nephro Flashcards
adult fluid/e-/glucose requirements a day
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride
and
approximately 50-100 g/day of glucose to limit starvation ketosis
in AKI, urine osmolality ____, urine sodium ____
low, high
How do you work out the urea:creatinine ratio?
plasma urea (mmol/L) / (plasma creatinine (μmol/L) divided by 1000)
How can you use urea:creatinine ratio to work out cause of AKI?
> 100 – pre-renal cause (urea absorption increased compared to creatinine)
40-100: – normal or post renal cause of AKI
<40 - intrinsic renal damage (urea unable to be absorbed -> become like creatinine -> ratio gets closer to 1)
This patient presents with the classical symptoms and history of the disease: a young child with recurrent episodes of macroscopic haematuria, typically associated with a recent respiratory tract infection and mild proteinuria.
IgA nephropathy
how to differentiate IgA nephropathy and post-strep glomerulonephritis
It is important to not confuse IgA nephropathy with post-streptococcal glomerulonephritis, which is caused by immune complex (IgG, IgM, and C3) deposition in the glomeruli. This happens more slowly, typically 7-14 days following a group A beta-hemolytic Streptococcus infection and causes proteinuria. To remember the different presentations you can think that IgA is a shorter word so presents after a few days, whereas post-streptococcal is a longer word so presents after many
__________________is an indication for dialysis
Uraemia (encephalopathy or pericarditis)
1st line tx in minimal change disease
prednisolone
stages of churg-strauss + what serology is it associated with?
- rhinitis/asthma, nasal polyps
- eosinophilia
- vasculitis: AKI
p-ANCA
Tricyclic antidepressants can cause ________incontinence (anticholinergic effect)
overflow
Type 1 renal tubular acidosis (distal) complication -
renal stones
also associated with autoimmune conditions
Bartter’s syndrome -
autosomal recessive disorder which causes renal tubular disease
hypokalemia, hypochloraemic, renal stones
Fanconi syndrome
RTA T2, osteomalacia
asymptomatic bacteria in catheterised Pts?
don’t treat?
Tx for HUS?
- supportive
- eculizumab
what is HSP? Px?
- IgA mediated small vessel vasculitis
- seen in children after infection
Haematuria
Surfaces - arms, legs, buttockd
Palpabile purpuric rash, polyarthritis
hyperK features on ECG?
- tall tented T waves
- broad QRS complexes
- loss of P waves
hypoK features on ECG?
- U waves
- small/absent T waves
- prolonged PR intervals
hypoK predisposes Pts to _______ toxicity
digoxin
post-streptococcal glomerulonephritis is associated with low ____________ levels
complement
‘tram track’ appearance of kidneys on electron microscopy indicates
T1 membranoproliferative glomerulonephritis
what does MCD show on renal biopsy?
fusion of podocytes and effacement of foot processes
Tx for MCD?
- oral corticosteroids
- cyclophosphamides
nephrotic syndrome - extrarenal effcts?
- loss of antithrombin-lll –> fibrinogen levels rise, more thrombosis
- loss of thryoxine-binding globulin –> total thryoxine levels decreased
- hyperlipidaemia
how to minimise risk of nephrotoxicity due to contrast media?
- use of 0.9% NaCl for 12h before and after procedure
most common cause of peritonitis in peritoneal dialysis? + Tx
staph epidermis
vancomycin
what biopsy finding do rapidly progressing glomerulonephritis cause? What are some causes?
crescents in glomeruli
Goodpastures, Wegner’s, SLE
features of RAS (triad)
- HTN
- CKD
- flash pulmonary oedema
hyperacute, acute and chronic graft rejection in renal transplant
- hyperacute: minutes to hours
- pre-exisitng ABO/HLA Ab
- no tx, remove graft - acute: <6 months
- reversible with steroids or immunosuppressants - chronic: >6 months
immunosuppression for renal transplant
ciclosporin, tacrolimud, monoclonal antibodies
which 2 drugs when co-prescribed can cause rhabdomyolsis?
statin + clarithryomcyin
causes of rhabdo?
seizure, coma/collapse, crush injury, drugs, ecstasy
7Ps of Signs and Sx of CKD
- Pallor - anaemia
- Pruritus - uraemia
- Paraythyroid overactivity - hypoC
- Pulmonary oedema - fluid overload
- Pericarditis - fluid overload
- Peripheral Nueropathy
- Painful big toe (gout)
Acute interstitial nephritis causes an ‘allergic’ type picture consisting usually of raised urinary
WCC and eosinophils, alongside impaired renal function
‘Muddy’ brown casts represent
secretions of necrotic cells in the urine
Renal transplant + infection =
CMV
All patients with chronic kidney disease should be started on a ____
statin
All diabetic patients with a urinary ACR of 3 mg/mmol or more should be
started on an ACE inhibitor or angiotensin-II receptor antagonist
Henoch-Schönlein purpura presents with
the triad of purpuric rash, joint pain, and abdominal pain. There is also often renal involvement, causing haematuria.
IgA nephropathy classically presents as
visible haematuria following a recent URTI
NSAIDs should be stopped in AKI except
aspirin at cardio-protective dose
The patient is deficient in the enzyme porphobilinogen deaminase - Tx?
acute attack of acute intermittent porphyria (AIP)
Intravenous haem arginate
Mx of renal stones
Stone <5mm = expectant treatment
Stone <2cm = lithotripsy (wave to break stone)
Stone <2cm + pregnant = uteroscopy
Stone complex = nephrolithotomy (invasive)
hydronephrosis/infection = nephrostomy
Most patients presenting with symptomatic renal cell carcinoma have stage _________ disease
stage IV
Post-streptococcal glomerulonephritis: ________________are used to confirm the diagnosis of a recent streptococcal infection
raised anti-streptolysin O titres
Pt with microscopic haematuria with +blood, +leukocytes on MC&S - Mx?
old patient: refer to urology
young patient: refer to nephro
___________________is frequently associated with malignancy (protein in urine)
Membranous nephropathy
