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3 - Urinary > deck_1665492 > Flashcards

deck_1665492 Flashcards

1
Q

What is Oliguria?

A

• Little urine • Less than 500ml of urine/day or less than 20ml/hour

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2
Q

What is anuria?

A

• No urine • Less than 100ml of urine/day • Indicates blockage of urine flow

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3
Q

Give three causes of acute kidney injury

A

• Pre-renal disease ○ Decreased perfusion • Post-renal failure ○ Obstruction • Intrinsic Renal Failure ○ Dame to kidney

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4
Q

What is pre-renal acute kidney injury caused by?

A

• A reduction in renal perfusion • If not treated promptly acute tublar necrosis will develop

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5
Q

Give two over arching causes of pre-renal AKI

A

• Reduced effect ECF volumeImpaired renal autoregulation

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6
Q

Give three overarching causes of reduced effective ECF volume

A

• Hypovolaemia • Systemic vasodilation • Cardiac failue

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7
Q

Give two causes of hypovolaemia

A

• Blood loss • Fluid loss

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8
Q

Give three causes of systemic vasodilation

A

• Sepsis • Cirrhosis • Anaphylaxis

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9
Q

Give three causes of cardiac failure

A

• LV dysfunction • Valve diseaseTamponade

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10
Q

Give two causes of impaired renal autoregulation

A

• Preglomerular vasoconstriction • Postglomerular vasodilation

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11
Q

Give four causes of preglomerular vasoconstriction

A

• Sepsis • Hypercalcaemia • Hepatorenal syndrome • Drugs - NSAIDS

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12
Q

Give two causes of post glomerular vasodilation

A

• ACE inhibitors • Angiotensin 2 antagonists

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13
Q

What is post renal AKI?

A

• Injury as a result urine flow obstruction

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14
Q

What are the three sites at which urine flow can be blocked, causing post renal AKI?

A

• Ureters • Bladder • Urethra

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15
Q

What are three places obstructions can be at each particular site in post renal AKI?

A

• Within the lumen • Within the wall • Pressure from outside

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16
Q

Give four causes of blockage within the wall of the ureter, bladder or urethra

A

• Calculi • Blood clot • Papillary necrosis • Tumour of renal pelvis, ureter or bladder

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17
Q

How large must a calculi be to stop it passing?

A

> 10mm

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18
Q

Give two causes of obstruction within the wall of the ureter, bladder or urethra

A

• Congenital • Ureteric stricture

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19
Q

What does obstruction with the wall of the ureter, bladder or urethra usually cause other than acute post renal AKI?

A

Chronic kidney injury

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20
Q

Give three congenital causes of obstruction within the wall of the ureter, bladder or urethra

A

• Pelviureterteric neuromuscular dysfunction • Megaureter • Neurogenic bladder

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21
Q

Give five causes of pressure from outside causng post-renal AKI

A

• Prostatic hypertrophy • Malignancy • Aortic aneurysm • Diverticulitis • Accidental ligation of ureter

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22
Q

Give three causes of intrinsic AKI

A

• Acute tubular necrosis • Glomerular and arteriolar disease • Acute tubule-interstitial

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23
Q

What are the two main causes of acute tubular necrosis?

A

• Severe acute ischaemia • Toxic acute tubular necrosis

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24
Q

What is severe acute ischaemia caused by?

A

• Pre-renal fall in perfusion, causing tubular necrosis

25
Q

What is toxic acute tubular necrosis?

A

• Nephrotoxins damage the epithelial cells lining the tubules and cause cell death • Nephrotoxins can be endogenous or exogenous

26
Q

What is the most common cause of acute tubular necrosis?

A

• Where there is toxic acute tubular necrosis AND severe acute iscaemia

27
Q

Name three endogenous nephrotoxins

A

BUM • Bilirubin • Urate • Myoglobin

28
Q

Give four exogenous causes of ATN

A

• Endotoxin • X-ray contrast • Drugs • Other poisons

29
Q

Give three main drugs which are exogenous nephrotoxins

A

• ACE inhibitors • NSAIDs • Aminoglycosides

30
Q

How are NSAIDs toxic to the kidney?

A

• Prostaglandins usually causes vasodilation of afferent arterioles in renal autoregulation • NSAIDs inhibit prostaglandin production by inhibition of COX • Unopposed vasoconstriction of afferent arteriole occurs -> Reduced glomerular perfusion pressure -> AKI

31
Q

Why are ACE inhibitors exogenous nephrotoxins?

A

• Angiotensin II has a key role in homeostatic control of kidney blood flow • Efferent arteriole constriction • ACE inhibtors remove this effect, decreasing GFR

32
Q

What will you see in Acute Tubular Necrosis?

A

• Muddy brown casts in urine • Fractional excretion of Na+ >3%

33
Q

How do you calculate fractional excretion of Na?

A

• (Na (urine) x Cr (plasma)/Cr (urine) x Na (plasma) ) x 100

34
Q

Give two types of glomerular and arteriolar disease

A

• Primary acute glomerulonephritis • Secondary acute glomeurlonephritis

35
Q

What is acute glomerulonephritis?

A

• Immune disease affecting glomerulus (See session 9)

36
Q

Give two causes of secondary acute glomerulonephritis?

A

• Systemic lupus erthyrematosusVasculitis

37
Q

What is acute tubulo-interstitial nephritis? Give two causes

A

• Inflammation of the kidney intersitium • Acute pyelonephritis and drugs

38
Q

What are the three questions that should be asked when treating a patient with AKI?

A

• Are the kidneys underperfused? Pre-renal injury • Are nephrotoxins implicated? Direct renal injury • Is there a renal tract obstruction? Post-renal injury

39
Q

If kidneys are underperfused, what are two main causes?

A

• Shock • Severe vascular disease

40
Q

What are the three main types of shock?

A

• Hypovoleamic • Septic • Cardiac

41
Q

What is the main cause of severe vascular disease causing AKI?

A

Emboli

42
Q

What are three main possible nephrotoxins in direct renal injury?

A

• Drugs • Sepsis (endotoxins) • Myoglobin

43
Q

What is one disease you can NEVER forget which also causes direct renal injury?

A

• UTI progressing to pyelonephritis

44
Q

Give five signs of cardiac failure

A

• Gallop rhythm • Raised BP • Raised JVP • Pulmonary oedema – Basal crackles and dyspnoea • Peripheral oedema (Sacral/ankle)

45
Q

Give five signs of sepsis

A

• Pyrexia and rigors • Vasodilation, warm peripheries • Bounding pulse • Rapid capillary refillHypotension

46
Q

Give six signs of a urinary tract obstruction

A

• Anuria • Single functioning kidney • History of renal stones, prostatism or previous pelvic/abdominal surgery • Palpable bladder • Pelvic/abdominal masses • Enlarged prostate (DRE)

47
Q

What signs will you see in ALL AKI?

A

• Increased serum urea and creatinine • Hyperkalaemia • Hyponatraemia • Hypocalcaemia • Hypophosphataemia

48
Q

What investigations are peformed in AKI?

A

• ECG • Urine tests - Dipstick and microscopy • Soluble immunological tests • Imaging • Biopsy

49
Q

What ECG changes will you see in hyperkalaemia?

A

• Tall T waves • Small/Absent P waves • Increase P-R interval • Wide QRS complex • ‘sine wave’ patternAsystole

50
Q

What do you look for in dipstick tests?

A

• Blood • Protein • Leucocytes

51
Q

Will there be proteinuria/haematuria/any abnormal microscopy in the urine of someone with PRE-RENAL AKI?

A

• No proteinuria • No haematuria • Hyaline cast in urine - Aggregations of protein seen in concentrated urine (normal sign, but will be present on every urination)

52
Q

Will there be proteinuria/haematuria/any abnormal microscopy in the urine of someone with ACUTE TUBULAR NECROSIS

A

• No proteinuria • No haematuria • Muddy brown casts in urine

53
Q

Will there be proteinuria/haematuria/any abnormal microscopy in the urine of someone withGLOMERULONEPHRITIS?

A

• Heavy proteinuria • Heavy haematuria • RBC casts

54
Q

What soluble immunological tests can you do in AKI?

A

• Look for ANA (anti-nuclear antibody) ○ Indication for SLE • Look for ANCA (anti-neutrophil cytoplasmic antibody (ANCA) ○ Systemic vasculitis • Look for anti-glomerular basement membrane antibodies Goodpasture’s disease

55
Q

What are two imagine techniques used in AKI?

A

• Ultrasound ○ Renal size ○ Hydronephrosis ○ Presence of obstruction • Chest X-ray ○ Pulmonary oedema

56
Q

What is the treatment for pre-renal AKI

A

• Volume correction ○ Hypovolaemia -> Fluids ○ Heart failure -> Diuretic

57
Q

What is the treatment for post-renal failure?

A

• Urological intervention to re-establish urine flow

58
Q

What is the treatment for acute tubular necrosis

A

• Maintain good kidney perfusionAvoid nephrotoxins

59
Q

When is dialysis indicated?

A

When kidneys can no longer adequately excrete salt, water and potassium

3 - Urinary (39 decks)

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