Fichas
Renal Week Qs
Fichas del conjunto (73)
- 1What is needed for a diagnosis of AKI?Rise in creatinine 26micromol/l, or grater than 50% in 48hrs
Fall in urine output - 7 days, less than 0.5mls/kg/hr - 2What is needed to be diagnosed with mild, moderate or severe AKI?Mild = >26micromoles, / >50%-99%
Severe = >350 / >200%
moderate = >27-299 / >100-200% - 3What is the likely difference between large and small kidneys?Large = hyperfiltrating kidneys, diabetic, obstruction,
Small = CKD - 4What is more specific in a urine dip for an infection?Nitrites
Not leukocytes - 5Impact of trimethoprim on kidneys?Can give false AKI diagnosis
Causes hyperkalaemia and interferes with tubular creatinine secretion - causes creatinine reabsorption (rises creatinine) - 6Impact of NSAIDs on kidneys?Constricts afferent arterioles
- 7Impact of ACEi on kidneys?Dilates efferent arterioles
- 8True or False, NSAIDS and ACEi together cause a fall in EGFR?True, decrease blood going in and increase blood going out
- 9When might the normal creatinine ranges be wrong?Trimethoprim - causes rise in creatinine
Amputaitons - less cr
Pregnancy - decrease
Elderly - lower muscle mass - 10How do diabetic drugs affect Cr levels?Metaformin = increased risk of lactic acidosis in patients with AKI and low egfr
Sulfonylurea = increased risk of hypoglycaemia (stays in system longer due to lack of renal clearance) - 11Where is creatine produced?Liver
- 12What does EGFR depend on?Age and Race
same level of creatine but different egfr - 13Causes of raised urea?- Dehydration
- GI bleed
- Protein breakdown (trauma, surgery, infection, malignancy, drugs, high protein intake)
(lower in liver disease and pregnancy) - 14What are the main components of intra, how are levels of this controlled?k+ levels are controlled by aldosterone at DCT, increases K+ excretion. In acidosis, K+ pushed out, H+ pulled in
- 15What is the main component of extracellular fluid and how are levels of this controlled?Na+ content monitored by aortic/ carotid body and cardiac stretch. Juxtaglomerular apparatus causes renin release. Increased Na+ absorption and water
- 16Complications of AKI?- Hyperkalaemia - muscle weakness and paralysis
- Volume overload - oedema
- Uraemia - encephalopathy, pericarditis
- CKD + endstage renal fialure - 17Features of Nephrotic syndrome- Protein urea >350mg/mmol
- Hypoalbuminaemia
- Oedema
- Hyperlipidaemia (due to increased liver activity)
- Hypercoagulability - 18Features of nephritic syndrome?Haematuria
Small protein uria
- Red cell casts
HTN
- Breaks in GBM
- Associated with small cell vasculitis - 19Which conditions are both nephritic and nephrotic?MPGN
Membrenoproliferative Glomerulonephritis
SLE - 20Causes of nephritic syndromeIGA nephropathy (Henoch Schloin Purupura)
Post infections
Rapidly progressive Glomerulonephritis - 21Causes of nephrotic syndrome- Minimal change disease
- Membrenous glomerulonephropathy
- FSGS
- Diabetic neuropathy
- Amyloidosis - 22True or false, patients with nephrotic syndrome tend to have normal renal function?True
Normalish BP and creatinine level
opposite in nephritic - 23True or False, biopsy is not needed in nephrotic syndrome?False, you need to find cause
- 24What blood test would you need in IGA nephropathy causing nephritic syndrome?Immunology
- 25Treatment of nephrotic vs nephritic syndrome?Nephritic = control BP, steroids and some immunosupression
Nephrotic = ACEi, diuretics (furosemide), steroids and immunosupression - 26What is minimal change disease and what would investigations show?- Minimal changes seen on biopsy
- Electron microscopy shows effacement of foot processes
- Most common cause in children
- treated with steroids - 27What is Glomerulonephropathy (Membranous GN) and what would investigations show?Common cause in adults
Rapidly - can cause nephritic syndrome
Biopsy = glomerular capillary loops and thickened basement membrane
Electromicroscopy = subepithelial dense deposits (spikes)
Treated with steroids - 28Primary Membrenous GN vs Secondary?Primary = antibodies to phopholipase A2 receptor (PLAR2)
Secondary = cancer, infection or drugs - 29What is the most common cause of nephrotic syndrome in black populations?Focal Segmental Glomerulosclerosis
- 30Features of FSGS- Associated with heroin abuse, HIV, obesity + sickle cell
Biopsy = focal and segmental segmental sclerosis
- Primary/ idiopathic can look like minimal change
- Seocndary = scarring glomerular disease - 31Features of membroproliferative GN- Both nephrotic and nephritic syndrome
- Due to subendothelial deposition of immune complexes
- Usually progresses to end disease - 32Features of post infectious GN- Usually 14-21 days after an infection
- Biopsy = proliferation of mesangial cells that are dome shaped. (subepithelial humps) - 33Features of IGA nephropathy?Most common cause of nephritic syndrome in adults
24-48hrs after a chest infection
wide range of severity
Biopsy = IgA deposition
Treated non-specifically (ace inhibitors)
high morbidity - 34What glomerular disease is also known as bergers disease?IgA nephropathy
- 35True or false, urine dip can pic up non-visible haematuria?True
- 36What imaging tool would you use to see kidney stones?X-RAY
- 37When would you suspect bladder cancer?visible haematuria >45, >60S non visible haematuria
- 38What is the most common inherited kidney disease? - what is the inheritance patternPolysitic Kidney Disease. Autosomal Dominant
- 39What are some complications of nephrotic syndrome?- Infection from capsulated organisms (pneumococcus and meningococcus)
Thromboembolism - 40What is Anti-GBM disease?Nephritic syndrome in association with multisystme disease e.g. lung haemorrhage
Characterised by antiGBM antibodies - 41True or false, raised JVP in nephrotic syndrome?False, this is assoicated with HTN found in nephritic
- 42True or false, nephrotic syndrome would have raised serum albumin?False, low because it is lost in urine
- 43What disease is associated with carpal tunnel and synovitis? What would show on EM?Amyloidosis (inherited)
Shows apple green bi-fringent disease
Also associated with cardiomyopathy, liver/gut malabsorption, sensory neuropathy, shoulder pad sign and macroglossia - 44What test if positive is diagnostic of membranous nephropathy?Phospholipase A2 receptor antibody
- 45What nephritic syndrome is caused by abnormalities of type 4 collagen?Alport's syndrome
Second most common inherited disease - 46What is the diagnostic range for CKD?<60 EGFR or evidence of kidney damage/ kidney transplant
- 47What is the gold standard of measuring EGFR?Chromium measurement/ Inulin measurement
But creatinine is more practical - 48What is EGFR approximately equal to?Creatinine clearance OR cyastatin C
- 49Metabolic complications of CKD?- Hyperkalaemia
- Acidosis
- Hypocalcaemia/ hyperphosphataemia (inability to activate vit D)
- Anaemia - 50What is the major cause of death in CKD?CVD
- 51What are some complications of an AKI- Hyperkamaemia
- Accumulation of salt
- Accumulation of uraemic toxins
- Metabolic acidosis - 52Signs of chronic AKI?- Small kidney
- Slow rising creatinine
- Anaemia (takes time)
- High PTH - 53True or false, casts in urine means blood from bladder or catheter?False, this indicates bleeding from glomerulous level
- 54True or false, ACEi and NSAIDS are nephrotoxicFalse, Only NSAIDs truly are because they lower perfusion of the glomerulus
- 55Causes of pre-renal AKI- Volume depletion
- Low cardiac output
- Distributive (sepsis, infection)
- Vasoconstrictors (NSAIDS, ACEI)
- Causes drop in EGFR - 56True or false, tubulo-interstitial disease presents with blood and protein?False, not nephritic or nephrotic syndromes (damage to tubules not glomeruli)
- 57Causes of tubulo-interstitial disease?- Acute allergic interstitial nephritis (reaction to drugs)
- Glomerulonephritis
- Tubular obstruction by casts/ tumour lysis
- Tubular necrosis due to ischaemia. Can result from pre renal aki or drugs
- Haemolytic uraemic syndrome
- infection
- cholesterol embolization - 58Features of rapidly progressive glomerulonephritis?- Linked to good pasteures
- Caused by antiglomerular basement membrane Ab and small cell vasculitis - 59What type of AKI can cisplatin cause?Intrinsic AKI (acute tubular necrosis)
- 60What causes haemolytic uraemic syndromeDamage to microvascular endothelium e.g. because of e.coli -0157
Or complement dysregulation - 61Causes of post renal AKI?Due to obstruction down stream
Function loss depends on bilateral or one impaired kidney before hand - 62How would a post renal aki present?Hydronephrosis and dilated kidneys.
Palpable bladder - 63Indications for emergency dialysis?- Refractory hyperkalaemia
- Pulmonary oedema
- Uraemia
- Acidosis
- Removal of toxic substance e.g. in overdose
AEIOU - 64At what GFR level would you consider dialysis?20
- 65What are complications of haemodialysis?- Fistula/ tunnelled line takes up to 6 weeks to develop before use
- Can stenose or be blocked by thrombosis
- Nausea, vomiting, arrhythmias, muscle cramps and HTN - 66Complications of peritoneal dialysis?- Uses glucose fluid
- Peritonitis, fluid leak, hyperlipidaemia, hyperglycaemia and weight gain - 67What are the contraindications for transplanted kidneys?- Chronic infection
- Cancer
- Serious cardiac disease
- Liver failure
- BMI
- Age - 68What is the most important think to do with patients with CKD?Reduce blood pressure
- 69What antibiotics are used in complex UTI?- Ciprofloxacin (amoxycillin/ ceflexin in renal impairment)
Trimethoprim/ Nitro is first line - 70Which disease is HSP part of?IgA nephropathy
- 71What is sterile pyuria?WCC on urine dip but neg culture (chalmydia, tb and sarcoid)
- 72What does urine dip sometimes have false positives for?Myoglobulin
- 73True or false - heavy proteinurea is associated with glomerular dysfunction?True
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- 4th YEAR Fichas sobre Renal Week Qs, creado por Wannie Chisala el 04/12/2019.
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- Wannie Chisala
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