Kidney Flashcards
Name 2 surrogates that are used for diagnosis of AKI?
Serum creatinine, urine ouptut
What are the 4 main physiological manifestations of kidney dysfunction?
- Na+/water imbalance
- Accumulation of solutes & wastes
- Accumulation of acids
- Abnormalities of endocrine function
How long does recovery from acute ATN usually take?
2-6 weeks
What are the investigations in the clinical assessment of AKI?
ABG, ECG, UEC, calcium, phosphate, FBE, ESR/CRP, coags, LFTs, CK, urinalysis, urine MCS, urine albumin/creatinine ratio, U/S kidneys
What are the STOP causes of AKI?
S - sepsis/hypoperfusion
T - toxin
O - obstruction
P - parenchymal disease
Outline management considerations for AKI (6 marks).
- Discontinue offending agents & nephrotoxins
- Meticulous volume status assessment
- Measure urea, creatinine, other electrolytes & venous bicarbonate daily
- Daily weighs, fluid chart, regular obs & fluid assessments
- Nephrology input to gauge the need for dialysis
- Loop diuretics if applicable for volume overload
What is the definition of chronic kidney disease?
-eGFR 3 months with or without evidence of kidney damage
OR
-evidence of kidney damage for >3 months - eg/ haematuria, proteinuria, pathological or anatomical abnormalities
What are 5 clinical manifestations of CKD?
- Urine change - anuria, oliguria, nocturia, polyuria
- Oedema
- Frothy urine (proteinuria)
- Fatigue, SOB, pallor (anaemia)
- Generalised weakness
- Nausea & anorexia
- Pruritus
- Constipation
- Fractures
Name 5 investigations you would perform if you suspect CKD and why.
- Urine MCS - to rule out infection as a cause for symptoms
- Urine albumin:creatinine ratio - to determine the degree of renal damage
- UEC - to determine eGFR & electrolyte imbalances
- HbA1c - if applicable
- U/S kidneys - to look for structural abnormalities
What is the target BP for patients with CKD?
130/80mmHg
OR
125/75mmHg in proteinuria/diabetics
What are 3 medications proven to be effective at reducing proteinuria?
- ACE inhibitors
- ARBs
- Spironolactone
Outline the management of CKD (6 marks).
- Identify & treat the underlying cause
- Reduce further progression of kidney disease
- Reduce CV risk
- Early detection & management of metabolic complications
- Medication adjustment/avoidance of renally excreted & nephrotoxic medications
What is the definition of nephrotic syndrome?
Proteinuria >3.5g/day
What is the definition of nephritic syndrome?
Haematuria ± proteinuria
What part of the kidney is required for biopsy - the cortex of medulla?
The cortex
What part of the glomerulus is disrupted (seen on EM only) in minimal change disease?
The podocytes (epithelial cells)
What is the mainstay of treatment of minimal change disease?
Steroids
How long after the precipitating infection does IgA nephropathy usually manifest?
Approx 10 days
What are the histologic findings in IgA nephropathy?
Mesangial proliferative glomerulonephritis with segmental lesions & crescents
cANCA and pANCA relate to which vasculitides?
cANCA = Wegener's granulomatosis pANCA = microscopic polyangiitis
How does microscopic polyangiitis manifest itself besides renal failure?
Progressive skin rash Fever Myalgia or arthralgia Weight loss SOB
What histologic feature is characteristic of diabetic nephropathy?
Kimmelstiel-Wilson nodules (nodular sclerosis)
