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Renal Flashcards

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1
Q

How much is GFR?

A

120 ml/min/1.73m2

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2
Q

What is creatinine?

A

Chemical waste product of muscle metabolism

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3
Q

Misleading creatinine level?

A

Cachexia

Bodybuilder

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4
Q

Why is creatinine clearance > GFR?

A

Secreted as well as filtered

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5
Q

3 hormones in Na excretion (and therefore volume control)

A

Aldosterone –> decrease excretion
Angiotensin II –> decrease excretion
ANP –> increase excretion (released by the heart in response to high BP)

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6
Q

Which hormone dilates afferent arteriole in kidney?

Constricts?

A

Prostaglandin dilates

Angiotensin II constricts

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7
Q

2 SEs of ACEi

A 
Impaired renal function
Hyperkalaemia
Post hypo
Dry cough (bradykinin)
Fatigue
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8
Q

2 SEs of ARB

A

Renal impairment
Post hypo
Hyperkalaemia

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9
Q

Medications causing hypokalaemia?

A

Loop diuretics

Thiazides

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10
Q

Medications causing hyperkalaemia?

A

Spironolactone
Amiloride
ACEi
ARB

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11
Q

Transporter in LoH?

A

NKCC2

Na K Cl Cotransporter

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12
Q

Where do ADH and aldosterone take effect?

A

DCT and CD

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13
Q

Barter’s syndrome?
Effect of..?
When?
Features?

A

Effect of loop diuretics

In childhood

Metabolic alkalosis, low Mg, High urinary Ca

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14
Q

Gitelman’s syndrome?
Effect of..?
When?
Features?

A

Same as thiazide (DCT)

Late childhood

Metabolic alkalosis, Mg decreased, urine Ca norm/low

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15
Q

Renal Tubular Acidosis causes what ABG?

A

Hypercholoraemic metabolic acidosis + hypobicarbonate + decreased arterial pH

Normal anion gap

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16
Q

Causes of renal tubular acidosis?

A

Drug induced

Fanconi syndrome

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17
Q

What is fanconi syndrome?

A

Generalised dysfunction of renal proximal tubule

–> urinary loss of bicarb, glucose, AA, phosphate, peptides

SALT WASTING AND VOLUME DEPLETION

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18
Q

2 RFs for renal tubular acidosis?

A 
Childhood
Urinary tract obstruction
DM
Stones
Adrenal insufficiency
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19
Q

Pres of RTA?

A 
Growth retardation
FTT
Muscle weakness (Fanconi)
Hypoglycaemia
Rickets
Kussmaul breathing in severe
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20
Q

Mx of RTA?

If hyperkalaemia + mineralocorticoid deficiency?

A

Sodium alkali

Dietary restriction of K

Fludrocortisone

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21
Q

Comps of RTA?

A 
Volume depletion
Nephrocalcinosis
Osteoporosis
Growth retardation
Rickets
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22
Q

Causes of end stage renal failure?

A 
DM
HTN
Glomerulonephritis
Pyelonephritis
PKD
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23
Q

Cause of pyelonephritis?

A

E. coli (ascending from LUTI)
UPEC

OR spread hematogenously to kidney (DM, HIV, malignancy, transplant)

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24
Q

3 RFs for severe pyehlonephritis?

A 
Extremes of age
Anatomical abnorm
Foreign body
Immunocomp
Obstruction
Pregnancy
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25
Pyelonephritis cause in men
prostate causing urethral blockage
26
Triad in pyelonephritis presentation
Fever Loin pain Renal tenderness
27
Ix in pyelonephritis
Urine dip, urinalysis, gram stain, culture FBC, ESR/CRP, Blood cultures Imaging [USS/CT w contrast]
28
Gram stain in pyelonephritis?
Gram negative rods (e.coli, klebsiella, proteus)
29
Mx of pyelonephritis: 1. mild 2. severe
1. ciprofloxacin PO BD ``` 2. Admit IV fluids IV pcm IV ceftriaxone/cipro/gent +/- catheter ```
30
2 comps of pyelo
renal failure, abscess, renal scarring, recurrent UTIs
31
2 types of RCC
80% clear cell | 15% papillary
32
RFs for RCC
smoking, obesity, HTN Occupational exposure [asbestos, lead, chlorine} Genetics: VHL
33
Pres of RCC
Asympto Triad [abdo mass, haematuria, loin pain]
34
Genetics cause increases risk of RCC?
Von Hippel Lindau | AD
35
Ix in RCC
Check function - U+Es, FBC, Calcium, LFT, Check structure - USS, CT Check for mets - CT abdo pelvis, MRI, CXR (?cannonball mets)
36
Comp of RCC?
paraneoplastic syndrome - anaemia hypercalcaemia, SIADH
37
Mx of RCC?
Surgical [partial / laparascopic nephrectomy]
38
Drug to use in late stage RCC?
Tyrosine kinase inhibitor | eg Sunitinib
39
Renal tumour in kids?
Wilm's --> nephroblastoma
40
What is AKI?
Acute decline in GFR from baseline/increase in creatinine | +/- oliguria
41
Causes of AKI
Pre renal - azotaemia, renovascular disease Renal - acute tubular necrosis (mainly due to sepsis); glomerulonephritis, nephritis, vascular Post-renal - obstruction
42
What is azotaemia? Features?
High N containing compounds in blood eg Ur, Cr Hypovolaemia, haemorrhage, sepsis
43
Who can you not give NSAIDs to?
B/l renal artery stenosis
44
Most common cause of AKI?
Acute tubular necrosis
45
Nephrotoxic drugs?
CANT DAMAG Contrast, abx (penicillin, ceph), NSAIDs, Therapeutic index (narrow), Diuretics, ACEi, Metformin, ARB, Gentamicin
46
How to measure AKI?
Creatinine | UO
47
Ix in AKI?
U+Es, FBC, VBG Urine dip, MC+S ECG Imaging
48
Mx in AKI?
``` Stop nephrotoxic drugs ABCDE Catheterise If obstruction --> urgent USS KUB, Dialysis if uraemic/severe acidosis/hyperkalaemia ```
49
What is CKD?
Proteinuria/haematuria and/or reduction in GFR to <60 for >3months
50
Causes of CKD?
DM HTN Autoimmune Smoking Obesity
51
Mx of CKD?
Glycaemic control | Optimise BP
52
Stages of CKD?
Based on GFR ``` 1 > 90 2 > 60 3a > 45 3b > 30 4 > 15 5 < 15 / on dialysis ```
53
Primary prevention of CKD? | Secondary prevention?
Optimise DM + BP, smoking cessation Salt + protein restricted diet
54
How does uraemic syndrome present?
``` Uraemic tinge (grey/yellow) N+V Itch *encephalopathy *pericarditis *bleeding ``` URGENT RRT
55
Comps of CKD
``` Anaemia Osteodystrophy CV disease Protein lsos HyperK Metabolic acidosis Pulm oedema ```
56
Ix in CKD
U+E, FBC Urinalysis Renal USS Bone profile
57
Mx of CKD
``` Treat reversible causes Optimise CVS risk factors Education re RRT EPO for anaemia Ca for bones Low protein and potassium diet ```
58
Stage 5 CKD mx?
RRT Dialysis Transplant
59
Indications for RRT in AKI?
``` Uraemia Resistant Pulm oedema Severe hyperK Severe metabolic acidosis Renal failure ```
60
Comps of haemodialysis?
Infection, thrombosis, aneurysm, IE, stenosis Hypotension N+V, headache, cramps Anaphylazis Diseuilibration syndrome
61
Comps of peritoneal dialysis?
Peritonitis Problems with catheters Constipation, fluid retention, hyperglycaemia, weight gain hernia
62
Why transplant > dialysis?
Survival, QoL, economic, enables pregnancy, reverse aneamia + bone disease
63
LT immunosuppression post transplant?
Prednisolone Calcineurin inhib [tacrolimus / ciclosporin] Anti-metabolite [azathioprine]
64
CIs for renal transplant in CKD?
Active infection Uncontrolled IHD AIDS
65
Comps for renal transplant?
Immediate [Local infection, DVT, pain] Immunosuppression [infections] Obstruction Drugs [bone marrow suppression] Rejection Other [cancer, CV disease]
66
Types of rejection? | What time frame?
Hyperacute (mins) - due to crossmatch Accelerated (days) - T-cell mediated crisis Acute cellular (weeks) Chronic (years)
67
Causes of glomerulonephritis?
Focal segmental glomerulonephritis in nephrotic syndrome
68
Causes of nephrotic syndrome?
``` Deposition (amyloidosis, light chain dep) MCD (kids) Focal + segmental GN (younger adults) Membranous nephropathy (adults) Membranoproliferative GN ``` NephrOtic depOsit
69
Causes of nephritic syndrome?
``` IgA nephropathy Postinfectious GN Rapidly progressing GN Vasculitis Anti-GBM ``` Nephritic is prolific
70
Signs of nephrotic syndrome?
Proteinuria (>3.5g/24h) Hypoalbuminaemia Peripheral oedema Hyperlipidaemia
71
Signs of nephritic syndrome?
Oliguria HTN Haematuria
72
Mx of MCD
Prednisolone
73
DDx of nephrotic syndrome?
CCF Liver disease (both cause oedema)
74
Comps of nephrotic syndrome?
Infection (urinary loss of IgG) Hypercoaguability Hypercholesterolaemia Hypocalcamia
75
Most common cause of nephritic syndrome? | What happens?
IgA nephropathy (Buerger's disease) Macroscopic haematuria 24-48h post GI/URTI IgA deposit in mesangial matrix
76
Causes of rapidly progressive glomerulonephritis?
Goodpastures (anti-GBM) Wegeners Microscopic polyangitis
77
Ix in glomerulonephritis?
FBC, U+Es, LFT Urinalysis Renal biopsy Antibody testing (ANCA, GMB, dsDNA)
78
Mx of post strep glomerulonephritis?
IM BenPen
79
Mx of mild glomerulonephritis? | isolated haematuria, normal GFR
Abx / antivirals Limit salt + fluid
80
Mx of severe glomerulonephritis? | haematuria, proteinuria, reduced GFR
ACEi + Abx + furosemide +/- prednisolone (if nephrotic syndrome)
81
Mx of Goodpastures?
Plasma exchange + IV methylprednisolone + IV cyclophosphamide
82
Mx of immune complex glomerulonephritis?
IV methylprednisolone
83
Mx of lupus nephritis?
IV methylprednisolone + cyclophosphamide
84
Comps of PKD?
HTN, CV morbidity, CKD, SAH, ESRD
85
Protein in PKD?
Polycystin
86
Which is worse? | ADPKD or ARPKD
ARPKD worse --> if homozygous will die in utero If heterozygous presents in neonatal period (enlarged kidneys), death by teens
87
Pres of PKD?
``` FH of PKD Flank/abdo discomfort + lumbar pain + haematuria HTN Infections Palpable kidneys Hepatomegaly ```
88
Where do you get cysts in PKD?
``` Kidneys Liver Pancreas Seminal vesicles Brain ```
89
Ix in PKD?
Renal USS Geneitc CT abdo/pelvis Urinalysis ECG, Echo, MRI angiography (screen for aneurysm annually)
90
Family screening in PKD
Screen for SAH in 1st degree relatives
91
Mx of infection in PKD?
Ciprofloxacin
92
Mx in PKD: Limit fluid secretion? Target cell proliferation?
Calcium mimetics, CFTR inhibitors, Metformin Somatostatin
93
Causes of glomerulonephritis
Idiopathic Infection Systemic [SLE, RA, Wegners, HUS, HSP, Goodpastures] Drugs [penicillamine, NSAIDs, cicosporin] Metabolic [HTN, DM] Other [amyloidosis]
94
Comps of CKD
NS [peripheral neuropathy, restless leg, tiredness, fatigue] CV [fluid overload, pericarditis, atherogenesis] GI [altered taste, reduced Ca absorp] Bone [Hyperparathyroidism, osteodystrophy] Electrolyte [hyperK, acidosi] Blood [anaemia]
95
Pain relief in renal colic? (drug, route and dose) Which class is better?
IM diclofenac 75mg NSAIDs > opioids
96
Mx of renal stones <5mm? <2cm? If pregnant? >2cm/complicated?
<5mm pass spontaneously <2cm - ESWL --> if pregnant - ureteroscopy >2cm - percutaenous nephrolithotomy

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