kidney diseases Flashcards
what is acute kidney injury
rapid decrease in kidney function/GFR
causes build up of uric acid, urea, ammonia, creatinine, lack of ECF and electrolyte control
what can cause AKI
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
what are risk factors for AKI
diabetes heart failure chronic kidney disease heart failure 65+ nephrotoxic drugs contrast medium
how does AKI present
nausea vomiting flank pain confusion drowsiness dehydration oliguria diarrhoea
what investigations would you do for AKI
urinalysis bloods creatinine US for stones renal biopsy
what are creatinine and oliguria values in AKI
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
how do you treat AKI
pre-renal - rehydration, IV fluids renal - refer, dialysis, transplant post-renal - remove stone/obstruction avoid nephrotoxic drugs monitor electrolytes
what are complications of AKI
hyperkalaemia
metabolic acidosis
fluid overload
uraemia
what is chronic kidney disease
irreversible damage to the kidneys causing progressive decline in function
hyperfiltration through remaining glomeruli causes hypertrophy and hyperplasia
what causes chronic kidney disease
diabetes hypertension AKI malignancy polycystic kidney disease renal stones (any renal disease can cause CKD)
what are risk factors for CKD
diabetes hypertension smoking age black asian
how does CKD present
insidious disease - only presents in later stages lethargy oedema loss of appetite pallor puritis muscle cramping oliguria anaemia hypertension
what investigations could you do for CKD
kidney biopsy
urinalysis
US for obstruction
eGFR
how could you manage CKD
control hypertension and diabetes
refer to renal - dialysis, transplant
treat acidosis
what is polycystic kidney disease
genetic disorder
cysts in kidney impair function and compress blood vessels causing hypertension (increased renin release) and ischaemia/necrosis
what causes PKD
genetics
PKD-1 gene - more severe
PKD - 2 gene
what are the types of PKD and which is more common
ARPKD
ADPKD
dominant is more common
how does ADPKD present
cysts elsewhere - pancreas, liver, ovaries hypertension berry aneurysms (+SAH) mitral regurgitation flank masses pain hepatomegaly
how does ARPKD present
presents in infants renal failure in womb - oliguria - oligohydramnios - lung under-development respiratory infection portal hypertension caput medusae oesophageal varices
what investigations do you do in PKD
US - infants
CT
MRI
genetic testing
how do you treat ADPKD
analgesics surgical drainage tolvaptan manage hypertension dialysis transplant
how do you manage ARPKD
ventilation
surgical drainage
antibiotics
diuretics
what is UTI
urinary tract infection
what are common UTI pathogens
staph A
e.coli
enterococcus
klebsiella
what else can cause UTIs
catheters
poor hygiene
sexual activity
what are risk factors for UTI
risk increases with age young, sexually active women menopause pregnancy diabetes urine stasis - stones, stricture, neurogenic bladder
how does UTI present
dysuria frequency urgency offensive cloudy urine flank/suprapubic pain upper UTI may also have fever/chills, haematuria, pain
what investigations could you do for UTI
MSSU urinalysis urine dipstick US IV urography if recurrent
how do you manage UTI
advice - drink fluids, void after sex, heat therapy
give abx - amoxicillin or cephalosporin
what are complications of UTI
pyelonephritis - sudden severe kidney inflammation
what is diabetic nephropathy
damage to the glomerulus due to hyperglycaemia
leads to glomerulosclerosis
proteins can leak through into the filtrate
what causes diabetic nephropathy
poorly controlled T1 or T2DM
how does diabetic nephropathy present
asymptomatic
GFR decreases causing end stage renal disease
proteinuria
what investigations would you do in diabetic nephropathy
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
how do you manage diabetic nephropathy
blood pressure and blood glucose control
what is interstitial kidney disease
inflammation of the interstitium - space between the nephrons and glomerulus
can be acute or chronic
what causes interstitial kidney disease
acute - NSAIDs, antibiotics, hypersensitivity
chronic - autoimmune disease, infection, granulomatosis disease
how does interstitial kidney disease present
acute IKD presents with AKI and hypertension
how do you manage interstitial kidney disease
treat underlying cause and give steroids
what is acute tubular necrosis
death/destruction of the tubule cells
most common cause of AKI
what can cause acute tubular necrosis
hypoperfusion - sepsis, shock, dehydration
toxins - NSAIDs, contrast dyes, gentamycin
what investigations would you do for acute tubular necrosis
urinalysis - muddy brown casts
only found in this disease!
how do you manage acute tubular necrosis
the cells replace themselves remove underlying cause rehydration with IV fluids stop toxins should get better in 7-21 days
what is renal tubule acidosis
describe type I and IV
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
what causes type I renal tubule acidosis
genetics hyperthyroidism sjoren's syndrome sickle cell anaemia marfan's lupus
what causes type IV renal tubule acidosis
addison’s disease (hypoaldosterism)
lupus
diabetes
HIV
how does renal tubule acidosis present
type 1&4
1 - failure to thrive, hyperventilation, osteomalacia (use up bicarbonate from bone), hypokalaemia because K binds to bicarbonate
4 - hyperkalaemia, high chloride, low urinary pH
what investigations do you do in renal tubule acidosis
K levels for hyperkalaemia/hypokalaemia
how do you treat type 1 RTA
oral bicarbonate to neutralise H
how do you treat type 4 RTA
fludrocortisone
sodium bicarbonate
treat hyperkalaemia with insulin, dextrose, calcium gluconate or 2nd line is salbutamol
what is haemolytic uremic syndrome
triad of haemolytic anaemia, thrombocytopenia and acute kidney injury
what can cause HUS
e.coli toxin
how does HUS present
easy bruising purpura oliguria haematuria abdominal pain hypertension oedema lethargy irritability confusion
how do you treat HUS
control BP
fluid balance
blood transfusions
what are kidney stones
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
where are common places for kidney stones to lodge
renal pelvis
abdo-pelvic junction
vesicoureteral junction
bladder neck
risk factors for kidney stones
hypercalcaemia
hyperparathyroidism
hyperuricaemia
male
how do kidney stones present
if in upper urinary tract may be asymptomatic as other kidney functions fine dull bilateral flank pain renal colicky pain dysuria haematuria pyrexia
what investigations can you do for renal stones
CT
urinalysis
urogram
US
how do you treat kidney stones
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
what is acute urinary retention
painful inability to void
what are clinical signs of acute and chronic urinary retention
palpable percussible bladder
what is chronic urinary retention
painless inability to void/incomplete voiding with LUTS
what LUTS might happen in chronic urinary retention
poor stream hesitancy incomplete emptying nocturnuria incontinence
how do you treat acute urinary retention
catheterisation
find and treat underlying cause
how do you treat chronic urinary retention
don’t need to if it’s asymptomatic + low residual volume
clean intermittent self catheterisation
long term catheter if unsuitable for CISC
