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Things I don't know, but need to know, for fourth year > Renal > Flashcards

Renal Flashcards

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1
Q

Type 1 Renal Tubular Acidosis

A

Cant secrete H+
Hypo k+
Renal Stones
Rheumatoid, SLE

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2
Q

Type 2 renal Tubular Acidosis

A

Reduced HCO3 reabsorption
Hypo K+
Causes Osteomalacia
Fanconi, Wilsons, Carbonic Anhydrase Inhibitors use

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3
Q

Type 3 Renal Tubular Acidosis

A

Rare due to Carbonic Anhydrase deficiency

Hypo K+

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4
Q

Type 4 Renal Tubular Acidosis

A

Hyper K+

Due to reduced Aldosterone

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5
Q

When can grade 1 and 2 CKD be diagnosed?

A

Only if signs and symptoms of CKD are present like altered U+Es.

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6
Q

What NSAID isn’t stopped during an AKI?

A

Aspirin at a cardio protective dose.

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7
Q

What are some signs of a prerenal injury?

A

Increased Serum Urea : Creatine ratio
Urea Plasma : Urea Urine is > 10:1
Urine Osmolarity >500
Low Urine Na+

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8
Q

Muddy brown casts within urine can indicate what?

A

Acute Tubular Necrosis

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9
Q

Causes of enlarged kidneys on USS

A

Polycystic kidney disease
Diabetic Nephropathy
Amyloidosis
Chronic HIV associated Nephropathy

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10
Q

What is the effect of CKD of kidney size?

A

Usually shrunken

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11
Q

Before a diagnosis of Renal Anaemia and EPO can be started what must be done?

A

Iron Studies and treatment of low iron

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12
Q

What is the commonest form of renal stones?

A

Calcium Oxalate - Radiopaque

Hypercalciuria

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13
Q

List some radiopaque renal stones and the common causes

A

Calcium Phosphate - Tubular Acidosis

Struvite Stones - Urease producing bacteria

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14
Q

What is the commonest Radiolucent renal stones?

A

Uric Acid stones

Xanthine stones

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15
Q

Struvite Stones

A

Magnesium Ammonia and Phosphate - Radiopaque
Staghorn Calculi
Urease producing bacteria

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16
Q

What bacteria are linked to struvite stones?

A

Proteus…

Ureaplasma

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17
Q

Signs of Acute Tubular Necrosis

A

> 40mmol of urinary Na+
<350 Urine osmolarity
Brown Casts
Poor response to fluid challenge

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18
Q

Risk Factors for Contrast Nephrotoxicity

A

> 70
Renal disease
Dehydration
Nephrotoxic drugs

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19
Q

How is the risk of contrast nephrotoxicity decreased?

A

12 hours pre and post operation give

IV 0.9% saline 1ml/kg/hour

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20
Q

What medication should be withheld post contrast and for how long?

A

Metformin for at least 48 hours until risk of AKI is decreased

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21
Q

Describe presentation, investigation results and management of Membranous Nephropathy.

A

Commonest nephropathy in adults
Linked to malignancy, hepatitis, Anti PLa2r antibodies
Thickened basement membrane and sub epithelial spikes on biopsy
ACEi + Statin + Corticosteroid + Cyclophosphamide + Anticoagulation if high risk

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22
Q

What is the screening test used in Adult Polycystic Kidney Disease

A

USS

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23
Q

What is the commonest type of APKD

A

Type 1
Chromosome 16
Early renal failure

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24
Q

What is the diagnostic criteria for APKD

A

USS
Two cysts uni or bilateral if <30
two cysts bilaterally 30-50
Four cysts bilaterally >50 years

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25
What is the management of APKD?
Tolvaptan
26
Biochemistry in Multiple Myeloma
Increased Calcium Normal or raised ALP Normal Phosphate Is ALP is raised think metastatic disease
27
First line investigation in renal colic
Non Contrast CT - KUB
28
How does CKD cause bone disease?
Increased Phosphate - drags calcium out of bones | Decreased Vitamin D - reduces calcium levels - 2 hyperparathyroidism
29
How do you manage CKD related bone disease?
``` Bisphosphonates - reduce bone turn over Reducing dietary phosphate is first line Phosphate binders Vit D Parathyroidectomy ```
30
If a stone is below 5mm what is the management?
Symptomatic - diclofenac and supportive | Passes within 4 weeks usually
31
Renal Stone over 2 cm
Lithotripsy
32
Renal Stone >2cm but pregnant
Ureteroscopy
33
Complex renal calculi + Staghorn
Percutaneous Nephrolithotomy
34
A patient presents with an infection secondary to a ureteric calculi obstruction. What is the management ?
Surgical decompression Nephrostomy Tubeplacement Ureteric Catheters Ureteric Stent
35
General advice to reduce renal stones
Increase fluid Reduce animal proteins Thiazides Reduce salt
36
What can help reduce the frequency of oxalate stones?
Cholestyramine
37
What can help reduce the frequency of uric acid stones?
Allopurinol
38
What is indicative of an AKI due to dehydration?
Urea and Creatinine have both increased but urea has increased by more.
39
In a young child presenting with an abdominal mass what must be considered?
Wilms Nephroblastoma
40
Sterile Pyuria + white cell casts + eosinophilia indicates what?
Acute Interstitial nephritis Rash and a fever is common Hypertension and mild renal impairment
41
How is Nephrogenic diabetes insipidus managed?
Thiazide + low salt diet
42
Acute Interstitial Nephritis causes
Penicillin NSAIDs Allopurinol | SLE Sjogrens Staphylococci infection
43
Signs of dehydration onFBC and U+Es
increased haematocrit haemoglobin urea and creatinine | Urea> Creatinine
44
What is the fastest rate K+ can be infused at?
10mmol / hour unless in an ICU with intensive cardiac monitoring
45
What should be done immediately if there is new onset hyperkalameia in a patient?
ECG
46
CKD classifications
``` Stage 1 = >90 plus signs and symptoms Stage 2 = 60 - 90 plus signs and symptoms Stage 3a = 45 - 59 Stage 3b = 30 - 44 Stage 4 = 15 - 30 Stage 5 = <15 ```
47
Diarrhoea causes what type of metabolic disorder?
metabolic acidosis - loss of HCO3-
48
Vomiting causes what type of metabolic disorder?
Metabolic alkalosis | Loss of HCl
49
What is a normal anion gap?
8 - 14 mol
50
If the albumin creatinine ratio is >30 what medication should be started?
ACEi -only if hypertensive
51
If the albumin to creatinine ratio is >70 what medication should be started regardless?
ACEi
52
What medication is always given in CKD
Statins
53
AKI - 1.5 to 2x creatinine increase | < 0.5ml/kg/hr urine
Stage 1 AKI
54
AKI - 2.0x - 2.9x creatinine increase | Urine <0.5ml/kg/hr
Stage 2 AKI
55
AKI - >3x creatinine increase | < 0.3ml/kg/hr
Stage 3
56
What is the first line dialysis in an independent patient?
Peritonial dialysis
57
A peritonitis related to peritoneal dialysis is likely to be due to what?
Staph Epidermidis
58
Signs of a Pre Renal AKI
Good response to a fluid challenge Low urinary Na Increased Urea to creatinine ratio
59
How much fluid should be used a fluid challenge?
500ml NaCl STAT | 250ml if signs of Heart Failure
60
Excessive fluid resus with NaCl can cause what?
Hyperchloraemic metabolic acidosis
61
What is a common cause of acute tubular necrosis?
Haemorrhage
62
In an AKI of unknown cause what investigations should be done?
Urinalysis | USS
63
Struvite stones are made up of what?
Magnesium and Ammonium
64
Days post URTI | Macroscopic haematuria
IgA nephritis
65
Weeks post URTI Proteinuria Low complement levels
Post Strep Nephropathy
66
IgA nephritis management
Normal eGFR + no proteinuria = follow up check Slightly low eGFR + persistent proteinuria = ACEi Falling eGFR and no response to ACEi = Steroid
67
What kind of stones may be lined to a patient with Crohns disease?
Calcium Oxalate
68
List the types of graft rejection and what mediates them
Hyperacute - HLA or ABO Acute - Mismathed HLA Chronic - Antibody and T cell mediated
69
Hyperacute graft rejection
Within minutes to hours post surgery. Thrombosis ischaemia and infarction of organ No treatment apart from removal
70
Acute Graft rejection
Within 6 months of graft insertion Usually asymptomatic - picked up on monitoring Increased creatinine Acute T cell is commonest variant Some are reversible with steroids and immunosuppression
71
Chronic graft rejection
Over 6 months | Fibrosis of the organ
72
Let the order of most important HLA antibodies to match
DR > B > A
73
What is it in nephrotic syndrome that causes hyper coagulability?
Loss of anti thrombin III
74
What is a cause of a semi opaque kidney stone?
Cystine
75
Management of Haemolytic Uraemic Syndrome
Supportive - bloods, fluids and dialysis No role for Abx Monitor Blood pressure and renal function
76
Severe haemolytic syndrome with no diarrhoea before hand
Plasma exchange | Eculizumab
77
Common causes of acute tubular necrosis
NSAIDs Ischaemia Contrast agents
78
Acceptable responce to ACEi initiation
Creatine increased by 30% | eGFR reduced by 25%
79
When is furosemide indicated for hypertension in CKD
eGFR below 45
80
Metformin in CKD
Caution if eGFR <45 | Stop if eGFR <30
81
Management of Anti GMB
Plasma exchange Steroids Cyclophosphamide
82
What can help reduce the frequency of calcium stones?
Thiazides
83
Isograft
Received from a twin
84
Autograft
Tissue harvested from own body
85
Allograft
Tissue taken from another person
86
Sterile pyuria + negative culture Dysuria Haematuria Abdopain
Renal TB
87
Differentiating a Chronic Kidney Injury from an AKI
CKD = anaemia and low vitamin D alongside normal urinary output
88
Urinary ACR >3 - what medication should you start?
ACEi / ARB
89
``` Brown grey skin N+V Confusion (encephalopathy) Seizures Comas ```
Urea toxicity
90
X linked dominant mutation in type IV collagen.
Allports Bilateral sensorineural hearing loss Microscopic haematuria and progressive renal failure Retinitis pigmentosa
91
An AKI + pulmonary oedema is an indication for what?
Haemodialysis
92
What DOAC is preferred in CKD?
Apixiban
93
Formulae for working out an Anion Gap
(Na + K) - (Cl + HCO3) = Anion Gap Normal anion gap ( if involving K+) = 10-18 - without K+ = 8-14
94
Management of systemic sclerosis with renal involvement.
ACEi
95
Kimmelstein Wilson nodules are seen in
Nodular glomerulosclerosis due to diabetes
96
Left sided flank pain + haematuria during or after a nephrotic syndrome.
Renal vein thrombosis - loss and antithrombin III causes hyper coagulability
97
Focal segmental Glomerulosclerosis - causes
``` HIV Idiopathic Heroin Alports Secondary to other renal nephropathy ```
98
Focal segmental glomerulosclerosis - presentation
Nephrotic syndrome and CKD in young adults
99
Management of focal segmental glomerulosclerosis
Steroids + immunosuppression
100
How does investigation of nephrotic syndrome differ between adults and children?
In adults you do a renal biopsy. | In children it is assumed to be minimal change disease. Biopsy is done if failure to resolve with prednisolone.
101
Pentameric Antibody
IgM - Waldenstroms
102
Monomeric antibody
IgG - Multiple Myeloma

Things I don't know, but need to know, for fourth year (31 decks)

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