Nephrology Flashcards
How is CKD staged?
Stage 1 - >90 + signs of kidney disease Stage 2- 60-90 + signs of kidney disease Stage 3a- 45-59 Stage 3b- 29-44 Stage 4- 15-29 Stage 5 - <15
How to stage AKI?
AKI Stage 1 = Creatinine raised 1.5x baseline, urine output less than 0.5ml/kg/hr for 6hrs
AKI Stage 2 = Creatinine raised 2x baseline urine output less than 0.5ml/kg/hr for 12 hrs
AKI Stage 3 = creatinine raised 3x baseline urine output less than 0.3ml/kg/hr for 24 hrs
Creatinine which has raised by more than 24 in 48 hours = AKI
Which drugs can cause acute interstitial nephritis?
Nephrotoxic drugs Penicillins PPIs Allopurinol Ciprofloxacin Rifampicin
What results are seen in rhabdomyolysis?
Raised CK
Hyperkalaemia
Hyperphosphataemia
Myoglobinaemia
What are acceptable changes in eGFR and creatinine after starting an ACEi? What about potassium?
eGFR - 25% decrease
Creatinine - 30% rise
Potassium can rise up to 5.5
What triad is seen in haemolytic uraemia syndrome?
- Haemolytic anaemia
- AKI
- Low platelets
What are extra-renal manifestations of ADPKD?
Cerebral aneurysms Hepatic/splenic/pancreatic/ovarian/prostatic cysts Mitral regurg Colonic diverticula Aortic root dilation
What is Alport’s syndrome? How does it present?
X-linked recessive Haematuria + renal failure Sensorineural deafness Protrusion of lens surface Retinitis pigmentosa
Indications for dialysis in AKI?
AEIOU
Acidosis (severe metabolic acidosis with pH of less than 7.20)
Electrolyte imbalance (persistent hyperkalaemia with ECG changes)
Intoxication (poisoning)
Oedema (refractory pulmonary oedema not responding to medication)
Uraemia (symptomatic uraemia - encephalopathy or pericarditis)
All the causes of glomerulonephritis!!!!!
x
Which infection must you consider in someone who has had a renal transplant?
Cytomegalovirus
What is seen on urinalysis in acute interstitialnephritis?
Sterile pyuria (raised WCC)
What are the two main manifestations of uraemia?
Uraemic pericarditis or uraemic encephalopathy
Management of CKD bone disease?
- Decrease phosphate in diet
- Phosphate binder e.g. sevelamar
- Vit D analogues - colecalciferol
- Bisphosphonates
Which antibiotic can cause an isolated rise in creatinine with normal urea?
Trimethoprim
What is the most common viral cause of Focal Segmental Glomerulosclerosis?
HIV
What is hyper acute graft failure?
What is the cause?
How is it managed?
Minutes to hours after re-vascularisation of transplanted kidneys - AKI
Reason: Pre-existing antibodies in recipients blood e.g. ABO
RF: Prev blood transfusions, prev tansplants, multiple pregnancies
Management: No treatment possible. Graft must be removed.
What is acute graft failure?
Graft failure <6 months
May be reversible with steroids and immunosuppressants
Usually asymptomatic but picked up on with raised creatinine, pyuria and proteinuria
What is chronic graft failure?
> 6 months
Due to repeated episodes of acute rejection
Results in fibrosis
What is amyloidosis? How does it present?
Extracellular deposition of amyloid
Most common presenting features = breathlessness, weakness
Often causes loss of renal function + proteinuria
Hepatomegaly
Management of hyperkalaemia - when to give calcium gluconate?
More than 6 = ECG
More than 6.5 = straight to calcium glauconite. Do not wait for ECG
Screening test for PKD?
Abdominal ultrasound
AKI + proteinuria - what does this mean?
Has to be a renal cause. Pre-renal and post-renal would not cause proteinuria
What is an AV fistula and how long do they take to start working?
Direct connection between artery and vein - preferred method of access for haemodialysis
Takes 6-8 weeks to develop
What are signs of CKD that you may see on examination?
Pallor Uraemic tinge Brsiing Peripheral oedema Hypertension AV fistula
What are complications peritoneal dialysis?
Peritonitis Catheter infection Catheter blockage Constipation Fluid retention Hyperglycaemia Hernia Back pain Malnutrition
What are complications of haemodialysis?
Site infection Endocarditis Cardiac arrhythmia Air embolus Anaphylactic reaction Amyloidosis Hypertension Disequilibration syndrome (Acute cerebral oedema - headache+drowsy)
What is dialysis disequilibrium syndrome?
Complication of haemodialysis
Acute cerebral oedema due to rapid excretion
What is the most common organism which causes peritonitis due to peritoneal dialysis?
How can we prevent peritonitis from peritoneal dialysis?
Staph epidermis
Add antibiotics to the dialysis fluid
What are physical signs of haemolytic uraemic syndrome?
Jaundice (due to haemolysis)
Bruising(due to low platelets)
Abdominal tenderness
What is the main complication of nephrotic syndrome?
What are other complications?
Increased risk of VTE due to loss of Antithrombin III
AKI, CKD, end stage renal disease
How does membranous glomerulonephitis present and how is it seen on renal biopsy?
Nephrotic syndrome
Renal biopsy - thickened basement membrane, igG and complement deposits on basement membrane –> “Spike and dome appearance”
What is seen on renal biopsy in anti-GBM disease?
Linear IgG deposits on basement membrane
Epithelial crescents
(Same as what is seen in rapidly progressive glomerulonephritis)
How is diabetic nephropathy diagnosed?
Monitor early morning albumin:creatinine ratio
If abnormal - conduct 1st pass urine for Proteinuria
What are the two types of ADPKD?
PKD1 - chromosome 4
PKD2 - chromosome 16
What are causes of metabolic ALKALOSIS?
Vomiting Diuretics Hypokalaemia Primary hyperaldosteronism Cushing’s
What is Alport’s syndrome?
X-linked recessive condition Microscopic haematuria Progressive renal failure Bilateral sensorineural deafness Protrusion of lens surface Retinitis pigmentosa
What is seen on renal biopsy in Alport’s syndrome?
Longitudinal splitting of the lamina densa
Basket-weave appearance
What is the NICE criteria for AKI?
Rise in creatinine of ≥ 25 micromol/L in 48 hours
Rise in creatinine of ≥ 50% in 7 days
Urine output of < 0.5ml/kg/hour for > 6 hours
What is type 4 renal tubular acidosis? What are causes?
Reduced aldosterone which leads to reduced ammonium excretion by the proximal tubule
Due to... Adrenal insufficiency ACEi Spironolactone SLE HIV
What is sterile pyuria and what are causes?
Raised white cells in urine but Negative urine culture Renal tuberculosis Partially treated UTI Acute interstitial nephritis Urinary tract stones
What is seen on electron microscopy in minimal change disease?
Effacement of foot processes
Fusion of podocytes
What is the gold standard diagnostic investigation for renal artery stenosis?
Renal angiography
Also renal ultrasound (first line)
What are complications of renal transplant?
DVT/PE Opportunistic infection Malignanies - lymphoma/skin cancer Bone marrow suppression Urinary tract obstruction CVD Graft rejection
What can cause metabolic acidosis in someone who has received too much NaCl?
Hypercholeraemic metabolic acidosis
Due to Cl in sodum chloride
What is dialysis disequilibrium syndrome?
Rare complication after haemodialysis
Causes cerebral oedema - drowsiness and headache
What is the serum urea:creatinine ratio in pre-renal AKI?
Raised
How does lupus nephritis present?
Proteinuria
Can become focal segmental proliferative glomerulonephritis
Electron microscopy = endothelial and mesangial proliferation
How is lupus nephritis managed?
Treat HTN
Prednisolone + Mycophenolate/Cyclophosphamide
How does lupus nephritis present?
Proteinuria
Can become focal segmental proliferative glomerulonephritis
Electron microscopy = endothelial and mesangial proliferation
How is lupus nephritis managed?
Treat HTN
Prednisolone + Mycophenolate/Cyclophosphamide
