Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medicine Block Year 3 > Renal > Flashcards

Renal Flashcards

(79 cards)

Start Studying
1
Q

What are parts of the fluid status examination?

A

General inspection - oedema, SOB, pallor, anything around the bed
Look in patient notes for fluid chart

Hands - oedema, temperature, radial pulse, capillary refill time

Arms - check BP, Lying and Standing BP, Assess skin turgidity ( pinch skin and see how quick it is to rebound)

Face - mucous membranes, eyes for pallor and sunken

Neck - Check JVP

Abdomen - ascites , shifting dullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What should you ensure when checking for AKI?

A

Even if Creatinine is normal look at urine output , use whichever one is higher to stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What drugs should be withheld in AKI?

A

Contrast
ACEi
NSAIDs
Diuretics
B-Blokcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is shown on ECG in hypokalaemia?

A

PR Prolongation
Widespread ST depression
T wave flattening
U waves
QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Due to AKI due to vomit , what fluid prescription should be given? ( estimated 500ml fluid loss)? He is an 80kg male and has hypokalaemia

A

Needs 2400ml
Needs 50-100g glucose
Needs 80mmol of Na, Cl and K ( extra K due to hypokalaemia )

1L NaCl 0.9% + 40mmol KCL
1L Dextrose 5% + 40mmol KCl
1L Dextrose 5% + 20mmol KCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is renal replacement therapy indicated in AKI?

A

A - Acidosis
E - Electrolyte abnormalities ( severe and unresponsive hyperkalaemia)
I - Intoxication ( overdose of certai medications such as lithium or metformin)
O - Oedema ( Severe and unresponsive pulmonary oedema )
U - Uraemia symptoms ( Seizures or reduced consciousness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 12 year old visits the walk in centre with visible haematuria, what questions would be useful in the history?

A

Onset
Pain
LUTS
Period History
Systems Review ( Fevers/ infections)
Anemia symptoms
Medications
PHMx
FHx of kidney problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If she had a sore throat/infection a few weeks ago what would the top differential be?

A

Post-streptococcal glomerulonephritis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management for post-streptococcal glomerulonephritis?

A

Usually self limiting

Can be ACEi/ARBs for proetinuria and HTN
Low sodium diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the differences between Nephrotic Syndrome and Nephritic Syndrome?

A

Nephrotic - Insiduous onset, Oedema, Proteinuria, Hypoalbuminaemia, Low serum Albumin
Nephritic - Abrupt onset, Haematuria, Hypertension, Raised JVP, Can have proetinuria, Red Blood Cell Casts in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If a patient presents with frothy urine what test would you do?

A

BP
Urine Dipstick
Albumin levels
HbA1C
Clotting
Lipid levels
FBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do patients with low serum Albumin present with oedema?

A

As protein is lost in the urine, reduced colloid oncotic pressure which causes fluid to leave vessels into the interstitium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do patients with CKD present with low clotting factors?

A

Clotting factors are a type of protein that are lost in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why do patients with CKD present with anemia?

A

EPO Insufficiency due to poor synthetic function of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why might a patient with CKD present with back pain?

A

Rugger-Jersey Spine ( Renal Osteodystrophy ) -> Appears opaque/sclerosis on xray (excess osteoid )

Kidneys produce Calcitriol , reduced production leads to hyperparathyroidism which causes decreased absorption of dietary calcium which causes increased serum Ca2+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs of hypercalcaemia?

A

Moans - depression, confusion
Bones - osteolysis, fractures
Stones - renal stones
Abdo groans - Anorexia, N+V, Constipation, Pancreatitis
Lethargy
Hyporeflexia
Muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are signs of hypocalcaemia?

A

Tetany/muscle cramps
Peri-oral numbness
Peripheral paresthesia
Irritability
Seizure/collapse
Chvostek sign
Trosseau sign
Prolonged QT Interval
Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are fundoscopy findings in Diabetic Retinopathy?

A

Cotten wool spots
Blot haemorrhage
Hard exudates
Neovascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should diabetics be started on if there HbA1c is above 58mmol/L?

A

Lifestyle advice - Weight loss, Smoking cessation, Diet
Dual therapy - Metformin + SGLT2 Inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What medication has can cause a decrease in Creatinine clearance?

A

Trimethoprim

It competitively inhibits the mechanism for tubular secretion of creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What imaging investigation is important to in AKI to rule our obstructive causes?

A

Renal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does Acute Interstitial Nephritis happen due to?

A

Typically results from hypersensitivity reactions to certain medications, which are not mediated by direct toxicity

Or SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which drugs can cause Acute Interstitial Nephrits?

A

Antibiotics, such as β-lactams, cephalosporins, and fluoroquinolones
Non-steroidal anti-inflammatory drugs (NSAIDs)
Diuretics
Rifampicin
Allopurinol
Proton-pump inhibitors (PPIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common cause of intrinsic AKI?

A

Acute Tubular Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the causes of Acute Tubular Necrosis?
Ischemic Causes Nephrotoxic Causes
26
What are some ischaemic causes of Acute Tubular Necrosis?
Hypotension Shock ( haemorrhagic, cardiogenic, septic) Post-MI Direct vascular injury ( trauma, surgery)
27
What are the nephrotoxic causes of Acute Tubular Necrosis?
Drugs such as: Aminoglycoside antibiotics (e.g., gentamicin) Antifungals (e.g., amphotericin) Chemotherapy agents (e.g., cisplatin) Antivirals (e.g., tenofovir) NSAIDs Contrast Myoglobin (as seen in rhabdomyolysis) Haemoglobin (as seen in haemolysis) Uric acid (as seen in tumour lysis syndrome)
28
What are causes of acute urinary retention?
Luminal - kidney stone, blood clot, tumour, UTI Mural - stricture, NM dysfunction Extra-mural - abdominal/pelvic masses, retroperitoneal fibrosis Neurological - CES, MS Infectious diseases Anticholinergic medications ( Amitriptyline, Duloxetine, Diphenhydramine, Oxybutynin, Olanzapine) Post-operative Constipation
29
What test would be useful to do in a patient who has not passed urine in a while ?
Bladder scan - assess if catheterization is needed
30
What organisms can cause Haemolytic Uraemic Syndrome?
E.Coli Shigella Streptococcus Pneumoniae Release the shigella toxin
31
What is the triad of Haemolytic Uraemic Syndrome?
Microangiopathic haemolytic anaemia (MAHA) Thrombocytopenia AKI Blood clots block the small vessels of the kidneys
32
What genes are associated with ADPKD?
PKD1 gene on chromosome 16 ( Majority) PKD2 gene on chromosome 4
33
Refractory hyperkalaemia, Severe intractable metabolic acidosis Intractable fluid overload Pulmonary oedema, Presence of uraemic complications such as pericarditis, encephalopathy and seizures
34
What is the most common cause of CKD?
Diabetic nephropathy
35
How would you describe the RBCs in anaemia of CKD?
Normocytic Normochromic
36
When are ACEi offered to patients with chronic kidney disease?
ACEi prevent proteinuria, so can help with oedema CKD plus Diabetes - Urine ACR >3 CKD plus HTN - Urine ACR >30 CKD no DM/HTN - Urine ACR >70
37
A rise in Creatinine over what timeframe would meet the criteria for an AKI?
More than 25micromol/L in 48 hours More than 50% in 7 days Creatinine should be excreted, as it is a waste product, so a rise indicates the kidney is not working effectively
38
What is the most common cancer in immunosuppressed patients ( e.g patients with renal transplant)
Skin cancer
39
What symptoms does Alport's Syndrome present with?
Glomerulonephritis ( Nephritic) Hearing loss Vision abnormalities
40
What infections are more likely in immunosuppressed patients?
CMV TB Aspergillus PIP Viral infections (VZV, HSV, EBV )
41
Glomerulonephritis post infection causes?
Days after - IgA Nephropathy 1-2 weeks after - Post-Streptococcal GN
42
What are indicators of bad prognosis in IgA Nephropathy?
Microscopic Haematuria ( presents later in course of disease) Hypertension
43
What antibodies will be raised after streptococcal infection, indicative of PSGN ?
Raised Antistreptolysin O Titer (ASOT)
44
What is the gold standard for diagnosing IgA nephropathy?
Renal biopsy - shows IgA deposition and mesangial proliferation
45
What are the presenting symptoms of minimal change disease and the treatment?
Frothy urine Oedema ( Periorbital and ankle) treated with Steroids
46
What is the classic presentation of Goodpasture's?
Haemoptysis Haematuria Anti-GBM is present in both lungs and kidneys
47
What is the gold standard for diagnosis or all nephrotic syndrome?
Renal biopsy It is worth noting that a renal biopsy is not always required (for example, in young children presenting with minimal change disease) or if there is a high risk of bleeding
48
What would be the expected histological finding on renal biopsy in PSGN?
Subepithelial humps in the glomeruli
49
What would be the expected histological finding on renal biopsy in IgA Nephropathy?
IgA and C3 deposits in sub-endothelium of glomerulus
50
What would be the expected histological finding on renal biopsy in Goodpasture's?
Linear deposition of antibodies along the glomerular basement membrane
51
What would be the expected histological finding in Minimal change disease?
Effacement of podocyte foot processes - only seen on electron microscope
52
What would be the expected histological finding in Rapidly progressive glomerulonephritis?
Epithelial crescents in the glomeruli
53
When does acute graft rejection take place?
FIrst few months of renal transplant Pain around site Fever Declining renal function
54
When does Chronic graft rejection take place?
More than 6 months post-transplant
55
What are some immunosuppressive medications for renal transplant and their side effects?
Tacrolimus - tremor Ciclosporin - gingival hypertrophy Mycophenolate mofetil - GI upset
56
What are the causes of Type 1 renal acidosis?
Autoimmune disorders: Sjögren's, SLE, rheumatoid arthritis Drug-induced: analgesic nephropathy, lithium Nephrocalcinosis Chronic tubulointerstitial nephritis (TIN) Renal stone association!!
57
What are the causes for Type 2 renal tubular acidosis?
Fanconi syndrome Myeloma Amyloidosis Heavy metal toxicity: lead, cadmium
58
What are some causes of Renal Tubular Acidosis Type 4?
Diabetes Drugs, e.g., NSAIDs Obstructive uropathy Addison's disease Chronic TIN
59
What do the kidneys look like on renal US in CKD?
Bilaterally shrunken - helps differentiate from AKI
60
What is the best treatment for Hydronephrosis?
If small - Urgent cystoscopy with JJ stent insertion If >2cm or staghorn - Percutaneous Nephrostomy
61
What is the treatment for renal stones?
Analgesia - IM/PR Diclofenac <5mm = Watchful waiting <2cm = ESWL or Ureteroscopy ( if pregnant or distal/middle ureteric stone) >2cm or complex e.g Staghorn/Cysteine stones = Percutaneous nephrolithotomy
62
What can be used to prevent recurrence of renal stones?
Calcium based - Indapamide Urate - Allopurinol Keep hydrated Avoidd lots of Vitamin C or calcium supplements Reduce salt intake
63
What organisms can cause bacterial peritonitis due to peritoneal dialysis?
Skin commensals- Staphylococcus Epidermidis = MOST COMMON also Staph Aureus
64
If you started a patient on an ACEi , what rise in Creatinine from baseline should prompt you to stop it?
>30% in 2 weeks Could cause an AKI
65
Why does CKD cause low Vitamin D?
Reduced alpha hydroxylase 1 expression . This means the active form of Vitamin D cannot be made.
66
What is the likelihood of a sibling being a HLA match?
25%
67
What is the treatment for Lupus Nephritis
Cyclophosphamide and methylprednisolone
68
Which type of dialysis is dependent on the patient having some residual renal function?
Peritoneal
69
Which immunosuppressant drug given for Renal transplant has a long-term side effect of direct nephrotoxicity?
Ciclosporin
70
What are some uraemic pathologies? ( indications for dialysis in AKI)
Encephalopathy Pericarditis
71
What is a commonly forgotten way to stage an stage 3 AKI?
Increase in creatinine to ≥353.6 µmol/L Even if it is not 3x baseline, this is still a stage 3 AKI
72
What is the treatment for severe hyperkalemia? (>6.6.5)
Calcium Gluconate Insulin/Dextrose
73
What ABG result does diarrhoea cause?
normal anion gap acidosis
74
What U&E result does vomiting cause?
hypochloremia hypokalemia metabolic acidosis
75
WHat do the kidneys look like in US in Diabetic Nephropathy and CKD?
Chronic diabetic nephropathy will have large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys
76
Why are patients with Nephrotic syndrome in a hypercoagulable state?
Loss of antithrombin III ( destroys clotting factor) and plasminogen
77
What is a normal ion gap?
10-18 mmol/L
78
Which test indicated pre-renal AKI?
Raised serum urea:creatinine ratio
79

Medicine Block Year 3 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions