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Flashcards in Renal Deck (109):
1

Which type of fluid should resuscitation be attempted with?

Crystalloid

(Hartmann's, Ringer's or plasma-lyte)

2

With which condition should fluid resuscitation be attempted with colloid?

Rhabomyolysis

3

When is the only situation in which human albumin should be considered in resuscitation?

Severe sepsis

4

How much human albumin solution should be given?

100ml every 3L in normal renal function
100ml every 3L if renal dysfunction

5

What is special about the basal lamina of the Bowman's capsule?

Thicker

6

What is CKD ?

Abnormal kidney structure or function persisting for more than 3 months

7

What is the criteria for stage I CKD?

GFR >90 but structural abnormality or genetic fault

8

What is the criteria for stage 2 CKD

GFR 60-89, mild reduced kidney function, anatomy and genetic fault

9

What is the criteria for stage 3 CKD?

3a - GFR 45 - 59
3b - GFR 30 - 44

10

What is the criteria for stage 4 CKD

GFR 15-29

11

What is the criteria for stage 5

GFR <15, renal failure

12

How long should someone with an AKI be monitored for CKD?

2-3years

13

Define accelerated CKD

Sustained decrease in GFR of 25%+ and a change in GFR category within 12 months

14

What is target BP for CKD?

140/90

15

What is target BP for CKD + diabetes

130/80

16

Symptoms of CKD

Pallor, weight loss, "lemon yellow", uraemic frost, itching, confusion, pericardial rub, Kussmaul breathing, etc

17

What dietary advice should be given to CKD patients ?

Phosphate, salt, potassium and fluid restriction

18

What medications can be given in CKD?

Vit D - Alfacalcidol
Phosphate binders - aluminium, calcium or non-calcium based

19

Define AKI

Abrupt reduction in kidney function in <48hours
Increase in creatinine by 50% or reduction in urine output

20

Criteria for AKI stage 1

Increase in serum Cr by 26umol or 1.5x
Urine output <0.5mL/kg/hr for 6 hours

21

Criteria for AKI stage 2

Increase Cr by 2-2.9x
Urine output <0.5mL/kg/hr for 12 hours

22

Criteria for AKI stage 3

Increase Cr by 3

23

What are pre-renal causes of AKI?

Hypovolaemia, hypotension or renal hypo perfusion

(Haemorrhage, shock, drugs)

24

What effect does angiotension II have on GFR

Increases

25

What is the commonest form of AKI?

ATN

26

How is pre-renal AKI treated?

Fluid resus (NOT WITH DEXTROSE), if no improvement with 1L, get help

27

What are renal causes of AKI

Vascular, glomerular, interstitial nephritis or tubular injury
(Vasculitis, glomerulonephritis, drugs, infection, contrast dyes)

28

How is renal AKI investigated?

U&Es - high potassium?
FBC and Coag screen - anaemia and abnormal clotting
USS - obstruction and kidney size
Immunology - ANCA, ANA, GBM

29

When should a renal biopsy be performed?

Rapidly progressive glomerulonephritis, positive immunology and AKI
Unexplained AKI
Only if it is safe to do so

30

How is a post renal AKI treated?

Relieve the obstruction

31

At what level is hyperkalaemia considered life threatening?

>6.5

32

What should be given in hyperkalaemia?

10mls 10% calcium gluconate
Insulin and salbutamol

33

When is HD needed in AKI?

Hyperkalaemia, ph<7.15, urea >40

34

Which "casts" are concerning?

Red cell - nephritic syndrome
Leucocyte - infection or inflammation
Granular - chronic disease

35

What are the features of nephrotic syndrome?

Proteinuria >3g/day
Hypoalbuminaemia
Oedema (periorbital)

36

What are the features of nephritic syndrome?

AKI, oliguria, oedema, hypertension, granular casts

37

What is glomerulonephritis

Immune-mediated disease affecting the kidneys with secondary tubulointerstitial damage

38

How do podocytes react to injury?

Atrophy

39

How does the mesangium react to injury?

Prolierates, releases angiotensin II and

40

How do endothelial cells react to injury?

Vasculitis

41

How is GN investigated?

Urinalysis - haematuria and proteinuria
Urine microscopy - dysmorphic RBCs, grnaular casts
Biopsy and UPCR

42

Quantify microalbuminuria

30-300mg/day

43

Quantify proteinuria

<1g/day

44

Quantify heavy proteinuria

1-3g/day

45

Quantify Nephrotic syndrome

>3g/day

46

What are the complications of nephrotic syndrome?

Infection, renal vein thombosis, PE, volume depletion

47

How can GN be classified?

1 - idiopathic
2 - caused by infection/drugs/disease

Proliferative/non-proliferative
Focal/diffuse
Global/segmental
crescentic

48

What are non-immunosuppressive managements for GN

Anti-hypertensives, ACEi, diuretics, statins

49

What are immunosuppressive treatments for GN?

Steroids, azothioprine, IV Igs

50

How is nephrotic syndrome treated

Fluid restriction
Salt restriction
Diuertics
ACEi
Immunosuppression

51

What are the suptypes of idiopathic GN?

Minial change
FSGS
Membranous
Membranoproliferative
IgA nephropathy

52

Which group is most likely to get minimal change GN?

Children

53

How is minimal change GN treated?

Steroids - 94% achieve remission
Cyclophosphamide

54

How does FSGS GN affect renal function long term?

50% progress to end stage renal failure after 10 years

55

What can be 2ndry causes of membranous nephropathy?

Infection, CTD, malignancy, drugs

56

Which is the commonest GN overall?

IgA nephropathy

57

What usually precedes IgA nephropathy GN?

resp/GI infection, HSP

58

How is IgA nephropathy treated?

BP control

59

What treated should be given for Rapidly Progressive GN?

Immunosuppression

60

Outline the pathogenesis of diabetic nephropathy

Plasma glucose stimulates growth factors in kidney --> Mesangial expansion --> Diffuse Glomeruloscelrosis
Also inflammation

61

How do diabetics differ in terms of RRT?

Get kidney-pancreas transplant if type 1
Start RRT earlier

62

Define ischaemic nephropathy

Reduced GFR a/w reduced renal blood flow

63

Who gets Renal Artery Stenosis?

Older males with artherosclerosis risk factors

64

How does Renal Artery Stenosis present?

Hypertension, AKI/CKD, flash pul oedema, abdo bruit

65

How is renal artery stenosis diagnosed?

Imaging - USS, duplex, CT, MR angiography

66

How is renal artery stenosis treated?

Statins, anti-platelets, stenting

67

Which mutations are a/w ADPKD

PKD1 gene chromosome 16
PKD2 gene chromosome 4

68

What are common findings in ADPKD

Massive cysts, enlarged kidneys, benign adenomas

69

How may ADPKD present

Pain, hypertension, haematuria, light urine

70

What are extra-renal features of ADPKD

Hepatic cysts that don't affect function
Intra-cranial aneurysms
CV valve disease
Hernias

71

What will USS show with ADPKD

Bilateral cysts and renal enlargment

72

How can ADPKD be distinguished from ARPKD in kids?

Hepatic fibrosis suggests recessive disease

73

How is ADPKD managed?

BP control, hydration, proteinuria reduction

74

Where are cysts classically in ARPKD?

Collecting ducts

75

What is found on examination of ARPKD?

Palpable kidney, hypetension

76

Describe the morality of ARPKD?

Up to 24% in first year of life
After than 80% live past 15 years

77

What is the inheritance pattern of Alport's syndrome?

X linked

78

What is Alport's syndrome

Disorder of type IV collagen matrix

79

Which mutation is a/w Alport's syndrome?

COL4A5 gene

80

What are features of Alport's syndrome?

Haematuria
Proteinuria
Sensorineural deafness
Ocular defects
Leiomyomatosis of oeso/genetaia

81

What does renal biospy show on Alport's syndrome?

Variable thickness GBM

82

How is Alport's treated?

BP control, RRT

83

What is Anderson-Fabry's disease?

Error of glycophingolipid metabolism causing lysosomal storage disease

84

How is Anderon-Fabry's disease inherited

X-linked

85

What are features of Anderson-Fabry's disease

Dark red/blue angiokeratomas, CV disease, stroke, psychiatric disorders, renal failure

86

How is Anderson-Fabry's disease treated?

Enzyme replacement - Fabryzyme

87

How is medullary cystic kidney disease inherited?

AD

88

How is medullary cystic kidney disease inherited?

RRT

89

What is a medullary spongy kidney?

Dilation of the collecting ducts

90

How is medullary sponge kidney diagnosed?

Excretion urography

91

Define diffusion in dialysis

The movement of solutes from high to low concentration across a semi-permeable membrane

92

Which electrolytes build up in ESKD

Urea, K, Na

93

Define convection in dialysis

Movement of water and its solutes across a semi-permeable membrane in response to a pressure gradient - ULTRAFILTRATION

94

What is a fistula ?

An artery and vein joined to make an enlarged vessel

95

What are the cons of a fistula

Requires surgery and maturation of 6-12weeks
Can thrombose/stenose

96

What is a tunneled venous catheter?

Catheter in a large vein like internal jugular or femoral

97

What are the cons of a tunneled venous catheter?

High infection risk, can become blocked, can cause damage to central veins

98

What are pros of tunneled venous catheter?

Easy to insert
Used right away

99

What are the pros of a fistula?

Less likely to cause infection
Good blood flow

100

How is a tunneled venous catheter infection treated?

Vancomycin + Gentamicin

101

How does PD work?

Solute removal by diffusion across the peritoneal membrane
Water removal by osmosis driven by dialysate fluid glucose

102

What are the two types of PD?

Continuous PD
Automated PD

103

How many times does CAPD need to be changed per day?

4

104

How many times does APD need to be changed per day?

1

105

What are complications of PD?

Infection, hernia, anaemia, CV disease

106

How long does an HD session take

First session 90-120 minutes then build up to 4 hours

107

What rapid correction of uraemic toxin levels cause?

Disequilirbium syndrome - oodema nad seizures

108

What are the 6 voiding symptoms?

Poor/intermittent flow, spraying, hesitancy, dribbling, straining

109

What are the 6 storage symptoms

Frequency, urgency, incontinence, nocturia, incomplete emptying, pain