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My Renal > Disease > Flashcards

Disease Flashcards

1
Q

What do the symptoms of kidney disease come from?

A
  • local effects
  • underlying disease
  • effects of loss of kidney function (advanced disease)
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2
Q

What are the important systemic enquiry questions for the kidneys?

A
  • appetite and weight loss
  • nausea and vomiting
  • dyspepsia
  • dyspnoea
  • urinary symptoms ie frequency, hesitancy, polyuria and nocturia
  • joint pain and arthralgia
  • skin rashes
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3
Q

What are the possible examination signs with a kidney issue?

A
  • pyrexia
  • skin rash
  • heart murmurs
  • retinopathy
  • neuropathy
  • arterial bruits
  • pallor
  • raised JVP
  • lung creps
  • oedema
  • gout
  • palpable kidneys
  • arrhythmias
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4
Q

What is accelerated hypertension?

A

this is a medical emergency

  • diastolic BP>120mmHg
  • papilloedema
  • end-organ decompensation
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5
Q

How is urine protein tested?

A
  • 24hr urine collection

- urine protein to creatinine ratio

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6
Q

What are urinary casts?

A

form by precipitation of Tamm-Horsfall mucoprotein and formation is pronounced in low urine flow and low pH

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7
Q

What are the main types of urinary casts?

A
  • hyaline: usually benign
  • red cell: always pathological, associated with nephritis syndrome
  • leukocyte: infection/inflammation
  • granular: chronic disease
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8
Q

What is the best measure of kidney function?

A

GFR

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9
Q

What are the stages of kidney failure with GFR?

A 
G1= >90- kidney damage with normal/ increased GFR
G2= 60-89- kidney damage with mild decrease in GFR

^These are only CKD if there are markers of kidney damage too

G3= 30-59- moderate decrease in GFR
G4= 15-29- severe decrease in GFR
G5= <15 or dialysis- kidney failure
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10
Q

What is acute kidney injury?

A

decline in GFR over 48h with or without oliguria where there is an absolute increase in serum creatinine by >26.4 or increase in creatinine by >50% or reduction in urinary output

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11
Q

What is involved in nephrotic syndrome?

A

this is often normal renal function

  • proteinuria >3g/day
  • hypoalbuminaemia
  • oedema
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12
Q

What is involved in nephritic syndrome?

A

this is signs and symptoms of glomerulonephritis

  • acute kidney injury
  • oliguria
  • oedema/fluid retention
  • HTN
  • active urinary sediment
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13
Q

What are the patient risk factors for AKI?

A
  • old
  • CKD
  • diabetes
  • cardiac failure
  • liver disease
  • PVD
  • previous AKI
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14
Q

What are the exposure risk factors for AKI?

A
  • hypotension
  • hypovolaemia
  • sepsis
  • decreasing NEWS score
  • recent contrast
  • exposure to certain medications
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15
Q

What are the main classes of causes of AKI?

A
  • pre-renal/functional
  • renal/structural
  • post-renal/obstruction
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16
Q

What are the pre-renal/functional causes of AKI?

A
  • hypovolaemia (haemorrhage and volume depletion eg D+V or burns)
  • hypotension (cariogenic, distributive shock)
  • renal hypoperfusion (NSAIDs, ACEI, hepatorenal syndrome)
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17
Q

What is pre-renal AKI?

A

reversible volume depletion leading to oliguria (<0.5mls/kg/hr) and an increase in creatinine

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18
Q

What is nausea/vomiting and weight loss caused by in renal?

A

uraemia

acidosis

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19
Q

What is itch caused by in renal?

A

uraemia
hyperphosphataemia
acidosis

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20
Q

What is SOB caused by in renal?

A

anaemia

acidosis

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21
Q

What are the two main groups of symptoms of bladder outflow obstruction?

A

Storage-

  • frequency
  • nocturia
  • urgency

Voiding

  • hesitancy
  • poor flow
  • intermittent flow
  • sensation of incomplete emptying
  • post-micturition dribbling
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22
Q

What are the red flags symptoms for bladder and prostate cancer?

A 
–	Haematuria
–	Suprapubic pain
–	Recurrent Urinary Tract Infections
–	Bone pain
–	Weight loss
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23
Q

What is the treatment for hyperkalaemia?

A
  • calcium gluconate to protect against arrhythmias
  • insulin (with glucose) to move K into cells
  • salbutamol which moves K into cells too
    will need haemodialysis eventually
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24
Q

If there is both proteinuria and haematuria where is the issue most likely to be?

A

kidneys

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25
Q

What is the most likely cause of haematuria without proteinuria?

A
  • in young is kidneys <45

- in old is bladder >45

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26
Q

What can metformin do to the kidneys?

A

when there is a reduced GFR there is an increased risk of lactic acidosis

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27
Q

Which class of drug is proven to slow progression of diabetic nephropathy?

A

ACEi or ARB

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28
Q

Which classes of medications are stopped on sick days?

A
  • ACEi/ARB
  • NSAIDs
  • Diuretics
  • Diabetic medication ie gliclazides and metformin
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29
Q

What is the mnemonic for indications for dialysis?

A

AEIOU

  • A-acidosis that is not medically improved
  • E-electrolyte disturbance eg hyperkalaemia
  • I-intoxication ie drug overdose
  • O-verload ie pulmonary oedema
  • U-uraemia >40
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30
Q

What is the physiological response in the body to a decrease in renal perfusion?

A
  • renin released
  • renin causes angiotensin 2 to cause vasoconstriction of the efferent arteriole
  • GFR is maintained
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31
Q

What do ACEI do?

A

cause a reduction in GFR by inhibiting angiotensin 2 from vasoconstricting the efferent arteriole

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32
Q

What happens if there is a decrease in renal perfusion in a patient who takes an ACEI?

A

there is a severe drop in GFR

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33
Q

What does untreated pre-renal AKI lead to?

A

acute tubular necrosis

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34
Q

What are the causes of acute tubular necrosis?

A
  • sepsis
  • severe dehydration
  • rhabdomyolysis
  • drug toxicity
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35
Q

What is the treatment of pre-renal AKI?

A
  • assess for hydration: BP, HR, UO, JVP, cap refill, pul oedema
  • fluid challenge for hypovolaemia using crystalloid
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36
Q

What is renal AKI caused by?

A

inflammation or damage to cells

  • vascular eg vasculitis
  • glomerular eg glomerulonephritis
  • interstitial eg drugs, sarcoid, TB
  • tubular eg ischaemia, drugs, contrast
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37
Q

What are the symptoms of renal AKI?

A
  • anorexia
  • weight loss
  • fatigue
  • N and V
  • itch
  • fluid overload
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38
Q

What are the signs of renal AKI?

A
  • fluid overload: HTN, oedema, pulmonary oedema, effusions
  • uraemia: itch, pericarditis
  • oliguria
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39
Q

What is the treatment and diagnosis for renal AKI?

A

Diagnosis: U and E, FBC, crag, urinalysis, USS, immunology

Treatment: fluids, ?inotropes if fluid doesn’t increase BP, treat underlying cause, stop nephrotoxic drugs, ?dialysis

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40
Q

What are the main life threatening complications of AKI?

A
  • hyperkalaemia
  • fluid overload
  • severe acidosis
  • uraemia pericardial effusion
  • severe uraemia
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41
Q

What is post-renal AKI?

A

obstruction of urine flow leading to hydronephrosis

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42
Q

What are the causes of post-renal AKI?

A
  • stones
  • cancer
  • strictures
  • extrinsic pressure
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43
Q

What is the treatment for post-renal AKI?

A

relieve the obstruction with a catheter or a nephrostomy

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44
Q

What are the signs of hyperkalaemia on an ECG?

A
  • tall, peaked T waves with a narrow base (best seen in precordial leads)
  • shortened QT interval
  • ST-segment depression
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45
Q

What are the main drugs to avoid in a patient with AKI?

A
  • NSAIDs
  • ACEI/ARB
  • Diuretics
  • Gentamicin
  • Contrast
  • Trimethoprim
  • Potassium sparing diuretics
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46
Q

What is needed ideally for a diagnosis of CKD?

A

two samples at least 90 days apart using eGFR of less than 60

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47
Q

What is classed as accelerated progression of CKD?

A
  • 25% decrease in GFR and change in category in 12m

- decrease in GFR of 15ml/min per year

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48
Q

What are the RF for CKD?

A
  • chronic NSAID use
  • smoking
  • African/ Caribbean/ Asian
  • proteinuria (more likely to progress)
  • diabetes
  • hypertension
  • acute kidney injury
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49
Q

What is the definition of CKD?

A

decreased GFR and/or evidence of kidney damage present for more than 3 months

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50
Q

What are the BP aims for CKD and also with diabetes?

A

for CKD= <140/90

for CKD and diabetes= <130/80

51
Q

What is the prevention of CVD in CKD?

A

huge risk

  • atorvastatin and ?aspirin
  • smoking cessation, weight loss, aerobic exercise, limit salt
  • control HTN
52
Q

What are the causes of CKD?

A
  • diabetes
  • HTN
  • small vessel vasculitis
  • chronic glomerulonephritis
  • reflex nephropathy
  • PKD
  • obstructive post-renal disease eg calculi, prostatic or bladder
53
Q

What are the clinical signs of CKD?

A
  • anaemia
  • weight loss
  • advanced uraemia (lemon yellow, twitch, confusion, pericardial rub/effusion)
54
Q

What are the symptoms of CKD?

A
  • Uraemia: confusion, N and V, weight loss, itch, muscle twitch, altered taste and fatigue
  • Pain: neuropathic, ischaemic, bony and visceral
  • Anaemia: fatigue and muscle weakness
55
Q

What are the renal consequences of CKD?

A
  • local pain and infection
  • haematuria and proteinuria
  • HTN
  • acid-base disturbances
    leading to end-stage renal disease
56
Q

What are the extra-renal consequences of CKD?

A
  • CVD
  • mineral and bone disease
  • anaemia
  • nutrition
57
Q

What happens in mineral bone disease?

A

Vit D is normally hydroxylated in the kidneys but it isn’t so there is calcium imbalance and high PTH

58
Q

What is the treatment for CKD with mineral bone disease?

A
  • restrict phosphate
  • consider lower salt, restrict potassium and fluid
  • medication= Alfacalidol (active Vit D), phosphate binders, calcimimetic
59
Q

What is the treatment for renal anaemia?

A

common esp in DM due to low production fo erythropoietin (target is 100-120Hb)

  • Ferinject/Venofer which is iron therapy, give IV iron if this is unsuccessful
  • check for B12 and folate deficiency too
60
Q

What are the physical effects of CKD?

A
  • thirst
  • malnutrition
  • anaemia
  • loss of interest in food
  • vitamin/mineral imbalance
    there is a high depression rate in ESRD
61
Q

What are the adverse affects of the post renal transplant drugs?

A
  • infections
  • cancer
  • GI upsets
  • hirsutism
  • weight changes
62
Q

What main areas does vasculitis affect?

A

kidneys, skin and lungs

63
Q

What are the types of ANCA antibodies?

A

cANCA is GPA (anti-PR3)

pANCA is MPA (anti-MPO)

64
Q

What are the features of lupus nephritis?

A
  • proteinuria is observed
  • classification ranges from minimal to advanced sclerosis
  • biopsy of kidneys is needed
65
Q

What are the zones of the prostate?

A
  • transitional zone
  • central zone
  • peripheral zone- most prostate adenocarcinomas come from here
  • fibromuscular zone
66
Q

What is the role of PSA?

A

it is involved in liquefaction of semen and is increased in prostate cancer and other conditions
aka glycoprotein enzyme kallikrein 3

67
Q

What are the three parts to dialysis?

A

diffusion, convection and adsorption

68
Q

What is involved in the diffusion part of dialysis?

A

creating an equilibrium which removes urea, potassium and sodium and allows bicarbonate infusion

69
Q

What is involved in the convection part of dialysis?

A

water and dissolved solutes move across a membrane in response to a pressure gradient aka ultrafiltration

70
Q

What is involved in the adsorption part of dialysis?

A

plasma proteins stick to the membrane surface and are removed by membrane binding
high flux membrane do this more than low flux

71
Q

What is haemodiafiltration?

A

this is more convective than HD with a large solute drag so is a better treatment

72
Q

How often is haemodialysis done?

A

4 hours a week three times a week

73
Q

What are the lifestyle changes for someone on dialysis?

A
  • 1l a day of fluid
  • low salt, potassium and phosphate diet
  • give phosphate binders with meals
74
Q

What are the two types of access for dialysis?

A
  • tunneled venous catheter= easy, infection with S.aureus, vein damage
  • fistula= gold standard, can’t be used immediately. needs surgery, less infections, surgical connection between artery and vein
75
Q

What are the problems with dialysis?

A
  • hypotension leading to under-filing of intravascular space
  • haemorrhage
  • loss of vascular access
  • arrhythmia
  • cardiac arrest
76
Q

What is peritoneal dialysis?

A
  • solute removal by diffusion of solutes across peritoneal membrane
  • water removal by osmosis driven by high glucose conc in dialysate fluid
77
Q

What are the issues with peritoneal dialysis?

A
  • infection ie peritonitis or exit site
  • peritoneal membrane failure so can’t remove enough water or solutes
  • hernias due to high intra-abdominal pressure
78
Q

What are the reasons for starting dialysis?

A
  • resistant hyperkalaemia
  • eGFR<7
  • urea<40
  • unresponsive metabolic acidosis
  • N+V, anorexia, fatigue, itch and unresponsive fluid overload
79
Q

What is disequilibrium syndrome?

A

the correcting of urea levels too fast

80
Q

What are the three types of renal transplant?

A
  • deceased heart beating donor
  • non-heart beating donor
  • live donation
81
Q

What are the contraindications for renal transplant?

A 
malignancy
active HIV
untreated TB
severe heart/airways disease
acute vasculitis
severe PVD
hostile bladder
82
Q

What is desensitisation in relation to renal transplant?

A

active removal of blood group or donor specific antibody by plasma exchange or B cell antibody (rituximab)

83
Q

Where is the new kidney attached?

A

to the external iliac artery and vein in the iliac fossa

84
Q

What are the types of rejection?

A
  • hyperacute: preformed antibodies, transplant needed
  • acute: cellular/antibody mediated, increase immunosuppression
  • chronic: antibody mediated slow progression decline which has no treatment
85
Q

What is involved in anti-rejection therapy?

A

decreased activation of T cells

86
Q

What happens if the anti-rejection therapy becomes too much?

A
  • infection so UTI or LRTI
  • cytomegalovirus causes death in first 3 months and causes renal dysfunction, give IV ganciclovir
  • BK virus can cause nephropathy
  • EBV infection can lead to lymphoma due to immunoproliferation
87
Q

What are the types of anti- rejection drugs?

A
  • monoclonal antibodies: prevent activation fo CD4 T cells so no rejection
  • glucocorticoids: inhibit lymphocytes action and suppress cytokines
  • calcineurin inhibitors =: inhibit T cell activation and prevent cytokine release
  • anti-metabolites: block purine synthesis so suppress lymphocyte proliferation
88
Q

What are the features of acute urinary retention?

A
  • inability to urinate and increasing pain
  • due to BPH or can be precipitated by catheter, anaesthesia or medication
  • give catheter, uroselective alpha blocker and then remove catheter
89
Q

What is post-obstructive diuresis?

A

present in patients with chronic bladder outflow obstruction associated with uraemia, oedema and HTN

90
Q

What are the features of ureteric loin pain?

A
  • caused by a stone with the pain caused by prostaglandins
  • give NSAIDs and /opiate
  • give alpha blocker (tamsulosin) for small stones
  • treatment is ureteric stent or stone fragmentation and removal
91
Q

When should stones in the ureter be treated urgently?

A

unrelieved pain
pyrexia
persistent nausea/vomiting
high-grade obstruction

92
Q

What are the causes of frank haemturia?

A
  • trauma

- coagulation/platelet deficiencies

93
Q

What is the best test for frank haematuria?

A

CT urogram and cytoscopy

94
Q

What are the features of a spermatic cord torsion?

A
  • adolescent, spontaneous, n and v, referred pain to lower abdomen
  • do doppler US
  • surgical fixation
95
Q

What is the blue dot sign?

A

this is an appendage torsion in the testicle which has a spontaneous resolution

96
Q

What is the presentation of epididymitis?

A
  • dysuria and pyrexia in a child

- history of UTI, urethritis and catheter

97
Q

What is the diagnosis and treatment for epididymitis?

A
  • do urine culture
  • give analgesia and scrotal support
  • give oflaxacin
98
Q

What are the features of idiopathic scrotal oedema?

A

it is self-limiting and can cause itch

99
Q

What is paraphimosis?

A

a painful swelling of the foreskin distal to the phimotic ring caused by foreskin not being replaced after a procedure

100
Q

what is the treatment for paraphimosis?

A

puncture, compression and slit

101
Q

What is Fournier’s gangrene?

A

this is necrotising fasciitis of the testicles which starts as cellulitis but goes purple, swollen with crepitus

102
Q

What is the treatment for Fournier’s gangrene?

A

antibiotics and surgical debridement

103
Q

What are the predisposing factors for Fournier’s gangrene?

A

diabetes, local trauma and periurethral extravasation

104
Q

What are the voiding symptoms of BOO?

A
  • weak or intermittent urinary stream
  • straining
  • hesitancy
  • terminal dribbling
  • incomplete emptying
105
Q

What are the storage symptoms of BOO?

A
  • urgency
  • frequency
  • incontinence
  • nocturia
106
Q

What are the causes of urinary incontinence?

A
  • urethral: urge, stress, mixed or overflow

- fistula/ectopic ureter

107
Q

What device is used to assess pressures in urinating?

A

cystomethograms show pressures of filling and voiding phases

108
Q

What are the nerves involved in urination?

A

afferent= pelvic parasympathetic
efferent= pudendal
facilitation and inhibition is by S2-3

109
Q

What is overflow incontinence?

A

bladder outflow obstruction so huge palpable bladder so there is chronic retention leading to wetness at night and renal impairment

110
Q

What does urge incontinence consist of?

A

high daytime frequency with small voided volumes which can be due to detrusor overactivity so it contracts during inhibition of voiding

111
Q

What are the causes of over excitation of the bladder?

A
  • afferent overstimulation due to irritation of the bladder
  • excess facilitation by S2-3
  • loss of central inhibition due to paraplegia
112
Q

What is stress incontinence?

A

urine leaks out due to increased intra-abdominal pressure with our detrusor contraction due to pelvic floor damage or urethral function issues
urodynamic diagnosis - USI

113
Q

What is a painless palpable mass in pelvis on examination that is dull to percussion?

A

bladder

114
Q

What is the treatment for overflow urinary incontinence?

A

assess renal function, treat obstruction, catheter, rehabilitate bladder, teach intermittent self catheterisation

115
Q

What is the treatment for urge urinary incontinence?

A

bladder retraining, drugs (antimuscarinics and beta3 adrenergic), neuromodulation (pacemaker) or surgery

116
Q

What is the treatment for stress urinary incontinence?

A

decrease weight, stop smoking, pelvic floor physiology, surgical correction eg tape procedure

117
Q

What is the emergency management of haematuria?

A
  • FBC, renal function, clotting
  • 3 way catheter with bladder washout
  • monitor output and haemoglobin
  • remove catheter
  • USS/CT and cystoscopy
118
Q

What is the initial management of UT calculi?

A
  • ABCDE
  • analgesia- NSAIDs eg Diclofenac IM/PR
  • bloods- FBC, U and E, CRP, urate and calcium
  • CT KUB is gold standard
  • treat sepsis
119
Q

What is the elective treatment for UT stones?

A

ureteroscopy
shock wave lithotripsy
percutaneous nephrolithotomy
(stones up to 6mm don’t need treatment)

120
Q

What are the most common causes of retention of urine in men vs women?

A
  • men= prostate cancer, BPH and urethral stricture

- women= pelvic prolapse, post-surgery, pelvic mass due to gynae issue

121
Q

What is the management for acute retention?

A
  • catheter and record residual volume
  • FBC, renal function and urine dip
  • treat cause
  • alpha blocker
122
Q

What is the management for chronic retention?

A

catheter and monitor for post-obstructive diuresis and decompression haematuria

123
Q

What are the main causes of CKD?

A
  • hypertension
  • diabetes
  • glomerular disease

My Renal (8 decks)

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