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Medicine for Finals > Renal > Flashcards

Renal Flashcards

1
Q

KDIGO Stage 1 AKI

A

Serum creatinine >1.5x baseline or urine output <0.5ml/kg/hr for >6h

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2
Q

KDIGO Stage 2 AKI

A

Serum creatinine >2x baseline or urine output <0.5ml/kg/hr for >12h

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3
Q

KDIGO Stage 3 AKI

A

Serum creatinine >3x baseline or urine output <0.3ml/kg/hr for >24h or anuria >12hrs

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4
Q

AKI: pre-renal causes

A

hypovolaemia (e.g. haemorrhage, D&V)
hypotension (e.g. HFrEF, hepatorenal syndrome, sepsis)
drugs

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5
Q

AKI: nephrotoxic drugs

A

NSAIDs
iodinated contrast media
aminoglycosides
ACE inhibitors
angiotensin receptor blockers
diuretics

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6
Q

AKI: features of nephrotic syndrome

A

Proteinuria
Hypoalbuminaemia
Oedema

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7
Q

AKI: features of nephritic syndrome

A

Haematuria (+/- red cell casts)
Proteinuria
Hypertension
Oliguria

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8
Q

AKI: features of tubulointerstitial disease

A

Polyuria or oliguria
Typically absence of ‘active urine’ (occasional mild proteinuria)

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9
Q

minimal change disease: causes

A

primary

secondary:
- infection (HIV, CMV)
- malignancy (thymoma, Hodgkin’s Lymphoma)
- drugs (NSAIDs, lithium, rifampicin)
- other (SCD)

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10
Q

membranous nephropathy: causes

A

primary (autoimmune)

secondary:
- autoimmune (SLE)
- infection (Hep B, malaria)
- malignancy
- drugs (gold)

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11
Q

membranoproliferative disease: causes

A

primary:
“C3 nephropathy”

secondary:
- autoimmune (SLE)
- infection (endocarditis)
- chronic thrombotic microangiopathy
- malignancy (monoclonal gammopathy)

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12
Q

AKI: causes of nephrotic syndrome

A

children => minimal change disease
adults => membranous nephropathy

small print: FSGS, membranoproliferative disease

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13
Q

AKI: causes of nephritic syndrome

A

IgA nephropathy (common, associated with DM, occurs WITH streptococcal URTI)

Post-streptococcal glomerulonephritis

Anti-GBM disease
ANCA vasculitis
Immune complex-mediated glomerulonephritis

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14
Q

AKI: causes of tubulointerstitial disease

A

acute tubular necrosis
acute interstitial nephritis
multiple melanoma
tumour lysis syndrome

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15
Q

acute tubular necrosis: features

A

Tubulointerstitial pattern of AKI (polyuria or oliguria without ‘active urine’)

High urinary sodium and low urine osmolality due to failure of kidneys to concentrate urine

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16
Q

acute tubular necrosis: causes

A

prolonged pre-renal AKI or ischaemia
rhabdomyolysis
haemoglobinuria (e.g. malaria, haemolysis, transfusion reaction)
nephrotoxins (concurrent use of ACEi/ARB with iodinated contrast media or gentamicin)

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17
Q

acute interstitial nephritis: features

A

“allergic-type picture”
urinary WCC, eosinophilia, IgE
reduced eGFR

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18
Q

acute interstitial nephritis: causes

A

drugs (antibiotics, chemotherapy)

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19
Q

AKI: post-renal causes

A

calculi
prostatic hyperplasia
metastatic cancer
retroperitoneal fibrosis (rare)

20
Q

AKI: management of pre-renal disease

A

Fluid resuscitation
Manage underlying cause

21
Q

AKI: management of post-renal disease

A

USS KUB
Stent / stone retrieval
Monitor for post-obstructive diuresis

22
Q

AKI: management of nephrotic syndrome

A

Remove precipitant drugs
Symptomatic relief - salt restriction and loop diuretics
Anticoagulate (DVT risk!)

Minimal change disease => steroids

23
Q

AKI: management of nephritic syndrome

A

Assess for dialysis and/or respiratory support
Immunosuppression (steroids, azathioprine, cyclophosphamide)
Acute pulmonary haemorrhage => PLEX

24
Q

AKI: management of tubulointerstitial disease

A

Remove precipitant drugs
Treat underlying cause
Supportive treatment

25
Q

CKD Stage 1

A

eGFR > 90 plus signs of renal disease (haematuria, proteinuria, deranged electrolytes, structural anomaly)

26
Q

CKD Stage 2

A

eGFR 60-90 plus signs of renal disease (haematuria, proteinuria, deranged electrolytes, structural anomaly)

27
Q

CKD Stage 3a

A

eGFR 45-60

28
Q

CKD Stage 3b

A

eGFR 30-45

29
Q

CKD Stage 4

A

eGFR 15-30

30
Q

CKD Stage 5

A

eGFR <15

31
Q

CKD Stage A1

A

Albumen:creatinine ratio <3mg/mmol (normal)

32
Q

CKD Stage A2

A

Albumen:creatinine ratio 3-30mg/mmol (microalbuminaemia)

33
Q

CKD Stage A3

A

Albumen:creatinine ratio >30mg/mmol (macroalbuminaemia)

34
Q

CKD: causes

A

Hypertension
Diabetes

Small print: inherited disease (ADPKD), renovascular disease, recurrent AKI, HF, immunodeficiency

35
Q

CKD: management

A

Optimize risk factors (blood pressure, glycaemic control, vascular risk factors)

ACE inhibitor or angiotensin receptor blocker first-line antihypertensive, consider amoldipine or doxazocin in low eGFR.

Furosemide for symptomatic relief of fluid overload and hyperkalaemia.

Empaglifozin (an SGLT2 inhibitor) slows progression in eGFR >45

Dialysis, transplant

36
Q

CKD: sick day rules

A

Stop antihypertensives (ACE inhibitor, ARB) and diuretics (furosemide) in dehydration

37
Q

CKD: thresholds for dialysis

A

eGFR <7%: prepare for dialysis
eGFR <5%: dialysis

38
Q

CKD: complications

A

HTN
Fluid overload
Renal anaemia
Hyperkalaemia
Secondary hyperparathyroidism (raised PTH and Pi, calcium normal until end-stage where calcium falls)
Uraemia (pericarditis and encephalopathy)
Acidosis

39
Q

Type 1 RTA: features

A

Hyperchloraemic metabolic acidosis (normal anion gap)

Hypokalaemia and hypercalciuria

Nephrocalcinosis and renal stones

40
Q

Type 2 RTA: features

A

Hyperchloraemic metabolic acidosis (normal anion gap)

Hypokalaemia, osteomalacia

41
Q

Type 4 RTA: features

A

Hyperchloraemic metabolic acidosis (normal anion gap)

Hyperkalaemia

42
Q

Type 1 RTA: causes

A

Idiopathic
Rheumatoid arthritis
SLE
Sjogren’s syndrome

=> impaired H+ excretion in distal tubule

43
Q

Type 2 RTA: causes

A

Idiopathic
Fanconi Syndrome
Wilson’s Disease
Cystinosis
Tetracyclines
CA inhibitors

=> impaired HCO3- reabsorption in proximal tubule

44
Q

Type 4 RTA: causes

A

hypoaldosteronism
diabetes

45
Q

ADPKD: features

A

multiple renal cysts (number and bilaterality required for diagnosis depends on age)

pancreatic or hepatic cysts
mitral valve prolapse
aortic regurgitation
berry aneurysm

46
Q

ADPKD: management

A

tolvaptan (vasopressin receptor 2 antagonist)

Medicine for Finals (10 decks)

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