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Renal General Flashcards

(55 cards)

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1
Q

How does trimethoprim affect creatinine?

A

it blocks tubular secretion of Cr and increases serum creatinine

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2
Q

What GFR is CKD epi best in ?

A

eGFR above 60

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3
Q

Which GFR is MDRD best in ?

A

eGFR 15-60

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4
Q

Which protein is detected on urine dipstick?

A

Albumin

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5
Q

What BSL causes you to have glucosuria?

A

BSL 10

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6
Q

Causes of Sterile pyuria?

A 
Infections
- TB
- HIV
- STI
- Fungus
AIN 
Bladder tumour
Kidney stones
Transplant rejection
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7
Q

Cause of eosinophils in urine?

A 
Allergic reaction 
Atheroembolic disease
RPGN 
UTI 
Parasites
AIN
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8
Q

In intrinsic renal damage what happens to the Urea: cr ratio?

A

It is low less than 40:1 as urea is unable to be absorbed due to the intrinsic damade

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9
Q

What causes high Urea:cr ratio?

A
  • pre-renal
  • steroids
  • GI haemorrhage
  • protein rich diet
  • catabolic state
    ( high urea)
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10
Q

Causes of low complement +renal disease?

A 
SLE
Post infectious GN 
Mixed cryoglobulinaemia 
MPGN 
Subacute IE
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11
Q

Hypokalaemia + Hypertension

+ raised aldo and renin ?

A

Renovascular hypertension
Renin secreting tumour
Aortic co-arctation

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12
Q

Hypokalaemia + Hypertension + low renin and aldo

A
  • 11-beta hydroxylase deficiency
  • Liddle’s
  • Liquorice
  • Cushing’s
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13
Q

Hypokalaemia + normotension

A 
Diuretics
GI loss - diarrhoe or vom 
RTA - type 1 and 2
Bartters syndrome
Gitelman
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14
Q

What do the macula densa cells respond to and cause?

A

Respond: Na
Cause: vasodilates afferent arteriole
release renin from the juxtaglomerular cells

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15
Q

Where does aldosterone act

A

distal and collecting tubules, promoting insertion of Na channels luminal membranes and increase Na/K/ATPase into the basolateral membrane, thus increase Na and H2O reasborption.

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16
Q

How does angiotensin II act?

A

Peripherla vasoconstriction
stimulates thirst
stimulates ADH release

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17
Q

Where does thiazide act?

A

DCT

Na/Cl transporter

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18
Q

AE of thiazides?

A

Hypokalaemia
Hypocalciuria
Hyponatraemia
Hyperglycaemia

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19
Q

What occurs in the PCT?

A 
Most Na is reabsorbed
Most HCO3 is reabsorbed
All glucose and AA reabsorbed
Many things are secreted 
- Abx - penicillin, cephalosporins, constrast, diuretics, cr and lithium
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20
Q

Where does Frusemide act?

A

Thick ascending LOH

- on Na/K/Cl transporter

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21
Q

What occurs in the LOH ?

A
  • Na/K/CL in reabsorbed creating the counter current mechanism
  • Mg and Ca are passively absorbed down gradient
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22
Q

What does Barter’s cause?

A 
AR + Baby (B)
Normotensive
Hypokalaemic metabolic alkalosis 
Hypomagnesimia ( not passively absorbed as lumen is less positive)
Hypercalciuria
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23
Q

what occurs in the distal tubule?

Study These Flashcards
A

Na/CL is absorbed
Mg is reabsorbed by TRPM6 (inhibited by tac)
calcium is reabsorbed

24
Q

What occurs in Gitelmans

Study These Flashcards
A

Normontensive
Metabolic alkalosis
Hypocalciuria
Normal urine PGE

25
What occurs in late distal tubule?
Aldosterone acts to increase Na channel BNP acts to decrease Na channels Aquaporins control water reabsoption
26
How does liddles present clinically ?
``` Na channels are not broken down , thus sodium is continually reabasorbed Hypertension Hypokalaemic metabolic alkalosis High sodium Low aldo renin as Na high ```
27
How does Tolvaptan work?
Vassopressin recepto antagonist | acts on V2 receptor which binds to receptor and decreases aquaporins and thus creates dilute urine
28
What is type 1 RTA?
Distal defect in H + secretion Hypokalameia Causes hypercalciuria and thus nephrocalcinosis Causes are: Autoimmune (Sjrogrens), PPI, Treat with Bicarb
29
What is type 2 RTA ?
Proximal defect in bicarb absorption Associated with Fanconi syndrome Cause osteomalacia Treat with Bicarb
30
What is type 4 RTA?
Due to aldosterone deficiency Causes hyperkalaemia Associated with Diabetes, NSAIDS, ACE Treat with fludorcoritsone
31
Most common cause of renal stone?
calcium oxalate or phosphate | calicum oxalate more common
32
Cause of calicum renal stones?
``` Primary hyperparathyroidism Sarcoidosis Vitamin D excess Hypercalciuria Idiopathic ```
33
Prevention of calicum stones?
Thiazide diuretics Low sodium diet don't reduce calcium in diet
34
Pathogenesis of oxalate stones in malabsorption ?
Calcium usually binds oxalate in gut and this is excreted in poo. If high fat because no bile etc, calcium preferentially binds to fat, and oxalate is absorbed and precipitates in body
35
Prevention of oxalate stones?
calcium carbonate increase fluid intake avoid oxalate food - spinach, chocolate Pyrodoxine b6 converts glyoxylate for glycine instead of oxalate
36
Cause of Oxalate stones?
Gastric bypass, disease of distal ielum Primary hyperoxaluria - AR condition Excess oxalate ingestion - spinach, chocolate black tea
37
What is the classic presentation of struvite stones?
Klebsiella or proteus UTI cause urease which alkalisines urine causes precipitation of magneium ammonium phosphate (struvite) these form staghorn calculi
38
Causes of uric acid stones
Low urine volume + high urine urate - gout - diarrhoea - diabetes - high protein diet
39
Which stones are radiopaque?
Calcium oxalate Struvite Calcium phosphate not urate, cysteine or xanthine
40
What are the two types of Autosomal dominant polycystic kidney disease and what are there differences?
Both large cysts through kidneys ``` PKD1 - 85% - worse prognosis, present younger - chromosome 16 - Age eskd 50 PCK 2 - 15% - age of ESKD 75 - chromosome 4 ```
41
Extra renal manifestation of AD PCKD ?
Extrarenal manifestations - diverticulosis, hernias, cysts in liber, spleen, pancreas, thyroid, intracranial aneurysms, mitral valve prolapse
42
Screening for PCKD?
Ultrasound at age 30 - 2 cyst - diagnostic - no cyst - no disease
43
Classic presentation of AR PCKD?
Rare present in kids with massive kidnye enlargment and failure to thrive
44
Manifestation of Tuberous sclerosis ?
``` AD haemartomas of kindey, brain, skin, dental pits gingival fibromas Kidneys -cysts, angiomyolipomas ```
45
Manifestations of Medullary cystic kidney disease?
AD | presents with CKD, proteinuria and occasional cysts ( usually not present)
46
Presentation of alports?
AD, mostly X linked Mutation in Type IV collagen Sensoneural hearing loss and Glomerular disease 5% get anti GBM post transplant
47
Top 3 causes of CKD in order?
1. Diabetes 35% 2. GN 19% 3. HTN 14%
48
What GFR do you stop ACE?
30 | rise of creatinine of 30% and decrease of GFR by 25% is acceptable when starting
49
Management of HTN in diabetes with CKD?
Ace/ARB Non dihydropyrodine calcium channel blocker spiro
50
Most common cause of PD peritonitis ?
Coag neg staph
51
Do you use statins in CKD with hyperlipidaemia?
No Reverse epidemiology increase cholesterol does not increase mortality
52
Non tranditional RF for CVD in CKD?
``` Anaemia Uraemia Advances Glycoslyation end products high PTH Phosphate Malnutrition ```
53
What does EPO improve?
QOL
54
When do you start
Hb
55
What is your Hb aim with EPO?
110-115 | risk of stroke > 130

Renal G (4 decks)

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