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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
Acute interstitial nephritis presentation
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
Renal Tubular Acidosis
impaired acid excretion leads to hyperchloraemic metabolic acidosis. This leads to activation of the Renin Angiotensin system leading to potassium wasting and hypokalaemia.
27
muddy brown casts
Acute tubular necrosis
28
Nephrotic syndrome
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
Causes of nephrotic syndrome
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
Clinical presentation nephrotic syndrome
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
Treatment of nephrotic syndrome
•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
Amyloidosis
Congo red stains
33
Nephritic syndrome
more likely to present with haematuria and non-nephrotic range proteinuria (+/++ on the urine dipstick). Hypertension is also more common.
34
Causes of nephritic syndrome
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
Goodpasture syndrome/Anti-glomerular basement membrane disease
patient that presents with acute kidney failure and haemoptysis , anti-GBM antibodies
36
Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
Patients are typically under 30 years. presents 1-3 weeks after a streptococcal infection Raised ASO titre suggests recent Streptococcal infection
37
IgA nephropathy (AKA Berger’s disease)
pt in 20s, visible haematuria which usually starts within a day or two (12-72h)of a non-specific upper respiratory tract infection
38
Alport syndrome
X linked “Cant pee cant see cant hear a bee “
39
Risk factors for kidney cancer
Male Obesity Smoking Adult PCKD long term renal dialysis HTN family history eg von-Hippel Lindau disease radiotherapy for previous testicular/gynaecological cancer
40
Staging system for kidney cancer
Also Robson staging
41
Clinical presentation kidney cancer
• haematuria • palpable mass • weight loss/ night sweats/fatigue, anorexia • anaemia • bone pain/ fracture •Vague loin pain •Paraneoplastic syndromes
42
Paraneoplastic syndromes of kidney cancers
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
2ww kidney cancer
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
Ix kidney cancer
Ultrasound and CT with contrast (for formal staging) Cannonball mets on xray
45
Tx kidney cancer
• 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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