Renal

Question 1

mnemonic for Ix

Answer 1

Can’t Bloody Imagine Looking Fresh

Cultures

• Urinanaysis
• Blood cultures

Bloods

• Arterial - ABG
• Venous - K, Urea/creatinine, Autoantibodies, LFTs, Lipids

Imaging

• CXR (fluid overload) / AXR (stone)
• USS
• MRI

Looking
-Endoscopy

Functional
-ECG - Tented T waves

Question 2

MCV and GGT raised =

Answer 2

alcohol

Question 3

Ratio of Urea vs creatinine…Chronic vs Acute

Answer 3

acute - Urea rises first [U’re ‘ere, then your gone]

chronic - creatinine

Question 4

2 Most common cause of nephritic

Answer 4

IgA nephropathy

post strep

Question 5

2 most common causes of nephrotic

Answer 5

diabetic nephropathy
minimal change (kids)

Question 6

Causes of post renal renal failure

Answer 6

infection, stones, malignancy

Question 7

Main causes of renal failure

Answer 7

HTN
Diabetes
Glomerulonephritis

Question 8

CKD main comps

Answer 8

Neuro
Peripheral nephropathy
restless leg
fatigue

Cardio
Accelerated atherogenesis - [main cause of death]
Fluid overload
Uraemia - pericarditis / encephalitis

GI
Reduced absorption of Ca

Bone
Hyperparathyroid
Osteodystrophy

Electrolyte
HyperK
Acidosis

Haem
Reduced Epo-> anaemia of chronic disease
Impaired platelet (due to uraemia) -> bruising

Question 9

Mx options CKD

Answer 9

Conservative
Education eg dialysis planning,
Low K diet
Fluid restriction

Medical
HTN/diabetes
Epo
Bicarbonate

Interventional
Renal Replacement therapy

Question 10

4 causes of CKD

Answer 10

diabetes 
HTN 
Glomerulonephritis 
PKD
Pyelonephritis 
Obstructive disease 
Renovascular disease

Question 11

3 reasons to do an USS in kidney pain

Answer 11

Exclude obstruction
Assess renal size
Exclude PKD

Question 12

name 3 signs of CKD OE

Answer 12

pallor, uraemia tinge
bruising, purpura, brown nails, scratch marks
Peripheral oedema
HTN
Evidence of pleural effusion
Evidence of renal replacement therapy eg fistula

Question 13

Usual Ca when on long term immunosuppression Eg Renal transplant

Answer 13

Squamous cell carcinoma Skin

Question 14

CKD… now high PTH and low Ca. What is this ?

Whats seen in tertiary

Answer 14

Secondary hyperparathyroidism

Hyperplastic change in PTH due to prolonged stimulation
High PTH + High Ca

Question 15

2 actions of PTH

Answer 15

increase Ca

• increase osteoclast
• Increased absobtion in kidney (+P04)

Increased vit D synthesis

Question 16

2 places for hydroxylation of vit D

Answer 16

liver

kidney

Question 17

indications for dialysis in Acute kidney injury

Answer 17

Pulmonary oedema
HyperK - persistent
Severe acidosis
Uraemic encephalopathy / pericarditis

Question 18

How does rhabdomyolysis cause kidney injury?
Key blood test?
Urine test?
Seen on Urinalysis?

Answer 18

Acute tubular necrosis
Creatinine kinase
Urinary myoglobin
Muddy brown / granular casts

Question 19

Name 3 causes of rhabdomyolysis

General Mx - Which drugs should be stopped?

Answer 19

Immobility 
crush 
burns 
seizures 
Neuroleptic malignant syndrome 

IV fluids 
Stop nephrotoxic drugs 
-ACEi
-Metformin
-NSAIDS
-Furosemide

Question 20

ECG hyperK

Answer 20

tall T
Wide QRS
flat P
Prolonged PR

Question 21

Bar calcium gluconate + insulin and dextrose what other drug can you give in hyperK early?

Answer 21

Salbutamol nebs

Question 22

2 key blood tests in rapidly progressive glomerulonephritis with blood++ protein+++

Answer 22

ANCA

AntiGBM

Question 23

Confirm Dx of wegners

Answer 23

Renal biopsy

Question 24

Define nephrotic

Answer 24

proteinuria >3.5g /24hrs
hypoalbuminaemia <30g/dL
Oedema

Question 25

3 comps and Mx in nephrotic

Answer 25

infection - prompt Abx if needed / pneumococcal vaccine Thromboembolism - avoid prolonged bed rest, consider anticoagulants Hyperlipidaemia - statin

Question 26

Diet advice in nephrotic

Answer 26

normal protein | restrict salt

Question 27

Most common cause of nephrotic in kid, adult, elderly

Answer 27

minimal change membranous nephropathy focal segmental glomerulonephritis

Question 28

risk of correcting hyponatraemia too quickly

Answer 28

cererbral pontine myelinosis

Question 29

Where is ADH secreted? what does it do?

Answer 29

post pituitary | Increases aquaporin channels

Question 30

Drug used for severe SIADH? Urine osmolality?

Answer 30

demeclocycline High [>500mmol/L] in SIADH [Usually fluid restirct and Mx of cause]

Question 31

2 signs on dipstick of UTI

Answer 31

leucocyte esterase | nitrites

Question 32

3 peices of advice to prevent UTIs

Answer 32

wipe front to back urinate post sex stay hydrated

Question 33

pt with suspected pylelonephritis 4 parts during initial clerking 4ix

Answer 33

ABCDE, Hx, Exam, IV access, Fluids, Urine dip, request Ix, start Abx, Discuss with senior FBC, U+E, CRP, urine MC+S, blood cultures, Renal USS

Question 34

2 signs of anaphylaxis in A B C

Answer 34

a - stridor, swelling of tongue / throat, hoarse voice b - tachypnea, wheeze, cyanosis c - tachy, pale, hypotension, clammy, prolonged cap refil

Question 35

Conc and route of adrenaline in anaphylaxis? 3 other things given?

Answer 35

IM - 1:1000 0.5ml IV chlorpheniramine, IV hydrocortisone IV fluid High flow O2

Question 36

2 contraindications for renal biopsy? | 3 comps?

Answer 36

Abnormal coagulation, 1 kidney, systolic >160, CKD with small kidneys haematuria pain haematoma infection

Question 37

1 finding in biopsy of IgA nephropathy

Answer 37

Mesangial proliferation | IgA deposition

Question 38

3 causes of a purpuric rash

Answer 38

``` HSP ITP TTP DIC Sepsis ```

Question 39

Post renal biopsy advice

Answer 39

avoid heavy lifting / strenuous activity for 2weeks