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Renal > Genitourinary - AKI, Polycystic Kidney Disease, CKD > Flashcards

Genitourinary - AKI, Polycystic Kidney Disease, CKD Flashcards

1
Q

Acute Kidney Injury (AKI) - what is it and what does it lead to?

A

It is a reduction in renal function following insult to the kidneys

Leads to failure to maintain fluid, electrolyte and acid-base homeostasis

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2
Q

AKI - what compound is measured to diagnose AKI?

A

Creatinine

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3
Q

AKI - what are the three NICE criterions for diagnosing AKI?

A
  1. Rise in creatinine of ≥ 26 micromol/L in 48 hours
  2. Rise in creatinine of ≥ 50% over 7 days
  3. Urine output of <0.5ml/kg/hour for > 6 hours
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4
Q

AKI - what are some risk factors that would predispose someone to an AKI?

A

Patient that is suffering from an acute illness or having a surgical operation

CKD
HF
DM
Liver disease
Older age

Nephrotoxic meds - NSAIDs and ACEi

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5
Q

AKI - what are the causes?

A

Pre-renal causes:

  1. Due to inadequate blood supply to kidneys
  2. Hypotension
  3. Renal artery stenosis
  4. Dehydration
Renal causes:
1. Tubular:
Acute tubular necrosis - ischaemia
Nephrotoxins - aminoglycosides, NSAIDs
2. Glomerular:
Caused by antigen-antibody complexes depositing in the glomerular tissue
Glomerulonephritis

Post-renal causes:

  1. Obstruction to outflow of urine from kidneys, causing back-pressure and reduced kidney function
  2. Kidney stones in ureter or bladder
  3. BPH
  4. Masses such as cancers
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6
Q

AKI - symptoms and signs?

A

Patients with early AKI may experience no symptoms

As renal failure progresses, may seen:

  1. Reduced urine output
  2. Pulmonary and peripheral oedema
  3. Arrhythmias - secondary to changes in K+ and acid base balance
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7
Q

AKI - what are the investigations?

A

U&Es

Urinalysis - to check for:
protein and blood - suggest acute nephritis
leucocytes and nitrites - suggest infection
glucose - suggests diabetes

Renal ultrasound - to look for obstruction if necessary

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8
Q

AKI - how do you prevent AKI?

A

Avoid nephrotoxic meds

Ensure adequate fluid input

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9
Q

AKI - treatment?

A

Fluid rehydration - IV fluids in pre-renal AKI

Stop nephrotoxic meds

Relieve obstruction

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10
Q

Polycystic Kidney Disease - what is it?

A

Genetic condition where kidneys develop multiple fluid-filled cysts, causing significant kidney impairment

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11
Q

Polycystic Kidney Disease - what is the type of genetic inheritance?

A

There is BOTH an autosomal dominant and recessive type

Dominant more common

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12
Q

Polycystic Kidney Disease - in ADPKD where do the mutations occur?

A

85% of cases - mutations in PKD1, chromosome 16

15% of cases - mutations in PKD2, chromosome 4

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13
Q

Polycystic Kidney Disease - what are the clinical features?

A 
Abdo pain
Haematuria
HTN
Recurrent UTIs
Kidney stones
CKD
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14
Q

Polycystic Kidney Disease - what are the extra-renal manifestations?

A

Liver Cysts (most common) - may cause hepatomegaly

Berry aneurysms

Cardaic valvular disease - mitral regurg

Splenic, pancreatic, ovarian, prostatic cysts

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15
Q

Polycystic Kidney Disease - autosomal recessive type:
1. Chromosome affected, and what does it encode?

  1. How does it often present?
  2. What are the clinical features?
A
  1. Chromosome 6, defect in gene that encodes protein fibrocystin, protein important for renal tubule development
  2. Often presents as oligohydraminos as the fetus does not produce enough urine
  3. Dialysis - first few days of life
    Dysmorphic features - underdeveloped ear cartilage, low set ears, flat nasal bridge
    End stage renal failure in childhood
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16
Q

Polycystic Kidney Disease - what is the management for ADPKD?

A

TOLVAPTAN - vasopressin receptor 2 antagonist

Slows progression of cyst development and progression of renal failure

Management mainly supportive of complications:

17
Q

Chronic Kidney Disease - what is it?

A

Defined as the presence of kidney damage or reduced kidney function for 3 or more months

18
Q

Chronic Kidney Disease - what defines reduced kidney function? (for more than 3 months)

A
  1. A reduction in the GFR (GFR < 60 ml/min/1.73m2)

OR

  1. Evidence of kidney damage characterised by presence of one or more of:
    - albuminuria
    - radiological abnormalities
    - pathological abnormalities
    - abnormal things in urine
19
Q

Chronic Kidney Disease - what are the causes?

A

Majority of cases are secondary to DM, HTN, Glomerulopathies

Other causes:

  • Meds - NSAIDs, PPIs, Lithium
  • PKD
20
Q

Chronic Kidney Disease - what are the symptoms?

A

Frequently asymptomatic in early stages

Symptoms start developing around eGFR < 45ml/min:

  • anorexia and nausea
  • pruritus
  • muscle cramps
  • dyspnoea
  • oedema
  • fatigue
21
Q

Chronic Kidney Disease - what are the signs?

A

Pallor

Fluid overload - raised JVP, peripheral and pulmonary oedema

Excoriation marks - from pruritus

Skin pigmentation

Peripheral neuropathy

22
Q

Chronic Kidney Disease - what are the investigations?

A
  1. eGFR - checked using U&E blood test
    - two tests required that are 3 months apart for diagnosis
  2. Proteinuria checked using a urine albumin:creatinine ratio (ACR)
    - ≥ 3mg/mmol significant
  3. Urine dipstick - haematuria
  4. Renal US - check for PKD, obstruction
23
Q

Chronic Kidney Disease - what are the G score stages?

A

G1 = eGFR >90

G2 = eGFR 60-89

G3a = eGFR 45-59

G3b = eGFR 30-44

G4 = eGFR 15-29

G5 = eGFR <15 (known as “end-stage renal failure”)

24
Q

Chronic Kidney Disease - what are the A score staging?

A

A1 = < 3mg/mmol

A2 = 3 – 30mg/mmol

A3 = > 30mg/mmol

25
Q

Chronic Kidney Disease - what are some complications?

A

Anaemia

Renal bone disease

Acidosis

CV disease

26
Q

Chronic Kidney Disease - what are the management aims?

A
  1. Treat underlying cause
  2. Prevent or slow progression (renoprotective therapy)
  3. Treat complications
  4. Renal replacement therapy
27
Q

Chronic Kidney Disease - renoprotective therapy

A

BP control

Optimise DM control

Smoking cessation

Statins

28
Q

Chronic Kidney Disease - treating complications?

A

Anaemia of chronic disease - give ERYTHROPOIETIN and Fe supplementation
- healthy kidney cells produce erythropoietin, which stimulates production of RBCs, but damaged CKD cells cause drop in erythropoietin production, so reduction in RBCs

Renal bone disease - give vitamin D

Metabolic acidosis - oral sodium bicarbonate

29
Q

Chronic Kidney Disease - what are the options for end stage renal disease?

A

Renal replacement therapy encompasses:

  • haemodialysis
  • peritoneal dialysis
  • renal transplant, gold standard

All indicated for ESRD

Renal (3 decks)

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