Renal Flashcards Preview

Year 1 Body Systems > Renal > Flashcards

Flashcards in Renal Deck (216)
Loading flashcards...
181

When would renal replacement therapy be indicated in AKI?

increasing hyperkalaemia unresponsive to medical therapy
Pulmonary oedema unresponsive to medical therapy
Severe acidosis pH

182

What other features tend to present with diabetic nephropathy?

1) retinopathy
2) Neuropathy
3) Proteinuria

183

How is glomerular disease mediated?

Immune mediated

184

What 4 things can glomerular disease present as?

1) Nephrotic syndrome
2) Asymptomatic haematuria/proteinuria
3) Nephritic syndrome
4) Rapidly progressive glomerulonephritis

185

What is IgA nephropathy?

Deposition of IgA in glomerulus causing glomerular disease

186

What is the likely type of glomerular disease in a child with throat infection, swollen ankles and hypotension?

Post streptococcal glomerular nephritis

187

A patient with joint pains, rashes and red eyes is likely to have what kind of glomerular disease?

Rapidly progressive glomerular nephritis

188

Why may a patient with CKD be given statins?

At increased risk of CV problems

189

How do calcimimetics given to patient with CKD help treat bone disease?

Inhibit parathyroid secretion

190

Other than hygrogen and bicarbonate reabsorption how else does the kidney buffer the blood?

Conversion of ammonia to ammonium in the urine (extra H+ leaves with it)

191

What is the normal pH range and when would it be considered dangerously high or low?

7.34-7.45
7.6

192

What is the Schwartz Barter approach to acid-base diseases based on?

Bonsted lowry definition of acids and bases
Sees hydrogen ion concentration as a function of the ratio between the PCO2 and the serum bicarbonate

193

What is the Stewart approach to acid base imbalance also termed and what is it based on?

Termed the strong ion difference
Based on the principal that serum bicarbonate does not alter blood pH

194

How is the anion gap calculated and what is its normal range?

[Na+] - ([HCO3-] + [Cl-])
5-11mmol/L

195

What does an increase or a decrease in anion gap indicate?

Increase = acidosis
Decrease = alkalosis

196

What does the MUDPALES acronym stand for in the high anion gap acidosis disease?

Methanol - Drug toxicity
Uraemia - CKD, AKI
Diabetes - ketoacidosis
Paraldehyde - Drug toxicity
Alcohol - drug toxicity
Lactate - Lactic acidosis from liver failure or tissue hypoxia
Ethelyne glycol - drug toxicity
Salicylate (aspirin) - drug toxicity

197

What is the osmolal gap and in what kind of high anion gap metabollic acidosis would you get an elevated osmolal gap?

In ethylene glycol toxicity
Osmolal gap = difference between serum osmolality and calculated osmolality
Calculated osmolality = 2 x [Na] + glucose + urea

198

What would calcium oxalate crystals in the urine and an osmolal gap of > 25mOsm/kg indicate?

Ethylene glycol toxicity

199

What is the treatment for ethylene glycol toxicity?

Alcohol/ Formepizole infusion - inhibit alcohol dehydrogenase (as ethylene glycol is metabollised to glycolate which is toxic to the tissues)
Dialysis

200

What are the 3 main causes of normal anion gap metabollic acidosis (hyperchloraemic)?

1) GI HCO3- loss
2) Renal HCO3- loss (renal tubular acidosis, atezolamide)
3) Infusion of 0.9% saline

201

What is the general treatment for acid base disorders in the acutely ill patient?

1) Correct fluid and electrolyte balance
2) Correct underlying cause for acid-base disorder
3) specific therapy to correct HCO3- or PCO2

202

Where does angiotensin II act on the kidney?

Causes vasoconstriction in the efferent arteriole to increase transglomerular pressure and therefore GFR

203

What are the 2 main effects of angiotensin II?

1) Vasoconstriction
2) Release of aldosterone from the adrenal cortex

204

How do Beta blockers act on the RAAS?

Inhibit the sympathetic tone influence on Renin release

205

How do renin inhibitors act on the RAAS?

Prevent Conversion of angiotensinogen to angiotensin 1

206

How do ACEi work on the RAAS?

Prevent the conversion of angiotensin 1 to angiotensin 2 in the lungs

207

How do ARBs work on the RAAS?

Prevent Ang 2 causing release of aldosterone and vasoconstriction

208

Ramipril and Lisonopril are examples of what kind of drug?

ACEi

209

What are the indications of ACEis and ARBs?

Hypertension
Cardiac failure
CKD

210

hat are the 2 possible side effects of ACEi and ARBs?

1) Hypotension
2) Hyperkalaemia (prevents the action of aldosterone)