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renal high yield Flashcards

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1
Q

drugs to stop in AKI

A

CANADA
C-contrast media
ACEi
Nsaids - apart from cardioprotective aspirin
A- aminoglycosides
D- diuretics
A- ARBs

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2
Q

what type of stones can thiazides prevent

A

calcium

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3
Q

most common kidney stone

A

calcium oxalate

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4
Q

which stones are radio-lucent

A

uric acid

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5
Q

which stone assoc with chronic infection

A

struvite (mangesium ammonium phosphate)
-form staghorn calculi

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6
Q

Ix for renal/ureteric stones

A

non-contrast CT KUB within 24 hours

USS if:
- children/young people
- preggers

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7
Q

pain management for stones

A

-NSAIDs (diclofenac)
-if NSAIDs contraindicated = IV paracetamol
-if admitted then IM diclofenax
-distal ureteric stones <10mm = alpha blockers (tamsulosin)

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8
Q

renal stones mx

A
  • Watchful waiting if <5mm and asymptomatic
    • 5-10 mm = shockwave lithotripsy
    • 10-20 mm = shockwave lithotripsy OR ureteroscopy
      >20mm = percutaneous nephrolithotomy
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9
Q

ureteric stones mx

A
  • Shockwave lithotripsy +/- alpha blockers if <10mm
    -10-20mm = ureteroscopy
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10
Q

ureteric obstruction due to stones with infection

A

SURGICAL EMERGENCY
-nephrostomy tube

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11
Q

pre renal causes of AKI

A

ischaemia/lack of blood flow
-hypovolaemia
-renal artery stenosis

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12
Q

intrinsic AKI causes

A

-toxins
-glomerulonephritis
-acute tubular necrosis
-acute interstitial nephritis
-rhabdomyolysis
-tumour lysis syndrome

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13
Q

post renal causes of AKI

A

obstruction
kidney stone
BPH
compression of ureter

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14
Q

stage 1 AKI

A

increase in creatinine to 1.5-1.9 times baseline or by >=26.5
or
urine output <0.5ml for >=6hours

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15
Q

stage 2 AKI

A

increase in creatinine to 2-2.9 times baseline or
urien output <0.5ml for >= 12 hours

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16
Q

stage 3 AKI

A

rise in creatinine to >= 3 times baseline
or increase to over 353.6
or
reduction in urine to < 0.3ml/kg/hr for >=24 hours
in patients under 18, decrease in eGFR to < 35

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17
Q

what does high omsolality mean

A

means really concentrated

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18
Q

mx of hyperkalaemia

A

cardiac membrane
- IV calcium gluconate

short term shift
- combined insuline/dextrose
- salbutamol

removal from body
- calcium resonium
- loopdiuretics
- dialysis

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19
Q

muddy brown casts

A

acute tubular necrosis

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20
Q

acute interstitial nephritis causes

A

DRUGS
-penicillin
-rifampicin
-NSAIDs
-allopurinol
-furosemide

SYSTEMIC DISEASE (sle, sarcoid, sjogren’s)
INFECTION

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21
Q

white cell casts in urine/sterile pyuria

A

acute interstitial nephritis

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22
Q

red-brown urine

A

rhabdomyolysis

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23
Q

blood results rhabdomyolysis

A

elevated CK
Hypocalcaemia (myoglobin binds to calcium)
elevated phosphate
hyperkalaemia
metabolic acidosis

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24
Q

calcium levels in CKD and what is the result of this

A

they are low, and so it Vit D
-this casues secondary hyperparathyroidism
-causes bone disease

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25
anaemia caused by CKD?
due to reduced erythropoietin levels normocytic normochromic anaemia happens when eGFR < 35
26
urine albumin/creatinine ratio in CKD
above 3mg/mmol
27
CKD stages
1) GFR > 90 (must have other signs) 2) GFR 60-90 (must have other signs too) 3a) GFR 45-59 3b) 30-44 4) 15-29 5) less than 15
28
when refer to nephrology for CKD
eGFR less than 30 urine ACR more than 70 accelerated progression uncontrolled hypertension
29
when are ACEi used for CKD
key management of proteinuria they should be used first-line in patients with coexistent hypertension, if the ACR is > 30 mg/mmol if the ACR > 70 mg/mmol
30
what other drug used for CKD
SGLT-2 inhibitors
31
in what patients does a urine culture need to be done to diagnose UTI
women > 65 men pregnant women catheterised patients recurrent UTI (2 in 6 months or 3 in 1 year) haematuria
32
non-pregnant women UTI Mx
trimethroprim or nitrofurantoin for 3 days
33
pregnant women UTI Mx
1) nitrofurantoin (avoid near term) 2) amoxicillin or cefalexin all for 7 days
34
UTI in men Mx
trimethroprim or nitrofurantoin for 7 days
35
UTI in catheterised patients Mx
don't treat if asymptomatic if symptomatic = 7 days antibiotics
36
Mx of BPH
mod to severe voiding symptoms = tamsulosin, alfuzosin (alpha-1 antagonists) significantly enlarged prostate = finasteride (5 alpha reductase inhibitor) - symptoms may not improve for 6 months combination if severe voiding symptoms and prostate enlargement surgery = TURP
37
causes of nephritic syndrome
rapidly progressive IgA nephropathy Alport syndrome
38
causes of nephritic and nephrotic
diffuse proliferative membranoproliferative post-streptococcal
39
proteinuria more than 3g/24hours
nephrotic syndrome
40
primary causes of nephrotic syndrome
minimal change disease (children) FSGS membranous
41
what condition assoc with IgA nephropathy
henoch schonlein purpura coeliac dermatitis herpetiformis
42
how long after URTI can IgA nephropathy develop
1-2 days after
43
how long after URTI can post-strep GN develop
1-2 weeks after
44
Mx of IgA nephropathy
isolated haematuria, no or minimal proteinuria = no treatment ACEi for proteinuria failure to response or active disease? -corticosteroids
45
causes of rapidly progressive GN
goodpasture's (ANCA neg) GPA (ANCA pos)
46
glomerular crescents on renal biopsy
rapidly progressive GN
47
alport's syndrome presentation
-nephritic syndrome -bilateral sensorineural deafness splitting of the lamina densa seen on electron microscopy X-linked dominant condition
48
immune complex deposits and mesangial proliferation
membranoproliferative GN -tram track appearance (type 1) -dense deposits (type 2) steroids may be effective but poor prognosis
49
starry sky appearance on immunofluorescence
post-strep GN
50
which GN does malignancy cause
membranous
51
thickened basement membrane with spike and dome appearance
membranous GN
52
treatment of membranous GN
ACEI or ARB immunosuppression if severe
53
congo red staining: apple green birefringence
amyloidosis
54
AA amyloidosis
systemic/inflammatory -production of acute phase protein -due to chronic inflammatory condition -affects liver, spleen, kidneys, adrenals
55
AL amyloidosis
light chain -production of abnormal immunoglobin light chains -affects heart, bowel, skin, nerves, kidneys -age 55-60 at diagnosis
56
treatment of AL amyloidosis
steroids, chemo, stem cell transplant
57
cause of goodpasture's
anti-GBM antibodies against type IV collagen | small vessel vasculitis
58
extra-renal complications of ADPKD
- Cerebral aneurysms (berry aneurysms, then potentially SAH) - Hepatic, splenic, pancreatic, ovarian and prostatic cysts - Mitral regurgitation - Aortic root dilation - Aortic dissection Colonic diverticula
59
screening for ADPKD
abdo USS
60
what ABG result does renal tubular acidosis cause
hyperchloremic metabolic acidosis (normal anion gap)
61
which types of renal tubular acidosis cause hypokalaemia
types 1 and 2
62
type 4 renal tubular acidosis
hyperkalaemia -reduction in aldosterone leads to reduction in proximal tubular ammonium excretion
63
first line Ix prostate cancer
multiparametric MRI
64
what initially can happen when you prescribe someone with prostate cancer a GnRH agonist (goserelin)
tumour flare -bone pain, bladder obstruction etc | may co-prescribe anti-androgens (cyproterone acetate)
65
if an STI causes epididymo-orchitis what do u do
urgent referral to sexual health
66
most common bladder cancer
transitional cell
67
risk factor for SCC bladder
-smoking -schistosomiasis
68
risk factors for transitional cell cancer
-smoking -working in textile/printing industry -rubber manufacture -cyclophosphamide
69
Mx bladder cancer
superficial lesions - TURBT surgery or radiotherapy
70
Ix for testicular cancer
ultrasound
71
ECG change for hypercalcaemia
shortened QT interval
72
ECG change for hypocalcaemia
prolonged QT interval
73
causes of hypokalaemia with alkalosis
- vomiting - thiazide and loop diuretics - cushing's syndrome - conn's syndrome (primary hyperaldosteronism)
74
causes of hypokalaemia with acidosis
- diarrhoea - renal tubular acidosis - acetazolamide - partially treated DKA
75
Tx of testicular torsion
urgent surgical exploration of BOTH TESTES
76
who gets partial nephrectomy in renal cancer
< 7cm
77
Mx for HIV associated nephropathy
restart antiretroviral therapy
78
screening for diabetic nephropathy
all patients annually using ACR - should be an early morning specimen !!!!
79
what is the most common presentation of testicular cancer
painless testicular lump in a 27 year old man
80
what is TURP syndrome
life threatening complication of TURP procedure -causes hyponatraemia -caused by irrigation with large volumes of glycine
81
management of anaemia due to CKD
check iron status first !!! -administer erythropoietin stimulating agents - oral iron if not - if iron targets not reached within 3 months then patients should be switched to IV iron
82
side effects of radiotherapy for prostate cancer
proctitis (blood diarrhoea) also at increased risk of bladder, colon and rectal cancer
83
causes of normal anion gap metabolic acidosis
HARDASS Hyperalimentation (treatment with IV fluids) Acetazolamide Renal tubular acidosis Diarrhoea Addison's Spironolactone Saline
84
causes of raised anion gap metabolic acidosis
MUDPILES Methanol Uraemia DKA Paracetamol Iron (isoniazid overdose) Lactic acidosis (shock, sepsis, hypoxia) Ethylene glycol (antifreeze poisoning) Salicylates (aspirin overdose)
85
why does nephrotic syndrome put you in a hypercoaguable state
due to loss of antithrombin III and plasminogen in the urine
86
urea that is proportionally higher than the creatinine
dehydration
87
Mx of renal stones in pregnant women
uteroscopy
88
how much does CK need to be elevated for a diagnosis of rhabdomyolysis
5 times
89
what drug can cause rhabdomyolysis/raised CK
statins
90
how do you differentiate a hydrocele from another testicular lump
it has a distinct fluctuation in size -less tense when supine they transilluminate
91
treatment of osteomalacia in CKD
alendronic acid if eGFR < 30 then denosumab
92
prostate cancer histological grading
gleason score
93

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