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Year 3 - Metabolic Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is the RAAS system

A

Renin - angiotensin - aldosterone - system

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2
Q

what triggers the RAAS system

A

Blood pressure decreases. Sympathetic nervous system is stimulated (constrictive), MDC’s sense drop in Na+

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3
Q

Describe the RAAS

A

Trigger sets of release of renin from the juxta-glomerular cells
Renin mixes with angiotensinogen to make ACE 1
AC1 mixes with ACE converting enzyme to male ACE 2
ACE 2 acts on adrenal medulla to release aldosterone from the zona glomerulous cells
ACE 2 also increase sympathetic activity and causes constriction of the mouth muscle cells
ACE 2 acts on pituitary and increases ADH secretion = increased H20 reabsorption back into the body meaning less fluid is released as urine

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4
Q

What 3 actions does ACE 2 have on the body?

A
  1. Signal pituitary to release and increase ADHormone, causes increase of fluid reabsopriton back into the body = less urine
  2. Stimulates sympathetic nervous system and restricts blood vessels
  3. Signals adrenal gland to release aldosterone
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5
Q

Where is aldosterone released from?

A

Adrenal cortex (outside of the kidney)

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6
Q

What is the function of aldosterone

A

Acts on the kidneys and colon:
- increase the amount of sodium and chloride reabsorbed into the blood stream (therefore more water)
- increase the amount of potassium excreted into the urine

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7
Q

What are the 3 subgroups of AKI

A

Pre renal
Intra renal
Post renal

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8
Q

What does AKI mean

A

Acute Kidney Injury

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9
Q

What is often associated as the cause of pre renal AKI

A

Heart problems

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10
Q

examples of pre-renal AKI causes (6)

A
  1. Hypovolemia (burns, vomiting, diarrhoea, dehydration)
  2. Extreme blood loss (trauma)
  3. Renal artery stenosis
  4. V-fib = low cardiac output = low perfusion
  5. Cardiogenic shock!
  6. Occlusion
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11
Q

What is often associated with intra-renal AKI

A

Renal injury

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12
Q

What are some causes of intra-renal AKI?

A
  1. Acute Tubular Necrosis
  2. Acute interstitial nephritis
  3. Glomerulonephritis
  4. Rhabdomyolysis
  5. Tumour lysis syndrome
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13
Q

What is often associated with post-renal AKI

A

Ureters, Bladder and urethra

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14
Q

What are common causes of post-renal AKI?

A

Ureter = stones, fibrosis and tumour/mass pressing to occlude

Bladder = transitional zone malignancy, blocked catheter

Urethral = tumour, stones, BPH

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15
Q

What is measured to diagnose AKI

A

Creatinine and urine output

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16
Q

What is classified as stage 1 AKI?

A

Creatinine increased 26 micromol OR 1.5-1.99x baseline

OR

Urine output <0.5 for more than 6 hours

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17
Q

What is classified as stage 2 AKI

A

Creatinine of 2-2.99x baseline

OR

Urine <0.5 for more than 12 hours

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18
Q

What classification indicates stage 3 AKI?

A

Creatinine 3x baseline

OR

Urine output <0.3 for more than 24 hours OR anuria for 12 hours

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19
Q

What is acute tubular necrosis

A
  • Cause of intra-renal AKI
  • ischaemia/death of epithelial cells of the renal tubule
  • indicated by muddy brown casts through a microscope
  • most common cause of intra-renal AKI
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20
Q

What are types of Acute Tubular necrosis

A

Ischaemic and Neprotoxic

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21
Q

What is ischameic acute tubular necrosis

A

Poor blood flow = cell death due to hypoperfusion

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22
Q

What is nephrotoxic ATN

A

Death of epithelial cells of the renal tubules due to drugs such as:
- diuretics
- Aminoglycosides (vancomycin and gentomycin)
- metformin
- NSAIDs
- IV contrast and chemo (cisplatin)

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23
Q

What is AIN

A

Acute interstitial necrosis

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24
Q

What is ATN

A

Acute tubular necrosis

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25
Q

What causes AIN (3 categories)

A
  1. Drugs usually = diuretics(furosemide), antibiotics (penicillin), allopurinol (gout), NSAIDs
  2. SLE, Sjorgrens and sarcoidosis (connective tissue disease)
  3. Infection
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26
Q

What are signs of AIN

A

White cell casts under microscope
Pyuria (puss urine)
Triad - fever, rash and eosinophils on FBC

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27
Q

What is renal artery stenosis

A

Cause of pre-renal AKI

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28
Q

What are renal stones

A

Calcifications that form in renal pelvis and travel down the ureters
- obstruct the vesicles-uterine junction
- can cause post-renal AKI
- can cause obstructive pyelonephritis

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29
Q

What is the most common form of renal stone

A

Calcium oxalate

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30
Q

What are common renal stones/ (5)

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Uric acid stones (due to gout)
  4. Cystine stones
  5. Xanthine stones
  6. Struvite stones = staghorn
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31
Q

What renal stones are caused by infection

A

Struvite

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32
Q

What renal stones are caused by gout?

A

Uric acid stones

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33
Q

what renal stones are radio lucent

A

Uric acid stones and xanthine stones

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34
Q

How to treat renal stones in emergency

A

If infection/emergency situations = treat as emergency and use analgesia (IV diclofenac + paracetamol)

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35
Q

How to treat a <5mm renal stone

A

Watch and wait

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36
Q

How to treat a 5-10mm renal stone

A

Shockwave lithotripsy

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37
Q

How to treat a 10-20 mm renal stone

A

Shockwave lithotripsy + uretoscopy

38
Q

How to treat a >20mm renal stone or Staghorn

A

Nephrolithotomy - consider URS if PCNL is not an option

39
Q

When is pre-stenting used in shockwave therapy

A

Staghorn calcifications

40
Q

What is used to diagnose renal stones

A

Non-contrast CT

41
Q

How to treat pre-renal AKI?

A

250-500ml fluid and STOP any DAMN dugs

42
Q

What other drugs need to be stopped in AKI

A

Lithium & Digoxin

43
Q

What can AKI lead to?

A

Hyperkalaemia

44
Q

How do we treat hyperkalameia

A
  1. IV calcium gluconate
  2. Insulin/dextrose infusions to pull potassium into cells out of blood. OR neb salbutamol for same reason
  3. Calcium resonium (remove all potassium)
  4. Sodium bicarbonate pulls potassium into cells and out of blood
  5. Haemodialysis
45
Q

What is defined as chronic kidney disease

A

Rapid decline in function within 3 months

46
Q

What causes chronic kidney disease?

A
  1. High blood sugars (causes scaring of the kidneys as sugar passes through) = increased creatinine
  2. Hypertension (high blood pressure = scarring)
  3. Medications/drugs
  4. Glomerulonephritis
  5. PCKD
47
Q

What is ADPKD

A

Autosomal Dominant Polycystic kidney disease

48
Q

Signs and symptoms of CKD (6)

A
  • pallor
    -foamy urine from protein leakage
  • nausea
  • pruritis
  • HTN
  • peripheral neuropathy
49
Q

What are 3 measurements to diagnose CKD

A
  1. Haematuria
  2. eGFR
  3. ACR
50
Q

What does ACR measure in CKD

A

Proteinuria

51
Q

What does eGFR measure in CKD

A

Creatinine, age and gender - kidney function/filtration power

52
Q

what does haematuria measure in CKD

A

Infection, malignancy, glomerular nephritis, ADPKD, stones

53
Q

What is key when diagnosing CKD

A

Need consistent results 3 months apart

54
Q

What is the eGFR classification of stage 1 kidney disease

A

Stage 1 = >90 eGFR

55
Q

What is the eGFR classification of stage 2 CKD

A

Stage 2 eGFR 60-89 with some signs of kidney damage ( not just egfr signs need to be there and kidney tests need to be abnormal)

56
Q

what is the eGFR classification for stage 3a kidney disease

A

Stage 3a = 45-59, moderate reduction in kidney function

57
Q

What eGFR classification is correct for stage 3b CKD

A

Stage 3b - 30-44 moderate reduction

58
Q

what eGFR classification signifies stage 4 CKD

A

Stage 4 = 15-29 severe reduction

59
Q

What eGFR classification is stage 5 CKD

A

<15 = established kidney failure, dialysis or transplant may be needed

60
Q

What ACR classification indicates stage 1 CKD

A

<3mg

61
Q

What ACR signifies stage 2 CKD

A

3-30mg

62
Q

What ACR signifies stage 3 CKD

A

30mg+

63
Q

what should be started if ACR stage 3 CKD

A

ACE inhibitors or ARB if meeting the criteria and statins also recommended

64
Q

What is accelerated progression

A

Sustained decline within one year of either 25% or 15ml

65
Q

What zone is prostate cancer primarily developed from

A

Peripheral zone

66
Q

What are 4 signs of prostate cancer

A

Urinary changes
Incomplete voiding
Nocturia
ED in some cases

67
Q

What are red flags for prostate cancer

A
  • blood in urine
  • blood in sperm
  • weight loss
  • night sweats
  • back pain (mets)
68
Q

What can also be caused by prostate cancer

A

Acute hypercalcaemia due to bone degradation from tumours

69
Q

What are the 4 developments of prostate cancer

A

Stone (stones)
Bone (joint/muscle pain)
Groan (loin to groin pain)
Psychiatric moan (depression)

70
Q

Can prostate cancer casue back pain?

A

Yes as can spread to BREAST, BUNGS, BOSTATE, BONE, BIDNEY

71
Q

What criteria is used to assess prostate cancer severity??

A

Gleason criteria
6 =low grade
7 = middle
9,9,10 = high

72
Q

How to treat localised prostate cancer (T1/2)

A
  1. Conservatively (active monitoring/watch and wait)
  2. Radical prostatectomy
  3. Radiotherapy
73
Q

How to treat localised advanced prostate cancer (T3/4)

A

HRT
Radical prostatectomy
Radiotherapy

74
Q

How to treat metastatic prostate cancer

A

Anti-androgen therapy (GnRH agonist)
Chemo with docetaxel

75
Q

What chemo is used in mets stage prostate cancer

A

Docetaxel

76
Q

What are the red flags for renal cancer

A

Hameaturia
Loin pain
Abdo mass
Pyrexia
Cannon ball mets
Left sided varicocele (bag of worms)

77
Q

What is the most common form of renal cell carcinoma

A

Clear cell

78
Q

What area does bladder cancer stem from predominantly

A

Transitional cell

79
Q

What key risk factor contributes towards. Bladder cancer

A

Smoking

80
Q

What is a main issue of hyperkalaemia

A

Cardiac arrhythmia risk

81
Q

What is classified as raised potassium

A

> 4.5 really but 5.4 + = mild

82
Q

What is seen on ECG if hyperkalameic

A

Tall T waves no P waves broad QRS prolonged PR

83
Q

What is Rhabdomyolysis

A

Break down of muscle cells releasing chemicals into blood

84
Q

4 chemicals that release into the blood

A

K+, PO4-, myoglobin and CK

85
Q

What chemical from Rhabdomyolysis can cause AKi

A

Myoglobin

86
Q

5 causes of rhabdomyolysis

A
  1. Crush injuries
  2. Strenuous exercises
  3. Seizures
  4. Statins
  5. Prolonged immboility
87
Q

What urine changes occur in rhabdomyolysis

A

Red/brown

88
Q

What are the main 2 types of glomerulonephritis

A

Nephrotic and nephritic

89
Q

What is glomerulonephritis

A

Inflammation of the glomerulous in the kidney

90
Q

What are the 3 signs of nephrotic syndrome

A

Proteinuria
Peripheral oedema
Hypercholesterolameia
Low serum albumin

91
Q

What are 4 symptoms of nephritic syndrome

A
  1. Hameaturia
  2. Oliguria
  3. Proteinuria
  4. Fluid retention
92
Q

What is the key nephrotic syndrome in children

A

Minimal change disease

Year 3 - Metabolic Medicine (2 decks)

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