Renal Flashcards
(72 cards)
1
Q
Functions of Kidney (A WET BED)
A
Acid - base balance Water balance Erythropoeisis Toxin removal Blood pressure Electrolyte balance D vitamin activation
2
Q
3 features of AKI
A
- Uremia
- Oliguria
- High creatinine
3
Q
2 most important diagnostics for AKI
A
- USS - within 24hrs
- Dipstick
4
Q
Biggest risk factor for AKI
A
Hypertension
5
Q
What sign in AKI is associated with poor prognosis
A
-Oliguria
6
Q
4 progressive ECG changes with hyperkalemia
A
- Tall tented T waves
- Small/absent P waves
- Wide QRS
- Sine wave = fatal
7
Q
Treatment protocol hyperkalemia
A
-Calcium gluconate - stabilize myocardium
-Dextrose with Insulin
-(Salbutamol)
-Sodium bicarb
(Dialyse if necessary)
8
Q
When would you use a loop diuretic in AKI
A
Pulmonary oedema
9
Q
What NT contraindicated with AKI
A
Dopamine
10
Q
Most common form of AKI
A
Pre-renal
11
Q
Commonest cause of AKI in hospital and why is it difficult to manage
A
- Sepsis
- Vancomycin and Gentamycin = nephrotoxic
12
Q
Definition of pre-renal AKI and 4 major causes
A
- Impaired renal blood flow
- Hypovalemia (shock)
- Hypotension
- CO decrease
- Vascular disease (stenosis of renal vessels or emboli)
13
Q
Impact of pre-renal AKI on RAAS
A
Decreased blood flow activates RAAS, Na and H20 resorbed causing increased creatinine and urea
14
Q
3 Sub-categories of Intra-renal AKI
A
- Acute tubular necrosis
- Acute Interstitial nephritis
- Glomerulonephritis
15
Q
Causes of acute tubular necrosis
A
- Ischemia
- Drugs - aminoglycosides, lead, contrast, myoglobin
16
Q
What is tumor lysis, and how does it relate to acute tubular necrosis.
A
Tumor cells release nephrotoxic uric acid during chemo damaging tubules. - drink water during chemo
17
Q
Acute Interstitial Nephritis
- Causes
- Diagnostics
A
- Drugs: Penicillin, AlloP, PPI, Chemo, NSAID’s, Rifampacin
- Infective: Staph A, Hantavirus
- Eosinophilia
18
Q
What is glomerulonephritis and what does it encompass
A
Inflammation of the glomerulus and includes noth nePHROTIC and nePHRITIC pictures.
19
Q
Features of Nephritic syndromes
A
- Haematuria -
- High BP
- Low urine output
20
Q
4 Nephritic syndromes and their clinical features
A
- Goodpastures = Anti-GBM on basement membrane, tends to affect adults
- ANCA-Vasculitis = SLE, autoimmune, may present with endocarditis
- IgA Nephropathy = Most common form, begins few days after infection, IgA deposits in mesangial cells, young men often affected
- Alport syndrome: Kids, hearing loss, inherited collagen defect
21
Q
2 rarer forms of Nephritic syndrome
A
- HUS
- Henloch-Schonlein Purpura
22
Q
2 conditions that present with mixed nephrotic and nephritic picture
A
- Post Strep: Kids. 7-14 days after, starry sky and necrophilia
- Membranous proliferative: poor prognosis associated with hepatitis B and C patients.
23
Q
Features of Nephrotic syndrome
A
- Proteinuria
- Low albumin
- Oedema
24
Q
3 primary causes Nephrotic syndrome
A
- Minimal Change: Most common, esp kids
- Focal Segmental: Most common, adults. associated with HIV and heroin users
- Membranous: Autoimmune cause suspected
25
3 Secondary causes Nephrotic syndrome
- Diabetic nephropathy - causes membranous and focal segmental
- Sarcoidosis/Amyloidosis
- SLE
26
2 Marked features of nephrotic syndrome
- Hyperlipidemia
| - Hypercoagulability
27
Define CKD
Chronic (3month) decline in renal function, with low urine, low eGFR and high creatinine
28
How can you classify severity of CKD
RIFLE criteria
29
Most common causes of CKD in order of most to least likely
- Diabetes
- Hypertension
- Glomerular disease
30
Main indicator for dialysis
Hyperkalemia
31
Best diagnostic tool to determine Acute/Chronic KD
USS
32
3 Features of Uremia
- Encephalopathy
- Pericarditis
- Skin frost
33
3 Features of Na retention (RAAS activation)
- oedema
- thirst
- hypertension
34
Cause and treatment of CKD anemia
- Normocytic normochromic due to decreased EPO
| - Recombinant EPO
35
Treat CKD acidosis and biggest risk to this
Sodium bicarb - oral
| -oedema and BP
36
2 Causes of CKD bone disease and treatment
-High phosphate = High PTH = Osteoclast breakdown bone
-Low vitamin D = low calcium = High PTH
TREAT =
-Activated vit D (1-alfacalcidol)
-Decrease dietary phosphate
37
Endocrine complication of renal transplant
New onset diabetes
38
5 absolute contraindications for transplantation
- Active Cancer (2-5yrs free)
- Active infection
- Drug misuse
- Uncontrolled psychiatric condition
- <5yrs life expectancy
39
Basis for Acute + Chronic transplant rejections
MHC incompatibility
40
Basis for Hyperacute transplant rejection
Blood group rejection
41
Basis HLA typing
Tyhe more matched between A, B and DR group the better the prognosis
42
000 and 666 in relation to HLA matching
```
000 = No mismatch
666 = Complete mismatch
```
43
- Histology Renal cell carcinoma
- Main symptom
- 3 clinical signs
- Adenocarcinoma
- Haematuria
- High BP, Anemia, High ESR
44
Spread and route of spread
Bony mets via para-aortic nodes
45
Indication for poor prognosis and treatment in this case
- Metastasis (vascular involvement)
| - Biologics
46
Bladder cancer
- M:F
- Risk factors
- 5:2
| - Smoking, dyes, benzidine, radiation
47
What bladder cancer subtype is only associated with chronic UTI and schistosomiasis
Squamus cell carcinoma
48
Most common area and histology of prostate CA
- Peripheral zone
| - Adenocarcinoma
49
Unique feature of prostate bony mets
Increased bone density (osteosclerotic) - other cancers cause a decrease
50
3 instances where NICE recommends PSA use
- LUT
- Erectile dysfunction
- Frank Haematuria
51
Treatment for both low and med/high rick prostate CA
- Low: Watch/active surveillance
| - Med/High: Radical prostatectomy and radio
52
Brachytherapy
Implantation of radioactive seeds into prostate - associated with fewer side effects. Only recommended for low risk patients.
53
Androgen suppressors for non-localized disease
- Bicalutamide
- "Relins"
- Finasteride - prophylactic for cancer developing
54
2 types of testicular CA
- Seminoma
| - Teratoma
55
Most likely sites for seminoma spread (3 L's)
- Lungs
- Liver
- Lymphatics
56
Serum markers
- Teratoma
- Both
- Seminoma
```
T = alpha-fetoprotein (AFP)
Both = B-HCG
S = Lactate dehydrogenase
```
57
Treatment protocol and cure rate
Orchiectamy and platinum based chemo
| 95%
58
Stress Incontinence
Leakage due to an incompetent sphincter typically when laughing or couching (increased abdo pressure)
59
Urge Incontinence
Detrusor over-activity, caused by unstable muscle and increased contraction
60
Overflow Incontinence
Dribbling due to increased bladder volume - residual volume
61
What medication is not advised for overflow incontinence
Anticholinergics - chronic retention
62
3 types of renal calculi in order of most prevalent
- Calcium
- Uric acid
- Styruvate
63
Initial investigation
X-ray / CT
64
2 Smooth muscle relaxers for renal colic
Alpha receptor blockers - Tamsulosin
| Ca channel blockers - Rifedipine
65
Unique treatment and imaging for uric acid stones
Not seen on X-ray (CT)
| -Allopurinol
66
Symptom score for BPH
IPSS
67
Alpha-blockers for BPH, risk
Tamsulosin - "Ulosins" , floppy iris
68
5-alpha reductase for BPH MOA
Finasteride = decreases conversion of testosterone to DHDT so helps shrink prostate size
69
Meaurement for albumin
Early morning Albumin : Creatinine
70
First line management for calculi
NSAIDS + alpha blocker (moves stone)
71
What type of glomerular damage is post strep
Diffuse proliferative
72
2 types of PKD
- Multicystic/dysplastic = commonest form renal cystic disease in childhood
- Autosomal Dominant = most common mono-genetic disease. Extra-organ manifestations. Presents late!
- Autosomal Recessive = less likely childhood cause
