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Renal Flashcards

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1
Q

Define AKI (3)

A
  1. Increase in creat >26 in 24 hours
  2. Increase in creat by 50% over seven days
  3. UO <0.5mls/kg for >6 hours
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2
Q

What would an indication be to do an USS for an AKI

A

No identifiable cause for AKI, USS within 24 hours

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3
Q

Name three drugs that should be stopped due to risk of toxicity in an AKI

A
  1. Lithium
  2. Metformin
  3. Digoxin
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4
Q

Management of hyperkalaemia (7)

A
  1. Calcium gluconate - for cardiac stabilisation
  2. Combined insulin/ dex
  3. Salbutamol nebs
  4. Sodium bicarb
  5. Calcium resonium
  6. Diuretics (loop)
  7. Dialysis
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5
Q

Name five indications for RRT

A
  1. Persistent hyperkalaemia despite medical managment
  2. Refractory pulmonary oedema
  3. Severe metabolic acidosis, pH <7.2/ BE <10
  4. Uraemia complications e.g pericarditis
  5. Drug overdose
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6
Q

Drugs/ factors that can cause acute tubular necrosis (6)

A
  1. Lead
  2. Anti-freeze
  3. Contrast
  4. Uric acid
  5. Aminoglycosides
  6. Myoglobin
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7
Q

Autosomal dominant polycystic kidney disease

Classification

A

Type 1

  1. Chrm 16
  2. More common
  3. Presents earlier with renal failure

Type 2
1. Chrm 4

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8
Q

Autosomal dominant polycystic kidney disease

Diagnostic criteria and investigation of choice

A

USS
Criteria in pts with +ve FH
1. two cysts, unilateral or bilateral, if aged < 30 years
2. two cysts in both kidneys if aged 30-59 years
3. four cysts in both kidneys if aged > 60 years

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9
Q

Autosomal dominant polycystic kidney disease
Mx
Criteria

A 
Tolvaptan 
If
1. Can be at discounted price on pt access scheme
2. Rapidly progressing disease
3. CKD 2 or 3
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10
Q

Name four extra-renal features of ADPKD

A
  1. Liver cysts (most common)
  2. Beri beri aneurysms - can cause SAH
  3. Mitral + aortic valvular issues
  4. Cysts in other organs e.g spleen, pancreas
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11
Q

Features of ADPKD (6)

A
  1. HTN
  2. Renal stones
  3. Recurrent UTIs
  4. AP
  5. Haematuria
  6. CKD
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12
Q

What is Alport’s syndrome?

M/F

A

X linked dominant
Defect in type IV collagen results in abnormal GBM
Common and more severe in men

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13
Q

Name five features of Alport’s syndrome
Think three organs (3)
Biopsy (1)
Typical exam question (1)

A
  1. Failing renal transplant = Goodpasture’s (autoantibodies to GBM)
  2. Microscopic haematuria
  3. Bilateral sensorineural deafness
  4. Longitudinal splitting of lamina densa (basket weave)
  5. Lenticonus: protrusion of the lens surface into the anterior chamber
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14
Q

Which three organs are affected in Alport’s syndrome

Nephritic or nephrotic

A
  1. Kidney
  2. Ears
  3. Eyes
    Nephritic
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15
Q

Difference between nephritic and nephrotic syndrome

A

Nephritic

  1. Haematuria
  2. HTN

Nephrotic

  1. Proteinuria
  2. Normal BP
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16
Q

Dietary advice for CKD (4)

A

Low

  1. Protein
  2. Phosphate
  3. Potassium
  4. Sodium
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17
Q

CKD classification

A 
Needs to have some sort of kidney damage on other tests 
1 eGFR >90 
2 eGFR >60
3a eGFR >45
3b eGFR >30 
4 eGFR >15
5 eGFR <15
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18
Q

MDRD includes which four factors

A
  1. Age
  2. Ethnicity
  3. Gender
  4. Serum creatinine
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19
Q

Name three factors that can affect the MDRD result

A
  1. Pregnancy
  2. Red meat within last 12 hours of sample being taken
  3. Muscle mass
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20
Q

What is an acceptable change in creat/ eGFR once started on ACEi?

A

Fall in eGFR of up to 25%
OR
Rise in creatinine of up to 30%

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21
Q

What eGFR level/ what stage of CKD can furosemide be used as an anti-hypertensive?

A

eGFR <45 aka stage 3b

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22
Q

What is diabetes insipidus and what are the two types?

What is the urine osmolality?

A

Deficiency or failure to respond to ADH

  1. Nephrogenic - ADH acts on collecting ducts, collecting ducts fails to respond
  2. Cranial - hypothalamus doesn’t produce ADH

Failure/ insensitivity of ADH prevents reabsorption of water from the urine. This means in DI –> they have a low urine osmolality (as it is extremely diluted)

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23
Q

Diagnostic test for DI

A

Water deprivation test
Deprived of fluid intake for 8 hours
Urine osmolality checked - it would be expected to be low
Then given desmopressin (which is synthetic ADH)
In cranial DI –> urine osmolality post desmopressin is high
In nephrogenic DI –> urinary osmolality post desmopressin is low

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24
Q

Name four causes of cranial and and three causes of nephrogenic DI

A

Cranial

  1. Brain tumour/ surgery
  2. Wolfram’s syndrome (DIDMOAD)
  3. Idiopathic
  4. Post head injury

Nephrogenic

  1. Drugs e.g lithium, democlocycline
  2. Low K+
  3. High calcium
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25
Two symptoms of DI
1. Polyuria | 2. Polydypsia
26
How does spironolactone work? | Name two SE
Aldosterone antagonist SE 1. Gynaecomastia 2. Hyperkalaemia
27
Name four features on an ECG with a low K+
1. U waves 2. Prolonged PR 3. ST depression 4. Small or absent T waves
28
Name two signs of low K+
1. Hypotonia 2. Muscle weakness Can lead to digoxin toxicity
29
Name four causes of transient non-visible haematuria
1. UTI 2. Vigorous exercise 3. Menstruation 4. Sexual intercourse
30
Name two causes of transient visible heamaturia
1. Diet: beetroot, rhubarb | 2. Drugs: rifampicin, doxorubicin
31
Name six causes of persistent non visible haematuria
1. cancer (bladder, renal, prostate) 2. stones 3. benign prostatic hyperplasia 4. prostatitis 5. urethritis e.g. Chlamydia 6. renal causes: IgA nephropathy, thin basement membrane disease
32
How do you define persistent non-visible haematuria?
Blood being present on dipstick in 2 out of 3 samples tested 2-3 weeks apart
33
Criteria for urgent referral for haematuria
>=45yo unexplained visible haematuria without urinary tract infection OR visible haematuria that persists or recurs after successful treatment of urinary tract infection OR Aged >= 60 years AND unexplained non-visible haematuria AND either dysuria OR raised WCC
34
Criteria for non urgent referral for haematuria
>= 60 years with recurrent or persistent unexplained urinary tract infection
35
Haemolytic uraemic syndrome | Triad features
1. AKI 2. haemolytic anaemia 3. Thrombocytopaenia
36
Haemolytic uraemic syndrome Which organism? What do you seen on smear?
E coli - shiga toxin producing (0157H7) | Schistocytes
37
Haemolytic uraemic syndrome usually secondary to?
Stomach virus - think small child with bloody diarrhoea
38
What is ITP?
Immune mediated platelet destruction Commonly after a virus Idiopathic Increased bleeding time
39
What is TTP? The Terrible Pentad Thrombotic thrombocytopenic purpura Name five classic symptoms
``` Deficiency in ADAMTS-13 --> Increased vWF 1. Low platelets 2. Anaemia 3. Fever 4. Neurological sx 5. Renal dysfunction Cells: schistocytes ```
40
DIC What is it caused by? What are the lab findings? Damn I'm Clotting
``` secondary to trauma/ sepsis/ obstetric complications D dimer raised Schistocytes Decreased fibrinogen Increased bleeding time ```
41
1. Low platelets 2. Anaemia 3. Fever 4. Neurological sx 5. Renal dysfunction Cells: schistocytes =
TTP
42
``` Secondary to trauma/ sepsis/ obstetric complications D dimer raised Schistocytes Decreased fibrinogen = ? ```
DIC
43
What investigations would you do for suspected HUS? (4)
FBC - to check for thrombocytopenia Clotting - increased bleeding time U&E - AKI Stool culture - PCR for Ecoli shiga toxin producing
44
Triad of features for RCC
1. Haematuria 2. Loin pain 3. Abdominal mass
45
Name three non typical RCC features
1. Dragging feeling in testicle 2. Left varicocele 3. Pyrexia of unknown origin
46
Canonball secondaries =
RCC - metastases to lung
47
RCC - metastases to lung =
canonball secondaries
48
Three features of Churg-Strauss | Antibody
1. Recurrent sinusitis 2. Asthma (eosinophillia) 3. Mononeuritis multiplex p-ANCA
49
Churg-Strauss + Wegeners | Small/medium/large
Small to medium vessel vasculitis
50
Name six features of Wegeners/ granulomatosis with polyangitis
1. Saddle shaped nose 2. Chronic sinusitis 3. Nasal crusting 4. Haemoptysis 5. Epistaxis 6. SOB c-ANCA
51
Henoch-Schonlein purpura Features (4) Age group Mx
1. Association with IgA nephropathy and its features 2. Palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs 3. AP 4. Arthritis 3-14yo Mx self limiting, supportive
52
IgA nephropathy also known as Features (3) Age + gender
``` Berger's 1. Macroscopic haematuria 2. Current URTI 3. Mesangial hypercellularity Young male ```
53
Post Strep GN | Features (4)
1. 2 weeks post strep infection 2. Low complement levels 3. Proteinuria + haematuria + oedema 4. Smoky/ coca cola urine
54
Minimal change | What is it?
Most common cause of nephrotic syndrome | T cell + cytokine mediated damage to GBM
55
FSGS | focal segmental glomerulosclerosis
IgM and C3 deposits | Nephrotic syndrome
56
Name three associated conditions with IgA nephoropathy
1. HSP 2. Alcoholic cirrhosis 3. Coeliacs/ dermatitis herpetiformis
57
Name five markers of poor prognosis in post strep GN | One marker for good prognosis
1. Male 2. Proteinuria >2g/day 3. HTN 4. Smoking 5. High cholesterol Good prognosis 1. Frank haematuria
58
Name five nephritic syndromes
1. Alports 2. IgA nephropathy 3. Henoch-Schonlein purpura 4. Post strep GN 5. Goodpastures
59
Name two nephrotic syndromes
1. Minimal change | 2. FSGS
60
Fusion of podocytes on electron miscroscopy will be seen in which condition?
Minimal change
61
Name three causes of minimal change
1. Drugs: rifampacin, NSAIDs 2. Hodgkins lymphoma, thymoma 3. Infection mononucleosis
62
Rx minimal change
1. Steroids | 2. Cyclophosphamide
63
Immunofluorescence: granular or 'starry sky' appearance=
post Strep GN
64
Immunosuppresion management following renal transplant Initial Maintenance
Initial 1. Tacrolimus/ ciclosporin with a monoclonal antibody Maintenance 2. ciclosporin/tacrolimus with MMF or sirolimus
65
Define contrast media nephrotoxicity
Increase in creatinine by 25% within 3 days of contrast
66
Name four RF for contrast media nephrotoxicity
1. Known renal impairment (especially diabetic nephropathy) 2. >70yo 3. Dehydration 4. Heart failure 5. Use of nephrotoxic drugs
67
How can you prevent contrast media nephrotoxicity?
IV fluids for 12 hours pre- and post- procedure

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