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Renal > Kidney disease > Flashcards

Kidney disease Flashcards

1
Q

What may someone present with in kidney disease?

A
  • asymptomatic
  • loin pain
  • urinary symptoms
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2
Q

What may occur if the fluid balance is off?

A
  • oedema
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3
Q

What may occur if the electrolyte balance is off?

A
  • hyperkalaemia

- cardiac arrythmias

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4
Q

If what substance is reduced in production from the kidneys may result in anaemia?

A

-erythropoietin

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5
Q

What systemic enquiry questions do you want to ask with someone with kidney injury?

A
  • appetite
  • nausea/vomiting
  • dyspnoea
  • urinary
  • skin rashes
  • changes to medications
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6
Q

What drugs may cause renal impairment?

A
  • NSAIDs
  • ACEi
  • ARB
  • Metformin
  • Gentamicin
  • PPI
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7
Q

Define accelerated hypertension?

A
  • diastolic BP > 120mmHg
  • papilloedema
  • end organ decompensation
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8
Q

Splinter haemorrhages may be indicative of what?

A
  • endocarditis

- vasculitis

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9
Q

Vasculitic skin rash may be indicative of what?

A
  • acute glomerulonephritis
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10
Q

Specific gravity on urinalysis is describing?

A
  • urine concentration
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11
Q

Red cell casts may suggest?

A
  • pathological

- nephritic syndrome

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12
Q

Leucocyte cast may suggest?

A
  • infection

- inflammation

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13
Q

Granular casts may suggest?

A
  • chronic disease
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14
Q

ECG changes in hyperkalaemia?

A
  • peaked T waves
  • QRS wide
  • loss of p waves
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15
Q

Define acute kidney injury

A
  • decline in kidney function
  • increase in serum creatinine
  • reduction in urine output
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16
Q

What is the triad associated with nephrotic syndrome?

A
  • proteinuria
  • hypoalbuminaemia
  • oedema
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17
Q

Nephrotic syndrome urine contains ___many/few___ cast cells?

A
  • few
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18
Q

Symptoms of nephrotic syndrome?

A
  • perioribtal oedema

- frothy urine

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19
Q

Nephritic syndrome differs from nephrotic syndrome how?

A
  • patient has nephritis

- active urinary sediment

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20
Q

Active urinary sediment is indicative of ___nephrotic/nephritic__ syndrome

A
  • nephritic
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21
Q

Symptoms of nephritic syndrome

A
  • oliguria
  • oedema
  • hypertension
  • blood in urine
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22
Q

Define oliguria?

A
  • less than 400ml of urine/day
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23
Q

What may cause nephritic syndrome?

A
  • post streptococcal throat
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24
Q

What classification system is used in acute kidney injury?

A
  • KDIGO staging
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25
Q

What are the risk factors for acute kidney injury?

A
  • older age
  • CKD
  • Diabetes
  • medication change
  • hypovolaemia
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26
Q

Pre-renal causes of acute kidney injury?

A
  • hypovolaemia
  • hypotension
  • reduced renal perfusion
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27
Q

Complication of pre-renal cause of acute kidney injury?

A
  • acute tubular necrosis
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28
Q

Investigations into pre renal causes of acute kidney?

A
  • fluid status

- urinalysis

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29
Q

Describe the affect of ACEi on renal perfusion

A
  • vasoconstriction of arterioles

- reduced perfusion

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30
Q

Causes of acute tubular necrosis?

A
  • sepsis
  • severe dehydration
  • rhabdomyolysis
  • drug toxicity
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31
Q

Commonest form of AKI in hospital?

A
  • acute tubular necrosis
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32
Q

Renal causes of AKI?

A
  • Vasculitis
  • glomerulonephritis
  • drugs
  • tubular injury
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33
Q

Symptoms of a renal cause of AKI?

A
  • Causes and vomiting
  • itch
  • oedema
  • oliguria
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34
Q

Treatment of a renal cause of AKI

A
  • Fluid resuscitation

- treat underlying cause

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35
Q

Causes of a post-renal Aki?

A
  • Obstruction
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36
Q

Treatment of a post renal AKI

A
  • Catheter

- nephrostomy

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37
Q

Treatment of hyperkalaemia?

A
  • 10ml of calcium gluconate
  • insulin + dextrose
  • salbutamol neb
  • sodium bicarbonate
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38
Q

What can be given to an acidotic patient?

A
  • sodium bicarbonate
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39
Q

Haemodialysis must be conducted where?

A
  • dialysis centre
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40
Q

Peritoneal dialysis differs from haemodialysis how?

A
  • carried out at home

- every night

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41
Q

Define chronic kidney disease?

A
  • reduction in kidney function
    and / or
  • structural damage
  • present for 3 months or mole
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42
Q

What are markers of CKD?

A
  • ACR >3mg/mol
  • urine sediment abnormalities
  • tubular disorder
  • histological abnormalities
  • persistent reduction in renal function, eGFR<60ml/min
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43
Q

What are the 5 stages of CKD in relation to eGFR?

A
  • G1 = >90
  • G2 = 60-89
  • G3 a = 45-49
  • G3 b = 30-44
  • G4 = 15-29
    G5= <15
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44
Q

Stages of CKD in relation to ACR?

A
  • A1 = <3
  • A2 = 3-30
  • A3 = >30
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45
Q

Define accelerated progression of CKD

A
  • Persistent decrease of eGFR of 25% or change in stage within 12 months
  • persistent decrease of 15ml/min eGFR within 12 months
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46
Q

Causes of CKD

A
  • AKI
  • Hypertension
  • diabetes
  • glomerular disease
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47
Q

Name some nephrotoxic drugs

A
  • aminoglycosides
  • ACEi
  • bishosphonates
  • diuretics
  • lithium
  • calcinuerin inhibitor
  • NSAIDs
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48
Q

Name some multisystem diseases associated with CKD?-

A
  • SLE
  • Vasculitis
  • myeloma
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49
Q

Complications of CKD

A
  • AKI
  • hypertension
  • dyslipidaemia
  • CVD
  • renal anaemia
  • bone disorder
50
Q

Treatment of CKD

A
  • Treat underlying cause
51
Q

Hypertension targets in CKD

A
  • Systolic <130

- Diastolic <90

52
Q

Diabetes target in CKD

A
  • HbA1c = 53 or less
53
Q

What drug should be given in CKD to prevent CVD?

A
  • Atorvastatin 20mg
54
Q

Explain renal anaemia

A
  • associated with CKD

- Inadequate erythropoeitn

55
Q

Treatment of renal anaemia?

A
  • IV erythropoetin infusion
56
Q

Treatment of acidosis in CKD

A
  • Sodium bicarbonate
57
Q

Treatment of oedma in CKD

A
  • Restrict fluid and sodium

- loop diuretic and thiazide

58
Q

Treatment of bone disease in CKD

A
  • Phosphate binder

- vitamin D supplement (alfacalcidol)

59
Q

Most common inherited kidney disease?

A
  • Polycysic kidney disease - autosomal dominant

- ADPKD

60
Q

ADPKD is what mutation?

A
  • PKD1 = Chromosome 16 (most common)

- PKD2 = chromsome 4

61
Q

Pathology of ADPKD?

A
  • Large kidneys

- massive cyst enlargement

62
Q

Symptoms of ADPKD?

A
  • Haematuria
  • proteinuria
  • hepatic cysts
63
Q

Intracranial berry aneurysms may be associated with what kidney disease?

A
  • autosomal dominant polycystic kidney disease
64
Q

Treatment of ADPKD?

A
  • Tolvaptan
65
Q

Tolvaptan works by?

A
  • reducing cyst volume and progression in ADPKD
66
Q

What population is ARPKD seen more commonly?

A
  • children
67
Q

ARPKD is what mutation?

A
  • PKHD1 = chromosome 6

- codes for fibrocystin

68
Q

symptoms of ARPKD?

A
  • child
  • recurrent urinary tract infections
  • palpable kidneys
69
Q

Alport’s syndrome is what mode of inheritance?

A
  • X-linked
70
Q

Alport’s syndrome is what mutation?

A
  • COL4A5

- IV collagen matrix

71
Q

Sensiorneural hearing loss is associated with what kidney disease?

A
  • Alports
72
Q

Alport’s syndrome symptoms?

A
  • haematuria
  • proteinuria
  • sensiorneual hearing loss
73
Q

Anderson Fabry’s disease is what mode of inheritance?

A
  • X linked
74
Q

Andersons Fabry’s disease mutation?

A
  • a-GAL deficiency
75
Q

Diagnosis of Andersons Fabry’s disease?

A
  • Plasma a-GAL activity
76
Q

Treatment of Andersons Fabry’s disease

A
  • enzyme replacement of a-GAL = Fabryzyme
77
Q

Medullary cystic kidney disease presentation?

A
  • normal or small kidney size due to fibrosis
78
Q

Medullary sponge kidney disease presentation?

A
  • dilation of kidney collecting ducts

- recurrent kidney stones

79
Q

Medullary cystic kidney disease is what mode of inheritance?

A
  • autosomal dominant
80
Q

Presentation of diabetic nephropathy?

A
  • proteinuria

- raised creatine

81
Q

Explain the pathogenesis of diabetic nephropathy?

A
  • haemodynamic changes
  • inital increase in GFR
  • Renal hypertrophy
  • weakening of membrane - proteinuria
82
Q

Suspected diabetic nephropathy, but haematuria?

A
  • no haematuria associated with diabetic nephropathy

- should biopsy

83
Q

Glucose target for diabetic nephropathy?

A
  • aim for 53mmol/l
84
Q

Blood pressure aim for diabetic nephropathy?

A
  • less than 130/80
85
Q

Normal ACR?

A
  • less than 3
86
Q

Normal PCR

A
  • Proteinuria

- less than 50

87
Q

Explain the mechanism of ACEi

A
  • vasodilation of afferent arteriole
  • reduce pressure
  • reduce protein leakage
88
Q

Define vasculitis

A
  • inflammation of blood vessels
89
Q

What vasculitis are associated with kidney disease?

A
  • ANCA vasculitis
  • granulomatous w/polyangitis
  • microscopic polyangitis
90
Q

Blood results in ANCA vasulitis?

A
  • Raised CRP, ESR
  • ANCA
  • urinalysis
  • biopsy = necrotizing glomerulonephritis
91
Q

Symptoms of nephrotic vasculitis?

A
  • vague
  • weight loss
  • purpura
92
Q

Purpura associated with vasculitis is present where?

A
  • back
  • buttocks
  • legs
93
Q

Lupus nephritis is what type of disease

A
  • autoimmune
  • ANA
  • Anti-dsDNA
94
Q

What are the manefistations of lupus nephritis?

A
  • joint pain
  • skin - malar rash
  • lung involvement
  • renal involement
95
Q

Diagnosis of lupus nephritis?

A
  • ANA
  • Anti-dsDNA
  • Renal biopsy
96
Q

Treatment of lupus nephritis?

A
  • ACEi
  • ARB
  • immunosuppressant
97
Q

Presentation of renovascular disease

A
  • haematuria
  • hypertension
  • flash pulmonary oedema
98
Q

Flash pulmonary oedema is associated with what condition?

A
  • renovascular disease
99
Q

Potential treatment of renovascular disease

A
  • statin
  • aspirin
  • angioplasty +/- stent
100
Q

Describe myeloma

A
  • lymphoid malignancy
101
Q

Symptoms of myeloma

A
  • bone pain
  • weakness
  • amyloidosis
  • hypercalcaemia
  • IgG
102
Q

Congo red staining on biopsy?

A
  • apple green bifringent

- amyloidosis

103
Q

Granulomatous polyangitis is what ANCA?

A
  • cANCA
104
Q

Microscopic polyagitis is what ANCA?

A
  • pANCA
105
Q

Myeloma is cancer of ____

A
  • Plasma B cells

- overproduction of immunoglobulins

106
Q

What are the 2 main types of amyloidosis?

A
  • primary /light chain (AL)

- Systemic / secondary (AA)

107
Q

Define amyloidosis?

A
  • abnormal protein deposition due to abnormal protein folding
108
Q

Patient with a history of IBS and presents with severe protein uria?

A
  • secondar/systemic amyloidosis
109
Q

Investigations for amyloidosis?

A
  • urinalysis uPCR
  • Protein electropheresis
  • biopsy with congo red staining
110
Q

What scan can be used to show extend of amyloidosis deposition?

A
  • SAP scan
111
Q

How are renal stones formed?

A
  • due to a high concentration of precipitate in the urine
112
Q

What is the most common precipitate of renal stones?

A
  • calcium oxalate
113
Q

What are the risk factors for developing renal stones?

A
  • dehydration
  • males>females
  • elderly
  • hypercalcauria
  • hyperparathyroidism
  • diet high in protein and fat
114
Q

Stones < ___ mm may pass freely

A
  • <5mm
115
Q

Stones >___mm may require surgical intervention

A
  • > 5mm
116
Q

Where are the 2 constrictions the majority of renal stones get found?

A
  • uteropelvic junction

- vesicouterine junction

117
Q

Presentation/symptoms of renal stones

A
  • loin to groin pain
  • nausea and vomiting
  • sepsis
  • fever
118
Q

Investigations for a suspected renal stone

A
  • urinalysis
  • axr
  • non-contrast KUB ** 1st line
  • USS if pregnant or child
  • iv urogram
119
Q

Initial management for urinary stones?

A
  • analgesia
  • a blocker
  • ccb
120
Q

Invasive management for stent removal?

A
  • endoscopic with steric stent

- shock wave lithotripsy ( outpatient)

121
Q

What drug can be used in the prevention of kidney stones and why?

A
  • thiazide diuretiche as they reduce ca2+ excretion

Renal (14 decks)

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