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Acute Medicine > Renal > Flashcards

Renal Flashcards

(70 cards)

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1
Q

Define AKI

A

rise in serum creatinine >50% in 7 days
Rise in serum creatinine >25micromol/l in 48hrs
urine output <0.5ml/kg/hr for >6hrs

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2
Q

Risk factors for AKI

A 
CKD
Heart failure 
diabetes 
liver disease 
over 65
NSAIDs, ACEI
contrast medium
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3
Q

pre-renal AKI

A

inadequate blood supply

  • dehydration
  • shock
  • heart failure
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4
Q

renal causes of AKI

A

Glomerulonephritis
interstitial nephritis
ATN

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5
Q

post-renal AKI

A

obstruction to outflow of urine

  • calculi
  • masses, strictures, BPH
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6
Q

Investigating AKI

A

urinalysis - blood, leucocytes, nitrites and glucose

USS

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7
Q

treating AKI

A

stop nephrotoxic medication
Fluid rehydration
catheter if obstruction

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8
Q

DAMN drugs

A

diuretics
ACEI/ARB
metformin - lactic acidosis
NSAIDs

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9
Q

preventing contrast induced nephropathy

A

pre and post contrast IV 0.9% saline

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10
Q

complications of AKI

A

hyperkalaemia
fluid overload, pulmonary oedema
metabolic acidosis
uraemia

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11
Q

what can uraemia lead to?

A

encephalopathy or pericarditis

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12
Q

treating hyperkalaemia

A

IV calcium gluconate
insulin/dextrose
salbutamol
calcium resonium/dialysis

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13
Q

hyperkalaemia is

A

K > 5.5

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14
Q

first thing to do in hyperkalaemia

A

ecg

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15
Q

ecg findings hyperkalaemia

A

tall tented t waves
wide QRS
absent p waves

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16
Q

K requirements per day

A

1mmol/kg/day

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17
Q

what fluid to avoid in hyperkalaemia

A

hartmanns

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18
Q

how long for AV fistula to mature?

A

6-8 weeks

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19
Q

differentiate between AIN and ATN

A

AIN has raised WCC (eosinophils) on urine dip

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20
Q

alport syndrome

A

renal failure, sensorineural hearing loss and ocular abnormalities

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21
Q

nephrotic syndrome criteria

A

proteinuria >3g/24 hour
oedema
hypoalbuminaemia <30g/l

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22
Q

findings in diabetes insipidus

A

high serum osmolality, low urine osmolality

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23
Q

treating cranial and nephrogenic diabetes insipidus

A 
cranial = desmopressin
nephrogenic = TZD
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24
Q

cancer risk in transplant patients

A

SCC - skin cancer

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25
immunosuppression following transplant
ciclosporin/tacrolimus with monoclonal antibody | add steroids >1 rejection episode
26
detecting diabetic nephropathy
ACR in early morning urine annually
27
when to start ACEI in CKD
if ACR >70mg/mmol
28
medication used for spironolactone gynaecomastia
epleranone
29
goodpastures investigation
anti-GBM antibodies
30
how many stages for AKI?
3
31
what can saline cause?
hyperchloraemic acidosis
32
resus fluids
500ml 0.9% saline over 15 mins/STAT
33
define CKD
abnormal kidney structure or function >3 months
34
eGFR and CKD
``` 1 = >90 2= 60-90 3a = 45-59 3b = 30-44 4 = 15-30 5 = <15 ```
35
ACR and CKD
``` A1 = <3 A2 = 3-30 A3 = >30 ```
36
causes of CKD
``` diabetes glomerulonephritis PKD drugs and toxins heart failure ```
37
kidneys in CKD
bilaterally small
38
Why is it important not to combine ACEI and ARB?
risk of hyperkalaemia
39
management of CKD
``` DM, bp, weight control ACEI/ARB fluid and diet restriction EPO - anaemia phosphate binders vit D supplement sodium bicarbonate 20mg atorvostatin RRT ```
40
presentation of CKD
``` asymptomatic pruritus loss of appetite nausea oedema peripheral neuropathy hypertension ```
41
using eGFR to diagnose CKD
2 tests 3 months apart
42
complications of CKD
``` acidosis electrolyte imbalance renal bone disease CVD dialysis uraemia ```
43
When to refer CKD to a specialist
eGFR <30ml/min ACR >70mg/mmol accelerated decline uncontrolled HTN 4 anti-hypertensives
44
CKD - hyperparathyroidism
secondary due to high serum phosphate low active vitamin D high PTH
45
most common nephropathy in children
minimal change disease
46
underlying causes of nephrotic syndrome
HSP diabetes HIV FSGS
47
urinalysis - minimal change
small molecular weight proteins | hyaline casts
48
treating minimal change
CCS high dose 4 weeks | low salt diet, diuretics, albumin infusions
49
presentation of minimal change
oedema (periorbital and peripheral), frothy urine, proteinuria and low albumin
50
treating steroid resistant minimal change
ACEI | cyclosporine, tacrolimus, rituximab
51
complications of nephrotic syndrome
``` hypovolaemia thrombosis infection renal failure relapse ```
52
indications for acute dialysis
``` acidosis hyperkalaemia uraemia - seizures intoxication oedema ```
53
indications for long term dialysis
ESRF = CKD5
54
3 main options for maintenance dialysis
continuous ambulatory peritoneal dialysis automated peritoneal dialysis haemodialysis
55
catheter used in peritoneal dialysis
tenckhoff
56
how does peritoneal dialysis work?
filtration membrane = peritoneal membrane dialysis solution with dextrose added to peritoneal cavity ultrafiltration from blood to dialysis solution
57
complications of peritoneal dialysis
SBP peritoneal sclerosis ultrafiltration failure weight gain
58
typical haemodialysis regime
4 hours a day, 3 days a week
59
2 options for haemodialysis
tunnelled cuffed catheter | AV fistula
60
tunnelled cuff catheter
subclavian or jugular vein into SVC or right atrium 2 lumens - blood exits and blood enters dacron cuff provide barrier to infection
61
which vessels for AV fistula
radio-cephalic brachio-cephalic brachio-basilic
62
examining AV fistula
skin integrity aneurysms palpable thrill machinery murmur
63
AV fistula complications
``` aneurysm infection thrombosis stenosis STEAL syndrome high output heart failure ```
64
STEAL syndrome
inadequate blood flow distal to AV fistula | distal ischaemia
65
is it ok to take blood from AV fistula?
NO
66
matching renal donor
HLA type A, B and C on chromosome 6
67
what vessels are used in transplant?
external iliac
68
transplant rejection
hyperacute = remove graft acute <6 months chronic
69
cause of hyperacute rejection
HLA or ABO antibodies
70
complications related to immunosuppressants
``` IHD T2DM infections - PCP, CMV, TB Non-hodgkin lymphoma SCC - skin cancer ```

Acute Medicine (2 decks)

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