Renal Flashcards
(68 cards)
1
Q
What does the PCT reabsorb (6 things)
A
Glucose Amino acids Water Bicarbonate ions Na ions Cl ions
2
Q
Thin Descending loop of Henle reabsorbs
A
Water only
IMPERMEABLE to Na+
3
Q
Thick Ascending loop of Henle reabsorbs
A
PERMEABLE to Na+
- Contains Na/K/2Cl transporter
IMPERMEABLE to water
4
Q
DCT reabsorbs
A
Na and Cl
5
Q
Collecting duct 2 facts
A
Aldosterone increases number of Na+ channels in collecting duct
ADH binds to V2 receptors to increase AQUAPORINS
6
Q
4 ways ANGIOTENSIN II increases blood pressure
A
- vasoconstriction of smooth muscle
- stimulating ALDOSTERONE to increase Na and H2O retention
- stimulating ADH to increase H2O reabsorption
- Increase thirst by stimulating hypothalamus
7
Q
3 things stimulating RENIN secretion
A
- Decreased BP
—> Decreased Na and H2O delivery to MACULA DENSA
- INCREASED sympathetic activity
8
Q
Where are RENIN and ACE produced?
A
Renin- kidney
ACE- LUNGS
9
Q
Side effects of THIAZIDE DIURETICS (6 things)
A
Low Na/ K
High Ca/ glucose/ uric acid/ lipid
10
Q
3 Contraindications of THIAZIDE DIURETICS
A
GOUT (raised uric acid)
Liver/ Kidney Failure (same as sulphonylureas and meglitinides (-pregnancy))
May worsen DIABETES (cos of increased glucose)
11
Q
Effect of Hypokalaemia on Digoxin
A
Increases risk of digoxin toxicity
12
Q
The only diuretic that doesn’t decrease lithium excretion
A
Osmotic diuretic
13
Q
Contraindication of LOOP DIURETIC
A
Renal failure
14
Q
2 contraindications of K+ sparing diuretic
A
Hyperkalaemia
ADDISON’s DISEASE
15
Q
Contraindication for osmotic diuretic
A
Heart failure
16
Q
3 side effects of Loop diuretics
A
Low Na/ Ca
OTOTOXICITY
17
Q
2 side effects of K+ sparing diuretic
A
Hyperkalaemia
Gynaecomastia
18
Q
2 side effects of osmotic diuretic
A
Low Na
FEVER
19
Q
3 indications for Thiazide Diuretics
A
Hypertension
Heart Failure
Ascites
20
Q
2 indications for Loop Diuretics
A
Heart Failure
Severe hypercalcaemia
21
Q
5 indications for K+ sparing diuretics
A
—>Heart Failure
—>Ascites
—>Refactory Hypotension
OEDEMA
CONN’s SYNDROME
22
Q
3 indications for Osmotic Diuretics
A
CEREBRAL OEDEMA
—>HAEMOLYSIS
Rhabdomyolysis
23
Q
Drug interactions of Osmotic Diuretic
A
Increases levels of TOBRAMYCIN
24
Q
Types of stones in Renal Calculi
A
Calcium (radiopaque)- COMMON
Struvite (staghorn calculus) (associated with PROTEUS MIRABILIS)
Uric acid crystals (radiolucent)
25
Signs and Symptoms of Renal Calculi (4 things)
Suprapubic/ loin pain- may radiate to genital region
Dysuria
UTI
Haematuria
26
Causes of Renal Calculi (6 things)
HIGH calcium
HIGH urea
HIGH oxalate
Recurrent UTI
- -->Drugs (LOOP)
- -->Hereditary conditions (Polycystic Kidney Disease)
27
Investigations of Renal Calculi
24 hr urine analysis
CT scan KUB- Kidney/ Ureters/ Bladder
Ultrasound may also be used
Chemical analysis of stones
28
6 steps of Treatment for Renal Calculi
Pain- Analgesia and TAMSULOSIN
Dehydration- IV and ORAL FLUIDS
Nausea/ Vomiting- Antiemetics
Hypercalcaemia- Low Calcium Diet/ Stop THIAZIDE DIURETICS
Hyperoxaluria- Low Oxalate Diet
Hyperuricaemia- Allopurinol
29
4 complications of Renal Calculi
Recurrent UTI
Recurrent Calculi
Obstruction
Trauma to Ureter/ Ureteric Stricture
30
2 types of UTI
Lower UTI
Upper (PYELONEPHRITIS) UTI (E.Coli likely)
31
3 Signs and Symptoms of LOWER UTI
Dysuria
Frequency/ Urgency
SUPRAPUBIC PAIN
32
3 Signs and Symptoms of UPPER UTI
Haematuria
Fever/ Chills
FLANK PAIN
33
9 RISK FACTORS for UTI
Female
Menopause
Sexual intercourse
Pregnancy
Catheterisation
Urinary tract obstructions (like stones)
Genitourinary malformation
Diabetes
Immunosuppression
34
6 Causative organisms of UTI
E.Coli most common (METALLIC SHEEN)
Staph. Saprophyticus
Kleb. Pneumoniae
Proteus Mirabilis (produces UREASE)
Pseudonomas Aeruginosa (BLUE-GREEN information and FRUITY ODOR)
BK and JC viruses (associated with GRAFT FAILURE after transplant)
35
4 defences against UTIs
MICTURITION (urination)
Urine: osmolarity, pH, organic acids
Secreted Factors:
1) Tam- Horsfall protein
2) IgA
3) LACTOFERRIN- hoovers up free iron
Mucosal defences- mucopolysaccharides coat bladder
36
3 investigations for UTI
Urine dipstick- POSITIVE FOR LEUCOCYTES and NITRITES
Urine culture- to identify causative organisms
Radiology- consider US or cytoscopy if in CHILDREN OR recurs in MEN
37
Treatment for UTI
Trimethoprim (twice daily)
Prophylactic antibiotics if it is recurrent
If recurrent more than 4 a year- exclude anatomical variant or abnormality of renal tract
38
3 COMPLICATIONS of UTI
- Pyelonephritis
- Renal failure
- SEPSIS
39
Renal Cell Carcinoma definition
Adenocarcinoma originating from PCT
40
5 risk factors for Renal Cell Carcinoma
```
Male
50-70 years old
Smoking
Obesity
---> Mutation of Von Hippel Lindau Tumor suppressor gene
```
41
Signs and Symptoms of Renal Cell Carcinoma (5 things)
```
LOIN pain with palpable mass
FEVER
Haematuria
Unintentional weight loss
---> HYPERTENSION
```
42
2 paraneoplastic syndromes involved in Renal Cell Carcinoma
Secretion of ACTH- produces symptoms of HYPERCALCAEMIA
Secretion of ERYTHROPOETIN- produces symptoms of POLYCYTHAEMIA
43
Treatment for Renal Cell Carcinoma
4 medical treatments
Refer to Macmillan Nurses
Monitor Psychological Wellbeing
- --> Medical-
- Interferon ALPHA
- Sunitinib
- Sorafenib
- Bevacozumab
Surgical-
- Partial or total NEPHRECTOMY
- Radiofrequency ablation
44
4 complications of Renal Cell Carcinoma
METASTASIS
---> Hypertension
Hypercalcaemia
Polycythaemia
45
Where does Transitional Cell Carcinoma arise from?
The Transitional Urothelium
46
Risk factors of Transitional Cell Carcinoma
---> CAPS
Cyclophosphamide
---> Aniline dyes
---> Phenacetin
Smoking
47
Signs of Transitional Cell Carcinoma
Lower UTI symptoms (frequency/ urgency)
PAINLESS HAEMATURIA
---> PAINLESS
48
Investigations for Transitional Cell Carcinoma
Cytoscopy and Ureteroscopy with biopsy
---> Retrograde pyelography
CT/ MRI
49
Treatment for Transitional Cell Carcinoma
Refer to Macmillan Nurses
Monitor Psychological Wellbeing
Medical:
- --> MITOMYCIN
- --> GC regimen (gemcitabine and cisplatin)
- --> MVAC regimen (methotrexate, vinblastine, adriamycin, cisplatin)
Surgery:
- Nephroureterectomy
- Cystectomy
- Radiofrequency ablation
50
Complication of Transitional Cell Carcinoma
Metastases- usually to bone
51
3 main characteristics of Acute Kidney Injury
- rapid fall in GFR
| - increase in CREATININE and UREA
52
Pre renal causes of AKI (4 things)
Hypovolaemia-
- Haemorrhage
- DIURETICS
- Burns
Shock (SEPIS or CARDIOGENIC)
Hypoperfusion-
- NSAIDs
- ACE inhibitor
Oedematous conditions-
- Heart failure
- NEPHROTIC SYNDROME
53
Intrinsic causes of AKI (3 things)
Glomerular diseases-
- Immune complex diseases (SLE)
- Glomerulonephritis
- Vasculitis
Vascular lesions-
- BILATERAL RENAL STENOSIS
- Malignant hypertension
- Microangiopathy
Tubulointerstitial disease-
- Acute tubular necrosis
- MULTIPLE MYELOMA
- Acute tubulointerstitial nephritis
- NEPHROTOXIC drugs
54
Post renal causes of AKI (3 things)
Obstructions-
- STONES
- Tumors (including BENIGN PROSTATE HYPERTROPHY)
- STRICTURES
55
Signs and Symptoms of AKI (6 things)
Oliguria/ Anuria
Nausea/ vomiting
Confusion
Hypertension
Abdominal/ flank pain
Signs of fluid overload (high JVP)
56
Investigations of AKI
GFR
Urinalysis-
- BENCE JONES protein to exclude multiple myeloma
- Leucocytes and Nitrites to exclude UTI
Bloods
57
Treatment for AKI
Maintain renal blood flow and fluid balance
Monitor ELECTROLYTES
Treat UNDERLYING CAUSE
Stop all NEPHROTOXIC DRUGS
58
4 complications of AKI
- Metabolic acidosis
- Hyperkalaemia
- HYPERPHOSPHATAEMIA
- PULMONARY OEDEMA
59
Without treatment, CKI develops into...
End stage Kidney disease
60
7 causes of CKI
- Hereditary disease (polycystic kidney disease)
- Anatomical abnormality of renal tract
- Hypertension
- Diabetes
- Malignancy
- Glomerulonephritis
- ANY KIDNEY DISEASE tbh
61
Signs and Symptoms of CKI
Oliguria/ Anuria
Nausea/ vomiting
Confusion
Hypertension
OEDEMA (peripheral/ pulmonary)
KUSSMAUL BREATHING (sign of metabolic acidosis)
ANAEMIA
Metallic taste in mouth
62
Investigations for CKI
GFR
Urinalysis-
- BENCE JONES protein to exclude multiple myeloma
- Leucocytes and Nitrites to exclude UTI
Bloods
63
Treatment for CKI (6 things ish)
LOW SALT diet, maintain psychological wellbeing
Treat underlying cause
Control blood pressure
TREAT-
- Anaemia
- Acidosis (with sodium bicarbonate)
- Hyperphosphataemia (with phosphate binders)
DIALYSIS
Renal Transplant
64
9 Complications of CKI
- Metabolic ACIDOSIS
- ANAEMIA
- Hypertension
- Carpal Tunnel Syndrome
- Renal bone disease
- Depression
- Stroke
- Peripheral nerve disease
- OEDAMATOUS STATES
65
4 Signs of Nephrotic Syndrome
PHOH
- Proteinuria (>3g daily)
- Hypoalbuminaemia (<30g/L)
- Oedema
- Hyperlipidaemia occurs because-
1) Hypoproteinaemia stimulates production of more proteins from the live- so synthesis of more lipoproteins
66
7 causes of NEPHROTIC SYNDROME
- Minimal change disease
- Diabetic nephropathy
- Amyloidosis
- SLE
- Mesangial proliferative glomerulonephritis
- Membranous glomerulonephritis
- Focal segmental glomerulosclerosis
67
Investigations for Nephrotic Syndrome
Bloods
Urinalysis
NEPHRITIC SCREENING-
- C3/ C4
- ANA, dsDNA, ANCA, anti-glomerular basement membrane antibody
- HIV/ HBV. HCV serology
- Venereal Disease Research Laboratory for Syphilis
68
Treatment for NEPHROTIC SYNDROME
```
Low Salt Diet
Depends on cause-
- Hypertension
- Proteinuria
- Hypercholestrolaemia
- Prophylactic anticoagulation therapy
- Immunotherapy regimen- PREDNISOLONE/ CYCLOPHOSPHAMIDE/ AZATHIOPRINE
-Dialysis if severe
```
