Kidney Flashcards
How do you manage CKD?
fluid restriction, dietary protein restriction, ACEi
Treat complciations - hypertension - antihypertensives
- oedema - fluid restriction +/- furosemide
anaemia - erythropoietin +/- iron supplementation
secondary hyperparathyroidism - active vit D therapy
- dietary phsophate restriction +/- phosphate binders , calcium tablets if low
- acidosis - bicarb
- hyperlipidaemia - statin
- hyperkalaemia - dietary potassium
Dialysis
what ix should you do in hyponatraemia
plasma osmolality - to determine if pseudohyponatraemia - urinary sodium and osmolality Specific tests - e.g. addisons disease SIADH Hypothryoidism
how do you manage hyponatraemia
treat the cause
- sodium correction
- seizures/coma = consider 3% hypertonic saline with ICU input
- hypovolaemic - replace with saline of hartmans
- euvolaemic - coorect cuase
- if SIADH or odematous = fluid restriction 1 litre/day
what are the sx of hyponatraemia
nausea/vomiting headache confusion seizures reduced consciousness
hypernatreamia sx
thirst, confusion, muscle twitching/spasms
how do you tx hypernatraemia
treat cause
sodium correction
- most patients - 5% dextrose slowly if chronic
- signs of volume depletion - replace fluid with 0.9% saline/hartmans
what are the sx of hypokalaemia
arrhythmias, tremor, muscle weakness/cramps and constipation
what is the tx of hypokalaemia
> 2.5 potassium supplements or 20-40mmol in each litre of IV fluids
<2.5 40 mmol/l in saline over 4-6 hours
treat cuase
never correct too quickly
what are the sx of hyperkalaemia
arrhythmias, lethargy, muscle weakness
what is the acute management of hyperkalaemia
ecg and 3 lead cardiac monitoring
calcium gluconate - 10 ml 10% IV over 10 minutes
actrapid - 10 units in 250 ml 10% dextrose IV over 30 mins
calcium resonium -
consider haemodialysis and treat cause
what are the sx of hypocalcaemia
CATS go numb Convulsions Arrhythmias Tetany Numbness
what is the management of hypocalcaemia
if severe <1.9 - calcium gluconate 10 ml 10% over 10 minutes
mild = calcium supplements
treat cause - e.g. severe Vit D deficiency load with colecalciferol
what is the management of hypercalcaemia
treat cause
replace fluid defiicit and keep pt well hydrated
if severe = bisphonate
what are the sx of hypomagneaemia
lethargy muscle weakness/cramps and tremors
arrhythmias and seizures
what is the management of hypomagnesium
PO - magnesium asparate 1 sachet 10 mmol BD
IV 5 mg magnesium in 500 ml 0.9% saline over 5 hrs
correct hypomagnesaemia before concurrent hypok and hypoca
what investigations should you do in acute pyelonephritis
urinalysis, urine MC/S FBC, ESR, CRP, U/E, creaitnine, blood cultures consider renal US contrast enhanced CT MRI
what are the mx acute pyelonephritis?
could this be sepsis
empirical abx based on the severity and micro results
self care advice - fluids anaglesia and safety netting
if complicated IV abx - co-amox
in men tx with fluroquinolone e.g. ciproflox due to the prostatitis cover switch to oral when possible
treat men for minimum 14 days
reassess and admit if complicated
if reccurent may require repeat urine cultures to censure cure
follow up in pregnant ladies = important
what are the risk factors fo rrenal colic
dehydration, diet ,obesity and medicines
what are the ix for renal colic
acute urgent low dose non-contrast CT
renal US if pregnant or child
urinalysis, FBC, U/Es and urine pregnancy test
what are the differentials in kidney stones
acute appendicitis, ectopic, ovarian cyst, diverticulitis, bowel obstruction, pylonephritis
what is the management of kidney stones
urgent urological assessment if stone is in ureter/kidney with signs of infection or obstruction
diclofenac - NSAID analgesia
IV fluids
If stone is less than 5mm or asymptomatic can use watchful waiting
if uteric stone <10mm use alpha blockade
for stones >10mm or if they remain despite conservative tx
= shock wave lithotripsy if <10mm
= uteroscopy if 10-20
- percutaneous nephrolithotomy >20 or staghorn
If pregnant uteroscopy
Advise to drink 2.5-3 L per day, healthy lifestyle and low sodium
what icx do you do in testicular torsion
US - whirlpool sign, urinalysis, FBC, U/E, CRP, scintigraphy
what are the differentials for testicular torsion
testicluar appendix torsion (blue dot sign) epidiymitis hydrocele varicocele testicular cancer acute appendicitis
mx of testicualr torsion
immediate urological consultation for emergency scrotal exploration
suuportive care = pain relief, anti-emetic
cosmetic saline implant for resticle at later date
fixation of contralateral testis
orchidectomy or orchidoplexy
if over 6 hours can use manual detorsion while surgery is being prepared
educate on possibliity of recurrent torsion, hormonal tx if loss of both testes
monitor for post op complciaitons - infection, testicular atrophy and infertility
what is the management of urosepsis
haemodynamic support - IV fluids, vasopressors
resp support
metabolic support - blood glucose, DVT prophylaxis, monitor for signs of DIC, nutritional supplementation
abx - ciprofloxacin
DM pts at high risk counsel
what are the differentials for BPH
urinalysis, PSA, international prostate symptom score - determines severity of sc, global bother score, volume charting, US may be considered, CT abdo/pelvis
urodynamic studies
cytoscopy
what is the mx of BPH
watchful waiting if non bothersome
behavioural mx programme e.g. limitation of fluids, bladder training, timed voiding, tx of constipation
if no indication for surgery use -
alpha blocker, 5alpha reductase inhibitor, phosphodiesterase 5 inhibitors, anticholinergic agent e.g. tolteradine
Surgery e.g. transurethral incision of prostate
or open proctatectomy
council pt on ses
monitor and prostate cancer screening PSA and PR
what are the unilateral causes of hydronephrosis
pelvic uteric obstruction
aberrant renal vessles
calculi
tumours of the renal pelvis
what are the bilateral cuases of hydronephrosis
stenosis of the ureters urethral valve prostatic enlargement extensice bladder tumours retroperitoneal fibrosis
what are the ix for hydronephrosis
us, urine dip, U/es, fbc, non-contrast CT KUB and PSA
what are the mx of hydronephrosis
unilateral or bilaeral with signs of infection = urgent nephrostomy or ureteric stent
ABx - ceftriaxime
if due to BPH - alpah blockers, 5alpha reductase inhibitors
urethral catheterisation
Tx underlying cuase
risk of severe sepsis and CV collapse
what ix do you do in AKI
urine dip, bloods, FBC, UE, CRP, Ca, PO4, PTH, VBG, accurate fluid balance charts
stopping renally excreted drugs
what is teh STOP AKI mneumonic
sepsis - urgent spetic screen
Toxins - idnetify and stop
Optimise volume status and BP
Prevent harm - identify and tx cause, manage life-treatening complications and modify meds
Low threshold for haemodialysis
Quantify type using KDIGO criteria
