Kidney Disease Flashcards
List classic clinical features of kidney disease
Loin pain Haematuria Dysuria Proteinuria (frothy) Oligouria Asymptomatic
The kidney is involved in excretion of urea. What happens if this is impaired?
Uraemia (urea over 40 before manifests)
Can lead to pericarditis, encephalopathy, neuropathy etc.
The kidney is involved in fluid balance. What happens if this is impaired?
Fluid retention (oedema)
The kidney is involved in electrolyte balance. What happens if K becomes too high?
Hyperkalaemia can cause arrhythmias
The kidney is involved in acid-base balance. What is the classic breathing sign of an acidotic patient?
Metabolic acidosis leads to Kussmaul’s respiration
Which class of drug has to be closely monitored and can potentially cause renal failure?
ACE inhibitors/ARBs
What are the effects of NSAID on the kidney?
Allergic reaction Reduce GFR (inhibit prostaglandin production)
Which antibiotics can insult to the kidney?
Gentamicin
Trimethoprim
Penicillins
What might radiology contrast cause within the kidney?
Contrast nephropathy
What does specific gravity in urinalysis tell us?
Urine concentration
Define heavy proteinuria
1-3g of protein in the urine per day
Define acute kidney injury
Decline in GFR over hours/days/weeks with/without oliguria in a patient with normal or impaired renal function
How much urine a day is classed as oliguria?
Less than 400ml a day
Which equation is used to provide estimated GFR (eGFR)
MDRD4 equation
Encompasses serum creatinine, age, sex and race
eGFR overestimates GFR if high muscle mass. True/False?
False
eGFR overestimates GFR is muscle mass is low, and underestimates GFR if muscle mass is high
Define stage 1 CKD
Normal GFR (over 90) Evidence of kidney damage
Define stage 2 CKD
GFR 60-90
Evidence of kidney damage
Define stage 3 CKD
GFR 30-60
Define stage 4 (severe) CKD
GFR 15-30
Define stage 5 CKD (renal failure)
GFR less than 15
Patients with proteinuria are more likely to progress to CKD. True/False?
True
More proteinuria = faster progression
List common causes of chronic kidney disease
Diabetes (commonest) Hypertension Chronic glomerulonephritis Reflux nephropathy Polycystic kidneys
Symptoms due to reduced GFR don’t occur until late. True/False?
True
GFR less than 20 usually
List methods of slowing progression of CKD
Reduce proteinuria + control BP - ACE inhibitors, spironolactone
What is the initial danger of ACE inhibitors for kidney disease?
Cause initial fall in GFR which leads to hyperkalaemia
i.e. short term pain, long term gain
How does anaemia arise in CKD?
Erythropoietin production declines in CKD
How is anaemia in CKD rectified?
IV iron
Erythropoietin injection
How does bone disease arise in CKD?
Impaired vitamin D hydroxylation in damaged kidney
How is bone disease in CKD rectified?
Alfacalcidol (active vitamin D)
Phosphate intake
If initial CKD therapy is unsuccessful, what are the treatment options for renal failure?
Haemodialysis
Peritoneal dialysis
Transplant
Conservative/palliative management
What is the best form of access for dialysis?
Arteriovenous fistula (AVF)
Acute kidney injury is defined using creatinine and urine output. Define acute kidney injury
Increase in creatinine greater than 26.4 micomol//L, or by 50%
Reduction in urine output
How is acute kidney injury classified due t cause?
Pre-renal (functional)
Renal (structural)
Post-renal (obstruction)
List pre-renal causes of acute kidney injury
Hypovolaemia (haemorrhage)
Hypotension (shock)
Hypoperfusion (NSAID, ACEI)
Pre-renal AKI is reversible. True/False?
True
Outline the pathophysiology of AKI due to volume depletion
Decreased effective intravascular volume causes increased ADH and aldosterone release, causing salt and water retention, leading to oliguria and AKI
What is the commonest form of AKI in hospital?
Acute tubular necrosis due to decreased renal perfusion
Outline treatment for AKI
Treat cause/factors
0.9% saline
Antibiotic if sepsis
What is the main vascular cause of AKI?
Vasculitis
What is the main glomerular cause of renal AKI?
Glomerulonephritis
List tubular causes of AKI
Ischaemia
Antibiotics
Contrast nephropathy
Rhabdomyolysis
Dark urine in AKI may be a sign of what?
Rhabdomyolysis (myoglobin in urine)
List initial investigations for AKI
U+Es FBC, coagulation Urinalysis Ultrasound Antibodies
What are the indications for renal biopsy?
Rapidly progressive glomerulonephritis
+ve antibodies
Not improving
List life-threatening complications of AKI
Hyperkalaemia Pulmonary oedema Acidosis Uraemic pericardial effusion Severe uraemia
Trimethoprim can cause AKI. True/False?
True
List the main causes of post-renal AKI
Obstruction from stones/cancer
Stricture
Extrinsic pressure
Outline management of post-renal AKI
Catheter
Nephrostomy
Refer to urology
How is hyperkalaemia complicating AKI treated?
Calcium gluconate
Insulin
