Week 227 Acute Renal Failure Flashcards Preview

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Flashcards in Week 227 Acute Renal Failure Deck (87):
1

Week 227

What is the function of the kidneys?

 

 

  • Homeostasis
  • Regulation of volume and composition of ECF
  • Disposal of waste products
  • Hormone secretion and modification

 

2

Week 227

 

Where and how is glucose absorbed by the kidneys?

  • Proximal convoluted tubule
  • secondary active transport
  • Disrupted in dm 2

3

Week 227

 

How can we assess Glomerular filtration?

  • Average GFR (Glomerular filtration rate) is 125ml/min or 70kg male
  • Insulin is most accurate but rarely given as must be given IV
  • GFR = Insulin(urine) x Urine flow rate/{insulin in blood]
  • Creatinine is other option. Produced at constant rate in health
  • This gives an estimation of GFR, but it's not as accurate, as small amount secreted into PCT.

4

Week 227

 

The Proximal convoluted tubule is responsible for the reabsorbtion of what?

  • 2/3 of water
  • 2/3 of Na, K, Cl, PO4
  • Glucose (2ndary AT)
  • If glucose > than 12 mmol/l, transporters become saturated and so some glucose makes its way into the urine.
  • *Also responsible for the secretion of penicillin, ferusemide, and H+ ions.

 

5

Week 227

 

What are the functions of the distal convoluted tubule?

  • H+ regulation
  • Actively excretes H+ in response to high pHs
  • H+ combines with NH3 and PO4 in tubular fluid
  • HCO3 forms from CO2 --> H2CO2 --> HCO3, which then returns to blood
  • K, Na, Ca regulation
  • Production of prostaglandins (caused by low sodium after increased NA+ resorbtion) Which does two things:

1.) Causes afferent arteriolar dilation (directly)

2.) Causes the JGA to produce renin (think back to your renin - angiotensin - aldosterone system  = an increase in blood pressure.

 

6

Week 227

 

What is the effect of ADH on the collecting duct of the kidney nephrons?

Basically, encourages aquaporin incorporation. This massively increases water reuptake, which saves water! Woo! OK, it's 2:30 am now, I'm going to sleep.

 

NO really.

 

I'm actually going to sleep. I've been writing these goddamned flashcards for EIGHTEEN HOURS.

 

 

7

Week 227

 

Which drugs can you think of that would cause Hypokalaemia?

Thiazide diuretics (i.e. indapamide and metolozone)

 

Loop Diuretics (i.e. Furosemide)

8

Week 227

 

Which drugs can cause Hyperkalaemia?

ACEI i.e. Remipril

Angiotensin Receptor Blockers (they end in "sartan").

Sprionolactone (This is  pottassium sparing diuretic)

 

9

Week 227

 

Long term use of which drugs may cause irreversible renal damage?

Aminoglycosides (i.e. Gentamycin)

NSAIDS

 

10

Week 227

 

Which drugs will cause a falsely elevated seum creatinine?

  • Trimethoprim

This intereferes with renal metabolism/excretion of creatine

11

Week 227

 

Which drugs can cause hypercalcaemia, and increased calcium excretion in urine/renal stones?

Calcium preparations

Vitamin D

 

12

Week 227

Which drugs can cause high serum uric acid/urate?

 

Chemotherapy for bulky tumours

13

Week 227

 

Which drugs cause rhabdomyolysis/high creatanine kinase?

  • Statins (i.e. atorvostatin)
  • Calcineuin inhibitors (Cyclosporin/tacrolimus)

 

14

Week 227

 

Which investigation will best help identify the cause of renal disease in a patient that has presented with ARF, chest symptoms, urine dipstick with blood +++ and protein +++?

Renal biopsy.

15

Week 227

 

Which investigation is the most appropriate in a patient that has presented with ARF, fever, night sweats, dysuria, and loin pain?

Urine microscopy looking for white cell casts, urine culture (basically, this is an infection picture, and your tests wil go on to reflect that)

16

Week 227

 

Which investigation would be most appropriate for an elderly patient that developed ARF four days post hip surgery?

Urinary Na:

Surgery results in both an increase of catabolic hormones and cytokines. The main effect is the increased secretion of ADH, which will result in water retention. Increases in aldosterone (through activation of the renin–angiotensin system) coupled with increased glucocorticoids cause sodium and water retention and potassium loss. Plasma renin activity is also elevated as a result of a decrease in circulating blood volume. Thus, alterations in overall fluid and electrolyte homeostasis occur because of impaired water excretion, impaired sodium excretion, and increased excretion of potassium.

17

Week 227

 

What is the most appropriate investigation for a patient with symptoms of pulyuria, nocturia, hesitancy, and a gradual rise of serum urea and creat

Physical examination and bladder scan. This could well be a prostate cancer, or a metaplasic change within the bladder. Physical exam and uss of bladder would be best.

18

Week 227

 

What is the electrolyte abnormality likely to be associated with ARF after a marathon?

Hypocalcaemia. This occurs after strenuous exercise. Especially in the heat!

19

Week 227

 

Which electrolyteimbalance would you expct to see in a patient that was in the recovery phase of ARF that was due to rhabdomyolysis?

Hypercalcaemia.

 

Why?

 

This is related to the massive calcium uptake in the ischemic muscle cells during oliguria, followed by a muscle calcium release later in the polyuric stage of ARF.

20

Week 227

 

Which electrolyte imbalance would most likely be associated with ARF after introduction of ramipril in a patient with chronic heart failure?

Hyperkalaemia.

 

This is rare with this class of drugs, but it IS a side effect as noted in the BNF!

21

Week 227

 

Which electrolyte imbalance is most commonly associated with chronic use of thiazide diuretics?

Hypokalaemia. This isn't reabsorbed well, and with the SOA of thiazides being in the DCT, K just gets flushed out! Perhaps try potassium sparing like spirinolactone.

22

Week 227

Which pathology is suggested when urinary RBC casts are found?

Post streptococcal glomerulonephritis (acute inflammation)

23

Week 227

Which pathology is suggested if urine shows WBC casts?

Acute pyelonephritis

24

Week 227

 

Which pathology is most commonly associated with fatty casts in urine?

Nephrotic syndrome, also called nephrosis, causes massive proteinuria, which drops serum protein levels considerably. It also results in hyperlipidaemia and hypercholesterolaemia.

25

Week 227

 

Which pathology is most commonly associated wih pigmented urinary casts?

Rhabdomyolysis, The destructin of muscle cells releases myoglobin, which stains things!

26

Week 227

 

Which biochemical abnormailty would be MOST likely seen in a first time marathon runner?

HIgh creatinine kinase. Although you would also end up being hypocalcaemic, the clue is the "first time" AKA tonnes of muscle damage! ouch!

27

Week 227

 

Which biochemical abnormality are you most likey to see in a patient that is using ACEI for treatment of hypertension?

Hyperkalaemia.

28

Week 227

 

Which biochemical abnormality is most commonly associated with ecstasy use?

Hyponatraemia

29

Week 227

 

Which biochemical abnormality is most commonly associated with Prostatic carcinoma?

Metabolic acidosis.

30

Week 227

 

Which biochemical abnormality is most commonly associated with chemotherapy for a bulky sarcoma of the right thigh?

Hyperuricaemia, This is exogneous purines formed within cells are released, and broken to to urate/urea, before excretion. Chemo kills loads of cells, so this totes blates makes sense. Word.

31

Week 227

 

Which drugs will cause an AKI with hyperkalaemia?

ACEI can cause this, and so can potassium sparing diuretics, like spironolactone.

32

Week 227

 

Which drugs can cause AKI with hypercalcaemia?

Anything that pumps calcium in, so Vit D and Oral calcium.

33

Week 227

 

Which drugs can cause AKI with high creatinine kinase?

Statins and cyclosporin

34

Week 227

 

Which drugs can cause AKI with hyponatraemia?

Loop diuretics and thiazide diuretics can cause this.

35

Week 227

Which condition is associated with [histology]: Crescentic change in the bowmans space?

 

Rapidly progressive glomerulonephritis

36

Week 227

 

Which condition is associated with [histology]: eosinophils in the renal interstitium?

Acute interstitial nephritis

37

Week 227

 

Which condition is associated with [histology]: Mitotis figures in the tubular epithelial nuclei?

Acute tubular necrosis

38

                                                  Week 227

 

Which condition is associated with the following [histology]: Tubular dilatation?

Obstructive Uropathy

39

Week 227

 

Which one test would best establish the cause of renal injury in a cancer patient, with advanced disease (peritoneal intrusion) and high serum creatinine?

Renal USS

40

Week 227

Which one test would estabish the cause of renal injury in a young patient presenting with major crush injury?

 

Plasma creatinine phosphokinase

41

Week 227

Which one test could confirm the cause of renal injury in a patient recently started on an ACEI?

 

An Magnetic Resonance Angiogram of the renal arteries. ACEI are known to cause renal artery stenosis.

42

Week 227

 

Which one test could confirm the cause of renal injury in a patient recently treated with amoxicillin for an infection, with poor apetite and weight loss in following weeks?

Renal biopsy. There may be leucocytes and eosinophil infiltration.

43

Week 227

 

What is the aetiology of AKI in
A 71 yrs male with a permanent ileostomy following pan colectomy (1999) for UC is being investigated for a recent onset weight loss. Following an oral barium study, he reported increased stoma output (>3 litres/ day), a previously normal s. creatinine was found to be 220 umol/l.
 

This is pre-renal failure.

44

Week 227

 

What is aetiology og AKI in
A 76 yrs old female developed AKI post elective hip replacement. Preoperatively
she was treated with normal saline (1 litre/12hrs), and a single dose of
gentamicin 240mg

Acute tubular necrosis. Thanks "gent" (gettit?!)

45

Week 227

 

What is the aetiology of AKI in
A 55 yrs female has completed a course of pevic readiotherapy for the treatment
of advance cervical cancer. Two weeks later, she developed oliguria, urine test
showed hematuria, S creatinine 350umol/

This is obstructive uropathy. The clue is "cancer".

46

Week 227

 

What is the aetiology of AKI in a px that develops AKI with haematuria 2 weeks post URTI?

Glomerulonephritis

47

Week 227

 

Hypertension with normal size kidneys on renal USS is WHAT type of hypertension?

Essential hypertension

48

Week 227

 

What is the cause of hypertension in a px with asymetrical kidneys and rise in serum creatinine after into of ACEI?

Bilateral renal artery stenosis.

49

Week 227

 

What is the cause of hypertension in a px with asymetrical kidneys, and minimal/no change in creatinine after intro of ACEI?

Unilateral renal artery stenosis. Look out here! If creatine is ALSO UP, then it's more likely bilateral stenosis. Cheeky emq...

50

Week 227

 

What is the cause of hypertension in a px with normal size kidneys on uss, but microaneurysms on fundoscopy?

This is likely diabetic neuropathy (look at icm pics in the eye week for more info)

51

Week 227

 

Which investigation best aids in differentiating between pre renal and renal failure?

Urinary Na+. This is high in renal and lower/normal in pre renal.

52

Week 227

 

Which investigation could cause an AKI in patients with renal disease?

Coronary angiogram.

53

Week 227

 

Which investigation is safe to perform in patients with renal impairment to investigate obstruction?

Renal USS

54

Week 227

 

Which investigation may show values that are falsely low in patiens with increased muscle mass?

eGFR

55

Week 227

 

How does laxative abuse cause renal injury?

Laxative abuse causes volume depletion.

56

Week 227

 

How do ACEI (i.e. ramipril) cause renal injury?

Dilatation of efferent arteriole.

57

Week 227

 

How is renal injury caused by NSAIDS?

Reduction of vasodilatory prostaglandins.

58

Week 227

 

How is renal injury caused by radiocontrast agents?

Afferent arteriolar vasoconstriction/renal ischaemia.

59

Week 227

 

Which drug type can cause acute rhabdomyolysis?

Statins

60

Week 227

 

Which drug requires a dose reduction in patients with chronic kidney disease? *clue*  - it is a GABA analogue.

Gabapentin

61

Week 227

 

Which drug may cause post renal failure by inducing retroperitoneal fibrosis?

Bromocryptin

62

Week 227

 

Which drug/supllement may cause ureteric calcium stone formation?

Large doses of vitamin D

63

Week 227

 

What is the diagnosis?

Q image thumb

Bilateral polycystic kidneys

64

Week 227

 

What is the diagnosis?

Q image thumb

This is NORMAL kidney appearance!

65

Week 227

 

What is the diagnosis?

Q image thumb

Soft tissue shadow in renal pelvis with hydronephrosis.

66

Week 227

 

What is the diagnosis?

Q image thumb

Unilateral hydropnephrosis

67

Week 227

 

What is the diagnosis?

Q image thumb

Unilateral renal carcinoma

68

Week 227

 

What is the diagnosis?

Q image thumb

Unilateral renal stone

69

Week 227

What is the likely cause of this urinary sediment?

 

Q image thumb

Calcium oxalate

70

Week 227

 

What is the likely cause of this urinary sediment?

Q image thumb

Cystine

71

Week 227

 

What is the most likely cause of this urinary sediment?

Q image thumb

Triple phosphate (struvite)

72

Week 227

 

What is the most likely cause of this urine sediment?

Q image thumb

Uric acid

73

Week 227

 

Which renal condition is suggested by foamy/frothy urine?

Nephrotic syndrome

74

Week 227

 

Which renal condition is suggested by urine that is cloudy in appearance?

Acute pyelonephritis

75

Week 227

 

Which renal condition is suggested with urine that is dark, and contains red cell casts.

Acute post streptococcal glomerulonephritis

76

Week 227

 

Which renal condition is suggested by urine that ir dark, with no red cell or red cell casts?

Rhabdomyolysis

77

Week 227

 

Which renal condition is suggested by urine that has macroscopic haematuria, with no red cell casts

Transitional cell carcinoma of bladder

78

Week 227

Plasma urea is shown to be disproportionately high in _____ and disproportiontely low in ______.

 

HIgh in patients with dehydration and low in patients with liver disease.

79

Week 227

 

Serum creatinine is increased in _____ and is used as a variable in _____

Increased in px with high muscle mass and used as a variable in the modified eGFR equation.

80

Week 227

 

Which investigation is useful in investigating renal stone disease?

IV Urogram

81

Week 227

 

Which investigation is invalid in patients that are on diuretics?

Urinary sodium

82

Week 227

 

What are the adverse effects/most notable adverse effect of Trimethoprim?

Can cause falsely high serum creatinine levels.

Hyponatraemia

Hyperkalaemia

83

Week 227

 

What are the (kidney related) adverse effects of gentamycin?

Causes acute tubular necrosis

84

Week 227

 

What are the related adverse effects (on the kidneys) of ramipril?

REduces GFR by acting on efferent arteriole. This is usually only small and corrects quickly, but can have a more substantial effect.

85

Week 227

 

Which is the common adverse effect(s) (on kidneys) of Mannitol?

Mannitol is an osmotic diuretic. It increases plasma osmolality.

86

Week 227

 

What is the key (renal) side effect(s) of thiazide diuretics?

Hypokalaemia.

 

This is why ACEI is given in conjunction.

87

Week 227

 

Long term use of which drug type causes irreversible renal damage?

NSAIDS