Nephrology Flashcards
What is nephrolithiasis?
- Presence of calculi within the urinary tract.
What is the clinical presentation of nephrolithiasis?
- Severe, acute loin to groin pain. (Renal-colic).
- Commonly associated with nausea and vomiting.
What are the risk factors for nephrolithiasis?
- Male.
- Dehydration.
- High salt intake.
- Obesity.
What is the most common type of renal stone?
- Calcium oxalate.
Which renal stones are radiolucent?
- Urate stones.
What are all 5 types of renal stone?
- Calcium oxalate (most common).
- Calcium phosphate.
- Uric acid.
- Cysteine.
- Struvite.
What is the first line investigation for suspected kidney stones?
- Non-contrast CT of KUB.
What is the treatment for nephrolithiasis?
If smaller:
- Ibuprofen
- Watch and wait, hope the stone passes.
If larger (>10mm): - Shock wave lithotripsy (SWL).
If there is obstruction:
- Insert uteric stent to drain/decompress the urinary tract.
What is AKI?
- Acute decline in kidney function.
What are the key diagnostic features of AKI?
- Raised creatinine/urea.
- Decreased urinary output/GFR.
What are the 3 types of AKI? 2/3 examples of each.
Pre-renal:
- Heart failure
- Hypovolaemia (hypotension).
- Overdiuresis (too many diuretics given).
Renal:
- Glomerulonephritis.
- Acute tubular necrosis.
Post-renal:
- BPH.
- UTI.
- Renal stones (cholelithiasis).
How do arterioles in the kidney affect the GFR?
Afferent go towards the glomerulus. Efferent go away from the glomerulus.
- Dilate afferent and constrict efferent to increase GFR.
- Constrict efferent and dilate afferent to decrease GFR.
What are the nephrotoxic medications?
Which drug specifically is SAFE in CKD/AKI?
“DAMN” + gentamycin. Cause drug-induced AKI.
- Diuretics.
- ACEi/ARBs
- Metformin
- NSAIDs.
- PARACETAMOL IS SAFE IN AKI.
What electrolyte changes are commonly seen in AKI?
- Hyperphosphataemia.
- Hyperkalaemia.
- Metabolic acidosis.
What is the treatment for AKI?
- Stop nephrotoxic drugs (DAMN + gentamycin).
- Give fluids for hypovolaemia.
- If there are electrolyte imbalances, RRT (renal replacement therapy/dialysis).
What is CKD?
Abnormal kidney structure/function that has been present for over 3 months.
How does CKD present?
Often asymptomatic in the early stages.
Can present with:
- Oedema (fluid overload due to low GFR).
- Nausea.
- Pruritus (due to hyperphosphataemia).
- Restless leg syndrome (anaemia due to low EPO production).
What is the most common cause of CKD?
- Diabetes mellitus. Causes DKD (a form of CKD).
How is GFR classified?
Stage 1: GFR>90 Stage 2: GFR 60-89 Stage 3a: GFR 45/58 Stage 3b: GFR 30-44 Stage 4: GFR 15-29 Stage 5 (Kidney failure): GFR <15.
What are the investigations used to diagnose CKD?
- Creatinine/urea. Raised
- Estimated GFR. Low.
- Urinalysis. Haematuria and proteinuria.
What is the treatment for CKD?
- ACEI is first line for control of hypertension (e.g. ramipril).
For renal failure (stage 5 kidney disease):
- RRT (renal replacement therapy such as dialysis).
- Kidney transplant.
What is calcium gluconate used for?
To stabilise the cardiac membrane when the patient is hyperkalaemic.
What is nephrotic syndrome?
- Kidney disease characterised by proteinuria and hyperphosphataemia.
What is nephritic syndrome?
- Kidney disease associated with haematuria, and a raised BP.
What is the most common cause of nephrotic syndrome in children?
Minimal change disease.
What is the most common cause of nephrotic syndrome in adults?
Membranous nephropathy.
What is the typical clinical presentation of IgA nephropathy?
- Haematuria, usually proceeded by a GI or upper respiratory tract infection.
What is Polycystic kidney disease?
- Inherited renal cystic disease, that is normally autosomal dominant.
What is are the diagnostic factors for PKD?
- +ve family history.
- Gross haematuria.
- Flank pain.
What are the investigations used for PKD?
- Urinalysis: haematuria and proteinuria.
- USS kidney. Reveals cysts.
What is the treatment for PKD?
- Tolvaptan.
What is the most common form of primary kidney cancer?
- Renal cell carcinoma.
What is the presentation of a renal cell carcinoma?
Classic triad is:
- Haematuria.
- Palpable loin mass.
- Flank pain.
What is the imaging used for suspected kidney cancer?
USS kidney.
What is the treatment for renal cell carcinoma?
- Resection of the tumour.
What is the mechanism of action of loop diuretics?
Give an example.
- Inhibition of the Na/Cl/K channels in the ascending limb of the loop of Henle.
- Furosemide is an example.
What are the electrolyte changes seen with loop diuretic use?
- Hyponatraemia.
- Hypokalaemia.
- Hypocalcaemia.
What is the mechanism of action of thiazide diuretics?
Give an example.
- Inhibits sodium reabsorption in the distal convoluted tubule.
Hydrochlorothiazide is an example.
What are the electrolyte changes seen with thiazide diuretic use?
- Hyponatraemia.
- Hypokalaemia.
- HYPERcalcaemia.
What is the mechanism of action of potassium-sparring diuretics?
- Aldosterone antagonists.
- Example is spironolactone.
What are the electrolyte changes seen with potassium sparring diuretic use?
- Hyponatraemia.
- HYPERkalaemia.
- Hypocalcaemia.
What is the ECG presentation of hypocalcaemia?
- QT prolongation.
What are the two signs associated with hypocalcaemia?
Trosseau’s sign: Inflation of a blood pressure cuff leads to flexion of the hand/wrist.
Chvostek’s sign: Tapping of the facial nerve causes spasm of the facial muscles.
What are the ECG changes seen in hyperkalaemia?
“Go, go tall, go long, go far”
- Absent P waves.
- Tall tented T waves.
- Long PR interval.
- Wide QRS complex.
What medication is given to protect the cardiac membrane in a state of hyperkalaemia?
- Calcium gluconate.
What are the ECG changes seen in hypokalaemia?
- ST depression.
- T wave flattening/inversion.
