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RW Year 6 > Renal > Flashcards

Renal Flashcards

(52 cards)

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1
Q

Features of renal failure

A

Inability to remove metabolic waste –> Uraemia

Inability to control acid-base –> Metabolic acidosis, Hyperkalaemia

Inability to control Na+ and fluid –> Oedema, SOB

Loss of Erythropoietin and activated Vit D –> Anaemia, Osteomalacia

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2
Q

Drugs which cause ATN

A

Paracetamol

Aminoglycosides

Contrast

NSAIDs

ACE inhibitors

Lithium

Myoglobin (Rhabdomyolysis)

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3
Q

Drugs which cause AIN

A

NSAIDS

Penicillin

Sulphonamides

Phenytoin

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4
Q

Definition of Oliguria

A

Oliguria = urine output < 0.5ml/kg/hr

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5
Q

Muddy brown urinary casts

Diagnosis?

A

Acute Tubular Necrosis

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6
Q

Red cell casts in urine

Diagnosis?

A

Nephritic syndrome

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7
Q

Tx of Hyperkalaemia

A

10ml 10% IV Calcium gluconate

100ml 20% IV Dextrose with 10 units of Actrapid (over 30min)

Nebulised salbutamol 10-20mg

+/- Calcium resonium

+/- Dialysis

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8
Q

Treatment of AKI

A

Fluid balanace assessment

Stop nephrotoxic drugs (ACEi, NSAIDs, K+ sparing diuretics)

Treat compilcations (Hyperkalaemia, Met Acidosis, Pulmonary oedema)

Treat underlying cause

  • Pre-renal failure or Intrinsic renal failiure
    • If volume depleted –> IV Fluids
    • If volume overload –> Furosemide +/- RRT (haemodialysis)
  • Post-renal failure
    • Urinary catherisation
    • Remove obstruction
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9
Q

Causes of renal failure

A

Pre-renal failure (hypovolaemia)

  • Hypovolaemia (blood loss, shock, 3rd spacing)
  • Heart failure (cardiogenic shock)

Intrinsic renal failure

  • Acute Tubular Necrosis (ATN)
  • Acute Interstitial Nephritis (AIN)
  • Acute glomerulonephritis
  • Vasculitis

Post-renal failure (obstruction)

  • Renal calculi
  • BPH
  • Tumour
  • Ascending UTI
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10
Q

Fall

Dark urine (coca cola urine / tea coloured)

Blood +++ (but no RBC on microscopy)

Microscopy: Muddy brown casts

Hyperkalaemia

Raised CK

A

Rhabdomyolysis

Blood ++ is Myoglobulin ++

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11
Q

Rash

Arthralgia

Eosinophilia

Raised Creatinine and Urea

Diagnosis?

A

Acute interstitial nephritis

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12
Q

Indications for RRT

A

Acute (Tip: AEIOU)

  • Acidosis (pH < 7.2)
  • Electrolytes (persistent K > 7.0)
  • Intoxication
  • Overload of fluid (refractory to treatment)
  • Uremic pericarditis / encephalopathy

Chronic

  • CKD Stage 5
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13
Q

Stages of CKD

A
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14
Q

Causes of CKD

A
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15
Q

Tx of CKD

A

Conservative

  • Diet (low K+ diet)
  • Modify cardiovascular risk factors
    • Diet and Exercise
    • Smoking cessation
    • Weight loss

Medical

  • Anti-hypertensives
  • +/- Statin
  • +/- Low-dose aspirin
  • Optimise Diabetes control
  • Treat compilcations
    • Anaemia –> Iron or Erythropoietin
    • Fluid overload –> Fluid restriction +/- Furosemide
    • Secondary hyperPTH –> Vitamin D +/- Bisphosphonates

Surgical

  • RRT (Haemodialysis, Peritoneal dialysis, Renal transplant)
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16
Q

Flank pain

UTI symptoms

Haematuria

Early-onset Hypertension

Hepatomegaly

Palpable enlarged kidneys

Diagnosis? Treatment?

A

Polycystic kidney disease

Autosomal dominant (most commonly) ==> ADPKD

Tx:

  • Anti-hypertensives
  • Cyst aspiration
  • Manage CKD
    • 50% progress to CKD
    • ADPKD accounts for 10% of CKD Stage 5
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17
Q

Presentation of glomerulonephritis

A

Asymptomatic haematuria

Nephrotic syndrome

Nephritic syndrome

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18
Q

Definitions

Glomerulonephritis

Nephrotic syndrome

Nephritis syndrome

A

Glomerulonephritis = immune complex formation or deposition in glomeruli –> inflammation

Nephrotic syndrome = proteinuria, hypoalbuminaemia, oedema

Nephritis syndrome = proteinuria + haematuria, oedema

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19
Q

Anti-phospholipase 2A antibodies

A

Membranous nephropathy

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20
Q

Glomerulonephritis and Hepatitis C

A

Membranoproliferative glomerulonephritis (MPGN)

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21
Q

Types of Rapidly progressive GN (Cresecentic GN)

Study These Flashcards
A

Type 1

  • Goodpastures (Anti-GBM)

Types 2 (immune complex deposition)

  • IgA
  • HSP
  • SLE

Type 3 (Pauci-immune / ANCA +ve) ==> Nephritic syndrome

  • Wegner’s
  • Charg-Strauss
  • Microscopic polyangiitiis
22
Q

IgA nephropathy vs Post-streptococcal glomerulonephritis

Study These Flashcards
A

IgA nephropathy = post-strep 2-3 days

Short “IgA” ==> Days

Post-streptococcal glomerulonephritis = post-strep 2-3 weeks

Longer word ==> Weeks

23
Q

Features of HSP

Study These Flashcards
A

Tetrad (PAAG)

  • Palpable purpuric rash
    • On buttocks and extensor surfaces of arms and legs
  • Arthralgia / Arthritis
  • Abdominal pain
  • Glomerulonephritis
24
Q

Most common cause of asymptomatic haematuria

Study These Flashcards
A

Thin basement membrane

25
Glomerulonephritis Haemoptysis
**Goodpasture's syndrome** Anti-GBM antibodies (against Type IV Collagen in kidneys and lungs)
26
Causes of nephrotic syndrome
Primary * Glomerulonephritis (all types) Secondary * Diabetic nephropathy (most common) * Deposition of immune complexes * SLE * Hepatitis B and C * Amyloidosis
27
Tx of nephrotic syndrome
**Fluid restriction +/- Furosemide** *_Proteinuria_* ==\> **ACE inhibitor** *_Lipids_* ==\> Statin *_VTE_* ==\> TED stockings + LMWH **Treat underlying cause**
28
Causes of Nephritic syndrome
Primary * Glomerulonephritis * **IgA nephropathy** (most common) * **Membranoproliferative glomerulonephritis** Secondary * Glomerulonephritis * **Post-streptococcal glomerulonephritis** * **Goodpasture's** * **Vasculitis**
29
Definition of urinary retention on Bladder USS
Bladder volume \> 300ml indicates urinary retention
30
Tx of renal stones
31
Most common locations for stones
Pelvic-ureteric junction (PUJ) Vesico-ureteric junction (VUJ) Sacroiliac joint
32
Types of renal calculi
Calcium (80%) - Calcium oxalate, Calcium phosphate Uric acid Magnesium ammonium phosphate Cystine stones
33
Ix for renal calculi
CT KUB (non-contrast)
34
Definition of UTI
Urine culture grows **\> 100,000 colony-forming units** (CFU) / mL of a single organism
35
LUTS symptoms
Storage symptoms (FUN) -- **F**requency / Polyuria -- **U**rgency -- **N**octuria If underlying obstructive cause --\> Emptying symptoms (WISE) -- **W**eak stream / Hesitancy -- **I**ntermittent flow / Incontinence -- **S**training to urinate -- Incomplete **E**mptying
36
Tx of UTI
(1) **Nitrofurantoin** (2) **Trimethoprim** In pregnancy (1) Nitrofurantoin (avoid at term) (2) Amoxicillin
37
Tx of overactive bladder
(1) Anti-muscarinic drugs (**Oxybutynin**, Tolterodine) (2) **Mirabegron** (3) **Duloxetine**
38
Causes of renal artery stenosis
Atherosclerosis (90%) - older patients Fibromuscular dysplasia (10%) - young patients
39
Ix for Renal artery stenosis
Digital subtraction angiography
40
Tx for renal artery stenosis
Conservative --\> Modify cardiovascular risk factors Medical --\> Anti-hypertensives (but avoid ACEi in **bilateral** RAS) Surgical * Renal artery stenting * Renal artery balloon angioplasty * Surgical revascularisation (aortorenal bypass)
41
Type 1-4 Renal tubular acidosis
**Type 1** = excess H+ reabsorption in DCT - Hypokalaemic, metabolic acidosis **Type 2** = low HCO3- reabsorption in PCT - Hypokalaemic, metabolic acidosis **Type 3** = Type 1 + Type 2 **Type 4** = Low **_Aldo_**sterone - Hyperkalaemia, metabolic acidosis
42
Tx of BPH
Mild BPH (IPSS 0-7) * **Urinary catherisation** (self or long-term) Moderate-to-Severe BPH (IPSS 8-35) * **alpha-blocker (Tamsulosin, Doxazosin)** * **​**Relaxes smooth muscle tone * Requires dose titration * **5a-reductase inhibitor (Finasteride)** * Decrease in prostate size * Requires 3-6 months before improvement * **Phosphodiesterase-5 inhibitor (Sildenafil)** * **Anti-cholinergic (oxybutynin)** Refractory to medical Tx * If prostate \< 80g * Minimally invasive therapy (TUMT, TUNA, PUL) * Moderatively invasive thearpy (TURP, TUVP, Laser) * If prostate \> 80g * Laser enucleation (HoLEP, ThuLEP) * Open prostatectomy
43
**LUTS** **Perineal pain** **Fever** **Painful ejaculation** **(VERY) Tender, boggy prostate** Diagnosis? Treatment?
Prostatitis Treated with Antibiotics + Analgesia +/- Urinary catherisation
44
Cause of epididymo-orchitis
Age \< 35 years old ==\> STI organism * **Chlamydia trachmatis** * **Neisseria gonorrhoeae** Age \> 35 years old ==\> Non-STI organism * Enteric organisms * **E. coli** (following UTI)
45
**Unilateral scrotal pain** **Fever** **Scrotal swelling** **Hot, red, swollen hemiscrotum** **Prehn's sign +ve** **(elevation of testes relieves pain)** Diagnosis? Treatment?
Epididymo-orchitis Antibiotics Analgesia
46
**Painless scrotal mass** **NOT separate from testies** **Able to get above mass** **Variable size (bigger with activity and in evening)** **Transillumination** Diagnosis? Treatment?
Hydrocele (1) Conservative (scrotal support) If large --\> surgical excision and repair (_or_ aspiration) Ix for underlying cause (torsion, malignancy, varicoele operation)
47
**Sudden onset testicular pain** **Nausea and Vomiting** **Loss of cremasteric reflex** **High riding testis** **Abnormal transverse lie** **Prehn's sign -ve** Diagnosis? Treatment?
Testicular torsion Do NOT delay Tx for imaging Surgical detorsion ASAP (within 4-8hr) If torsion --\> fix BOTH sides If necrosis --\> +/- Orchidectomy
48
Tx for undescended testis (cryptorchidism) Complication?
Orchiopexy (move undescended testicle into scrotum) _Complications_: Testicular cancer Infertility
49
**Painless scrotal mass** **Left sided** **Infertility** **Bag of worms appearance** Diagnosis? Treatment?
Varicocele Supportive underwear or Surgery (but does not improve fertility)
50
TURP syndrome - Sx, Tx
Body absorbs irritation fluid _Clinical features_ * Dilutional hyponataremia --\> Confusion, N&V, Changes in Vision * Fluid overload * Glycine toxicity _Management_ * Fluid restriction * Tx hyponatraemia
51
Complications of TURP
Early * UTI * TURP syndrome Late * Retrograde ejaculation * Inferility * Urinary incontinence (due to sphincter damage)
52
CK value in Rhabdomyolysis
CK \> 10,000

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