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
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
3
Q
what are risk factors for AKI
A
diabetes heart failure chronic kidney disease heart failure 65+ nephrotoxic drugs contrast medium
4
Q
how does AKI present
A
nausea vomiting flank pain confusion drowsiness dehydration oliguria diarrhoea
5
Q
what investigations would you do for AKI
A
urinalysis bloods creatinine US for stones renal biopsy
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
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
8
Q
what are complications of AKI
A
hyperkalaemia
metabolic acidosis
fluid overload
uraemia
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
10
Q
what causes chronic kidney disease
A
diabetes hypertension AKI malignancy polycystic kidney disease renal stones (any renal disease can cause CKD)
11
Q
what are risk factors for CKD
A
diabetes hypertension smoking age black asian
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
13
Q
what investigations could you do for CKD
A
kidney biopsy
urinalysis
US for obstruction
eGFR
14
Q
how could you manage CKD
A
control hypertension and diabetes
refer to renal - dialysis, transplant
treat acidosis
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
16
Q
what causes PKD
A
genetics
PKD-1 gene - more severe
PKD - 2 gene
17
Q
what are the types of PKD and which is more common
A
ARPKD
ADPKD
dominant is more common
18
Q
how does ADPKD present
A
cysts elsewhere - pancreas, liver, ovaries hypertension berry aneurysms (+SAH) mitral regurgitation flank masses pain hepatomegaly
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
20
Q
what investigations do you do in PKD
A
US - infants
CT
MRI
genetic testing
21
Q
how do you treat ADPKD
A
analgesics surgical drainage tolvaptan manage hypertension dialysis transplant
22
Q
how do you manage ARPKD
A
ventilation
surgical drainage
antibiotics
diuretics
23
Q
what is UTI
A
urinary tract infection
24
Q
what are common UTI pathogens
A
staph A
e.coli
enterococcus
klebsiella
25
what else can cause UTIs
catheters
poor hygiene
sexual activity
26
what are risk factors for UTI
```
risk increases with age
young, sexually active women
menopause
pregnancy
diabetes
urine stasis - stones, stricture, neurogenic bladder
```
27
how does UTI present
```
dysuria
frequency
urgency
offensive cloudy urine
flank/suprapubic pain
upper UTI may also have fever/chills, haematuria, pain
```
28
what investigations could you do for UTI
```
MSSU
urinalysis
urine dipstick
US
IV urography if recurrent
```
29
how do you manage UTI
advice - drink fluids, void after sex, heat therapy
| give abx - amoxicillin or cephalosporin
30
what are complications of UTI
pyelonephritis - sudden severe kidney inflammation
31
what is diabetic nephropathy
damage to the glomerulus due to hyperglycaemia
leads to glomerulosclerosis
proteins can leak through into the filtrate
32
what causes diabetic nephropathy
poorly controlled T1 or T2DM
33
how does diabetic nephropathy present
asymptomatic
GFR decreases causing end stage renal disease
proteinuria
34
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
35
how do you manage diabetic nephropathy
blood pressure and blood glucose control
36
what is interstitial kidney disease
inflammation of the interstitium - space between the nephrons and glomerulus
can be acute or chronic
37
what causes interstitial kidney disease
acute - NSAIDs, antibiotics, hypersensitivity
| chronic - autoimmune disease, infection, granulomatosis disease
38
how does interstitial kidney disease present
acute IKD presents with AKI and hypertension
39
how do you manage interstitial kidney disease
treat underlying cause and give steroids
40
what is acute tubular necrosis
death/destruction of the tubule cells
| most common cause of AKI
41
what can cause acute tubular necrosis
hypoperfusion - sepsis, shock, dehydration
| toxins - NSAIDs, contrast dyes, gentamycin
42
what investigations would you do for acute tubular necrosis
urinalysis - muddy brown casts
| only found in this disease!
43
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
```
44
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
45
what causes type I renal tubule acidosis
```
genetics
hyperthyroidism
sjoren's syndrome
sickle cell anaemia
marfan's
lupus
```
46
what causes type IV renal tubule acidosis
addison's disease (hypoaldosterism)
lupus
diabetes
HIV
47
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
48
what investigations do you do in renal tubule acidosis
K levels for hyperkalaemia/hypokalaemia
49
how do you treat type 1 RTA
oral bicarbonate to neutralise H
50
how do you treat type 4 RTA
fludrocortisone
sodium bicarbonate
treat hyperkalaemia with insulin, dextrose, calcium gluconate or 2nd line is salbutamol
51
what is haemolytic uremic syndrome
triad of haemolytic anaemia, thrombocytopenia and acute kidney injury
52
what can cause HUS
e.coli toxin
53
how does HUS present
```
easy bruising
purpura
oliguria
haematuria
abdominal pain
hypertension
oedema
lethargy
irritability
confusion
```
54
how do you treat HUS
control BP
fluid balance
blood transfusions
55
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
56
where are common places for kidney stones to lodge
renal pelvis
abdo-pelvic junction
vesicoureteral junction
bladder neck
57
risk factors for kidney stones
hypercalcaemia
hyperparathyroidism
hyperuricaemia
male
58
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
```
59
what investigations can you do for renal stones
CT
urinalysis
urogram
US
60
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
61
what is acute urinary retention
painful inability to void
62
what are clinical signs of acute and chronic urinary retention
palpable percussible bladder
63
what is chronic urinary retention
painless inability to void/incomplete voiding with LUTS
64
what LUTS might happen in chronic urinary retention
```
poor stream
hesitancy
incomplete emptying
nocturnuria
incontinence
```
65
how do you treat acute urinary retention
catheterisation
| find and treat underlying cause
66
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
