Renal Flashcards
(110 cards)
1
Q
What is hypernatraemia?
A
Serum sodium levels >145mmol/L
2
Q
Give 4 symptoms of hypernatraemia
A
Lethargy Thirst Weakness Irritability Confusion Coma Fits Signs of dehydration
3
Q
Give 4 hypotonic causes of hypernatraemia
A
Vomiting Diarrhoea Burns Diabetes insipidus Osmotic diuresis
4
Q
Give 2 causes of normotonic hypernatraemia
A
Primary aldosteronism
Iatrogenic (excess IV saline)
5
Q
How is hypernatraemia managed?
A
Replace water loss orally
Can give 5% glucose slowly (1L/6hrs) or 0.9% saline if hypotonic
6
Q
What is hyponatremia?
A
Serum sodium <135 mmol/L
7
Q
Give 5 symptoms of hyponatremia
A
Anorexia Nausea Malaise Headache Irritability Confusion Weakness Seizures Increased risk of falls
8
Q
Give 3 causes of hypervolaemic hyponatraemia
A
Nephrotic syndrome
Heart failure
Liver cirrhosis
Renal failure
9
Q
Give 4 causes of hypovolaemic hyponatraemia
A
Diarrhoea Vomiting Trauma Small bowel obstruction Addison's disease Renal failure Osmotic diuresis Diuretic excess
10
Q
Give 3 causes of normovolaemic hyponatraemia
A
SIADH
Severe hypothyroidism
Glucocorticoid insufficiency
Iatrogenic (excessive IV 5% glucose)
11
Q
How is chronic hyponatraemia managed?
A
Fluid restriction
ADH antagonist
Treat underlying cause
12
Q
How is acute symptomatic hyponatraemia managed?
A
Rehydration slowly
Furosemide
ADH antagonist
13
Q
How is hyponatraemia treated in an emergency?
A
1.8% saline given at 70 mmol of Na+ per hour alongside Furosemide
14
Q
What is hyperkalaemia?
A
Serum potassium >6.5 mmol/L
15
Q
What are the symptoms of hyperkalaemia?
A
Fast irregular pulse, chest pain, weakness, palpitations, lightheadedness
16
Q
What ECG changes are seen in hyperkalaemia?
A
Tall tented T waves
Increased PR interval
Absent P wave
Widened QRS complex
17
Q
Give 5 potential causes of hyperkalaemia
A
Oliguric renal failure K+ sparing diuretics Rhabdomyolysis Metabolic acidosis Addison's disease Burns ACE inhibitors
18
Q
How is hyperkalaemia managed in a non-emergency?
A
Treat underlying cause
Calcium resonium 15g/8hrs
19
Q
How is hyperkalaemia managed in an emergency?
A
Calcium gluconate 10% (30ml) IV insulin (10 units) in 25g of glucose Salbutamol nebuliser (10-20mg)
20
Q
What is hypokalaemia?
A
Serum potassium <2.5 mmol/L
21
Q
What are the symptoms of hypokalaemia?
A
Muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, lightheadedness, constipation
22
Q
What ECG changes are seen in hypokalaemia?
A
Small or inverted T waves
U waves
Long PR interval
Depressed ST segments
23
Q
Give 5 causes of hypokalaemia
A
Diuretics Vomiting Diarrhoea Cushing's syndrome Steroid excess Conn's syndrome Alkalosis Pyloric stenosis Renal tubular failure
24
Q
How is hypokalaemia treated?
A
Oral K+ supplement
Swap to K+ sparing diuretic
Can give IV potassium if severe
25
What is hypercalcaemia?
Serum calcium >2.6 mmol/L
26
Give 5 symptoms of hypercalcaemia
```
Bones, stones, groans and psychiatric moans
Abdominal pain
Vomiting
Constipation
Polyuria
Polydipsia
Depression
Anorexia
Weight loss
Tiredness
Weakness
High blood pressure
Confusion
Pyrexia
Renal stones
Renal failure
Ectopic calcification
```
27
What ECG change is seen in hypercalcaemia?
Reduced QT intervl
28
Give 4 causes of hypercalcaemia
```
Bone metastases
Primary hyperparathyroidism
Sarcoidosis
Thyrotoxicosis
Lithium use
HIV
```
29
How is hypercalcaemia treated?
IV 0.9% saline to correct dehydration
Bisphosphonates
Treat the cause
30
What is hypocalcaemia?
Serum calcium <2.1 mmol/L
31
What are the symptoms of hypocalcaemia?
```
SPASMODIC
Spasms
Perioral paresthesia
Anxious
Seizures
Muscle tone increased
Orientation impaired (confusion)
Dermatitis
Impetigo infection
Choreoarthritis, cataracts, cardiomyopathy
```
32
What is Chvostek's sign?
In hypocalcaemia, the corner of the mouth twitches if the facial nerve is tapped
33
What is Trousseau's sign?
In hypocalcemia when a blood pressure cuff is inflated. The reduced blood flow to the hand causes ischaemia so the hand contracts
34
Give 3 causes of hypocalcaemia alongside a raised phosphate
CKD
Hypoparathyroidism
Rhabdomyolysis
Hypomagnesaemia
35
Give 3 causes of hypocalcaemia alongside a normal or lowered phosphate
```
Vitamin D deficiency
Osteomalacia
Acute pancreatitis
Overhydration
Respiratory alkalosis
```
36
How is hypocalcaemia treated?
Mild: Calcium 5 mmol/6hr PO
Severe: 10 ml 10% calcium gluconate IV over 30 minutes
37
What is glomerulonephritis?
A term for a number of conditions which affect the glomerulus.
38
What are the 3 main nephrotic syndromes?
Minimal change
Focal segmental glomerulonephritis
Membranous
39
What are the 3 main nephritic syndromes?
IgA nephropathy
Goodpasture's syndrome
Vasculitis disorder
40
What is a UTI?
Infection of the ureter, bladder or prostate
41
What are the 2 most common microbial causes of a UTI?
E.coli
| Staphylococcus saprophyticus
42
Give 4 risk factors for developing a UTI
```
Sexual activity
Urinary incontinence
Diabetes
Dehydration
Immunosuppression
Pregnancy
Renal tract malformation
Elderly
```
43
Give 3 symptoms of a UTI
```
Increased urinary frequency
Dysuria
Urgency
Suprapubic pain
Polyuria
Haematuria
```
44
What tests can be done to diagnose a UTI?
Urine dipstick
MSU culture
FBC, U&Es, CRP
Ultrasound scan (recurrent UTIs)
45
What is the treatment for an uncomplicated UTI?
3 day course of trimethoprim or nitrofurantoin
46
What is the treatment for a complicated UTI?
7 day course of trimethoprim or nitrofurantoin
47
Which UTI antibiotic should be avoided in T1 of pregnancy?
Trimethoprim
48
Which UTI drug should be avoided in T3 of pregnancy?
Nitrofurantoin
49
What is pyelonephritis?
Infection of the upper urinary tract
50
Give 4 symptoms of pyelonephritis
Fever, rigors, vomiting, loin to groin pain, costovertebral pain, lower UTI symptoms, septic shock
51
What is the treatment for pyelonephritis?
14 day course of trimethoprim or nitrofurantoin
52
What is rhabdomyolysis?
Excessive skeletal muscle breakdown causing a release of cellular contents into the blood. Cytokine release and decrease in nitric oxide causes vasoconstriction. Myoglobin release obstructs the glomeruli.
53
Give 4 risk factors for rhabdomyolysis
```
History of trauma
Recent surgery
Immobility
Seizures
Hyperthermia
Excessive exercise
```
54
Give 4 symptoms of rhabdomyolysis
Muscle pain
Swelling
Tenderness
Red-brown urine
55
How is rhabdomyolysis diagnosed?
Serum myoglobin
| Serum creatinine kinase
56
What electrolyte disturbance is common in rhabdomyolysis?
Hyperkalaemia
57
How is rhabdomyolysis treated?
Treat hyperkalaemia
| IV fluid rehydration
58
What is hyperuricaemia?
High levels of urate in the blood due to increased cell turnover
59
Which drugs can cause hyperuricaemia?
Cytotoxics
Thiazides
Loop diuretics
Pyrazinamide
60
Apart from drugs, what are 5 other causes of hyperuricaemia?
Gout, CKD, hyperparathyroidism, preeclampsia, lymphoma, psoriasis
61
How is hyperuricaemia treated?
Allopurinol
Rehydration
Loop diuretics
Retrograde ureteric catheterisation
62
Where are the 3 most common sites for urinary stones?
Pelviureteric junction
Pelvic brim
Vesicoureteric junction
63
What is the composition of most types of urinary stones?
Calcium oxalate
64
What are the symptoms of urinary stones?
```
Loin to groin pain
Renal colic
Lower UTI symptoms
Haematuria
Anuria
```
65
How is a urinary stone treated acutely?
Analgesia
IV fluids
Increase fluid intake
Antibiotics if needed
66
How is a urinary stone <5mm treated?
Conservative- let it pass naturally
67
How is a urinary stone >5mm treated?
Nifedipine
Alpha blockers
Lithotripsy
Percutaneous nephrolithotomy (keyhole surgery)
68
How can kidney stones be prevented?
Good hydration, low calcium and oxalate diet, allopurinol, thiazide diuretic
69
What is autosomal dominant polycystic kidney disease?
Inherited condition where many small, fluid filled sacs appear on the kidney
70
Give 4 symptoms of autosomal dominant polycystic kidney disease
```
Abdominal pain
Hypertension symptoms (headache, nosebleeds, blurred vision, SOB)
Haematuria
Upper UTI symptoms
Kidney stone symptoms
```
71
How is autosomal dominant polycystic kidney disease treated?
Treat complications as normal (ie. hypertensives)
Analgesia (not NSAIDs)
Tolvaptan (reduces size of the cysts)
Plan for future CKD
72
Give 3 potential complications from autosomal dominant polycystic kidney disease
Liver cysts
CV disease
Brain aneurysms
73
What is AKI?
Acute decreased renal function
74
What is stage 1 AKI?
Serum creatinine >26umol/L over 48 hours
OR >1.5-1.9 x baseline serum creatinine over 7 days
PLUS <0.5 ml/kg/hr urine output over >6 hours
75
What is stage 2 AKI?
>2.0-2.9 x baseline serum creatinine over 7 days
PLUS <0.5 ml/kg/hr urine output over >12 hours
76
What is stage 3 AKI?
Serum creatinine >354umol/L over 48 hours
OR >3 x baseline serum creatinine over 7 days
OR if on renal replacement therapy
PLUS <0.3 ml/kg/hr urine output over >24 hours
OR anuric for > 12 hours
77
Give 4 risk factors for AKI
```
CKD
Old age
Male
Diabetes
CV disease
Malignancy
Chronic liver disease
Complex surgery
```
78
Give 5 potential causes for prerenal AKI
```
Haemorrhage
D&V
Burns
Pancreatitis
Hypotension
MI
Cardiogenic shock
Sepsis
NSAIDs
ACE inhibitors
ARB
Hepatorenal syndrome
```
79
Give 4 renal causes of AKI
Glomerulonephritis
Infection
Drug reaction
Vasculitis
80
Give 5 causes of post renal AKI
```
Stone
Malignancy
Stricture
Clot
Prostatic hypertrophy
Retroperitoneal fibrosis
```
81
Give 2 potential complications of AKI
Hyperkalaemia
| Metabolic acidosis
82
How is AKI treated?
IV fluids
Treat the cause
Stop nephrotoxic drugs
83
What is CKD?
Abnormal kidney function for >3 months which results in health implications
84
What is stage 1 CKD?
Mild kidney damage, eGFR >90
85
What is stage 2 CKD?
Mild kidney damage with eGFR 60-89
86
What is stage 3 CKD?
Moderate kidney damage with eGFR 30-59
87
What is stage 4 CKD?
Severe kidney damage with eGFR 15-29
88
What is stage 5 CKD?
End-stage renal disease with eGFR <15 or on dialysis
89
Give 4 potential causes of CKD
```
Diabetes
Glomerulonephritis
Renovascular disease
Heart failure
Nephrotoxic drugs
```
90
How is CKD managed?
```
ACE inhibitor
Control diabetes
Lose weight
Stop smoking
Reduce CV risk --> aspirin and low dose statins
Plan for RRT in the future
```
91
What is dialysis?
Artificial filtration of the blood used when the kidneys can no longer function
92
When is dialysis started?
1 or more of the following symptoms:
- Pulmonary oedema
- Uncontrollable high blood pressure
- Serositis
- Acid-base and electrolyte imbalances
- Pruritis
- Deterioration of nutritional status
- Cognitive impairment
93
Explain the process of haemodyalysis
Blood is passed over a semi-permeable membrane against dialysis fluid moving in the opposite direction.
94
How many times a week must haemodyalysis be done?
3 times a week
95
Where is the blood collected from the body in haemodyalysis?
AV fistula in the arm
| Uses brachial artery and cephalic vein
96
Give 4 potential problems of haemodyalysis
```
Creating AV fistula
Thrombosis
Stenosis
Infection
Blockage
Cerebral oedema
Hypotension
Time consuming
```
97
Explain the process of peritoneal dialysis
Uses the peritoneum as a semi-permeable membrane. A catheter is placed into the peritoneal cavity and fluid is infused. The solutes move across and into the blood.
98
Give 2 potential problems of peritoneal dialysis
Catheter site infection
Peritonitis
Hernia
Loss of membrane function over time
99
What is haemofiltration?
Type of dialysis used in emergency situations when haemodyalysis cannot be used because the blood pressure is too low.
100
Give 5 complications of dialysis
```
Hypertension
Vascular stiffness
Dysregulation of calcium and phosphate
Oxidative stress
Bone disease
Infection
Carpal tunnel syndrome
Arthralgia
```
101
In which patients is renal transplantation contraindicated?
HIV
Cancer with metastases
Active infection
CV disease
102
Which 4 types of drugs are required for a renal transplant?
Monoclonal antibodies
Calcineurin inhibitors
Antimetabolites
Glucocorticoids
103
Give 5 potential complications of a renal transplant
```
Rejection
Surgical bleed
Infection
Thrombosis
Hernia
Delayed graft function
Malignancy (x25 increased risk of cancer)
```
104
Give 4 symptoms of renal cell carcinoma
```
Haematuria
Lump in kidney area
Weight loss
Fever
Persistent pain in lower back
Tiredness
Loss of appetite
Weight loss
```
105
What is stage 1 renal cell carcinoma?
<7cm mass inside kidney
106
What is a stage 2 renal cell carcinoma?
>7cm mass inside kidney
107
What is a stage 3 renal cell carcinoma?
Cancer has spread to adrenal glands, nearby veins or 1 nearby lymph node
108
What is stage 4 renal cell carcinoma?
More than 1 lymph node affected or spread to distant area of the body
109
In what ways can renal cell carcinomas stage 1-3 be treated?
Surgery
Cryotherapy
Radiotherapy
Artificial embolisation (block blood flow to kidney)
110
How is a stage 4 renal cell carcinoma treated?
Chemotherapy
| Hormone therapy
