renal 1

Question 1

complication of AKI

Answer 1

fluid overload> pulmonary oedema
M: IV furesomide/ GTN infusion

uraemia - uraemic encephalitis , uraemic pericarditis
Mx: haemodialysis

met acidosis
confusion, tachy, KUSSMAUL breathing
M: IV/PO sodium bicarb / dialysis

Question 2

what occurs with AKI in terms of ions

Answer 2

hyperkalaemia

arrhythmia
muscle weakness, cramps, parasthesia
bradycardia hypotension

Question 3

what ecg changes happen in AKI?

Answer 3

hyperkalaemia occurs 
which means that you get 
TENTED t waves
prlonged PR
wide qrs

= bradycardia

Question 4

management of Hyperkalaemia ?

Answer 4

1) cardiac monitor
2) calcium gluconate 10% 30ml IV
OR cacl2 10% 10mls IV
protects myocardium

3) 10U soluble insulin - encourages K+ uptake by cells
4) so then you need to give additional glucose 5omls 50%

Question 5

investigations of AKI

fluid assessment

Answer 5

cap refill,
signs of dehydration so mucous membrane
raised JVP?
peripheral oedema so sacral and pitting

Question 6

what are the benefits of VBG?

Answer 6

lactate
metabolic acidosis
potassium
bicarb

Question 7

Bloods?

Answer 7

FBC
U&E
CRP
LFT
CK
clotting 

last two can indicate a cause

Question 8

nephrotoxic drugs?

Answer 8

lithium

abx - amoxicillin IV

Question 9

pre renal causes of AKI?

Answer 9

dehydration/ diuresis

Question 10

3 ways you can get pre renal ?

Answer 10

HYPOvolaemia 
acute haemorrhage 
sepsis 
pancreatitis
burns 
Gi losses

Low volume : 
heart failure 
cardiorenal syndrome
liver failure
hepatorenal syndrome
not enough proetein > oncotic pressure go down 

vascular insults 
ACEi
ARBs
NSAIDS
contrast 
renal artery stenosis

Question 11

post renal aki

classify?

Answer 11

Luminal
kidney stone in the ureter
blocking urine outflow
anuria

Mural
tube of ureter has become narrower
cancers
or stricture formation eg from chronic cystoscopy

extramural
BPH
abdo/ pelvic cancers

Question 12

renal AKI causes?

Answer 12

tubular
interstitial
vascular
glomerular

Question 13

spike and dome appearance on electron microscopy suggests which cause of nephrotic syndrome ?

mx?

Answer 13

membranous glomerulonephritis

steroids and conservative

Question 14

injury to podacytes
what would you see on renal biopsy?

this is what type of nephrotic syndrome?

mx?

Answer 14

focal segmental areas of mesangial collapse and sclerosis

FSGS

corticosteroids

Question 15

how does glomerular damage occur in diabetes ?

Answer 15

excess glucose > glycation of proteins> increased matrix deposition> glomerular damage

nodules of just pink which shows damage