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Renal & Genitourinary > CKD and AKI > Flashcards

CKD and AKI Flashcards

1
Q

What is the minimum urine output below which a patient is “oligouric”

A

1/2ml / kg / hr = 35ml / hr for 70kg male

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2
Q

Main causes of pre-renal AKI

A

All - hypoperfusion, so hypotension / hypovolaemia, renal artery stenosis, renal artery thrombus

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3
Q

Intra renal causes of glomerular damage i.e. glomerulonephritis

A

Hypertension (malign HTN)

AI - eg. IgA nephropathy

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4
Q

Intra renal causes of mesangial damage (2)

A

NSAIDS

Infection - post strep throat

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5
Q

Intra renal causes of acute tubular necrosis (4main ones)

A
  1. Drugs e.g. gentamicin / aminoglycosides or chemotherapy
  2. Immunoglobulin damage - myeloma
  3. Radio contrast from CT scans
  4. Rhabdomyolisis - myoglobin build up
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6
Q

Post-renal causes of AKI

A

Blockage / obstruction, so calculi, infection (ureter) tumours

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7
Q

Vascular causes of AKI

A

Thrombus, vasculitis, HTN, dissection

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8
Q

3 drugs which might causes rhabdomyolisis

A

Statins, also colchicine (gout) and cyclosporin

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9
Q

These electrolyte disturbances may cause rhabdomyolisis (2)

A

Hypokalaemia

Hypophosphataemia

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10
Q

2 endocrine causes of rhabdoymolysis

A

DKA / Honk

Hypothyroidism

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11
Q

Physical causes of rhabdomyolisis

A

Crush, immobilisation, compartment syndrome, hyperthermia (marathon runners)

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12
Q

What might you see on microscopy of tubules in rhabdomyolisis

A

Pigmented casts

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13
Q

Electrolyte results expected in rhabdomyolisis for K, Ca, Phosphate, Urea, Creatine kinase, LDH

A 
K, Phosphate, Urea, CK and LDH all UP (released from cell breakdown)
Ca DOWN (gets deposited in damaged muscles. When recovery occurs, get a hyper calcaemia as this Ca is released)
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14
Q

What might you expect the patients urine to look like in rhabdomyolisis

A

Red brown. NB rhabdomyolisis is often asymptomatic so must do tests if has a history with risk of injury.

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15
Q

3 treatments for rhabdomyolisis

A
  1. Fluid ++ - wash out casts
  2. Forced alkaline diuresis
  3. Mannitol - osmotic diuretic (beware hypernatraemia and hypocalcaemia)
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16
Q

Painless haematuria in 65 yr old

A

Bladder ca?

17
Q

Intra renal causes of haematuria (5)

A 
Trauma
Glomerulonephritis eg IgA nephropathy
Cancer
Polycystic kidneys
Tubulointerstitial nephritis
18
Q

Extra renal causes of haematuria 3

A

Trauma
Calculi
Infection

19
Q

5 drugs which can cause haematuria

A 
Captopril (ACEi)
NSAIDS
Furosemide
Cephalosporin
Ciprofloxacin
20
Q

Normal, microalbuminurea, macroalbuminurea, proteinurea are defined by what vol of albumin / 24hrs

A

Normal - 300mg / 24hrs

protein > 3.5g / 24hrs

21
Q

Someone presents with AKI like symptoms (loin pain, haematuria, reduced urinary output) - what tests might you do and why? 7

A
  1. Urine dipstick (check for blood, protein, nitrites glucose - always think is DM related to kidney disfunction?)
  2. U&Es - what are K & Na levels like
  3. LFTs - related liver dysfunction / disease
  4. ESR / CRP - infective / inflammatory cause?
  5. Coagulation screen - thrombus cause?
  6. Creatine kinase
  7. ABG - check for acidosis / lactate
22
Q

What would you do to manage the following in AKI: Hyperkalaemia, pulmonary oedema

A

High K+: 1. Ca gluconate to protect heart (10ml of 10% IV)
2. IV insulin / glucose
Pulmonary oedema: Furosemide, venous vasodilators, dialysis if reqd.

23
Q

6 causes of CKD

A 
DM (20%)
glomerulonephritis (eg IgA)
HTN / vasc disease
Infection - pyelonephritis
Idiopathic (20%)
Rarer - obstructive, eg myeloma / amyloid, Polycystic kidneys
24
Q

5 Stages of CKD and their GFR ranges

A
  1. > 90 ml/min
  2. 60 - 89
  3. 30 - 59(often asymptomatic until st 3)
  4. 15 - 29
    5.
25
Q

Complications of CKD to look out for 6

A
  1. Anaemia - SOB, pallor, dizzyness, red cap refil
    2 Fluid overload - lots of signs
  2. Uraemia - nausea, vom, pruritis, anorexia, fatiuge, bone pain, restless leg & check bloods
  3. Bone disease - check bloods
  4. Malnutrition
  5. hypertension
26
Q

Ways to assess fluid status 11+

A 
Cap refil
Skin turgor (neck)
Mucous membranes & eyes
Pulmonary oedema (fine end inspiratory crackles)
JVP
BP
Peripheral oedema
Urine output
HR
Weight
Albumin (if low - not keeping fluid in vasculature)
27
Q

Differences between Nephrotic and Nephritic syndrome: 1. BP, 2. abnormalities in urine, 3. GFR

A

Nephrotic:
Mild incr. BP
Proteinurea >3.5g / day
Mild decr GFR

Nephritic:
Mod - Sev incr BP
Haematuria
Mod - sec dec GFR

28
Q

Nephrotic and nephritic syndrome are an example of what global term for this type of kidney problem

A

Glomerulonephritis (damage to glomerulus = reduced renal blood flow, compensates by increaseing BP) Filtration dysfunction - blood / protien in urine

29
Q

4 causes of Nephrotic syndrome

A
  1. Membraneous nephropathy 20-30% adults- caused by Hep B, NSAIDs, Autoimm. malig, ideopathic
    Treat - ACEi, diuretics (AI treatm if reqd)
  2. Minimal change - 75% kids - ideopathic, NSAIDs, Hodgkins Lymphoma
    Treat - steroids
  3. Mesangiocapillary
    Immune complex / complement - linked to underlying disease Hep, SLE
  4. FSGS - Focal segmental glomeruloslerosis - many causes
30
Q

4 other diseases which can cause Neprhotic sydnrome

A

DM
SLE
Hep
Amyloid

31
Q

3 causes of Nephritic syndrome

A
  1. AgA Nephropathy - assoc with Henloch schonlein purpura, often young male, post infection. ACEi treat & autommune if req.
  2. Mesangiocapillary GN
  3. Post strep infection
32
Q

This x linked disease - defect in collagen, abnormal glom base.membr. - in childhood, microsc. haematuria, renal fail, deafness, eye probs.

A

Alport’s - nephritic syndrome

33
Q

This AI disease - antibodies to Type4 collagen - damage glomer. bas memb and lung

A

Goodpastures - nephritic syndrome & pulm haemmorage

34
Q

Purpuric rash on extensor surfaces, abdo pain and GI bleed, polyarthritis - related to IgA nephropathy

A

Henloch schonlein purpura - treat w. steroids

35
Q

Results to help tell if AKI is a. pre-renal or b. acute tubular necrosis in origin:

  1. Urine Na levels
  2. Response to fluid challenge
  3. Casts
  4. Urine : plasma osmolaltiy
  5. Urine : plasma urea
A

Pre-renal / ATN

  1. Na 30mmol / l
  2. Responds to fluid Does NOT respond
  3. No casts Brown, granular casts
  4. > 1.5 (incr) 10.1 (incr)
36
Q

This is a classic triad in young kids, after a diarrhoeal illness: AKI, haemolytic anaemia, thrombocytopaenia.
What is the condition?

A

HUS - Haemolytic uraemic syndrome

Post dysentry, Ecoli 0157 - produces shiga like toxin

Renal & Genitourinary (4 decks)

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