syndrome

3°: autonomous PTH secretion post renal transplant

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11
Q

What leads to tubular cell apoptosis? (2)

A

Aminoglycosides + Radiological Contrast Media

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12
Q

What leads to tubular cell necrosis? (2)

A

Myoglobinuria + Haemolysis

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13
Q

How do the different tx for hyperK work?

A

Stabilises the cardiac membrane: 10mL 10% IV calcium gluconate

Shifts K extra-intracellular: 50mL 50% dextrose w 10U insulin infusion or 5mg salbutamol nebs

Removes K from the body: calcium resonium enema>oral, loop diuretics, dialysis

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14
Q

What is spironolactone switched to following troublesome gynaecomastia?

A

Eplerenone

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15
Q

How do pts w rhabdomyolysis typically px?

A

Had a fall or prolonged epileptic seizure and found w acute kidney injury on admission

Ddx UTI, dehydration, biliary obstrc, renal cell carcinoma

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16
Q

What are the clinical findings if rhabdomyolysis?

A

AKI w disproportionately raised creatinine, elevated CK, myoglobinuria, low Ca, high PO4, high K, met acidosis

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17
Q

Why do pts w rhabdomyolysis have low Ca and high PO4?

A

The myoglobin binds to calcium and the myocytes release phosphate

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18
Q

What is McArdle’s syndrome?

A

Def of muscle phosphorylase needed for glycogen breakdown

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19
Q

Tx Rhabdo -> AKI

A

Rehydrate w normal saline until the JVP is seen but if still anuric ?dialysis ?US ?catheter

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20
Q

What are the indications for dialysis? (4)

Study These Flashcards
A

HyperK >6.1
Acidosis <7.35
Pulmonary Oedema
Uraemic Pericarditis

Too much: potassium, acid, fluid, urea

21
Q

Comps of haemodialysis

Study These Flashcards
A

Infection and stenosis at site, endocarditis, arrhythmia, hypotension, air embolus, anaphylaxis, disequilibration syndrome

22
Q

Comps of peritoneal dialysis

Study These Flashcards
A

Infection and blockage of catheter, peritonitis, constipation, fluid retention, hyperglycaemia, hernia, back pain

23
Q

Which drugs are usually safe to continue in AKI? (6)

Study These Flashcards
A

Paracetamol, low dose aspirin, clopidogrel, warfarin, beta blockers, statins

24
Q

Which drugs should be stopped in AKI as may worsen renal function? (5)

Study These Flashcards
A

NSAIDs, ACEi, ARBs, diuretics, aminoglycosides

25
Which drugs may have to be stopped in AKI as inc risk of toxicity? (3)
Metformin, lithium, digoxin
26
What is the most common extra-renal manifestation of ADPKD?
Liver Cysts
27
What ix excludes diabetes insipidus?
Urine osmolality of >700 mOsm/kg
28
Which hereditary condition can cause cranial DI?
Haemochromatosis
29
Which psych drug can cause nephrogenic DI?
Lithium
30
HUS
Preceding diarrhoea then the triad of AKI, MAHA and thrombocytopenia
31
TTP
Px w neuro signs
32
What is the relative importance of the HLA antigens when matching for a renal transplant?
DR > B > A
33
Which infection can cause acute graft failure post kidney transplant?
CMV
34
Timeframe of acute + chronic graft failures
> 6mnths
35
Why can you get an aortic flow murmur in anaemia?
The hyperdynamic circulation causes turbulent flow
36
What do you need to monitor when pts are on long term immunosuppression? (3)
CVS, Renals, Malignancy
37
What are the criteria for dx AKI?
1. Riss in Cr of >=26 over 48hrs 2. Rise in Cr by >=50% over 7d 3. Fall in UO to <0.5ml/kg/hr for 6hrs adults and 8hrs children 4. Fall in eGFR by >=25% over 7d
38
Anti-GBM: DISGAPMMSSP
A rare type of small-vessel vasculitis a/w both pulm haemorrhage and rapidly progressive glomerulonephritis Twice as common in males w a bimodal age distribution of 20-30 and 60-70 a/w HLA DR2 The abs are against type IV collagen and linear IgG deposits can be seen along the basement membrane on renal biopsy Tx w plasmapheresis, steroids, cyclophosphamide
39
At what eGFR do you refer to the nephrologist? (3)
Anytime <30, <15 in a year, <25% and change in category
40
What should be checked before starting EPO in CKD pts?
Iron Studies
41
When does the anaemia in CKD become apparent?
GFR <35
42
When should other causes of anaemia be considered aside from ACD in CKD?
GFR >60
43
How long do AV fistulae take to develop?
2m
44
What flow rates can AV fistulae stand?
500mL/min
45
McArdle Disease: Inheritance + Deficiency
AR + Muscle Phosphorylase
46
Comp of CAPD
Peritonitis w staph epidermidis
47
Addison’s Disease Na + K
Low Na + High K
48
Def of persistent non-visible haematuria
Pos urine dip 2/3 samples tested 2/3 wks apart
49
When do you urgently refer haematuria to urology?
>=45 AND unexplained visible w/o UTI >=60 AND unexplained non-visible w either dysuria or raised WCC

Year 6 - MBBS COPY (35 decks)

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