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Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Stage 1 Acute Kidney Injury is defined as

A

Increase in serum creatinine of 26 μmol/L within 48 hours or
an increase in serum creatinine ≥1.5 times above baseline value within 1 week or
urine output of <0.5 ml/kg/hr for > 6 consecutive hours.

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2
Q

drugs affecting kidneys

A

Diuretics ( more likely to make you hypovolaemic)
ACE-I/ARBs
NSAID
Spironolactone
Gentamicin - may need dose adjustment if necessary for treatment
Chemotherapy
Contrast medium such as during CT scan
Lithium
Immunosuppressants like mesalazine

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3
Q

Indications for Acute Dialysis

A

Acidosis (pH <7.2 or bicarbonate <10mmol/L)
Electrolyte (persistent hyperkalaemia, i.e. >7mmol/L)
Intoxication (overdose of barbiturates, lithium, * alcohol, salicylates, theophylline, aspirin)
Oedema (pulmonary that is refractory)
Uraemia (urea >40 or complications e.g. encephalitis, pericarditis)

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4
Q

investigations for AKI

A

Find and treat causes (e.g. sepsis, drugs, obstruction)
Bloods - FBC, U+Es, CRP, consider antibody screen if autoimmune cause suspected
Urine dip and microscopy
Bladder scan - if retention suspected
Ultrasound renal tract - if obstruction suspected
ECG - looking for hyperkalaemia/pericarditis

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5
Q

Stage 2 AKI definition

A

Creatinine 100-200% increase
<0.5 ml/kg/hour for 12 hours

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6
Q

Stage 3 AKI definition

A

Creatinine >200% increase
or
>345umol/L (started <310)
or
Needs dialysis

Urine output is <0.3ml for 24 hours, or anuria for 12 hours or needs dialysis

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7
Q

Commonest causes of AKI

A

Sepsis
Major surgery
Cardiogenic shock
Other hypovolaemia
Drugs
Hepatorenal syndrome
Obstruction

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8
Q

Stage 1 CKD definition

A

have a normal GFR but have some sort of abnormality of their kidney eg someone with Autosomal dominant polycystic kidney disease with normal kidney function or someone with T1D and microalbuminuria

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9
Q

Stage 2 CKD definition

A

GFR= 60-89 ml/min

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10
Q

Stage 3 CKD definition

A

GFR
3a= 45-59
3b = 30-44

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11
Q

Stage 4 CKD definition

A

GFR= 15-29ml/min

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12
Q

Stage 5 CKD definition

A

<15 ml/min or RRT

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13
Q

Causes of Chronic Kidney Disease

A

Over 70% of CKD is due to diabetes mellitus, hypertension and atherosclerosis

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14
Q

Complications of ckd

A

can be understood by considering the key functions of the kidney.

Waste excretion - Uraemia and hyperphosphataemia
Regulation of fluid balance - Hypertension and peripheral/pulmonary oedema.
Acid-base balance - Metabolic acidosis.
Erythropoietin production - Anaemia.
Activation of vitamin D - Hypocalcaemia.

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15
Q

Pre renal causes of AKI

A

Perfusion failure
- hypotension/shock/hypovolaemia/pump failure/distributive changes eg burns
- renal artery occlusion eg AAA
- made worse by ACEi/NSAID/anti HTN, diuretics

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16
Q

Renal causes of AKI

A

Intrinsic disease of the kidney
- systemic disease eg vasculitis, SLE, myeloma
- infection eg HIV, endocarditis
- Allergic eg acute interstitial nephritis form PPI/Abx
- Drug toxicity
- primary glomerulonephritis

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17
Q

Post renal causes of AKI

A

Obstruction of the urinary system
- stones
- BPH
- Tumours - intrinsic eg bladder, extrinsic eg colon , prostate
- Fibrosis
- Iatrogenic eg surgery and blocked catheter

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18
Q

People at risk of AKI

A

Older age, diabetes, HTN, heart disease, liver disease , CKD, neurological problems that increase dependency eg stroke, dementia ( increased hypovolaemia risk)

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19
Q

Medications that put people at risk of AKI

A

Diuretics, ACEi/ARB, NSAID, Gentamicin, Vancomycin, Chemotherapy

20
Q

How to asses current fluid volume status related to prerenal AKI

A

Mucus membranes, blood pressure, pulse rate, JVP, capillary refill,

21
Q

Investigations used to identify the underlying pre renal cause

A

ecg, echo, lactate, sepsis screen

22
Q

Investigations renal causes of AKI

A

History - systemic disease, blood
borne virus infection ,disease in more than 1 organ for vasculitis
Urinalysis is likely to be positive for blood and protein (but not nitrites or leucocytes) - glomerulonephritis
Immunology tests and blood borne virus screen
kidney biopsy

23
Q

Investigations post renal causes of AKI

A

History - LUTS, haematuria, catheter
O/E- Distended bladder may be present if lower urinary tract obstruction
Imaging - Ultrasound first line, CT KUB other imaging as indication. No IVU

24
Q

Alports syndrome

A

progressive kidney disease, hearing loss and eye abnormalities

25
Q

Acute interstitial nephritis presentation

A

typically present after a triggering medication with delayed (2-40 days) picture of
Rash
Fever
acute kidney injury
and eosinophilia
some report transient arthralgia.
Some have features of nephrotic syndrome

26
Q

Renal Tubular Acidosis

A

impaired acid excretion leads to hyperchloraemic metabolic acidosis.
This leads to activation of the Renin Angiotensin system leading to potassium wasting and hypokalaemia.

27
Q

muddy brown casts

A

Acute tubular necrosis

28
Q

Nephrotic syndrome

A

Heavy proteinuria (24 hour urine collection >3-3.5g protein/24 hour or spot urine PCR >300-350 mg/mmol)
Peripheral oedema ( due to hypoalbuminaemia)
Hyperlipidaemia

29
Q

Causes of nephrotic syndrome

A

primary:
•Membranous nephropathy/glomerulonephritis (most common cause in adults)
•Minimal change disease ( most common cause in children, idiopathic )
•Focal segmental glomerulosclerosis (another cause in children)

Secondary:
•Diabetes Mellitus
•Cancers
•Drugs
•Infections (eg HIV, HBV, HCV and malaria )
•SLE
•Amyloid
•IgA nephropathy
•Henoch schonlein purpura (HSP)

30
Q

Clinical presentation nephrotic syndrome

A

Odema
urine may be frothy because of its high protein content. Fatty casts
generalised symptoms: including lethargy, fatigue and reduced appetite
predisposes patients to thrombosis, hypertension and high cholesterol
Lethargy
Swelling around the eyes

31
Q

Treatment of nephrotic syndrome

A

•Diuretics (loop eg furosemide)
•Salt restriction
•Proteinuria reduction – ACEi/ARB
•Thrombo-prophylaxis (depending on risk)
Specific treatment
•Depends on the underlying cause
Treatment of minimal change disease involves steroids

32
Q

Amyloidosis

A

Congo red stains

33
Q

Nephritic syndrome

A

more likely to present with haematuria and non-nephrotic range proteinuria (+/++ on the urine dipstick). Hypertension is also more common.

34
Q

Causes of nephritic syndrome

A

Autoimmune diseases
•SLE
•ANCA vasculitis
•Anti-glomerular basement membrane antibody disease/Goodpastures
•Mesangiocapillary GN
•Berger disease/IgA
•Rapidly progressive glomerulonephritis

Infection related
•Postinfectious glomerulonephritis
•Bacterial endocarditis
•HCV

In children:
•Hameolytic uraemic syndrome
•Henoch schonlein purpura
•Post streptococcal GN
•Alport syndrome

35
Q

Goodpasture syndrome/Anti-glomerular basement membrane disease

A

patient that presents with acute kidney failure and haemoptysis , anti-GBM antibodies

36
Q

Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)

A

Patients are typically under 30 years.
presents 1-3 weeks after a streptococcal infection
Raised ASO titre suggests recent Streptococcal infection

37
Q

IgA nephropathy (AKA Berger’s disease)

A

pt in 20s, visible haematuria which usually starts within a day or two (12-72h)of a non-specific upper respiratory tract infection

38
Q

Alport syndrome

A

X linked
“Cant pee cant see cant hear a bee “

39
Q

Risk factors for kidney cancer

A

Male
Obesity
Smoking
Adult PCKD
long term renal dialysis
HTN
family history eg von-Hippel Lindau disease
radiotherapy for previous testicular/gynaecological cancer

40
Q

Staging system for kidney cancer

A

Also Robson staging

41
Q

Clinical presentation kidney cancer

A

• haematuria
• palpable mass
• weight loss/ night sweats/fatigue, anorexia
• anaemia
• bone pain/ fracture
•Vague loin pain
•Paraneoplastic syndromes

42
Q

Paraneoplastic syndromes of kidney cancers

A

Polycythaemia (RCC secretes unregulated erythropoietin)
Renin - raised BP
Hypercalcaemia (RCC secretes a hormone that mimics the action of PTH)
Stauffer Syndrome (abnormal liver function tests demonstrating an obstructive jaundice – without any localised liver or biliary metastasis!)

43
Q

2ww kidney cancer

A

if they are aged 45 and over and have:
Unexplained visible haematuria without urinary tract infection or
Visible haematuria that persists or recurs after successful treatment of urinary tract infection.

44
Q

Ix kidney cancer

A

Ultrasound and CT with contrast (for formal staging)
Cannonball mets on xray

45
Q

Tx kidney cancer

A

• observation for small tumours ( <3 cm generally) in elderly or those with significant medical co-morbidity
• for localised tumour , surgery (nephrectomy), Radiofrequency ablation (RFA) or Cryotherapy
RCCs not usually chemo or radio sensitive
In advanced cases tend to use immunotherapy and cytoreductive nephrectomy

Medicine (72 decks)

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