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R - renal (Rachel) > kidney diseases > Flashcards

kidney diseases Flashcards

1
Q

what is acute kidney injury

A

rapid decrease in kidney function/GFR

causes build up of uric acid, urea, ammonia, creatinine, lack of ECF and electrolyte control

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2
Q

what can cause AKI

A 
pre-renal 
- hypotension (haemorrhage, shock, burns)
- dehydration 
- hypoperfusion from NSAIDs 
renal 
- glomerulonephritis 
- interstitial nephritis 
- acute tubular necrosis 
post - renal 
- abdominal or pelvic masses 
- ureter constriction 
- kidney stones 
- prostatic enlargement
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3
Q

what are risk factors for AKI

A 
diabetes 
heart failure 
chronic kidney disease 
heart failure 
65+
nephrotoxic drugs 
contrast medium
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4
Q

how does AKI present

A 
nausea 
vomiting 
flank pain 
confusion 
drowsiness 
dehydration 
oliguria 
diarrhoea
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5
Q

what investigations would you do for AKI

A 
urinalysis 
bloods 
creatinine 
US for stones 
renal biopsy
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6
Q

what are creatinine and oliguria values in AKI

A

creatinine of more than 25micromoles/l in 48 hrs
creatinine increase of 50% in 7 days
urine output of less than 0.5mg/kg/hr for > 6hrs

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7
Q

how do you treat AKI

A 
pre-renal - rehydration, IV fluids 
renal - refer, dialysis, transplant 
post-renal - remove stone/obstruction 
avoid nephrotoxic drugs 
monitor electrolytes
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8
Q

what are complications of AKI

A

hyperkalaemia
metabolic acidosis
fluid overload
uraemia

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9
Q

what is chronic kidney disease

A

irreversible damage to the kidneys causing progressive decline in function
hyperfiltration through remaining glomeruli causes hypertrophy and hyperplasia

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10
Q

what causes chronic kidney disease

A 
diabetes
hypertension 
AKI 
malignancy 
polycystic kidney disease 
renal stones 
(any renal disease can cause CKD)
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11
Q

what are risk factors for CKD

A 
diabetes 
hypertension 
smoking 
age 
black 
asian
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12
Q

how does CKD present

A 
insidious disease - only presents in later stages 
lethargy 
oedema 
loss of appetite 
pallor 
puritis 
muscle cramping 
oliguria 
anaemia 
hypertension
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13
Q

what investigations could you do for CKD

A

kidney biopsy
urinalysis
US for obstruction
eGFR

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14
Q

how could you manage CKD

A

control hypertension and diabetes
refer to renal - dialysis, transplant
treat acidosis

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15
Q

what is polycystic kidney disease

A

genetic disorder
cysts in kidney impair function and compress blood vessels causing hypertension (increased renin release) and ischaemia/necrosis

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16
Q

what causes PKD

A

genetics
PKD-1 gene - more severe
PKD - 2 gene

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17
Q

what are the types of PKD and which is more common

A

ARPKD
ADPKD
dominant is more common

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18
Q

how does ADPKD present

A 
cysts elsewhere - pancreas, liver, ovaries 
hypertension 
berry aneurysms (+SAH)
mitral regurgitation
flank masses 
pain 
hepatomegaly
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19
Q

how does ARPKD present

A 
presents in infants 
renal failure in womb - oliguria - oligohydramnios - lung under-development 
respiratory infection 
portal hypertension 
caput medusae 
oesophageal varices
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20
Q

what investigations do you do in PKD

A

US - infants
CT
MRI
genetic testing

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21
Q

how do you treat ADPKD

A 
analgesics 
surgical drainage 
tolvaptan 
manage hypertension 
dialysis 
transplant
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22
Q

how do you manage ARPKD

A

ventilation
surgical drainage
antibiotics
diuretics

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23
Q

what is UTI

A

urinary tract infection

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24
Q

what are common UTI pathogens

A

staph A
e.coli
enterococcus
klebsiella

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25
Q

what else can cause UTIs

A

catheters
poor hygiene
sexual activity

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26
Q

what are risk factors for UTI

A 
risk increases with age 
young, sexually active women 
menopause
pregnancy 
diabetes
urine stasis - stones, stricture, neurogenic bladder
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27
Q

how does UTI present

A 
dysuria 
frequency 
urgency 
offensive cloudy urine 
flank/suprapubic pain 
upper UTI may also have fever/chills, haematuria, pain
28
Q

what investigations could you do for UTI

A 
MSSU
urinalysis 
urine dipstick 
US
IV urography if recurrent
29
Q

how do you manage UTI

A

advice - drink fluids, void after sex, heat therapy

give abx - amoxicillin or cephalosporin

30
Q

what are complications of UTI

A

pyelonephritis - sudden severe kidney inflammation

31
Q

what is diabetic nephropathy

A

damage to the glomerulus due to hyperglycaemia
leads to glomerulosclerosis
proteins can leak through into the filtrate

32
Q

what causes diabetic nephropathy

A

poorly controlled T1 or T2DM

33
Q

how does diabetic nephropathy present

A

asymptomatic
GFR decreases causing end stage renal disease
proteinuria

34
Q

what investigations would you do in diabetic nephropathy

A

screening of diabetics - look for albumin in urine microalbuminuria in early stagers, macro in late
biopsy - kimmelsteil wilson lesions, damaged podocytes
eGFR
albumin/creatinine ratio

35
Q

how do you manage diabetic nephropathy

A

blood pressure and blood glucose control

36
Q

what is interstitial kidney disease

A

inflammation of the interstitium - space between the nephrons and glomerulus
can be acute or chronic

37
Q

what causes interstitial kidney disease

A

acute - NSAIDs, antibiotics, hypersensitivity

chronic - autoimmune disease, infection, granulomatosis disease

38
Q

how does interstitial kidney disease present

A

acute IKD presents with AKI and hypertension

39
Q

how do you manage interstitial kidney disease

A

treat underlying cause and give steroids

40
Q

what is acute tubular necrosis

A

death/destruction of the tubule cells

most common cause of AKI

41
Q

what can cause acute tubular necrosis

A

hypoperfusion - sepsis, shock, dehydration

toxins - NSAIDs, contrast dyes, gentamycin

42
Q

what investigations would you do for acute tubular necrosis

A

urinalysis - muddy brown casts

only found in this disease!

43
Q

how do you manage acute tubular necrosis

A 
the cells replace themselves 
remove underlying cause 
rehydration with IV fluids 
stop toxins 
should get better in 7-21 days
44
Q

what is renal tubule acidosis

describe type I and IV

A

metabolic acidosis because of tubule pathology
type I - distal tubule can’t excrete H
type IV - reduced aldosterone causing decreased Na resorption, hyperkalaemia, acidosis, increased K inhibits ammonia production

45
Q

what causes type I renal tubule acidosis

A 
genetics 
hyperthyroidism 
sjoren's syndrome 
sickle cell anaemia 
marfan's 
lupus
46
Q

what causes type IV renal tubule acidosis

A

addison’s disease (hypoaldosterism)
lupus
diabetes
HIV

47
Q

how does renal tubule acidosis present

type 1&4

A

1 - failure to thrive, hyperventilation, osteomalacia (use up bicarbonate from bone), hypokalaemia because K binds to bicarbonate
4 - hyperkalaemia, high chloride, low urinary pH

48
Q

what investigations do you do in renal tubule acidosis

A

K levels for hyperkalaemia/hypokalaemia

49
Q

how do you treat type 1 RTA

A

oral bicarbonate to neutralise H

50
Q

how do you treat type 4 RTA

A

fludrocortisone
sodium bicarbonate
treat hyperkalaemia with insulin, dextrose, calcium gluconate or 2nd line is salbutamol

51
Q

what is haemolytic uremic syndrome

A

triad of haemolytic anaemia, thrombocytopenia and acute kidney injury

52
Q

what can cause HUS

A

e.coli toxin

53
Q

how does HUS present

A 
easy bruising 
purpura 
oliguria 
haematuria 
abdominal pain 
hypertension
oedema 
lethargy 
irritability
confusion
54
Q

how do you treat HUS

A

control BP
fluid balance
blood transfusions

55
Q

what are kidney stones

A

solid lumps usually of calcium oxalate or phosphate due to solutes in urine moving into kidneys and solidifying
usually form in kidneys but can form in rest of urinary tract

56
Q

where are common places for kidney stones to lodge

A

renal pelvis
abdo-pelvic junction
vesicoureteral junction
bladder neck

57
Q

risk factors for kidney stones

A

hypercalcaemia
hyperparathyroidism
hyperuricaemia
male

58
Q

how do kidney stones present

A 
if in upper urinary tract may be asymptomatic as other kidney functions fine 
dull bilateral flank pain 
renal colicky pain
dysuria 
haematuria 
pyrexia
59
Q

what investigations can you do for renal stones

A

CT
urinalysis
urogram
US

60
Q

how do you treat kidney stones

A

if they are less than 5mm they will pass themselves in a few hours
hydration
analgesics
shock wave lithotripsy
percutaneous nephrolithotomy
open surgery
potassium citrate to prevent precipitation

61
Q

what is acute urinary retention

A

painful inability to void

62
Q

what are clinical signs of acute and chronic urinary retention

A

palpable percussible bladder

63
Q

what is chronic urinary retention

A

painless inability to void/incomplete voiding with LUTS

64
Q

what LUTS might happen in chronic urinary retention

A 
poor stream 
hesitancy 
incomplete emptying 
nocturnuria 
incontinence
65
Q

how do you treat acute urinary retention

A

catheterisation

find and treat underlying cause

66
Q

how do you treat chronic urinary retention

A

don’t need to if it’s asymptomatic + low residual volume
clean intermittent self catheterisation
long term catheter if unsuitable for CISC

R - renal (Rachel) (4 decks)

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