AKP take 2 > Nephrology > Flashcards

Nephrology Flashcards

(57 cards)

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1
Q

Under 6 months with UTI

A

Responds well (<48hrs) = USS within 6 weeks only

Atypical = USS acute, DMSA + MCUG

Recurrent = USS acute, DMSA + MCUG

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2
Q

HSP also known as?

A

IGA Vasculitis

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3
Q

Features of HSP

A

Palpable purpuric rash
Ankle swelling
Haematuria
Persistent proteinuria

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4
Q

Persistent proteinuria >0.5g/day

A

Captopril (ACE -I)

Proteinuria can have toxic effect on glomerulus

Decreases intraglomerular hypertension, which causes the proteinuria (even if no recorded HTN)

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5
Q

Hyperkalaemia: Asymptomatic with normal ECG (5.5 - 6.5)

A

Nebulised salbutamol +/- Bicarb if pH <7.25

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6
Q

Hyperkalaemia: unstable or ECG changes or >7

A

IV calcium gluconate
Then Nebulised salbutamol
IV Insulin/Dex
Consider Furosemide

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7
Q

What Ix to identify cause of Post streptococcal Glomerulonephritis?

A

If Skin source: Anti-deoxyribonuclease (anti-DNAse) - 3 weeks lag

If other: ASO titres - 10 days lag

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8
Q

Gitelman Syndrome

A

Distal convoluted tubule
Autosomal recessive
NaCl cotransporter

Low K+
Low Cl-
Low Mg2+
Metabolic acidosis

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9
Q

Haemolytic Uraemic Syndrome criteria (3)

A
  1. Microangiopathic haemolytic anaemia
  2. Thrombocytopaenia
  3. AKI
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10
Q

HUS trigger (organism)

A

95% preceded by diarrhoeal illness

Shiga-toxin-producing E.COLI O157

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11
Q

HUS complication

A

Pancreatitis
Myocarditis
Hypovolaemic shock
Seizures

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12
Q

What is the microvasculature component of HUS?

A

Ischaemic process
Affects kidneys
Endotoxins cause vascular injury = micro thrombosis
Platelet consumption in thrombi
RBCs fragmented/ damaged

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13
Q

Blood film in HUS?

A

Schistocytes
(Fragmented RBCs)

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14
Q

Prodrome to HUS

A

Bloody diarrhoea and vomiting
3-14 days after exposure to infection

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15
Q

Approach to any blood diarrhoea of unknown aetiology

A

FBC and film
U&E, LFTs
Clotting
Urinalysis
Urgent stool culture
E.coli serology

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16
Q

Why does HUS cause AKI?

A

Glomerular injury
Endotoxins cause microvascular injury
Leads to reduced u/o

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17
Q

Atypical UTI criteria

A

Non-E.coli organism
Seriously unwell
Sepsis
Failure to respond to Abx in 48 hrs
Poor urine flow
Abdo/ bladder mass
Raised creatinine

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18
Q

Signs of upper UTI

A

Fever >38C
Loin pain

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19
Q

Diagnosis UTI <3 mo

A

Urgent cytometry/ microscopy

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20
Q

Diagnosis UTI 3mo-3yr

A

Dipstick - treat as UTI if Leuk OR nit positive

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21
Q

Diagnosis UTI >3 years

A

Nitrites pos always treat, if only leuk pos consider sending MC&S first

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22
Q

UTI 6mo - 3 years

A

Responds to abx in 48 hrs - nil imaging

Atypical UTI - USS acute infection, DMSA

Recurrent UTI - USS 6 weeks, DMSA

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23
Q

When is MCUG indicated?

Study These Flashcards
A

only <6 months
Atypical or recurrent UTI

Looking for Vesicoureteral Reflux or Posterior Urethral valve

24
Q

DMSA scan

Study These Flashcards
A

Looking for renal scarring following ANY atypical UTI or recurrent UTI (any age)

Gold standard for reflux nephropathy and early detection of renal scarring

25
Causes of hypernatremia
Dehydration Nephrogenic DI Primary Hyperaldosteronism (Conn's Syndrome) Salt poisoning
26
Normal serum osmolality
275-295
27
Primary hyperaldosteronism (Conn's Syndrome) biochemistry
High sodium Low potassium Metabolic acidosis HTN
28
SIADH biochemistry
Low Serum Sodium Low Plasma osmolality High Urinary sodium High Urinary osmolality
29
Where does ADH bind in the kidneys?
Distal Convoluted Tubule
30
What is happening in SIADH?
Continuous secretion of ADH from posterior pituitary - no neg feedback
31
Triggers of SIADH
Brain injury Infection Hypothyroidism Malignancy e.g. Small Cell LC Drugs e.g. SSRIs
32
Management SIADH with signs cerebral oedema?
3% hypertonic saline
33
Management SIADH - asymptomatic and euvolaemia/overload
Fluid restriction
34
Salt poisoning biochem
High serum sodium Normal K+ High urine osmolality
35
Nephrogenic Diabetes Insipidus biochemistry?
High serum sodium Normal serum K+ Low urine osmolality
36
Normal urine osmolality (first morning)
>750
37
Whats happening in Nephrogenic DI?
Kidneys continue to excrete water despite dehyration Congenital or acquired (AKI)
38
Correction of hypernatraemic dehydration?
Oral fluids
39
Dilute urine Where plasma osmolality is higher than urine osmolality
Diabetes insipidus
40
Concentrated urine Where urine osmolality is higher than plasma osmolality
Kidneys attempting to reabsorb sodium and water in response to low plasma volume e.g. extra-renal fluid loss (D&V)
41
Hydronephrosis causes?
Obstruction at PUJ or vesiocoureteric junctions Reflux of urine from bladder
42
Renal tubular acidosis | What is it? How many types?
Kidneys are unable to acidify urine due to loss of bicarb or hydrogen ions. Metabolic acidosis normal anion gap 1. Distal RTA 2. Proximal RTA 3. Hyperkalaemic
43
Bartter Syndrome
Ascending limb of henle Low K+ Low Na2+ Low Cl Metabolic alkalosis Faltering growth
44
Pseudo-Bartter syndrome?
Similar to Bartter in context of Cystic Fibrosis
45
Phaeochromoctyoma?
Tumour on adrenal gland - Episodic Headaches - Sweating - Tachycardia - HTN
46
Alport Syndrome
Type IV collagen disorder X-linked inheritance
47
Features of Alport Syndrome?
Renal disease > CKD Eye abnormalities
48
Nephrotic syndrome triad
1. Proteinurina 2. Hypoalbuminemia 3. Oedema Also Hyperlipidaemia
49
Dose Prednisolone in Nephrotic syndrome?
60mg/m2/day for 4 weeks, then 40mg/m2/day
50
Common Causes renal calculi?
Proteus infection Hypercalciuria
51
Fanconi Syndrome
Dysfunction at Proximal Tubules - failure to reabsorb amino acids, glucose, bicarb, phosphate and urate Genetic
52
Clinical signs of Fanconi's syndrome
Failure to thrive Skeletal changes due to hypophosphatemic rickets Dehydration + wasting Polyuria
53
Fanconi's syndrome biochem
Low K+ Low phosphate Low bicarb Low glucose Metabolic acidosis Glucose in urine
54
Cystinosis clinical signs
Polyuria, Polydipsia Poor weight gain Rickets (bowed legs) Photophobia Retinitis pigmentosa
55
Minimal change disease
Most common form of nephrotic syndrome
56
Renal Tubular Acidosis
57
AKP take 2
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