Nephro Flashcards
Which medications worsen AKIs
-NSAIDs (except cardiac dose of arpsin at 75mg od)
-Aminoglycosides
-ACEi
-angiotensin II receptors
-Diuretics
Drugs which may have to be stopped in AKI as increased risk of toxicity
Metformin
Lithium
Digoxin
Berry aneurism site
Circle of Willis most commonly anterior communicating artery
Autosomal dominant polycystic kidney disease Sx + extra-renal manifestifations
-HTN
-Recurrent UTIs
-flank pain
-Haematuria
-Liver cysts (hepatomegaly)
-Berry aneurysms (SAH)
-mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
Haemolytic uraemic syndrome
young children usually: triad of
AKI,
microangiopathic haemolytic anaemia
thrombocytopenia
usually 2ndary to Shiga toxin-producing Escherichia coli
Acute interstitial nephritis causes + Sx
drugs: the most common cause, particularly antibiotics
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
systemic disease: SLE, sarcoidosis, and Sjögren’s syndrome
infection: Hanta virus , staphylococci
Sx: fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
Pre-renal uraemia vs acute tubular necrosis
Pre-renal(kidneys hold onto sodium to preserve voume): good response to fluid challenge, raised serum urea:creatinine ratio, brown granular casts in urine
Acute tubular necrosis: poor response, normal urea:creat ratio
Minimal change disease
Sx: nephrotic syndorme (proteinurea)
normal BP
Renal biopsy: normal glomeruli on light micro, electon micro shows podycyte fusion
mx: oral corticosteroids
2nd line: cyclophoaphamide
GBS causative agent
Campylobacter jejuni
membranoproliferative glomerulonephritis biopsy findings
Type 1: “tram-track”
Type 2: causes partial lipodystrophy “dense deposits”
Anti-glomerular basement membrane (GBM) disease/ Goodpasture’s syndrome
Path, Sx, Ix, Mx, RFs
*Path: small-vessel vasculitis caused by anti GBM antibodies against collagen
*RF: men, and bimodal prevalence 20-30 and 60-70
*Sx: Pulmonary haemorrhage (haemoptysis) and rapidly progressive glomerulonephritis (proteinuria and haematuria)
*Ix: renal biospy: linear IgG deposits in basement membrane
*Mx: Plasma exchange (plasmanephrisis)
Nephrotic syndrome
-Proteinuria >3g/24hr
-Hypoalbuminaemia <30g/L
-Oedema
Acute Tubular Necrosis
Most common cause of AKI, ischaemia or nephrotoxins e.g. gentamycin
Dx: Muddy brown casts on urinalysis
Epithelial cells regenerate so can reverse in 1-3 weeks
Acute interstitial Nephritis
inflammation of the interstitium by IMMUNE response to Drugs (e.g. NSAIDs or antibiotics), Infections (e.g., E. coli or HIV) or Autoimmune conditions (e.g., sarcoidosis or SLE)
Rash
Fever
Flank pain
Eosinophilia
Hypocalcaemia in CKD MOA
Chronic renal failure leads to impaired 25-hydroxyvit D conversion (needed for calcium absorption)
IgA nephropathy vs Post-strep glomerulonephritis
IgA: macroscopic haematuria 1-2 dyas after URTI
Post-Strep: proteinuria +/- haematuria 1-2 weeks after URTI
ADPKD Features
Abdo pain
Early satiety
HTN
Flank masses
Systolic apical murmur (mitral valve prolapse)
Berry aneurysms
Liver cysts (hepatomegaly)
Membranous glomerulonephritis
Can present with proteinuria or nephrotic syndrome
Renal biopsy: BM thickened with subepithelial electron dense deposits creating a ‘spike and dome’ appearance
Fanconi syndrome
Underlying dysfunction in PCT resulting in impaired reabsorption
Sx: polydipsia, polyuria, failure to thrive, hypokalaemia
Acute interstitial nephritis Ix
WBC/ white cell casts in urine
IgA nephropathy pathophysiology
Mesangial deposition of IgA immune complexes
No tx required usually, follow up to check renal function
Maintainence fluids regime
30ml/kg/24hours
Anion gap calculation
(Na+Ka) - (Bicarb +Cl)
Normal is 8-14mmol/L
Diabetes insipidus Ix
High plasma osmolality and low urine osmolality
Ix: Water deprivation test
Decreased ADH: cranial (desmopressin-vasopressin v2 agonist) nephrogenic (thiazides)
Paediatric fluid requirements
100, 50, 20 rule
100 for first 10kg
50 for second 10kg
20 for everything above to a max of like 2L
Osteomalacia secondary to CKD mx
1st line: reduce dietary phosphate intake
2nd line: phosphate binders
Renal cell carcinoma sx
Haematuria, loin pain, abdo mass
Ongoing fevers, weight loss
Acute graft failure
Few months post transplant
-leucocytes and protein in blood
-rising creatinine
Mx: IV steroids and T cell depletion
