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Clinical Years / Progress Test > Renal and Urology > Flashcards

Renal and Urology Flashcards

(50 cards)

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1
Q

AKI Staging

A

1: 1.5-1.9x baseline creatinine or an increase of 26 urology/L
<0.5 ml/kg/hr for 6-12 hours

2: 2-2.9x baseline creatinine
<0.5ml/kg/hr for more than 12 hours

3: 3x baseline creatinine
<0.3 ml/kg/hr for 24 hours or Anuria for 12 hours

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2
Q

SALFORD management of AKI

A

Sepsis and other causes- treat
ACEi/ARBs and other nephrotoxic drugs - stop
Labs - Cr and urea
Fluid assessment and challenge
Obstruction - identify with USS
Renal/crit care referral if non resolving
Dip the urine

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3
Q

Causes of AKI

A

Pre renal; sepsis, dehydration, hypotension, shock, severe heart failure
Renal; acute interstitial nephritis , nephrotoxic drugs, rhabdomyolysis
Post renal; obstructed by stones, prostate, cancer

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4
Q

drugs that may have to be stopped in AKI because of risk of toxicity - but not worsening AKI in themselves

A

Metformin
Lithium
Digoxin

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5
Q

stages/diagnosis of CKD

A

1 - kidney damage evidence with GFR >90
2 - kidney damage evidence with GFR 60-89
3 - GFR 30-59
4 - GFR 15-29
5 - GFR <15 end stage renal failure

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6
Q

CKD management earlier stages

A

start an ACEi or ARB
start statin
control HTN and diabetes

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7
Q

CKD complications

A

Anaemia - EPO deficiency
Vitamin D deficiency –> tertiary hyperparathyroidism; increased PTH with reduced vit D and calcium

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8
Q

when should metformin be stopped in CKD

A

GFR <30

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9
Q

nephrotoxic drugs

A

Sulphonylureas
ACEi
Diuretics
Metformin
ARB
NSAID
SGLT2i

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10
Q

what features indicate need for dialysis in kidney failure

A

refractory hyperkalaemia
metabolic acidosis
uraemic encephalopathy
pulmonary oedema

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11
Q

hyperkalaemia ECG changes

A

in order…
peaked T waves
P waves widen and flatten then disappear
conduction abnormalities
bradycardia

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12
Q

hyperkalaemia treatment

A

IV calcium gluconate to protect the heart
rapid insulin in dextrose
salbutamol nebs

insulin + Sal moves potassium into the intracellular space

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13
Q

nephrotic syndrome + management

A

massive proteinuria with minimal haematuria
salt and fluid restrict
diuretics + ACEi/ARB
anticoagulate if needed

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14
Q

what features indicate need for dialysis in kidney failure

A

refractory hyperkalaemia
metabolic acidosis
uraemic encephalopathy
pulmonary oedema

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15
Q

hyperkalaemia ECG changes

A

in order…
peaked T waves
P waves widen and flatten then disappear
conduction abnormalities
bradycardia

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16
Q

hyperkalaemia treatment

A

IV calcium gluconate to protect the heart
rapid insulin in dextrose
salbutamol nebs

insulin + Sal moves potassium into the intracellular space

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17
Q

nephrotic syndrome + management

A

massive proteinuria with minimal haematuria
salt and fluid restrict
diuretics + ACEi/ARB
anticoagulate if needed

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18
Q

nephritic syndrome

A

haematuria + mild proteinuria
most commonly caused by IgA nephropathy

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19
Q

what features indicate need for dialysis in kidney failure

A

refractory hyperkalaemia
metabolic acidosis
uraemic encephalopathy
pulmonary oedema

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20
Q

hyperkalaemia ECG changes

A

in order…
peaked T waves
P waves widen and flatten then disappear
conduction abnormalities
bradycardia

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21
Q

hyperkalaemia treatment

Study These Flashcards
A

IV calcium gluconate to protect the heart
rapid insulin in dextrose
salbutamol nebs

insulin + Sal moves potassium into the intracellular space

22
Q

nephrotic syndrome + management

Study These Flashcards
A

massive proteinuria with minimal haematuria
salt and fluid restrict
diuretics + ACEi/ARB
anticoagulate if needed

23
Q

nephritic syndrome

Study These Flashcards
A

haematuria + mild proteinuria
most commonly caused by IgA nephropathy

24
Q

APCKD; features and management

Study These Flashcards
A

cystic kidneys with extra renal cysts in liver, aneurysms and mitral valve prolapse
management; BP control, screen for CVD, threapies in trial include vasopressin and somatostatin
test for it using USS

25
what is the anion gap? metabolic acidosis normal anion gap causes? raised anion gap causes?
(Na+ + K+) - (Cl- + HCO-3) normal anion gap: gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula renal tubular acidosis drugs: e.g. acetazolamide ammonium chloride injection Addison's disease raised anion gap: lactate: shock, sepsis, hypoxia ketones: diabetic ketoacidosis, alcohol urate: renal failure acid poisoning: salicylates, methanol
26
what is IgA nephropathy?
most common cause of glomerulonephritis classically presenting with macroscopic haematuria in young people following a respiratory tract infection (1-2 days after) not much proteinuria. usually self resolves
27
acute interstitial nephritis
cause of renal failure resulting in marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules Features -fever, rash, arthralgia -eosinophilia -mild renal impairment -hypertension caused by drugs, systemic disease, infection
28
anti-glomerular basement disease
small-vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis
29
post streptococcal glomerulonephritis
nephritis affecting young children 1-2 weeks after a streptococcal sore throat causes malaise, proteinuria and (sometimes visible) haematuria
30
urology 2WW referral
Aged >= 45 years AND: unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after successful treatment of urinary tract infection Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test
31
most common cause of nephrotic syndrome in children
minimal change disease then focal segmental glomerulosclerosis
32
how does acute interstitial nephritis present
allergic type picture, raised eosinophils, IgE and urinary WCC and impaired renal function
33
treatment of rhabdomyolysis
rapid IV fluid hydration
34
normal excretion of protein in urine
<150mg with <30mg albumin
35
4 causes/types of nephrotic syndrome
1. minimal change 2. focal segmental glomerulosclerosis 3. membranous glomerulonephritis 4. membranoproliferative glomerulonephritis diagnosed/distinguished by renal biopsy
36
what is rapidly progressive glomerulonephritis?
form of nephritic syndrome where you see glomerular haematuria (RBC casts or dysmorphic RBCs) and rapidly developing kidney injury - fatal if not treated quickly
37
causes of nephritic syndrome
nephritic syndrome aka acute glomerular nephritis caused mainly by IgA nephropathy also caused by post streptococcal glomerulonephritis
38
treatment of minimal change disease
corticosteroids
39
causes of acquired renal cysts
simple cysts acquired renal cystic disease hypokalaemia related cysts
40
non genetic developmental renal cysts
medullary sponge kidney multicystic dysplastic kidneys pyelocalyceal cysts
41
genetic causes of cystic kidney disease
ADPKD, ARPKD tuberous sclerosis, von hippel lindau disease, medullary cystic disease (all autosomal dominant) some X linked disorders
42
secondary causes of nephrotic syndrome
autoimmune infections drugs toxins diabetes tumours
43
what is vasculitis? examples of large, medium and small vessel vasculitis
inflammation of blood vessels large; giant cell arteritis, Takayasu medium; kawasaki, polyarteritis nodosa small; ANCA associated or 'other' e.g. in SLE
44
what indicates testicular torsion management?
- sudden onset pain - absent cremasteric reflex - unilateral swollen and retracted testicle - typically in adolescence surgical exploration
45
how does haemolytic uraemic syndrome present? how is it treated
children acute kidney injury microangiopathic haemolytic anaemia thrombocytopenia treat with supportive care and IV fluids
46
first line investigation for prostate cancer
multiparametric MRI
47
causes of transient or spurious haematuria
menstruation vigorous exercise UTI sexual intercourse drugs e.g. rifampicin food e.g. beetroot
48
What pain relief should be used in renal colic
IM diclofenac
49
acute pyelonephritis management
quinolone e.g. ciprofloxacin or a broad spectrum cephalosporin e.g. cefalexin for 10 days
50
membranous glomerulonephritis management
all pts should be on an ACEi or ARB immunosuppression; usually corticosteroids consider anticoagulation

Clinical Years / Progress Test (24 decks)

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