Renal Medicine Flashcards
(144 cards)
1
Q
How do you tell the difference between AKI and dehydration on bloods?
A
AKI - creatinine will be much higher than urea
Dehydration - urea will be much higher than creatinine
2
Q
How do you tell the difference between AKI and CKD?
A
CKD patients will have bilateral small kidneys except those with:
- ADPKD
- Early diabetic nephropathy
- Amyloidosis
- HIV nephropathy
3
Q
What is a common cause of fragility fractures?
A
CKD induced secondary hyperparathyroidism
4
Q
What is a common cause of drug-induced AKI?
A
Acute interstitial nephritis
5
Q
What drugs cause acute interstitial nephritis?
A
- Antibiotics including penicillin, rifampicin
- NSAIDs
- Allopurinol
- Furosemide
6
Q
How are diabetic patients screened for diabetic nephropathy?
A
albumin:creatinine ratio (ACR) in early morning specimens
7
Q
What are the ECG changes of hypokalaemia?
A
U waves
T wave flattening
ST segment changes
8
Q
What is the most common cause of nephrotic syndrome with malignancy?
A
Membranous nephropathy
9
Q
What would biopsy show for someone with membranous nephropathy?
A
subepithelial immune complex deposits
10
Q
What drugs should be withheld with AKi?
A
- Diuretics
- Aminoglycosides (gentamicin) and ACE/ARB
- Metformin
- NSAIDs
DAMN AKI
11
Q
What drug is most commonly used to decrease phosphate levels?
A
Sevelamer - a non calcium based binder which binds to dietary phosphate and prevents it being absorbed
12
Q
How can stages 1 and 2 of CKD be diagnosed?
A
GFR range PLUS if kidney tests must be abnormal
13
Q
What are causes of focal segmental gomerulosclerosis?
A
idiopathic
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport’s syndrome
sickle-cell
14
Q
What is the risk of using 0.9% NaCl fluid therpay in patients who need large volumes?
A
Hyperchloremic metabolic acidosis
15
Q
What can alcohol bingeing lead to?
A
ADH suppression in the posterior pituitary leading to polyuria as well as hypernatremia
16
Q
What is the classic triad for HUS?
A
- AKI
- Haemolytic anaemia
- Thrombocytopenia
17
Q
What organism typically causes HUS?
A
E coli
18
Q
What medication should be used as an alternative to spironolactone for patients with gynaecomastia?
A
Eplerenone
19
Q
How does membranous glomerulonephritis present on histology?
A
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
20
Q
What is hyperacute transplant rejection?
A
Rejection within minutes to hours
21
Q
What is the cause of hyper acute transplant rejection?
A
pre-existing antibodies against ABO or HLA antigens
22
Q
What type of hypersensitivity reaction of hyper acute transplant rejection?
A
Type 2
23
Q
Why does rhabdomyolysis cause renal failure?
A
Tubular cell necrosis
24
Q
What is the prognosis for HSP?
A
Full renal recovery
25
What is the diuretic of choice in ascites?
Spironolactone
26
When is a renal biopsy indicated for those with minimal change disease?
If the response to steroids is poor
27
What HLA subtype is the most important for transplants?
HLA-DR
28
What are the side effects of EPO?
- Accelerated hypertension
- Bone aches
- Flu like symptoms
- Skin rash
29
What medication can be used for recurrence of hyperkalaemia?
Calcium resonium
30
How does acute tubular necrosis respond to fluid challenge?
Poorly
31
What is prerenal uraemia?
Where the kidneys hold onto sodium to preserve volume
32
Prerenal uraemia vs ATN?
- Prerenal responds well to fluid challenge
- Urine osmlaitity will be raised
- Urine sodium will be low
33
Why should metformin be stopped in AKI?
Due to increased risk of toxicity
34
How does anti-GBM disease present?
- Haemoptysis
- AKI/proteinuria/haematuria
35
What is the most common cause of refractory HTN?
Renal artery stenosis secondary to atherosclerosis
36
eGFR is an inaccurate in which patients?
Those with extreme muscle mass
37
What investigation is needed for patients with AKI of unknown aetiology?
US
38
Patients with HSP require what to monitor for renal involvement?
BP and urinalysis
39
Patient presents with grey/brown tinge to the skin along with history of CKD?
Urea build up within the blood
40
Management of lupus nephritis?
Cyclophosphamide and methylprednisolone
41
What are the indications for acute haemodyialysis?
AEIOU
Acidosis
Electrolyte disturbance e.g. hyperkalaemia
Intoxication i.e. drug overdose
Oedema
Uraemia symptoms e.g encephalopathy
42
What is causes of sterile pyuria (white cells in urine with negative culture)
- Renal TB
- Partially treated UTI
- Drugs including NSAIDs, Abx
- Urinary tract stones
- Papillary necrosis
43
Schisotchtes on blood film?
Microangiopathic haemolytic anaemia -> HUS
44
Epithelial crescents in the glomeruli?
Rapidly progressing glomerulonephritis
45
What investigation should be done with all patients with AKI of unknown aetiology?
Renal US within 24 hours
46
Management of low urine output post surgery?
Fluid challenge - give bolus of NaCl
47
How should severe hyperkalaemia be managed?
Urgent discussion with nephrology/critical care
48
Pulmonary oedema with AKI needs what?
Haemodialysis
49
Cause of normal anion gap metabolic acidosis
Renal tubular acidosis
50
Causes of CKD
DM, Hypertension , glomerulonephritis, renovascular disease,
pyelonephritis, polycystic kidney disease, obstructive uropathy.
51
Signs of CKD on examination
purpura, bruising, brown discolouration of
nails, evidence of excoriation, peripheral oedema, hypertension,
pericardial rub, evidence o f pleural effusions, proximal myopathy,evidence of preparation for renal replacement therapy
52
How does haemodialysis work?
Blood and dialysis fluid flow either side of a semipermeable
membrane, molecules diffuse down their concentration gradients, plasma biochemistry changes to become more like the dialysis fluid.
53
What is the management of renal stones?
<5mm - wait and watch if asymptomatic
5mm - 10mm - Shockwave lithotripsy
10mm-20mm - Lithrotripsy / Ureteroscopy
>20mm - percutaneous nephrolithotomy
54
What is the management of ureteric stones?
If <10mm - shockwave lithotripsy +/- alpha blockers
If >10mm - Ureteroscopy
55
Which chromosome is affected in ADPKD?
16
56
Full house immunoflueoresence pattern on renal biopsy?
Lupus nephritis
57
How would Goodpastures present on biopsy?
Crescent formation and linear deposition of IgG antibodies across the glomerular basement membrane (anti-GBM antibodies)
58
What are C/I to renal biopsy?
- HTN
- CKD wit small kidneys
- Abnormal coagulation studies
59
Dietary advice for nephrotic syndrome
Restrict salt intake, normal protein intake
60
AKI + Haemoptysis + Lung changes?
Think Goodpastures
61
What are causes of rhabdomyolysis?
- Prolonged immobilisation
- Crush injuries
- Seizures
- Post surgery
- Medications such as statins
62
Period of hypotension followed by renal impairment with urinary casts
Acute tubular necrosis
63
How to calculate anion gap?
(sodium + potassium) - (bicarbonate + chloride)
Normal = 8-14
64
What are causes of normal anion gap metabolic acidosis?
- Diarrhoea
- Renal tubular acidosis
- Addisons
65
What are causes of raised anion gap metabolic acidosis?
- Shock
- DKA/Alcohol
- Acid poisoning e.g salicylates
66
How to work out pre, renal and post renal cause of AKI?
Urea / (creatinine(umol)/1000
Pre renal - >100
Renal/Normal - 40 - 100
Post renal - <40
67
What is in indication for chronic kidney disease over acute?
Hypocalcaemia
68
Acute interstitial nephritis vs acute tubular necrosis?
AIN is an inflammatory process so white cells will be in the urine whereas ATN is not therefore no white cells in urine
69
Diarrhoea causes what?
Hypokalaemia metabolic acidosis
70
Eosinophilic casts are an indication of what?
Acute interstitial nephritis
71
What does proteinuria indicate in the context of AKI?
Intrinsic renal AKI cause
72
Anyone with severe hyperkalaemia / ECG changes for hyperkalaemia?
IV 10mls of 10% Calcium Gluconate
Insulin/Dextrose
73
What must be assessed in someone with bilateral calculi?
Renal function
74
HIV nephropathy causes what?
Focal segmental glomerulosclerosis -> causes nephrotic syndrome
75
Rapidly progressing glomerulonephritis is associated with what?
Goodpasture's
GPA
76
What can invalidate an EGR?
Eating red meat
77
AKI values
Creatinine
Stage 1 - 1.5-1.9x baseline / Increased by 26 umol / urine output <0.5mls/kg >6 hours
Stage 2 - 2 - 2.9x baseline / urine output <0.5mls/kg >12 hours
Stage 3 - 3x baseline / urine output <0.3mls/kg >24 hours
78
What are the 4 variables in the MDRD equation to work out estimated EGFR in patients with CKD?
Creatinine
Age
Gender
Ethnicity
79
Addisons causes what?
Hyperkalaemic metabolic acidosis
80
Patients with CKD and ACR >30 should be started on what?
ACE + Statin
81
Hereditary haemochromatosis can cause what?
Cranial diabetes insipidus
82
fever + rash + renal dysfunction
Acute interstitial nephritis
83
Urine osmolality >500 + urine sodium < 20
Pre renal uraemia
84
Urine osmolality < 350 + urine sodium > 40
Acute tubular necrosis
85
Brown granular casts are a sign of what?
Acute tubular necrosis
86
What is the most common viral infection in solid organ transplant patients?
CMV
87
What is the treatment for acute clot retention in urethra?
Continuous bladder irrigation via a 3 way urethral catheter
88
What is a drug cause of nephrogenic diabetes insipidus?
Lithium - desensitizes the kidneys ability to respond to ADH in the collecting ducts
89
Granulomatosis with polyangiitis is associated with what?
Rapidly progressing glomerulonephritis
90
Young female patient with AKI after starting ACE?
Fibromuscular dysplasia
91
What is the daily maintenance fluids requirement?
25-30ml/kg/day
92
Haemodialysis can cause what?
A falsely low HbA1c
93
What is monitoring for ACE inhibitors?
Increase in creatinine up to 30% is acceptable
If K+ > 6 - stop ACE and switch to alternative
94
Why do you get kidney stones in PKD?
Cysts block collecting ducts leading to urinary stasis and stone formation
95
What part of nephron does RCC affect?
PCT
96
What are risk factors for RCC?
- Smoking
- Male
- Increasing age
- HTN
- FH
- Obesity
97
Symptoms of chronic renal failure?
- Anaemia
- Fatigue
- Vomiting
- Bone pain
- SOB
- Fluid overload
98
Complications of haemodialysis?
- Hypotension
- Thrombosis
- Infection
- Blockage
99
Complication of peritoneal dialysis?
- Peritonitis
- Obesity
- Hernias
- Loss of membrane function
100
Where does sodium reabsorption take place?
PCT
101
Anti-GBM has antibody against which type of collagen?
Type 4
102
What kind of reaction is IgA nephropathy?
Type 3
103
What can be given for calcium stones due to hypercalcicuria?
- Potassium citrate
- Thiazide diuretics (increase distal tubular reabsorption)
104
Most common cause of death in patients with CKD on harm-dialysis?
IHD
105
What is a complication UTI?
UTI in the presence of an abnormal urinary tract
106
What is the pathophysiology of IgA nephropathy?
IgA immune complex deposit in the mesangial cells
107
haemoptysis + haematuria
Think Good pastures
108
Sickness, headache, vomiting and drowsiness after haemodialysis?
Disequilibrium syndrome caused by rapid changes in plasma osmolality and cerebral oedema
109
Causes of raised CK?
- Burns
- Myositis
- Seizures
- Influenza
- Duchennes muscular dystrophy
110
What gene is responsible for PKD?
PKD1
111
What are complications of PKD?
- Renal failure
- HTN
- Renal calculi
- Cyst infection
- Hepatic cysts
112
What is screening of ADKPD for relatives?
Abdo US scan for first degree relatives
113
subepithelial 'humps' on electron microscopy
Post strep glomerulonephritis
114
A high urea can indicate what gastro pathology?
Upper GI bleed
115
What is a classic sign of renal artery stenosis?
- Worsening renal function after starting an ACE
- Refractory HTN
116
Which UTI medication can cause rise in creatinine?
Trimethoprim
117
What is a good marker prognosis in IgA nephropathy?
Macroscopic haematuria
118
Muddy brown casts
ATN
119
rash, eosinophilia and acute renal impairment
AIN
120
Most common component of renal stones?
Calcium oxalate
121
What is the most common cause of AKI?
Pre-renal causes
122
Management of acute upper urinary tract obstruction
Nephrostomy
123
fever, rash and eosinophilia in a setting of decreased renal function
Acute interstitial nephritis
124
When can a diagnosis of CKD be made?
When EGFR <60 on 2 tests which are 3 months apart
125
UTI + haematuria?
Must send MSU
126
Trimethoprim can cause a falsely low what?
eGFR
127
thickened glomerular basement membrane with IgG and C3 subepithelial deposits
Membranous nephropathy
128
Treatment of HTN in someone with IgA nephropathy?
ACE inhibitors
129
Headache and tremor can be signs of what?
Calcineurin inhibitors (tacrolimus) toxicity
130
Why are patients with nephrotic syndrome susceptible to clots?
Loss of antithrombin III and plasminogen via the kidneys
131
Periureteric fat stranding on CT KUB can indicate what?
Spontaneously passed calculus
132
Stag horn calculi are made of what?
Struvite (magnesium ammonium phosphate)
133
What is a vitamin D supplement which is used in end stage renal disease?
Alfacalcidol -> does not require activation in the kidneys
134
anti-MPO antibodies are indicative of what?
Microscopic polyangiitis
135
What are the types of renal tubular acidosis?
1 - inability to generate acid urine causing hypokalaemia (causes include RA, Sjogrens, SLE)
2 - decreased bicarb resorption causing hypokalaemia (causes include Wilsons)
4 - reduced aldosterone causing hyperkalaemia (causes include diabetes)
136
Crescent formation on biopsy with rapid decrease in EGFR?
Membranoproliferative glomerulonephritis
137
When is acute vs chronic rejection following transplant?
Acute - within first 6 months
Chronic - >6 months
138
Gold standard imaging for suspected renal cancer?
CT Abdo with contrast
139
Abx for UTI in egfr <45
Trimethoprim
140
What is the most common complication of haemodialysis?
Dialysis-induced hypotension
141
Worsening renal function with dark brown urine
ATN
142
Gentamicin can cause what?
ATN
143
What is calcitriol?
Active form of Vit D
144
