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Y4 Uro ENT Ophtho > Renal > Flashcards

Renal Flashcards

1
Q

Total body water = 2/3 X + 1/3 Y

A

2/3 ICF + 1/3 ECF

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2
Q

Is potassium / sodium / chloride high inside or outside the cell?

A

Potassium higher inside cell

Sodium / chloride higher outside cell

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3
Q

What effect does PTH have on calcium and phosphate?

A

Increases Ca and decreases phosphate

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4
Q

What should be measured on examination for a PTX presenting with haematuria?

A

Blood pressure

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5
Q

What is the 1st line investigation (other than bloods) for haematuria?

A

<50yr 1st line renal US

>50yr flexible cystoscopy

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6
Q

How many grams of proteinuria is in:

  • Microalbuminuria
  • Asymptomatic
  • Heavy
  • Nephrotic
A

Microalbuminuria 30-300mg
Asymptomatic <1g
Heavy >1g
Nephrotic >3g

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7
Q

NSAIDs should always be stopped in AKI except…

A

Aspirin in cardiac dose 75mg

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8
Q

Potassium greater than what is life-threatening?

A

6.5

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9
Q

Are the QRS broad or narrow in hyperkalaemia?

A

Broad

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10
Q

What is the management of hyperkalaemia?

A

10ml 10% calcium gluconate (protects myocardium) + 10 units insulin + 50ml 50% dextrose +- NEB SABA

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11
Q

What is the definition of an AKI?

A 
Creatinine rise >26.4 in 48hr
OR
Creatinine >50% baseline in 7 days 
OR
UO <0.5ml/kg/hr
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12
Q

What drugs should be stopped immediately if you suspect in AKI?

A

NSAID, ACEI, ARB, aminoglycoside, diuretic, metformin, contrast agents

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13
Q

What are the 3 types of AKI?

A

Pre-renal, renal, post-renal

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14
Q

What type of AKI can sepsis cause?

A

Pre-renal (due to hypotension)

Cardiogenic shock, anaphylaxis also cause AKI through hypotension

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15
Q

Volume depletion causes what type of AKI? Give an example of something causing volume depletion

A

Pre-renal

D&V, haemorrhage, burns

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16
Q

What type of AKI can NSAIDs/ ACEI/ ARB cause and through what mechanism?

A

Pre-renal through volume depletion

Gentamicin does it through renal cause

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17
Q

What causes “dark smokey grey urine”?

A

Rhabdomyolisis

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18
Q

Hypo or hyperkalaemia in rhabdomyolysis?

A

Hyper

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19
Q

Name 3 causes of rhabdomyolysis?

A

Fall with a long lie
Crush injury
Status epilepticus
PWID collapse

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20
Q

What blood test for rhabdomyolysis?

A

Creatinine kinase

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21
Q

Name 3 causes of post-renal AKI

A

Calculi
Urethral stricture
BPH/prostate Ca blocking urethra
Pelvic malignancy

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22
Q

What type of AKI does rhabdomyolsis cause?

A

Renal

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23
Q

What type of AKI can malignant HTN cause?

A

Renal

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24
Q

Describe the JVP in dehydration / fluid overload?

A

Dry can’t see

Raised overloaded

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25
Q

Presentation of AKI - fluid overload or dehydration?

A

Either / both

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26
Q

What is urine output for an AKI?

A

<0.5ml/kg/hr for 6hr

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27
Q

If you see protein on urinalysis, what Ix should you do next?

A

UPCR

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28
Q

What Ix if suspect AKI due to obstruction?

A

US

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29
Q

Does a CT KUB have contrast?

A

No

contrast nephrotoxic

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30
Q

What is a stage 1 AKI?

A

1-1.9X creatinine or

UO <0.5ml/kg/hr for 6hr

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31
Q

What is a stage 2 AKI?

A

2-2.9X creatinine or

UO <0.5ml/kg/hr for 12hr

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32
Q

What is a stage 3 AKI?

A

3X creatinine or
need for RRT or
UO <0.3ml/kg/hr for 12hr

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33
Q

What is the 1st line Mx of AKI?

A

250ml crystalloid fluid bolus

reassess + repeat, seek senior help if >1L with no response

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34
Q

What is the Mx of HUS?

A

Plasma exchange + FFP

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35
Q

What are the indications for dialysis in AKI?

A
  • Refractory K >6.5 or initial >7
  • Pulmonary edema
  • Stage 4/5 CKD
  • Intrinsic renal disease
  • Creatinine >300
  • Uremic comp
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36
Q

How long abnormalities present for Dx of CKD?

A

3mth

measure eGFR 3mth apart

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37
Q

If detect initial abnormal eGFR - should repeat in X to rule out rapid progression

A

2wk

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38
Q

Erythropoetin stimulates ____ production

A

RBC

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39
Q

What is the cause of renal artery stenosis?

A

Atherosclerosis

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40
Q

ACEI are contraindicated in bilateral RAS - T or F?

A

True

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41
Q

Lupus renal disease - what drug do you always give

A

Hydroxychloroquine

42
Q

DM nephropathy - patients should be screened annually using what

A

Urine albumin creatinine ratio ACR

43
Q

1st line Mx of diabetic nephropathy

A

ACEI

44
Q

What is the 1st sign of diabetic nephropathy?

A

Proteinuria

45
Q

CKD is usually asymptomatic - T or F

A

True

46
Q

What is GFR in CKD

A

Below 60

47
Q

“Low appetite, N&V, yellow skin, pericardial rub, pericarditis, itch, flap, tremor, encephalopathy”

A

Uraemia

48
Q

Brown granular casts

A

Acute tubular necrosis

49
Q

Red cell casts

A

Nephritic syndrome

50
Q

White cell casts

A

Interstitial nephritis or UTI

51
Q

Is urea a good marker of renal function?

A

Poor marker of renal function, varies with hydration / diet, levels vary throughout the day

52
Q

What type of anaemia is seen in CKD?

A

Normocytic normochromic anaemia

53
Q

Do all PTx with CKD get a renal US on initial investigation?

A

Only if accelerated progression / visible or persistent non-visible haematuria / suspect obstruction GFR <30 / FH PCKD

54
Q

If renal US abnormal in CKD, what scan is done next?

A

CT

55
Q

What size are kidneys in CKD?

A

Initially large then small

56
Q

What size are kidneys in GN?

A

Small

57
Q

What are the criteria for referral in CKD?

A 
GFR <30
Suspect genetic cause
Suspect RAS
HTN uncontrolled on 4 drugs
ACR>70
Decrease of eGFR of 15 or 25% in 1yr
58
Q

What are the stages of CKD?

A 
1 normal eGFR >70 + other evidence CKD
2 mild eGFR 60-89 + other evidence CKD
3a 45-59 moderate
3b 30-44
4 15-29 severe
5 <15 or on dialysis
59
Q

All CKD PTx get a statin - T or F

A

I think so

60
Q

What are the extra immunisations for PTx with CKD?

A

Influenza + pneumococcus

61
Q

1st line Mx of hypertensive nephropathy

A

ACEI

2nd ARB

62
Q

Mx of metabolic acidosis in CKD?

A

Oral sodium bicarbonate

63
Q

Mx of anaemia in CKD?

A

Fe + Epo IJ

64
Q

What vit is supplemented in CKD?

A

Vit D

65
Q

What is definition of kidney failure?

A

GFR<15 or need for RRT

66
Q

What is osteomalacia?

A

Severe vit D deficiency
(in CKD high phos levels drag Ca out bones)
(supplement calcitriol)

67
Q

Type of hyperparathyroidism in CKD?

A

Secondary

tertiary after years

68
Q

1st and 2nd line Mx of CKD mineral bone disease?

A

1st reduced dietary intake of phosphate

2nd phosphate binders (sevelamer)

69
Q

Rugger jersey spine

A

(secondary)

Hyperparathyroidism

70
Q

Is interstitial nephritis a type of glomerulonephritis?

A

No separate thing

inflam of interstitium not glomerulus

71
Q

Cresenteric on film

A

Rapidly progressive GN

72
Q

Ab against type IV collagen

A

Goodpasture’s syndrome

73
Q

What is the auto Ab in Goodpasture’s?

A

Anti-GBM Ab glomerular basement membrane

74
Q

Goodpasture’s = X + Y

A

AKI + haemoptysis

75
Q

Post-strep GN nephrotic or nephritic?

A

Nephritic

76
Q

Goodpasture’s - nephrotic or nephritic

A

Nephritic

77
Q

FSGS - nephrotic or nephritic

A

Nephrotic

78
Q

Membranous nephropathy - nephrotic or nephritic

A

Nephrotic

79
Q

Rapidly progressive GN - nephrotic or nephritic?

A

Nephritic

80
Q

Minimal change disease - nephrotic or nephritic

A

Nephrotic

81
Q

What is the commonest nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

82
Q

What is the commonest GN overall?

A

Membranous nephropathy

83
Q

What is the commonest nephrotic syndrome in children?

A

Minimal change disease

84
Q

There is normal renal function in minimal change disease - T or F

A

True

85
Q

On what test can minimal change disease be diagnosed?

A

Electron microscopy

86
Q

What is the Mx of minimal change disease?

A

PO CCS

87
Q

What is the Mx of FSGS?

A

PO CCS

88
Q

What are the features of nephrotic syndrome?

A

Proteinuria >3g frothy urine
Peripheral edema (incl face in child)
Hypercholesterolemia
Serum albumin <25

89
Q

What auto Ab is seen in membranous nephropathy?

A

PLA-2

90
Q

What type of GN may be idiopathic or caused by malignancy, lupus, rheumatoid arthritis or drugs eg gold?

A

Membranous

91
Q

Berger’s disease AKA

A

IgA nephropathy

92
Q

What are the features of nephritic syndrome?

A

HTN + haematuria

proteinuria <3g/24hr

93
Q

What is the commonest primary GN?

A

IgA nephropathy

94
Q

IgA nephropathy

  • peak age
  • what auto Ab
  • nephritic or nephrotic
  • what is common PC
A

20s
IgA1
Nephritic
Macroscopic haematuria following URTI

95
Q

What infections trigger post-strep GN?

A

Tonsillitis / impetigo

96
Q

Why are complement levels checked in kidney disease?

A

Low in SLE

97
Q

What test checks for strep?

A

ASO titre

98
Q

Commonest renal carcinoma type?

A

Clear cell

99
Q

Paraneoplastic effect from RCC?

A

Polycythemia (secrete epo)

Hypercalcaemia (parathyroid hormone like substance

100
Q

Paraneoplastic syndrome of RCC; >ALP liver dysfunction without liver met

A

Stauffer’s syndrome

101
Q

Cannonball metastasis to lungs (CXR multiple round lesions)

A

Renal Cell Carcinoma

102
Q

What test is diagnostic of renal cell carcinoma?

A

CT (enhances)

Other renal primaries are rare + don’t enhance on CT

Y4 Uro ENT Ophtho (4 decks)

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