Kidney Disorders Flashcards
define polycystic kidney disease (PKD)
an autosomal dominant disease characterised by cystic dilation of renal tubular epithelium
causes of PKD
PKD1 mutation (polycystin-1) on chromosome 16 (85%) PKD2 mutation (polycystin-2) on chromosome 4
risk factors of PKD
FH of PKD
FH of intracranial aneurysm
PMH of hypertension
clinical features of PKD
flank/suprapubic and lower back pain
bilateral kidney enlargement
polyuria, dysuria and urinary urgency
external manifestation features of PKD
intracranial berry aneurysm
mitral valve prolapse
colonic diverticular
extrarenal cysts
investigations of PKD
urine dip + M,C&S
bloods (FBC, U+E, CRP and lipids)
renal US
CT abdomen and pelvic
common investigation findings in PKD
proteinuria + haematuria ⬆️ urea, creatinine and cholesterol in bloods
⬇️ eGFR
bilateral cysts and kidney enlargement on imaging
medical management of PKD
vasopressin receptor antagonist (tolvaptan)
ACE inhibitor or ARB (ramipril or losartan)
paracetamol
conservative management of PKD
regular monitoring of bloods and cyst progression
avoiding contact sport
define nephrotic syndrome
a clinical syndrome characterised by a triad of:
- proteinuria (>3g/day)
- hypoalbuminaemia
- oedema
pathophysiology of nephrotic syndrome
arise secondary to increased permeability of serum protein through a damaged basement membrane in renal glomerulus
causes of nephrotic syndrome
systemic (DM, SLE)
minimal change disease
drugs (gold or penicillamine)
clinical features of nephrotic
weight gain
loss of appetite
nausea + vomiting
frothy urine
signs of nephrotic syndrome
periorbital + peripheral oedema
mild hypertension
investigations of nephrotic syndrome
bloods (FBC, U+Es, RFTs, LFTs, autoatnibodies, serum cholesterol, glucose)
urine dipstick
renal US + biopsy
management of nephrotic syndrome
high dose steroids
anticoagulants
diuretics
ACE inhibitors
complications of nephrotic syndrome
infection
venous thromboembolism
hyperlipidaemia
define chronic kidney disease (CKD)
a gradual irreversible decline in kidney function defined by either a decreased GFR or kidney damage markers
describe the requirements of a CKD diagnosis
decreased GFR (<60) for >3mnths
histological or structural kidney abnormalities
electrolye abnormalities
albuminuria
risk factors of CKD
CVD proteinuria AKI hypertension diabetes smoking chronic NSAID use
clinical features of advanced CKD
weight loss/anorexia nausea + vomiting fatigue and weakness pruritus muscle cramps dyspnoea
signs of CKD
skin pigmentation
pallor
peripheral oedema
pleural effusion
investigations of CKD
bloods (FBC, U+Es, creatinine, serology autoantibodies)
urine dipstick
ECG
renal US + biopsy
define stage I of CKD
> 90ml/min GFR with demonstratable kidney damage
define stage II of CKD
60-89ml/min GFR with demonstrable kidney damage, proteinuria or raised albumin/creatinine
define stage III of CKD
30-59ml/min GFR
define stage IV of CKD
15-30ml/min GFR
define stage V of CKD
< 15ml/min GFR
complications of CKD
CVD renal osteodystrophy fluid (oedema) hypertension electrolyte disturbance anaemia leg restlessness sensory neuropathy
management of anaemia in CKD
subcutaneous erythropoietin injections
management of oedema in CKD
reduce fluid and salt intake
diuretics (e.g. furosemide)
management of hypocalcaemia and hypophosphataemia in CKD
restrict dietary potassium
prescribe sevelamer and alfacalcidol
additional management of CKD
stop nephrotoxic drugs
start antihypertensives
refer for parathryoidectomy if PTH >28mmol/L
