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Y2 RENAL > Kidney Disease > Flashcards

Kidney Disease Flashcards

1
Q

List classic clinical features of kidney disease

A 
Loin pain
Haematuria
Dysuria
Proteinuria (frothy)
Oligouria
Appetite and weight
Asymptomatic
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2
Q

The kidney is involved in excretion of urea. What happens if this is impaired?

A

Uraemia (urea over 40 before manifests)

Can lead to pericarditis, encephalopathy, neuropathy etc.

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3
Q

The kidney is involved in fluid balance. What happens if this is impaired?

A

Fluid retention (oedema)

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4
Q

The kidney is involved in electrolyte balance. What happens if K becomes too high?

A

Hyperkalaemia can cause arrhythmias

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5
Q

The kidney is involved in acid-base balance. What is the classic breathing sign of an acidotic patient?

A

Metabolic acidosis leads to Kussmaul’s respiration

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6
Q

Which class of drug has to be closely monitored and can potentially cause renal failure?

A

ACE inhibitors/ARBs

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7
Q

What are the effects of NSAID on the kidney?

A 
Allergic reaction
Reduce GFR (inhibit prostaglandin production) due to vasoconstriction of afferent arteriole
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8
Q

Which antibiotics can insult to the kidney?

A

Gentamicin
Trimethoprim
Penicillins

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9
Q

What might radiology contrast cause within the kidney?

A

Contrast nephropathy

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10
Q

What does specific gravity in urinalysis tell us?

A

Urine concentration

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11
Q

Define heavy proteinuria

A

1-3g of protein in the urine per day

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12
Q

Define acute kidney injury

A

Decline in GFR over hours/days/weeks with/without oliguria in a patient with normal or impaired renal function

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13
Q

How much urine a day is classed as oliguria?

A

Less than 400ml a day

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14
Q

Which equation is used to provide estimated GFR (eGFR)

A

MDRD4 equation

Encompasses serum creatinine, age, sex and race

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15
Q

eGFR overestimates GFR if high muscle mass. True/False?

A

False

eGFR overestimates GFR is muscle mass is low, and underestimates GFR if muscle mass is high

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16
Q

Define stage 1 CKD

A 
Normal GFR (90 or over)
Evidence of kidney damage (proteinuria, haematuria, abnormal US)
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17
Q

Define stage 2 CKD

A

GFR 60-89

Evidence of kidney damage (proteinuria, haematuria, abnormal US)

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18
Q

Define stage 3 CKD

Define stage 3a and 3b

A

GFR 30-59
A = 45-59
B = 30-44

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19
Q

Define stage 4 (severe) CKD

A

GFR 15-29

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20
Q

Define stage 5 CKD (renal failure)

A

GFR less than 15 or renal replacement therapy

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21
Q

Patients with proteinuria are more likely to progress to CKD. True/False?

A

True

More proteinuria = faster progression

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22
Q

List common causes of chronic kidney disease

A 
Diabetes (commonest)
Hypertension
Vascular disease
Chronic glomerulonephritis
Reflux nephropathy
Polycystic kidneys
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23
Q

Symptoms due to reduced GFR don’t occur until late. True/False?

A

True

GFR less than 20 usually

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24
Q

List methods of slowing progression of CKD

A

Reduce proteinuria + control BP - ACE inhibitors, spironolactone
Glycaemic control in diabetes
Smoking cessation

25
Q

What is the initial danger of ACE inhibitors for kidney disease?

A

Cause initial fall in GFR which leads to hyperkalaemia

i.e. short term pain, long term gain

26
Q

How does anaemia arise in CKD?

A

Erythropoietin production declines in CKD

27
Q

How is anaemia in CKD rectified?

A

IV iron

Erythropoietin injection

28
Q

How does bone disease arise in CKD?

A

Impaired vitamin D hydroxylation in damaged kidney leading to reduced calcium absorption (secondary followed by tertiary hyperparathyroidism)

29
Q

How is bone disease in CKD rectified?

A 
Alfacalcidol (active vitamin D)
Phosphate intake
Phosphate binders (calcium carbonate, calcium acrete, sevalema)
30
Q

If initial CKD therapy is unsuccessful, what are the treatment options for renal failure?

A 
PREP FOR RENAL REPLACEMENT THERAPY
Haemodialysis
Peritoneal dialysis
Transplant (within 6 months of dialysis)
Conservative/palliative management (epo and symptom control)
31
Q

What is the best form of access for dialysis?

A

Arteriovenous fistula (AVF) - wait 6 weeks to mature

32
Q

Acute kidney injury is defined using creatinine and urine output. Define acute kidney injury

A

Increase in creatinine greater than 26.4 micomol//L, or by 50% or reduction in urine output in less than 48 hours

33
Q

How is acute kidney injury classified due to cause?

A

Pre-renal (functional)
Renal (structural)
Post-renal (obstruction)

34
Q

List pre-renal causes of acute kidney injury

A

Hypovolaemia (haemorrhage)
Hypotension (shock)
Hypoperfusion (NSAID, ACEI)

35
Q

Pre-renal AKI is reversible. True/False?

A

True

36
Q

Outline the pathophysiology of AKI due to volume depletion

A

Decreased effective intravascular volume causes increased ADH and aldosterone release, causing salt and water retention, leading to oliguria and AKI

37
Q

What is the commonest form of AKI in hospital?

A

Acute tubular necrosis due to decreased renal perfusion

38
Q

Outline treatment for AKI

A 
Treat cause/factors
0.9% saline +/- inotropes/ vasopressors
Antibiotic if sepsis
Stop nephrotoxines
Dialysis if anuric and uraemia
39
Q

What is the main vascular cause of renal AKI?

A

Vasculitis

40
Q

What is the main glomerular cause of renal AKI?

A

Glomerulonephritis

41
Q

List tubular causes of AKI

A

Ischaemia
Drugs (e.g. antibiotics - gentamicin, paracetamol)
Contrast nephropathy
Rhabdomyolysis

42
Q

Dark urine in AKI may be a sign of what?

A

Rhabdomyolysis (myoglobin in urine)

Destruction of skeletal muscle

43
Q

List initial investigations for AKI

A 
U+Es
FBC, coagulation, CK
Urinalysis (haematuria, proteinuria)
Ultrasound
Antibodies (ANA, ANCA, GBM)
44
Q

What are the indications for renal biopsy?

A

Rapidly progressive glomerulonephritis
+ve antibodies
Not improving

45
Q

List life-threatening complications of AKI

A 
Hyperkalaemia (K >5.5)
Pulmonary oedema
Acidosis (pH <7.15)
Uraemic pericardial effusion
Severe uraemia (UR > 40)
46
Q

Trimethoprim can cause AKI. True/False?

A

True

47
Q

List the main causes of post-renal AKI

A

Obstruction from stones/cancer
Stricture
Extrinsic pressure

48
Q

Outline management of post-renal AKI

A

Catheter
Nephrostomy
Refer to urology (ureteric stenting)

49
Q

How is hyperkalaemia complicating AKI treated acutely?

A

PROTECT MYOCARDIUM: 10mls 10% Calcium gluconate (Ca chloride second line)
MOVE POTASSIUM BACK INTO CELLS: 10 units of
insulin and 50mls 50% dextrose

50
Q

List investigations used in kidney disease

A 
GFR
Abdominal imaging
Blood pressure
ECG
Urinalysis looking for proteinuria and haematuria --> PCR if positive
51
Q

What is malignant/accelerated hypertension? What are the signs?

A

Diastolic BP >120
Papilloedema, headache, haematuria
End-organ complication (encephalopathy, fits, HF, acute RF)

52
Q

List late symptoms of CKD

A

Tiredness
Poor appetite
Itch
Sleep disturbance

53
Q

What is usually the first early sign of CKD?

A

Impaired urine concentrating ability - early nocturia

54
Q

How is AKI staged?

A

3 stage KDIGO scale

55
Q

List risk factors for AKI

A 
Age
HF
CKD/ previous AKI
Diabetes
Liver disease
PVD
Exposure
56
Q

List interstitial causes of AKI

A

Drugs
Infection (TB)
Systemic disease (sarcoid)

57
Q

List symptoms of AKI

A

Itch, fatigue
Nausea, vomiting
Anorexia, weight loss
High blood pressure, peripheral oedema

58
Q

State the main complication to be aware of in post-renal AKI. How is it diagnosed?

A

Hydronephrosis

US

59
Q

What is the first line investigation for a patient with suspected hyperkalaemia? What would the results be?

A

ECG

Tall T waves, reduced P waves, broad QRS

Y2 RENAL (17 decks)

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