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Renal Flashcards

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1
Q

Roughly how much blood do the kidneys filter in one minute?

A

250ml

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2
Q

How is sodium reabsorption regulated?

A

Hypotension or hyponatraemia are detected a the macula densa ->renin release -> aldosterone release -> Na/K pump insertion

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3
Q

What part of the nephron is responsible for the majority of Na reabsorption?

A

PCT - 70%

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4
Q

Where are NaK2Cl symporters found?

A

Ascending limb

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5
Q

Where is calcium reabsorbed?

A

DCT

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6
Q

What are the three endocrine products of the kidneys?

A

Renin
EPO
1alpha hydroxylase

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7
Q

Name one carbonic anhydrase inhibitor and suggest when it is used clinically

A

Acetazolamide - used as a diuretic in glaucoma

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8
Q

What are the side effects of loop diuretics?

A

Hypokalaemic metabolic alkalosis
Ototoxicity
Hypovolaemia

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9
Q

What are the side effects of thiazide diuretics?

A

Hypokalaemia
Hyperglycaemia
Hyperuricaemia

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10
Q

What are the side effects of Ksparing diuretics?

A

Hyperkalaemia

Antiandrogenic e.g. gynaecomastia

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11
Q

What are the causes of haematuria?

A

Renal or Extra renal

Renal
PKD
Trauma
Pyelonephritis
Neoplasm
Immune complex deposition
Extra renal
Stones
Catheter
Infection
Neoplasm
Drugs (NSAIDs, furosemide)
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12
Q

What are the cut offs for PCR?

A

<20 is normal,

>300 is nephrotic

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13
Q

What are the commonest causes of proteinuria?

A 
DM
Minimal change
Membranous 
Amyloidosis
SLE
HTN
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14
Q

What might cause a falsely low or high urea?

A

Raised in protein meal, UGI bleed, supplements, dehydration

Low in hepatic impairment

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15
Q

What are the causes of renal impairment?

A

Pre, renal, post

Pre-renal
Shock
RAS
Toxins
Thrombosis
Hepatorenal syndrome

Renal
Glomerulonephritis
ATN
Interstitial disease

Post renal
Obstruction (stone, cancer, prostate, valves, strictures, infection, post op)

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16
Q

What are the ECG features of hyperkalaemia?

A 
Peaked T waves
Flat P waves
PR prolongation
Wide QRS
VF
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17
Q

What are some causes of a sterile pyuria?

A

TB
Treated UTI
Appendicitis
Calculi

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18
Q

What are the four commonest causes of UTI?

A

E coli
S saphrophyticus
Proteus (causes struvite calculi)
Klebsiella

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19
Q

WHen would you ultrasound a UTI patient?

A

Children
Men
Recurrent
?pyelonephritis

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20
Q

Which UTI Abx is contraindicatedin renal failure?

A

Nitrofurantoin

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21
Q

How might GN present?

A

Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome

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22
Q

What are the causes of GN?

A 
Idiopathic
Immune - SLE, Goodpastures, vasculitis
Infection - mainly hepatitis, Strep
Drugs - penicillamine
Amyloid
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23
Q

How would you investigate GN?

A 
Bloods - 
Basics
Complement (SLE)
ANA, dsDNA, ANCA, GBM
Serum electrophoresis
Serology

Urine -
Dip, spot PCR, Bence Jones,MCnS

Imaging -
CXR for infiltrates
Renal USS +- biopsy

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24
Q

What is the management of GN?

A

Refer
Aggressive HTN management
Use ACEi and ARBs

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25
What are the three common causes of asymptomatic haematuria?
IgA nephropathy (Berger's) Young men with episodic macroscopic haematuria days after URTI Treat with steroids Thin BM disease (commonest) Alports - XLR Leads to progressive renal failure with SNHL and retinal flecks
26
What is the classical triad of nephritic syndrome?
Haematuria with RC casts Proteinuria -> oedema Hypertension
27
What are the two causes of nephritic syndrome?
1. Post strep | 2. Cresentic (Rapidly progressing GN)
28
What are the features, treatment and prognosis of post strep nephritic syndrome?
Young children with malaise, haematuria, oedema and HTN 2 weeks after URTI or skin infection Biopsy shows IgG and C3 deposition Treatment is supportive and 95% of children recover fully
29
What are the presenting features of an AKI?
Uraemia Acidosis Hyperkalaemia Fluid overload
30
What are the causes of AKI?
Pre, renal, post Pre - Hypovolaemia, RAS Renal - ATN (HUS, HTN, TTP, shock), direct nephrotoxins Nephritic syndrome Post renal - Obstruction
31
What is the management of hyperkalaemia?
10ml 10% CaGluconate 100ml of 20% dextrose + 10units of actrapid Salbutamol 5mg neublised
32
What are the indications for dialysis in AKI?
``` Persistent K>7 Refractory pulmonary oedema Symptomatic uraemia pH<7.2 Poisoning ```
33
How would you manage an AKI?
``` Resus and assess fluid status Treat life threatening complications Treat shock or dehydration Monitor - cardiac, urine, fluid balance Investigate post renal causes Hx and Ix Treats sepsis ```
34
What are the causes of interstitial nephritides?
Drug hypersensitivity in 70% NSAIDs, Abx, diuretics, allopurinol, cimetidine Infection - staphs and streps Immune - SLE, Sjogren's
35
How does interstitial nephritis present?
``` Fever Arthralgia Rash AKI Uveitis ```
36
What is found on investigation of an interstitial nephritis?
``` IgE Eosinophilia Haematuria Proteinuria Sterile pyuria ```
37
How would you treat an acute interstitial nephritis?
Stop offending drug/infection and give prednisolone
38
What are the commonly seen nephrotoxins?
Exo vs endogenous ``` Exo NSAIDs Antimicrobials (aminoglycosides, vancomycin, aciclovir, sulphonamides, tetracycline) ACEi Ciclosporin and Tacrolimus Contrast media ``` ``` Endo Haemoglobin Myoglobin Urate Ig in myeloma ```
39
In the case of rhabdomyolysis, how long does it take for AKI to develop>
10-12 hours
40
How would you treat rhabdomyolysis?
Manage hyperkalaemia IV rehydration IV NaHCO3 can detoxify myoglobin
41
What are the two commonest causes of CKD?
DM HTN Others inc RAS, GN, PKD, drugs, pyelonephritis
42
How would you investigate CKD?
Blood - Low HB, UnEs off, ESR, Low Ca high Po4, High ALP, high PTH Immune profile Film - burr cells Urine - all that stuff ``` Imaging - CXR (cardiomegaly, PE(ffusion), oedema) AXR - stones Renal USS (cysts?) Bone Xrays (fractures) CTKUB - cortical scarring from pyelonephritis ```
43
WHat are the complications of CKD?
CRF HEALS Cardiovascular disease Renal osteodystrophy Fluid overload ``` HTN Electrolyte disturbances Anaemia Leg restlesness Sensory neuropathy ```
44
What is the management of CKD?
General - treat reversibles and stop nephrotoxins Lifetsyle - Exercise, weight control, stop smoking, Na, fluid and Po4 restriction CV risk management (statins, aspirin, DM control) HTN - target <130/80 if diabetic with ACEi/ARB Oedema -> Furosemide (nephrotoxic) Bone disease - Phosphate binders Vit D analogues Ca supplements Anaemia - EPO Restless legs - clonazepam
45
What things are involved in the assessment for renal transplant?
Virology status CVD TB ABO and haplotype
46
What are the contraindications to renal transplant?
Active infection Active cancer Severe comorbidities
47
What is the predicted half life for a cadaveric renal repacement?
15 years
48
What complications may occur after renal transplant?
Post op - bleeding, thrombosis, infection, leakage Hyperacute rejection (minutes) - ABO incompatabily presents with thrombosis and SIRS Acute rejection (<6 months) - cell mediated and responds to immunosuppression Chronic rejection (>6 months) - interstitial fibrosis and tubular atrophy which doesnt respond to immunosuppression Ciclosporin/tactrlimus nephrotoxicity Impaired immune function ->inf, cancer CV disease
49
How does diabetes cause nephropathy?
Hyperglycaemia causes renal hyperperfusion resulting in hypertrophy and an increase in size. THis, and metabolic defects increase ROS production resulting in glomerulosclerosis, nephron loss, RAS activation and subsequent HTN
50
What screening should DM patients undergo to pick up renal damage?
6 monthly microalbuminuria screening
51
What is the commonest cause of renal artery stenosis?
Atherosclerosis
52
What efffect do ACEi and ARBs have on renal function in RAS patients?
Worsened function
53
What is the gold standard investigation for RAS?
Renal angiography
54
What are the featuers of HUS?
Bloody diarrhoea and abdo pain followed by: MAHA Thrombocytopaenia Renal failure
55
What are the investigation results in HUS?
Schistocytes Thrombocytopaenia Anaemia Normal clotting
56
What are the biochemical fetuers of renal tubular acidosis?
Hyperchloraemic metabolic acidosis with hypokalaemia
57
WHat is Bartter's syndrome?
NaCL channel blockage in LoH resulting in hypokalaemic metabolic alkalosis
58
What is Gitalman syndrome?
Blockage of NaCl channel in DCT resulting in hypokalaemic metabolic alkalosis with hypocalcuria
59
What is the pathology and progression of ADPKD?
Large cysts from all parts of nephron cause gradual decline in renal function, often in ESRF by 70
60
When does ARPKD typically present and with what?
Infancy with renal cysts and congenital hepatic fibrosis
61
Whsat are the featuers of ADPKD?
MISSHAPES ``` Mass Infected cyst Stones SBP high Haematuria Aneurysms Polyuria Extra renal cysts Systolic murmur ```
62
What are the features of tuberous sclerosis?
``` Skin - Adenoma sebaceum Ash leaf spots Shagreen patches Periungual fibromas ``` Neuro - Low IQ Epilepsy Renal - Cysts Angiomyolipomas
63
What are the differentials for renal enlargement?
PHONOS ``` Polycystic kidneys Hypertrophy (due to contralateral renal agenesis) Obstruction Neoplasia Occlusion (RV thrombosis) Systemic (early DM or amyloid) ```

Scott's Notes (21 decks)

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