Nephrology Flashcards
Indications for dialysis
Hyperkalaemia
Fluid overload
Metabolic acidosis
Uraemic
CKD stage 5
Drugs intoxication
Types of RRT and when they are used
Haemofiltrations- AV fistula made
Used in IBD and ITU
Peritoneal- 1st
Transplant- 3rd
Causes of ARF
Pre- sepsis or hypovolaemia
Renal- vasculitides, glomerulnephritis, ATN, AIN
Post renal- stones
Types of intrinsic renal failure and sx
Vasculitis- HUS, TTP, DIC, GPA, eGPA
GLN- minimal, membranous- nephrotic syndrome
ATN- hypo perfusion, rhabdo- high urine sodium, low urine osmolarity
AIN- drugs- systemic symptoms
Hypovolaemia vs ATN
Urine sodium- low in hypo, high in ATN
Urine osmolarity- high in hypo, low in ATN
Drugs to stop in AKI
DAMN
Diuretics
ACEi/ARB- these are ok in CKD
Metformin
NSAIDs
Stages of AKI
1- increase of creatinine by 1.5-1.9
Or 0.5ml/kg/hr for 6hrs
2- 2-2.9
For 12 hrs
3- >3
For 0.3 24 hours
Stages of CKD
1>90
2 60-90
3 30-60
4 15-30
5 <15
When to refer to nephrologist in CKD
GFR <30
Decrease >25% or by 15 in 12 months
Medical management of CKD
Phosphate binders- sevelamar
Vit D
IM erythropoietin
Consequences of CKD
Acidosis, hyperkalaemia
Anaemia, bone disease
CVD
Uraemia
Non proliferative GLN
Nephrotic syndrome
Membranous- adults- SLE or drugs
Minimal- children
Focal segmenting- secondary to obesity to HIV
Proliferative GLN
Nephritic
IgA- 2-3d after URTI
Post infection- weeks
Rapid progressing
Vasculitis- GPA, eGPA
Anti-GBM- goodpastures- haemoptysis, nephritic
Differentiating RPGLN
Saddle nose, epistaxis, haemoptysis, haematuria, cANCA- GPA
Asthma, eosinophils, nephritic- eGPA
Haemoptysis, haematuria, GBM AB
IgA nephropathy sx
Purpuric rash
Arthralgia
Abdo pain
GLN
Brown cells in urine
ATN
Red cast cells in urine
Nephritic
Mx of AD PKD
Tolvaptan
Features of AD PKD
Renal cysts
Liver cysts- hepatomegaly
Berry aneurysm
Mitral valve prolapse
Renal failure signs
Sx of renal cell carcinoma
Loin pain, mass and blood
Left varicocele
EPO- PC, PTHrP- hyper cal, renin, ACTH- Cushing
Cannon ball mets
Mx of renal cell carcinoma
Nephrectomy
ATN vs AIN vs GLN
Urine drip
Blood- GLN
AIN- higher white cells because inflammatory process- allergic response
ATN- no cellular content- caused by ischaemia or nephrotoxic drugs- gentamicin
Poor response to fluid challenge
Alports syndrome sx
Haematuria
Deafness
Progressive renal failure
Causes of AIN
PANDA
Allergic response to drugs:
PPI
ABx
NSAIDs
Diuretics
Allopurinol
Causes of renal artery stenosis
Old- atherosclerosis
Young- fibromuscular dysplasia
Fibromuscular dysplasia sx
String of beads on MR angiography
HTN
CKD- or acute after ACEi
Diagnosis of CKD
Reduced eGFR and markers of kidney disease
Proteinuria, haematuria, electrolyte abnormalities
Which antigen is most important for renal transplant
HLA DR
How to tell CKD vs AKI on imagine
CKD- small
Apart from PKD, diabetic nephropathy early, amyloidosis
Organism associated with peritonitis secondary to peritoneal dialysis
Coagulase negative staph
Staph epididimis
Monitoring of those with renal transplants
Malignancy- skin- sun exposure
Renal failure
CVD
How to tell if pre renal or renal from bloods
If Urea more than creatinine raise- pre renal
Tx of ACR >3 in CKD and DM
ACEi
Tx of ACR >3 in CKD and DM
ACEi
Types of tubule renal acidosis
All cause hyperchloraemic metabolic acidosis
Type 1- unable to secrete H+- distal
Hypokalaemia
Causes renal stones
Type 2- proximal
Hypokalaemia
Osteomalacia
Type 3- rare
Type4- Hyperkalaemia
Low aldosterone
214- low low more
AKI but with unknown aetiology and normal bloods Ix
Renal USS
What should all patients with CKD be started on
Statin
Mx of AKI
Fluid assess
Bloods- set up ECG
Assess medication
Urinalysis
Imaging for post renal
Correct the cause
Tx of hyperkalaemia
10% 10ml Calcium gluconate
10 U Insulin/dextrose
neb salbutamol
Calcium resonium
Dialysis
If CKD and need contrast what do you give
IV fluids to dilate and reduce nephropathy
How to tell if rhabdo caused AKI
If CK >10,000
Tea coloured urine
What should be monitored with a patient With IgA neph
Blood pressure
Urinalysis
Sx of IgA neph
After illness
Abdo pain
Arthritis
Rash
Minimal change tx
Prednisolone
Biopsy of membranous nephropathy
Thick BM
Sub epithelial spikes on silver staining
Biopsy of focal segmenting
Focal and segmental sclerosis on light microscopy and foot effacement on EM
Anti GBM biopsy
IgG along BM linear deposition
CI to transplant
Cancer
Active infection
Severe Co morbidity
Sx of urea build up
Grey tinge
Vomitting
Confusion
Seizure
Coma
Pt with pain in hips after transplant
Avascular necrosis
Why do those with replacing minimal change disease get repeated infections
Loss of IG in the urine
If CKD and normocitic anaemia what is tx
SC erythropoietin only if no IDA
What solution is use in peritoneal dialysis
1.5% glucose
Dx of IgA nephropathy
Urinalysis, MCS
Biopsy
Kidney stones order of Ix
Urine dip then CT
Which drug can cause a rise in creatinine without affecting kidneys
Trimethoprim
Types of chronic urinary retention
High pressure- if impaired renal function and bilateral hydronephrosis
Outflow obstruction
Low pressure- normal
If proteinuria and diabetic what drugs can you give
ACEi
SGLT2
Better to catch at microalbuminuria as it is reversible
Inheritance and chromosomes of PKD
AD
16 + 4- better
Drug that reduces CKD progression in ADPKD
Tolvaptan
If CKD post menopausal
Vit D- calcitriol and BP
Early testing for CKD in DM
Early morning ACR
What can cause FSG
HIV
DVT with low albumin dx and reasoning
Nephrotic syndrome
Allows loss of antithrombin 3 and plasminogen
Outcome for those with minimal change
1/3 never again
2/3 later reoccurrence
Types of hepatorenal sx
1- acute <2 weeks
2- slow
Excretion of DOACs
Dab- renal
Rivaroxaban- liver livarox
Apixiban- faecal - good if renal impaired
Large kidneys in chronic kidney disease
HIV induced
PKD
Early diabetic
Amyloid
Anaemia in CKD tx
Correct IDA first with supplements then
EPO
Ix of PKD
Ultrasound
High phosphate in CKD
Diet mod 1st then binders 2nd
How long does it take for AV fistula to be ready
6-8 weeks
Which murmur is heard in PKD
Mitral valve prolapse
Click and regurg
Tx of hyper acute rejection
Remove kidney
Which medications do not worsen AKI but have to be stopped due to toxicity
Metformin
Digoxin
Lithium
SE of calcium acetate
Calcium binders- cause hypercalcaemia and vascular calcification
Used to reduce phosphate
Selevemer moa
Phosphate binder- used in CKD
What is indicative that the patient has nephrogenic DI instead of cranial from history
Kindey damage ie low GFR
Investigating diabetic nephropathy
Measure ACR- can be spot test which if abnormal- >2.5
First pass- if + in 2/3 specimens with absence of infection
Loss of vision after renal transplant
CMV retinitis
Tx of rhabdo
Iv saline
eGFR variables
CAGE
Creatinine
Age
Gender
Ethnicity
Indication for dialysis
K >6.5
Fluid overload
<7.1 pH
Uraemia
CKD 5
Dx of post strep glomerulonephritis
Anti strep O titre
If AKI what ix do you have to do
US renal tract
Acute vs chronic graft rejection
Acute <6 month - rising pyuria, proteinuria and creatine
Confirmed with biopsy
Rhabdo features
Tea coloured urine
High K
Low Ca
What test can determine ATN
Poor response to fluid challenge
SE of EPO
Flu like
HTN
Encephalopathy
pure red cell aplasia
What should all CKD patients be on
Statin
What scan should CKD patients have
DEXA
