Kidneys Flashcards
What are some renal diseases?
UTI Stones and Tumours Most common > Prostatic hypertrophy and cancer > Bladder tumours > Renal tumours > Renal stone disease least common
When do you use a renal biopsy?
Diagnosis and treatment Reversibility Prognosis If size allows Anatomy acceptable
What are the indications of a renal biopsy?
Acute renal impairment Proteinuria Haematuria
What are the risks of renal biopsy?
Bleeding 5% Severe Bleeding needing intervention 0.1% Death (1/ 5000)
Where do you go when you biopsy a kidney?
Biopsy between 12th rib and iliac crest- left kidney is lower IRL but greys states right is, needle just lateral to lateral spinous processes, core of mostly cortex wanted Biopsy trocar into renal capsule Needle is spring loaded Done with US control Local anaesthetic/ sedation May require CT guidance
Where is the mesangial matrix?
Mesangial matrix holds capillary loops in bowman’s capsule
What is the epidemiology of Acute Renal Failure?
What are the causes of Acute renal failure?
Pre renal
Blood supply to kidneys
Volume depletion, hypotension, MI,renal artery thrombosis, hypovolaemia
Intrinsic renal
Intrinsic disease
Glomerulonephritis
Acute tubular nephrosis
Acute interstitial nephritis
Vasculitis
Nephrotoxins
Rhabdomyolysis
HUS/ TTP
Malignant hypertension
Post renal
Obstructive
Ureteric/ urethral obstruction
Blocked urinary catheter
Bladder tumour
What’s the difference between ARF and CRF?
ARF- Rapid decline- hours or days (may be weeks)- accumulation of waste products, life threatening, with or without reduction in urine output
It is potentially reversible.
CRF- progressive, months to years. May go to ESRF (like diabetic nephritis or polycystic kidney diseases) associated with metabolic complications.
When someone presents with renal failure what do you need to find out?
Acute vs Chronic
Acute- cause/ treatable
Chronic- Slow progression, Control complications, plan for ESRF (dialysis/ transplant)
How does ARF present?
What may cause a reduction in renal function?
Diagnosis- serum creatinine rise (Reduced renal function) with or without oliguria and acute time course
Serum creatinine comes from muscles so is higher in young muscular men (normal creatinine in little old women may show renal failure)
Rhabdo- release of nephrotoxic myoglobin from crush injury, fasciotomy may help as it releases pressure
Chemo- emetic, dehydration- may cause renal failure
what do you need to ask in a renal history?
What tests might you do on urine?
Urinalysis and microscopy
What might you find in urine?
Glomerular disease:- Red cells, red cell casts, proteinuria
Tubular disease- minimal blood, small protein, granular or white cell casts
Pre-renal causes of ARF- no blood or protein, no casts
CRF- depends on cause
This is how a man presents what is the diagnosis?
Severe Renal Failure
What is the pathology of ARF?
What are the tubular causes of ARF?
Acute tubular necrosis
Tubules ‘falling apart’
Lumen has protein and cell debris
Acute tubulointerstitial nephritis
Tubules are inflamed
Lots of cells in between tubules (inflammatory cells, mostly lymphocytes)
What are the glomerular causes of ARF?
Crescentic glomerulonephritis
Inflammatory cells (early crescenting) in bowman’s base around most of the capsule
Capillary loop crushed to one side
Pt will require dialysis
What are the investigations for ARF?
What are the immediate complications of ARF?
Potassium (Hyper/ hypo)
Pulmonary oedema
Acidosis
Hypertension
Uraemia (brain, nerve, heart)
What does this ECG show ARF?
Hyperkalaemia (peaked T)
PR elongation (LVH- hypertension)
What is the treatment of ARF?
What is the treatment of Pulmonary oedema?
Oxygen
Opiates
Diuresis (loop)
Dialysis
Venesection
IV nitrates
