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Nephrology > Chronic Renal Failure > Flashcards

Chronic Renal Failure Flashcards

1
Q

How will someone with chronic renal failure present?

A

The patient will have

1) Uraemic symptoms: pruritis, fatigue, anorexia, weight loss, pruritis, increased thirst
2) Urinary symptoms: frequency due to loss of concentrating ability, change in volume of urine passed, haematuria
3) Loin pain
4) Fluid overload - dyspnoea, oedema, ascites

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2
Q

Urine dipstick in a patient with chronic renal failure will have…? (1)

A

Proteinuria

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3
Q

What previous renal history is important in males vs females suspected of chronic renal failure?

A

For males - was CRF detected during NS check-up

For females - any kidney issues during pregnancy?

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4
Q

What are the commonest causes of chronic renal failure in patients?

A
  1. Diabetes
  2. HTN
  3. Glomerulonephritis
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5
Q

Glomerulonephritis caused by VITAMIN can lead to chronic renal failure in patients. What are the VITAMIN causes?

A 
V - vascular: HSP 
I - infectious: hep B/hep C
T - toxins: drugs e.g. gold, penicillamine
A - autoimmune: SLE
M - metabolic: diabetes
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6
Q

How will a patient with HSP causing glomerulonephritis and CRF present?

A

HSP causes a purpuric rash, joint and abdominal pain.

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7
Q

What will a patient with SLE causing CRF present with?

A

SLE:

Malar rash, photosensitivity, joint pain, oral ulcers

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8
Q

How to approach the aetiology of a patient with chronic renal failure? (3)

A
  1. Common causes e.g. diabetes, HTN, GNNS (glomerular nephrotic and nephritic syndromes)
  2. Renal causes
  3. Extrarenal causes
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9
Q

Patient comes in with loin pain, haematuria and headaches, what is a sensible differential?

A 
Capsule stretching (pain), bleeding, HTN >
Polycystic kidney disease
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10
Q

What symptoms may a person with pyelonephritis present with?

A

Fever, loin pain, previous Hx of infection

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11
Q

What are the renal causes of CRF? (acronym STOIC for the general categories, ignoring S)

A
  1. Toxins - analgesic nephropathy, interstitial nephritis
  2. Originating from elsewhere in the urinary tract: obstruction, reflux nephropathy
  3. Inflammation - pyelonephritis, renovascular disease (vasculitis)
  4. Cysts - Polycystic kidney disease
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12
Q

Patient has just been diagnosed with CRF. What are the possible extra-renal causes of his CRF?

A

Myeloma
Systemic sclerosis
Amyloidosis

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13
Q

What history in a patient with CRF points towards reflux nephropathy as the cause?

A

Patient may have history of enuresis as a child (prolonged bedwetting), history of UTIs, been treated with surgical cytoscopy before.

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14
Q

Give 3 categories of causes of chronic renal failure and some examples in each.

A
  1. Common causes - DM, HTN, GNNS (in order of decreasing frequency)
  2. Renal causes - STOIC acronym e.g. toxins, obstruction, infection, cysts
  3. Extra-renal causes - myeloma, systemic sclerosis, amyloidosis
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15
Q

What investigations should be carried out to confirm diagnosis of CRF in a patient?

A
  1. Urinalysis, urine microalbumin
  2. Serum creatinine and estimate GFR
  3. Renal U/S
  4. Biopsy
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16
Q

Why is a renal ultrasound useful for diagnosing CRF? What should you be looking out for to narrow down the cause of CRF?

A

Atrophic kidneys suggest CRF

Also, look for evidence of hydronephrosis, which suggests obstruction and stones.

17
Q

What symptoms and history suggest obstruction as the cause of a patient’s CRF?

A

Obstruction will cause loin-to-groin pain, haematuria, dysuria, LUTS
History of BPH or stones

18
Q

Which of the commonest causes of CRF can be diagnosed using renal biopsy?

A

GNNS - glomerular nephrotic syndrome and nephritis.

19
Q

What is the definition of chronic kidney disease?

A

CKD is defined as pathologic abnormality the kidney, or GFR < 60mL/min/1.73m2 for 3 or more months.

20
Q

What clinical markers are considered as “kidney damage” or “pathologic abnormalities” in the definition of CKD?

A
  1. Stuff in the urine - albuminuria (ACR ratio of >30mg/g or 3.4mg/mol), sediments (white or red cell casts)
  2. Pathology - biopsy reveals disease
  3. Imaging - atrophic/polycystic kidneys or hydronephrosis
  4. Previous kidney transplant
21
Q

What investigations can diagnose CKD? How do these clinical markers relate to definition of CKD?

A
  1. Renal biopsy - shows evidence of glomerular/vascular/tubulointerstitial disease > pathologic abnormality as defined in CKD
  2. Imaging of kidneys - shows hydronephrosis, atrophic kidneys, polycystic kidney > CKD
  3. Stuff in the urine - red or white cell casts, albumin > CKD
22
Q

What is the definition of CKD?

A

CKD is defined as

1) evidence of kidney damage based on lab, radiographic or pathologic abnormalities OR
2) GFR <60 mL/min/1.73m2 for 3 months or more

23
Q

How many stages are there for CKD?

A

1 to 5, with 3 broken down into 3a and 3b

24
Q

What is the GFR defined for each stage of CKD?

A

Stage 1: normal or increased GFR = 90 or more
Stage 2: slightly decreased GFR = 60 to 89 (30)
Stage 3a: 45 to 59 (15)
Stage 3b: 30 to 44 (15)
Stage 4: 15 to 29 (15)
Stage 5: <15

25
Q

Stage 5 CKD is a.k.a.

A

ESRD

26
Q

What are the common causes of CKD?

A
  1. Diabetes
  2. HTN
  3. VITAM(IN)
    • Vascular: HSP
    • Infection: hep B/C
    • Toxins: gold, penicillamine
    • Autoimmune: SLE
    • Metabolic: Diabetes
27
Q

After renal transplant, patients are put on steroids, which are immunosuppressants for preventing graft rejection. What side effects do these steroids have?

A
  1. Cataracts
  2. Hyperparathyroidism
  3. Proximal myopathy
  4. Osteoporosis
  5. AVN
  6. Easy bruising
  7. Susceptibility to infections*
  8. Diabetes
  9. Obesity / cushingnoid appearance
28
Q

History of presenting complaint of a patient with CKD - what to ask? 3 general categories of questions…

A
  1. Urinary symptoms: frequency, change in urine volume, frothy urine (proteinuria), haematuria
  2. Fluid overload: peripheral oedema, dyspnoea (pulmonary oedema), ascites
  3. Uraemic: N+V, fatigue
29
Q

What 3 things when asked will give an idea of how the patient’s CKD is like now?

A
  1. Urine o/p
  2. Fluid overload?
  3. Uraemia
30
Q

What is the definition of CKD?

A
  1. Kidney damage for 3 months or more, as evidenced by structural or functional abnormalities
  2. GFR <60, with or without kidney damage
31
Q

What is the definition of kidney failure?

A
  1. GFR < 15

2. Need for RRT/dialysis/transplantation

Nephrology (9 decks)

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