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Finals > Renal > Flashcards

Renal Flashcards

1
Q

Pre-renal causes of AKI

A

Hypovolaemia
Low BP
Renal artery stenosis

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2
Q

Intrinsic causes of AKI

A

Acute tubular necrosis
Nephrotoxic meds
Glomerulonephritis
Interstitial nephritis

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3
Q

Post-renal causes of AKI

A

BPH
Bladder cancer
Calculi
Any cause of obstruction

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4
Q

What are the three phases of AKI

A

Oliguric/anuric phase
Polyuric/maintenance phase
Recovery phase

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5
Q

Complications of AKI

A 
Hyperkalaemia
Pulmonary oedema/fluid overload
Metabolic acidosis
Uraemic encephalopathy/pericarditis
Low Ca, high PO4
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6
Q

ECG changes in hyperkalaemia

A

Small/absent P waves
Prolonged PR interval
Peaked T waves
Slurring into ST

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7
Q

Which treatments of hyperkalaemia increase K excretion

A

IV NaCl

Diuretics

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8
Q

Which treatments of hyperkalaemia move K into cells

A

Beta-agonists
Bicarbonate
IV insulin

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9
Q

What happens to BUN:Creatinine ratio in pre-renal AKI Vs intrinsic AKI

A
  • In pre-renal AKI as normal all Cr is excreted, tubules are still working and reabsorbing urea so serum urea is higher. So BUN:Cr >20:1
  • In intrinsic AKI as normal all Cr is excreted, tubules aren’t working though so more urea being excreted than normal so less serum urea compared to pre-reanl. So BUN:Cr <20:1 (closer to 1)
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10
Q

What happens to urine Na and osmolality in pre-renal AKI

A

Decreased renal blood flow but tubules still working. RAAS activated causing Na and H2O retention. Concentrated urine - high osmolality >500 but looking at just urine Na concentration this is low <20 because Na is being reabsorbed by the still-functioning tubules

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11
Q

What happens to urine Na and osmolality in intrinsic AKI

A

Tubules damaged so can’t function and cant reabsorb Na. So Na and H2O lost in urine - dilute urine with a high Na concentration. Low urine osmolality <350, high urinary Na concentration >40

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12
Q

Management of AKI

A

Treat underlying cause
Stop nephrotoxic drugs
Monitor pH, fluid balance and electrolytes
Involve renal team

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13
Q

How long does disease need to be present to classify as chronic kidney disease

A

3 months

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14
Q

Causes of CKD

A 
HTN
DM
Renal artery stenosis
Glomerulonephritis
Reflux nephropathy
Pyelonephritis
PCKD
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15
Q

Clinical features of CKD

A 
Polyuria
Oedema
Anaemia
Low Ca, High PO4
Metabolic acidosis
Hyperkalaemia
Uraemia
Mineral and bone disorder
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16
Q

Three main types of renal replacement therapy

A

Dialysis
Haemofiltration
Transplant

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17
Q

How long does it take before a fistula can be used for dialysis

A

4 weeks

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18
Q

When would you use haemofiltration rather than dialysis

A

When a patient is really haemodynamically unstable

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19
Q

What’s the difference between haemodialysis and haemofiltration

A

Dialysis uses a diffusion gradient whereas filtration uses a hydrostatic pressure gradient

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20
Q

Possible complications of an AV fistula

A 
Thrombosis
Stenosis
Steal syndrome
Infection
Heart failure
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21
Q

Haemodialysis is performed roughly how often and for how long each time?

A

Three times a week

4 hours

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22
Q

What are the two types of peritoneal dialysis

A 
Continuous ambulatory PD (4-6 exchanges/day)
Assisted PD (fill in morning, exchange overnight)
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23
Q

6 features of nephrotic syndrome

A 
Proteinuria 
Increased risk of infection
Oedema
Hypoalbuminuria
Hyperlipidaemia
Hypercoagulable state
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24
Q

2 most common causes of nephrotic syndrome in adults

A 
FSGS (black population)
Membranous nephropathy (white population)
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25
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease

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26
Q

Secondary causes of nephrotic syndrome

A 
SLE
Hep B
Hep C
HIV
DM
Malignancy
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27
Q

4 primary causes of nephrotic syndrome

A

Minimal change disease
FSGS
Membranous nephropathy
Membranoproliferative glomerulonephritis

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28
Q

Management of nephrotic syndrome

A 
Low Na and protein diet
Fluid restriction
Loop diuretics
ACEi/ARB
VTE prophylaxis
Statins
Renal biopsy
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29
Q

8 features of nephritic syndrome

A 
Haematuria
Hypertension
Oliguria
Uraemia
RBC casts
Sterile pyuria
Mild proteinuria
Mild oedema
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30
Q

5 causes of nephritic syndrome

A 
IgA nephropathy
Post-strep glomerulonephritis
Rapidly progressive glomerulonephritis (Anti-GBM, GPA, MPA, EGPA_
Membranoproliferative glomerulonephritis
HSP
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31
Q

Management of nephritic syndrome

A

Low Na diet
Fluid restriction
ACEi/ARB
Consider immunosuppression

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32
Q

cANCA positive vasculitis

A

Granulomatosis with polyangitis (Wegeners)

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33
Q

pANCA positive vasculitis

A

Microscopic polyangitis

Eosinophilic granulomatosis with polyangitis (Churg-Straus)

34
Q

Presentation of HSP

A

Purpuric rash on extensor surfaces of legs
Polyarthritis
Abdo pain (GI bleed)
Nephritis

35
Q

Which 3 diseases only present as rapidly progressive glomerulonephritis

A

Goodpasteurs
Granulomatosis with polyangitis (Wegeners)
Microscopic polyangitis

36
Q

What are the 3 classification types of rapidly progressive glomerulonephritis

A

Type 1 - linear immunofluorescence
Type 2 - granular immunofluorescence
Type 3 - negative immunofluorescence

37
Q

Type 1 RPGN cause

A

Goodpasteurs

38
Q

Type 2 RPGN causes

A

Post-strep GN
SLE
IgA nephropathy
HSP

39
Q

Type 3 RPGN causes

A

Granulomatosis with polyangitis (Wegeners)

Eosinophilic granulomatosis with polyangitis (Churg-Strauss)

40
Q

What does E.coli look like under microscope

A

Gram negative rod

41
Q

Symptoms of acute pyelonephritis

A

Fever, rigors
Nausea, vomiting
Loin pain, costovertebral angle tenderness
Associated symptoms of cystitis

42
Q

What is meant by ‘complicated UTI’

A

UTI in the setting of any condition/comorbidity that may predispose a patient to an increased risk of infection or failed treatment

43
Q

What is classed as ‘recurrent’ UTI

A

2+ in 6 months or 3+ in 12 months

44
Q

Differential diagnosis of haematuria

A 
Malignancy
Calculi/stones
UTI
Glomerulonephritis/nephritic syndrome
ADPKD
Trauma (biopsy)
Coagulopathy
Renal TB
45
Q

Which patients with haematuria need cystoscopy and upper tract imaging

A

If >45 years old with any haematuria

If <45 with macroscopic haematuria and no infection

46
Q

How do you manage someone <45 with microscopic haematuria

A

GFR + BP + PCR

Plus cystoscopy if having frequency/urgency and/or non-contrast CT if loin pain

47
Q

2 types of benign renal tumours

A

Angiomyolipoma

Oncocytoma

48
Q

2 types of malignant renal cancer

A

Renal cell carcinoma

Transitional cell carcinoma (urothelial cancer)

49
Q

The most common type of renal cell carcinoma

A

Clear cell carcinoma

50
Q

What is the classic triad of renal cell carcinoma

A

Haematuria
Flank pain
Palpable flank mass

51
Q

What is the classic triad of transitional cell carcinoma

A

Haematuria
Pain
LUTS

52
Q

What are the 2 main types of bladder cancer

A

Transitional cell carcinoma (urothelial cancer)

Squamous cell carcinoma

53
Q

How does bladder cancer typically present

A

Painless macroscopic haematuria
Irritative voiding symptoms (dysuria, frequency, urgency)
Suprapubic pain
Suprapubic mass

54
Q

Management options for bladder cancer that hasn’t invaded the muscle wall (

A

Transurethral resection of bladder tumour (TURBT)

Intravesical BCG

55
Q

Management options for bladder cancer that has invaded the muscle wall

A

Radical cystectomy

Radiotherapy

56
Q

What is the most common type of renal stone

A

Calcium oxalate

57
Q

Symptoms of renal stones

A 
Severe renal colic that radiates down to groin/perineum 
Costovertebral angle tenderness
Haematuria
Nausea, vomiting
Dysuria, frequency, urgency
Passage of material
58
Q

Gold standard investigation of renal stones

A

Non-contrast abdo/pelvis CT

59
Q

Indications for intervention for renal stones

A

> 1cm
Complicated
Failure to pass spontaneously after 4-6 weeks

60
Q

BPH develops in which anatomical zone of the prostate

A

Middle transitional zone

61
Q

Prostate cancer develops in which anatomical zone of the prostate

A

Outer peripheral zone

62
Q

What tool can you use to assess prostate symptoms

A

International prostate symptom score

63
Q

Describe the different types of LUTS

A

Voiding/obstructive - hesitancy, poor stream, intermittent flow, incomplete emptying, post-voiding dribbling, overflow incontinence
Storage - frequency, nocturia, urgency, urgency incontinence

64
Q

Common causes of voiding LUTS

A

BPH
Bladder neck stenosis
Urethral stricture
Poor detrusor contractility

65
Q

Common causes of storage LUTS

A

UTI
Bladder calculi
Urothelial carcinoma
Overactive bladder

66
Q

What investigation would you arrange if you suspected prostate cancer

A

Ultrasound guided prostate biopsy

67
Q

What score is used to interpret prostate biopsy

A

Gleason score

68
Q

Is BPH a risk factor for prostate cancer

A

No

69
Q

What is the first line medication for BPH

A

Alpha blockers - Tamsulosin, Doxazosin

70
Q

What class of medications are Tamsulosin and Doxazosin

A

Alpha blockers

71
Q

What medication can be used to decrease growth of BPH

A

5-alpha-reductase inhibitors - Finasteride, Dutasteride

72
Q

Finasteride belongs to which group of medications

A

5-alpha-reductase inhibitors

73
Q

Which mediation helps with both BPH symptoms and ED

A

Tadalafil - Phosphodiesterase 5 inhibitors

74
Q

How do patients with ADPKD typically present

A

Flank pain, HTN and progressive renal disease in adulthood

75
Q

How do patients with ARPKD typically present

A

Chronic renal failure, hepatomegaly, liver failure, pulmonary hypoplasia in utero/early life

76
Q

Which two genes cause ADPKS

A

PKD1 and PKD2

77
Q

Extra-renal diseases associated with ADPKD

A

Hepatic/pancreatic/splenic/ovarian/testicular cysts
Cerebral berry aneurysm –> SAH
Mitral valve prolapse
Diverticulosis

78
Q

Clinical features of testicular torsion

A 
Sudden onset of unilateral pain
Nausea/vomiting
Swollen, oedematous, tender testicle
Abnormal position
Negative Prehn sign
Absent cremasteric refex
79
Q

What is Prehn sign

A

Positive if lifting testicle relives pain (epididymitis)

Negative if it doesn’t (torsion)

80
Q

Clinical features of epididymitis

A

Gradual onset of painful swelling
Fever, dysuria, frequency, discharge
Positive Prehn sign
Positive cremasteric reflex

81
Q

Typical presentation/history of IgA nephropathy

A

Episodic gross hematuria during or directly after upper respiratory tract (URT), gastrointestinal (GI) infections, or strenuous exercise

Finals (32 decks)

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