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Clinical Years / Progress Test > Renal and Urology > Flashcards

Renal and Urology Flashcards

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

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

A

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

23
Q

nephritic syndrome

A

haematuria + mild proteinuria
most commonly caused by IgA nephropathy

24
Q

APCKD; features and management

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
Q

what is the anion gap?
metabolic acidosis normal anion gap causes?
raised anion gap causes?

A

(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
Q

what is IgA nephropathy?

A

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
Q

acute interstitial nephritis

A

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
Q

anti-glomerular basement disease

A

small-vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis

29
Q

post streptococcal glomerulonephritis

A

nephritis affecting young children 1-2 weeks after a streptococcal sore throat
causes malaise, proteinuria and (sometimes visible) haematuria

30
Q

urology 2WW referral

A

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
Q

most common cause of nephrotic syndrome in children

A

minimal change disease
then focal segmental glomerulosclerosis

32
Q

how does acute interstitial nephritis present

A

allergic type picture, raised eosinophils, IgE and urinary WCC and impaired renal function

33
Q

treatment of rhabdomyolysis

A

rapid IV fluid hydration

34
Q

normal excretion of protein in urine

A

<150mg with <30mg albumin

35
Q

4 causes/types of nephrotic syndrome

A
  1. minimal change
  2. focal segmental glomerulosclerosis
  3. membranous glomerulonephritis
  4. membranoproliferative glomerulonephritis

diagnosed/distinguished by renal biopsy

36
Q

what is rapidly progressive glomerulonephritis?

A

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
Q

causes of nephritic syndrome

A

nephritic syndrome aka acute glomerular nephritis caused mainly by IgA nephropathy
also caused by post streptococcal glomerulonephritis

38
Q

treatment of minimal change disease

A

corticosteroids

39
Q

causes of acquired renal cysts

A

simple cysts
acquired renal cystic disease
hypokalaemia related cysts

40
Q

non genetic developmental renal cysts

A

medullary sponge kidney
multicystic dysplastic kidneys
pyelocalyceal cysts

41
Q

genetic causes of cystic kidney disease

A

ADPKD, ARPKD
tuberous sclerosis, von hippel lindau disease, medullary cystic disease (all autosomal dominant)
some X linked disorders

42
Q

secondary causes of nephrotic syndrome

A

autoimmune
infections
drugs
toxins
diabetes
tumours

43
Q

what is vasculitis?
examples of large, medium and small vessel vasculitis

A

inflammation of blood vessels

large; giant cell arteritis, Takayasu
medium; kawasaki, polyarteritis nodosa
small; ANCA associated or ‘other’ e.g. in SLE

44
Q

what indicates testicular torsion
management?

A
  • sudden onset pain
  • absent cremasteric reflex
  • unilateral swollen and retracted testicle
  • typically in adolescence

surgical exploration

45
Q

how does haemolytic uraemic syndrome present? how is it treated

A

children
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

treat with supportive care and IV fluids

46
Q

first line investigation for prostate cancer

A

multiparametric MRI

47
Q

causes of transient or spurious haematuria

A

menstruation
vigorous exercise
UTI
sexual intercourse

drugs e.g. rifampicin
food e.g. beetroot

48
Q

What pain relief should be used in renal colic

A

IM diclofenac

49
Q

acute pyelonephritis management

A

quinolone e.g. ciprofloxacin or a broad spectrum cephalosporin e.g. cefalexin for 10 days

50
Q

membranous glomerulonephritis management

A

all pts should be on an ACEi or ARB
immunosuppression; usually corticosteroids
consider anticoagulation

Clinical Years / Progress Test (24 decks)

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