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SAQ for finals > Renal > Flashcards

Renal Flashcards

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1
Q

Other than diabetes, give 4 common causes of CKD

A

Hypertension
Medication (lithium, NSAIDs)
Glomerulonephritis
Polycystic kidney disease
Obstructive uropathy

*Diabetes is the most common cause of CKD in UK

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2
Q

Give 2 reasons why a renal USS would be requested in CKD

A

exclude obstruction, assess renal size, exclude polycystic kidneys

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3
Q

2 medical management options in CKD

A

ACE inhibitor
SGLT2 inhibitor (beneficial in proteinuric CKD regardless of diabetic status)

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4
Q

Give 2 common side effects of ACEi

A

Dry cough
Hypotension
Hyperkalaemia

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5
Q

Give 2 blood tests to check regularly in CKD

A

[Renal bone disease]:

Phosphate (high)
Calcium (low)
ALP
PTH
FBC

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6
Q

3 signs of CKD on examination

A

Pallor (anaemia)
Peripheral oedema
Peripheral neuropathy
Pruritis (uraemia)
Bruising

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7
Q

Explain the basic principles of haemodialysis

A

Blood from AV fistula flows into dialyser
Molecules diffuse down their conc. gradient via semipermeable mebrane from blood into the dialysis fluid
Filtered blood flows back into body

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8
Q

Give 2 complications of peritoneal dialysis

A

Bacterial peritonitis
Weight gain

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9
Q

Organ rejection is a possible complication of renal transplantation. What time period determines whether it is acute or chronic?

A

6 months

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10
Q

Why would someone with a renal transplant be seen annually by a dermatologist

A

Increased risk of SCC due to long term immunosuppression

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11
Q

Type of hyperparathyroidism

Low calcium + high PTH

A

Secondary e.g. CKD causes chronic hypocalcaemia which triggers excess PTH

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12
Q

Give 2 actions of PTH

A

Increased osteoclast activity (increased Ca and PO4 release from the bone)
Increased Ca and PO4 reabsorption via the kidney
Increased hydroxylation of vitamin D

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13
Q

At what sites does hydroxylation of vitamin D occur

A

Liver, kidney

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14
Q

What is the term given to bone disease in pts with renal failure

A

Renal osteodystrophy

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15
Q

Tertiary hyperparathyroidism - calcium and PTH results + why does tertiary develop?

A

High PTH (hyperplasia from primary) causes high calcium

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16
Q

Give 2 causes of pre-renal AKI

A

Dehydration
Shock (hypovolaemia, sepsis)
Renal artery stenosis
Congestive HF

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17
Q

Give 2 causes of intrinsic AKI

A

Acute tubular necrosis
Haemolytic uraemic syndrome
Glomerulonephritis
Nephrotoxins (nephrotoxic drugs, contrast)
Rhabdomyolysis

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18
Q

Give 2 causes of post-renal AKI

A

Renal calculi
Renal tumours
Ureteric tumours
BPH
Prostate cancer

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19
Q

Other than blood tests in AKI, give 2 other investigations you would request

A

Urinalysis
Renal USS

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20
Q

Name 2 potentially life-threatening complications of AKI

A

Pulmonary oedema
Hyperkalaemia

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21
Q

Give 2 indications for dialysis in a patient with AKI

A

AEIOU:
Acidosis
Electrolyte (hyperkalaemia)
Intoxification (NSAID, lithium)
Oedema (refractory pulmonary oedema)
Uraemic symptoms (pericarditis, encephalopathy)

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22
Q

How does rhabdomyolysis cause AKI?

A

ATN

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23
Q

What blood test is raised in rhabdomyolysis

A

Creatinine kinase

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24
Q

What urine test confirms the diagnosis of rhabdomyolysis

A

Urinary myoglobin

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25
What would you see on urine microscopy of rhabdomyolysis
Muddy brown casts
26
Which drugs to stop in AKI
stop the DAAAMN drugs Diuretics ACEi, aminoglycosides, ARBs Metformin (risk of acidosis) NSAIDs
27
Other than prolonged immobility, give 3 causes of rhabdomyolysis
Excessive exercise Crush injuries Seizures Drugs (ecstacy, heroin) Muscular dystrophy disorders
28
3 ECG changes in hyperkalaemia
Tall, tented T waves Widened QRS complex Flat P waves Prolonged PR interval
29
Treatment for hyperkalaemia with ECG changes (3)
10ml 10% calcium gluconate IV over 5 minutes IV insulin + dextrose Salbutamol nebulisers
30
Urgent blood tests for significant AKI and haemoptysis
p-ANCA (microscopic polyangiitis) c-ANCA (granulomatosis with polyangiitis) Anti-GBM (goodpasture syndrome)
31
Medication immediately started for rapidly progressive glomerulonephritis
Steroids
32
Investigation to confirm the diagnosis of rapidly progressive glomerulonephritis
Renal biopsy shows glomerular crescents
33
Define nephrotic syndrome
Highly permeable basement membrane causing: Proteinuria (>3g/24h) Hypoalbuminaemia Peripheral oedema
34
Commonest cause of nephrotic syndrome in a) children and b) adults
a) minimal change disease b) membranous nephropathy
35
Investigation to give a definitive diagnosis in of nephrotic syndrome
Renal biopsy
36
2 complications of nephrotic syndrome and 1 measure you would take to manage each
Hyperlipidaemia (statin) Infections (prompt Abx if suspected infection) Thromboembolism (avoid prolonged bed rest, consider anticoag)
37
2 pieces of dietary advice to give to a patient with nephrotic syndrome
1. Normal protein 2. Low salt
38
Serum osmolality equation
2 (Na+ and K+) + Glucose + Urea (all in mmol/L)
39
3 clinical observations and investigations to establish volume status
Examine JVP Postural blood pressure Peripheral oedema Measure urine output CXR U&Es
40
Risk of correcting chronic hyponatraemia too quickly
Central pontine myelinolysis
41
Where is ADH secreted
posterior pituitary
42
How does ADH increase water reabsorption
Recruits aquaporin channels to the apical membrane making it water-permeable
43
3 characteristic features of SIADH
1. Euvolaemic 2. Sodium in urine 3. Hyponatraemia 4. Osmolality - urine vs blood
44
Name a drug used to treat SIADH
Vasopressin receptor antagonists e.g. tolvaptan
45
Organism responsible for most UTIs
E. coli
46
4 risk factors for UTIs
Female Pregnancy Diabetes Renal calculi Long-term catheter Immunosuppression
47
Positive dipstick results indicating the presence of infection (2)
Nitrites Leucocytes
48
Young woman not pregnant - which antibiotic and how many days?
Nitrofurantoin, amoxicillin, trimethoprim for 3 days
49
3 pieces of advice for recurrent UTIs
Post-coital voiding Keep well hydrated Wipe front to back
50
3 initial management steps in pyelonephritis
ABC IV fluids Start empirical antibiotics
51
4 investigations for pyelonephritis
FBC U&Es CRP Urine MC&S Blood cultures Renal USS
52
Anaphylaxis 2 signs on assessment of a) Airway b) Breathing c) Circulation
A) stridor, hoarse voice, tongue swelling B) tachypnoea, cyanosis, wheeze C) tachycardia, hypotension, pale
53
Adrenaline Route Concentration Dose (adult)
IM 1 in 1000 0.5
54
Benefit of renal biopsy in IgA nephropathy
Definitive diagnosis to guide appropriate management
55
2 contraindications to renal biopsy
Abnormal coagulation results Single functioning kidney Systolic >160 or diastolic >90
56
3 complications of renal biopsy
Haematuria requiring blood transfusion Haematuria requiring nephrectomy Infection
57
1 histological finding in IgA nephropathy
Mesangial proliferation, IgA deposits
58
Other than HSP, give 3 causes of a purpuric rash
ITP TTP DIC
59
Appropriate urine tests for patient >65 with suspected UTI
Urine microscopy, culture and sensitivities *>65 urine dipstick is unreliable
60
Role of tolvaptan in polycystic kidney disease
Reduce the growth rate of cysts
61
Give 2 non-pharmacological management options for end-stage CKD
Dialysis Renal transplant
62
2 features of nephritic syndrome
Haematuria Oliguria Mild proteinuria Fluid retention/oedema
63
Most likely diagnosis for haemoptysis with AKI
Goodpasture syndrome (anti-GBM)
64
Name 3 causes of glomerulonephritis
Goodpasture syndrome IgA nephropathy Post-streptococcal glomerulonephritis

SAQ for finals (20 decks)

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