Renal Flashcards by Simon Thackray

What is the daily required amount of potassium?

1mmol/kg/day (same as for sodium and chloride)

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At what rate should maintenance fluids be prescribed?

30ml/kg/24hrs

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What are the typical features of interstitial nephritis, and what most commonly causes it?

Fever
Rash
AKI

Medications - penicillin, rifampicin, NSAIDs, allopurinol, furosemide

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What cancer are patients on long term immunosuppresants most at risk of developing?

Squamous cell carcinoma of the skin

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Aside from cancer, what other complications are long term immunosuppresed patients at risk of?

CVD - Tacro and Ciclo cause HTN and hyperglycaemia

Renal disease - Nephrotoxic effect of the drug OR graft rejection OR recurrence of original disease

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What adverse events are patients with nephrotic syndrome at increased risk of, why, and how should this be prevented?

At risk of VTE due to loss of anti-thrombin 3, meaning that LMWH prophylaxis is recommended

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Haemorrhagic cystitis is a commone SFx of which drug?

Cyclophosphamide

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What should be used as a vit D replacement in CKD patients and why?

Alfacalcidiol - already 1alpha hydroxylased so no need for activation in the liver

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What type of nephritis commonly affects children and young adults, and presents with nephrotic syndrome?

Minimal change disease

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What is seen on on renal biopsy of membranous IgA nephropathy?

Thickening of the glomerular basement membrane

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What is the commonest cause of glomerulonephritis in adults?

IgA disease

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What amount of glucose should patients be prescribed per day?

50-100g regardless of weight

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What is a common complication of specifically large volumes of saline therapy?

Hyperchloraemic metabolic acidosis

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What are the causes of cranial DI?

Idiopathic
Post traumatic
Pit surgery

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What are the causes of nephrogenic DI?

Genetic
Electrolytes - HyperCa HypoK
Lithium
Tubulointerstitial disease

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What is the management of Cranial and Nephrogenic DI?

Cranial - Desmopressin

Nephro - Thiazides and low salt/protein diet

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What is an acceptable drop in renal function after starting an ACEi?

GFR drop up to 25%

Cr rise up to 30%

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What are the characteristic biochemical features of DI?

High plasma osmolality
Low urine osmolality
High/normal sodium

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Which of the following medicines should be stopped in AKI?

Metformin
Asp 300
Ramipril
Asp 75
Ibuprofen
Bendroflumethiazide

All except Asp 75

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Outline the features of ADPKD

HTN
Recurrent UTIs
Renal calculi
Haematuria

Hepatic cysts manifesting as hmegaly
Diverticulosis
Berry aneurysms
Ovarian cysts
MV prolapse

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How does gentamicin damage kidneys?

Causes an intrinsic AKI

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What is the cause of death of 50% of dialysis patients?

IHD

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Outline the CKD stages

> 90
60-90
3a. 45-59
3b. 30-44
15-29
<15

NOTE - only diagnose CKD if there are accompanying signs of kidney disease (UnEs, proteinuria etc)

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What is the management of nephrotic syndrome secondary to minimal change disease?

Steroids - 80% responsive

Cyclophosphamide if non-responsive

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What do eosinophilic casts indicate?

Tubulointerstitial nephritis

What are the causes of hypokalaemia?

1. K+ loss - Drugs, GI, dialysis 2. Trans-cellular shift - insulin, salbutamol, theophylline 3. Decreased intake 4. Mg depletion

What is the definition and management of severe hypokalaemia?

Defined as a k+<2.5 Treat with cardiac monitoring and replace K+ quickly but at no greater a rate than 20mmol/hour - e.g. 3 bags normal saline with 40mmol KCl in 24hrs

How do you calculate paediatric maintenance fluids?

100:50:20

What are the features of HSP?

Purpuric rash over legs and buttocks Polyarthritis Abdo pain IgA nephropathy

What are the ABG findings in a renal tubular acidosis?

Metabolic acidosis with normal anion gap Hyperchloraemia Low bicarb

What is the most common and important viral infection in solid organ transplant recipients?

CMV

What is the management of CMV?

Ganciclovir

What urinalysis finding would make you consider lupus nephritis?

Proteinuria (with a background of SLE...)

What are the histological findings of lupus nephritis?

Wire loop thickening Immune complex deposition with capillary wall thickening Granulation

What is the maximum rate of K+ that can be infused through a peripheral line without cardiac monitoring?

10mmol/hr

What are the complications of haemodialysis?

``` Site infection Endocarditis Stenosis Hypotension Arrhythmia Anaphylaxis Air embolus ```

What are the complications of peritoneal dialysis?

``` Peritonitis Catheter infection/blockage Constipation Fluid retention Hyperglycaemia Herniae Back pain ```

What are the complications of renal transplantation?

``` VTE Infections Malignancies BM suppression Recurrence UT obstruction CV disease Rejection ```

What factors may influence GFR other than renal function?

``` Serum Cr Age Gender Ethnicity Pregnancy Muscle mass Eating red meat 12 hrs prior ```

What are the ABG findings in Addison's disease?

Metabolic acidosis with normal anion gap

What fluid should be prescribed for pre-renal AKI?

500ml 0.9% saline over 15 mins

What is calcium acetate, its use and its side effect

A calcium based phosphate binder used to treat hyperphosphataemia in CKD patients. May cause hypercalcaemia (stones, bones, moans etc.)

What is a Brown's tumour and who does it typically affect?

A bone tumour secondary to secondary hyperparathyroidism

Outline the presentation and management of an acute graft rejection

<6 months post op presenting with signs and symptoms of an infection Treat by upping steroid dose

What urea/creatinine picture would indicate AKI 2ary to dehydration?

Disproportionately high rise in urea vs creatinine

What should be done to protect CKD patients who need to have a contrast enhanced scan?

Give 0.9% NaCl for 12 hrs before and after the procedure ACEi/NSAIDs should be stopped in patients with eGFR<40

How should DM patients be monitored for nephropathy?

Measure albumin/creatine ratio on a spot urine sample. If abnorma (raised) then repeat with first pass morning urine specimen

What are the clinical features of amyloidosis?

Weakness and dyspnoea Hepatomegaly Proteinuria Worsening renal function

What are the features of Alport syndrome?

``` Presents in early childhood with: Haematuria Renal failure Bilat SNHL Lenticonus Retinitis pigmentosa ```

What are the side effects of EPO therapy?

``` Hypertension ->encephalopathy Bone aches Flu-like sx Rashes Pure red cell aplasia Thrombosis IDA ```

What type of acid base balance would Addison's disease cause?

Hyperkalaemic metabolic acidosis

What are the causes of a sterile pyuria?

``` Partially treated UTI Renal TB Chlamydia Renal stones Appendicitis Cancer PKD ```

What are the similarities and differences between IgA nephropathy and post strep glomerulonephritis?

Similarities- - Both present after a recent URTI with haematuria Differences - IgA develops 1-2 days after, while PSGN is 1-2 weeks after URTI PSGN also shows proteinuria dna low complement, unlike IgA nephropathy

What are the hallmark features of nephritic vs nephrotic syndrome?

Nephritic - HTN and haematuria Nephrotic - Hypoalbuminaemia, proteinuria, oedema

What are the causes of rapidly progressive glomerulonephritis, and what is the hallmark finding on biopsy?

Goodpastures Granulomatosis with polyangiitis SLE Cresentic glomerulonephritis

What are the histological findings of membranous glomerulonephritis?

BM thickening Subepithelial spikes on silver stain PLA2R antibodies

What are the AKI stages?

1. Cr increase 1.5-1.9x baseline 2. Cr increase 2-2.9x baseline 3. Cr increase >3x baseline OR >354

What are the features of salicylate poisoning and what is the remedy?

Raised anion gap metabolic acidosis IV bicarb

When might you see hyaline casts in a patient's urine?

In those taking loop diuretics (inocuous)

What must be followed up immediately on detection of bilateral renal calculi?

UnEs

What is a common endocrine complication of hereditary haemochromatosis?

Cranial diabetes insipidus

What are the common first presentations of HH?

Lethargy and arthralgia with family Hx

What is the inheritance pattern of HH?

AR so skips generations

Why do HH patients have venesection?

To prevent iron toxicity

What do HH patients commonly die of?

Cardiac disease due to iron deposition

Which diuretic should be used to prevent ascites in CLD patients, and what are its side effects?

Spironolactone Hyperkalaemia

What is the difference in presentation between HUS nd TTP?

Both presentwith thrombocytopaenia, anaemia and purpuric rash, however Hus generally presents over days-weeks with renal features, whereas TTP generally presetns more acutely and with neurological signs

What is dialysis disequilibrium syndrome?

A rare but serious complication of haemodialysis characterised by cerebral oedema with normal bloods - diagnosis of exclusion

What is the key investigative difference between pre-renalAKI and ATN?

ATN has raised urinary sodium >40, while it is <20 in pre-renal disease I.e. In pre-renal, the kidneys will retain sodium to hold on to as much water as possible

A 21-year-old female complains of dysuria for the past week, despite just completing a three day course of trimethoprim. Urine dipstick is positive for blood + and leucocytes +. A MSSU shows no organism.

Chlamydia - causes a sterile pyuria

What is the single commonest extra renal manifestation of ADPKD?

Liver cysts

What are the most common causes of pure nephrotic syndrome in adults?

Focal segmental glomerulosclerosis | Membranous glomerulopathy

What is the classical presentation of fibroumscular dysplasia?

A young female who develops AKIafter initiation of an ACEi, with beading of the renal arteries seen on MR angiography.

What is a normal anion gap?

10-18

What might cause a patient to fail to respond to EPO therapy?

``` Iron deficiency Inadequate dose Conc infection Hyperparathyroid bone disease Aluminium toxicity ```

How would you differentiate between primary and secondary hyperaldosteronism?

Look at the renin - if it is high then a secondary cause is more likely - e.g. RAS

What is a common side effect of spironalactone which might warrant switch to eplerenone?

Gynaecomastia

What is reflux nephropathy, and how would you investigate it?

Chronic pyelonephritis due to vesicoureteric reflux Diagnose with micturating cysttography

What is the prognosis of minimal change glomerulonephropathy in children?

1/3 have infrequent relapses 1/3 have frequent relapses 1/3 have no relapses

What is the commonest cause of peritonitis in peritoneal dialysis patients?

Staph epidermis

What is the screening test for ADPKD?

Ultrasound

Which patients with CKD will NOT have bilateral small kidneys?

ADPKD Diabetics AMyloidosis HIV associated nephropathy

Renal Flashcards

(82 cards)