Disorders basics Flashcards
1
Q
Where are the glomeruli?
A
In the cortex of the kidney
2
Q
What is the role of the glomeruli?
A
They are the filtering units of the kidney
3
Q
What is glomerulonephritis?
A
Inflammation or scarring of the glomeruli
4
Q
Name 4 glomerulonephritises
A
- Minimal change disease
- membranous nephropathy
- Focal segmental glomerulosclerosis
- IgA nephropathy
5
Q
What happens to the kidneys when there is systemic disease?
A
- The kidneys are often an innocent bystander
- AKI
- CKI
- Proteinuria
- Nephritis/nephrotic syndrome
- Symptoms of underlying condition
6
Q
Explain diabetes and the kidney
A
- Hyperglycaemia leads to hyperfiltration, glomerular damage, proteinuria and chronic kidney disease
- normally experiencing other microvascular complications
- Manage diabetes, control BP (ACEi/ARB)
- SGLT2i in T2DM reduce the risk of kidney failure
7
Q
Renovascular disease
A
- Reduction to arterial flow to kidney due to atheroma
- Cortical hypoxia results in scarring
- Kidneys asymmetrical on ultrasound
- Avoid ACEi/ARB as glomerular perfusion dependent on angiotensin II
- Statin, stop smoking
8
Q
SLE and the kidney
A
- Autoimmune: immune complexes deposited in the glomeruli with complement activation
- Blood and protein in the urine
- Usually systemic features of lupus
- Kidney biopsy to confirm
- Management is usually immunosuppression
9
Q
Myeloma and amyloid
A
- Myeloma (monoclonal B cell disorder) leads to paraprotein in glomeruli, amyloid fibrils can also be deposited
- Various presentations: AKI/nephrotic
- Management: treat the underlying cause
10
Q
Serum creatinine in acute kidney failure
A
Large increase
11
Q
Urine volume in acute kidney failure
A
- Decreased urine volume
* Oedema
12
Q
Potassium in acute kidney failure
A
Increases: risk of cardiac arrhythmia
13
Q
Blood tests to look for secondary causes of glomerulonephritis
A
- Lupus - ANA, dsDNA
- Viral - HIV, hep B and hep C
- Vasculitis - Anca,
- Myeloma - Serum immunoglobulins and electrophoresis, BJP, serum free light chains
- Infective - RF, complement
14
Q
What should you do to manage hyperkalaemia in the context of renal failure
A
- Stabilise myocardium: IV calcium gluconate
- Remove potassium from the body: Dialysis (fast) or resins (slow)
- Stabilise myocardium: IV calcium gluconate
15
Q
What are the indications for acute haemolysis?
A
- Toxins
- fluid overload unresponsive to diuretic
- severe hyperkalemia
- severe metabolic acidosis
- acute uraemia (seizure/pericarditis)
