Nephrology Flashcards by Deo S.O.

What are the features of AKI?

➜ Acutely raised creatinine with reduced urine output

⬆︎ creatinine of ≥ 26.5µmol/L from baseline within 48h;

⬆︎ creatinine of ≥ 50% from baseline within 7 days;

⬇︎ in urine output < 0.5ml/Kg/h for 6h.

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What are the drugs that cause renal failure?

DAMN
- Diuretics
- ACEi/ARBs
- Metformin
- NSAIDs

Metformin: not nephrotoxic, just needs to be reduced in renal failure.

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What are the features of CKD?

➜ Chronically ↓ eGFR and/or proteinuria.

Minimum of 3 months:
- eGFR < 60
- Proteinuria (ACR) > 3mg/mmol

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Describe what is Goodpasture syndrome?

Autoimmune disease;

Characterized by:
➔ Glomerulonephritis
➔ Pulmonary alveolar haemorrhage

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What are the symptoms of Goodpasture syndrome?

Haematuria
Hemoptysis
Impaired renal function tests

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What are the investigations done in Goodpasture syndrome?

Most initial:
- anti-GBM antibodies

Most definitive:
- Lung biopsy
- Kidney biopsy

Others:
- Chest x-ray
- Chest CT scan

Anti-glomerular basement membrane antibodies

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In rhabdomyolysis what are the components released (from the muscles) into the bloodstream?

Myoglobin
Potassium
Creatine kinase

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What are the symptoms of rhabdomyolysis?

Myoglubinuria (dipstick would pick up blood with no red cells)
Hyperkalaemia
AKI (acute tubular injury)
⬆︎ creatine kinase

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What are the causes of rhabdomyolysis?

➔ Prolonged immobilisation
- Muscle ischaemia ➝ rhabdomyolysis

➔ Trauma
➔ Severe exhertion or dehydration (marathon runner)

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What are the causes of acute tubular necrosis?

1. Ischaemic
➜ Decreased renal perfusion
- Shock (haemorrhagic, septic, cardiogenic);
- Hypotension

2. Nephrotoxic
- Aminoglycosides
- Radiocontrast media
- Myoglobin
- Cisplatin

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What is the Rx of acute tubular necrosis?

Treat the cause
Shock
- Fluids
- Fluid balance management

Nephrotoxic
- Stop the causative drug

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What is the cause of acute interstitial nephritis?

Immune-mediated tubulointerstitial injury initiated by:
- Drugs
- Infection

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What are the features of acute interstitial nephritis?

➔ Acute kidney injury in a euvolaemic patient.

Mild eosonophilia
Urine dipstick: bland/normal

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What are the drugs that can cause acute interstitial nephritis?

NSAIDs
Antibiotics (penicillins, cephalosporim, rifampicin)
Proton pump inhibitors

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How is the diagnosis of acute interstitial nephritis made?

Definitive Dx: renal biopsy

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What is the Rx of acute interstitial nephritis?

Oral prednisolone.

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Describe the Vit D deficiency in chronic kidney disease.

2nd hydroxylation in kidney doesn't occur
No formation of 1,25-dihydroxycholecalciferol (activacted Vit D/ calcitriol)

What are the causes of pyelonephritis?

Pregnancy
Vesico-ureteric reflux
DM
Stone

What are the symptoms of pyelonephritis?

Acute:
- Fever
- Rigors
- Loin pain

Chronic
- Hypertension
- Repeated UTI (renal scarring)
- No active infection

What is the investigation done for pyelonephritis?

Urinalysis
Urine culture and sensitivity

What is the Rx of pyelonephritis?

➜ E.coli (most common cause)

Co-amoxiclav
Cefalexin

7 days.

What is the Rx for UTI in men and non-pregnant women?

Women:
- Trimethrophin
- Nitrofurantoin
- 3 days

Men:
- Trimethrophin
- Nitrofurantoin
- 7 days

What is the management of proteiunuria?

If no symptoms and health:
- Repeat test
If still ⬆︎
- 24h urine collection
- Urinary albumin/creatine ratio and/or cretine/protein ratio

DDx of common cause of nephrotic syndrome:
- Children
- Adults

Children
- Minimal change nephrophaty

Adults
- Membranous glomerulonephritis

What are the `types` of **glomerulonephritis**?

**1. Presented with nephritic syndrome** - Haematuria - Hypertension **2. Presented with nephrotic syndrome** - Oedema - Proteinuria

What are the `types` of **glomerulonephritis**: - Presented with nephritic syndrome?

- Crescentic / rapid progressive glomerulonephritis - IgA nephropathy / Berger's disease - MPGN (membranoproliferative glomerulonephritis)

What are the `types` of **glomerulonephritis**: - Presented with nephrotic syndrome

- Minimal change diseases - Membranous glomerulonephritis - Focal segmental glomerulosclerosis

When to `suspect CKD`?

- Anaemia - Hypocalcaemia - Hyperphosphatemia - Small kidney on ultrasound < 9 cm

When should a **patient** be `reffered to nephrology`?

- eGFR < 30 OR - ACR ≥ 70 (unless diabetic) OR - eGFR ⬇︎ > 15 within 1 year.

What are the **symptoms** of `polycystic kidney disease`?

- Haematuria - Hypertension - Loin or flank pain - Enlarged and palpable kidneys on examination `➜ Associated with intracranial aneurysm`

What are the **investigationd** done in `polycystic kidney disease`?

Ultrasound.

**DDx between:** - Haemolytic uremic syndrome - Thrombotic thrombocytopenic purpura

**HUS** - Haemolytic anaemia - Uraemia - Thrombocytopenia **TTP** `- Fever` `- Neurological symptoms` - Haemolytic anaemia - Uraemia - Thrombocytopenia

**DDx between:** - IgA nephropathy - Post-streptococcal glomerulonephritis

**IgA nephropathy / Berger's disease** - 1-2 `days` after URTI - Haematuria **Post-streptococcal glomerulonephritis** - 1-2 `weeks` after URTI - Proteinuria | Both caused by streptococcus pyogenes.

What is the `management` of **IgA nephropathy / Berger's disease**?

- Annual BP measurements - Renal function - Urinalysis **If high risk of progression** - ACEi/ARBs - Prednisolone

What are the **causes** of `small kidneys`?

- Hypertensive renal diseases - Bilateral/unilateral renal stenosis - Chronic pylenophritis - Chronic glomerulonephritis

What are the **causes** of `large kidneys`?

- Autossomal dominant polycystic kidney diseases - Obstructive uropathy

What are the `indications` of **haemodialysis**?

- `Persistent` ⬆︎K⁺ - Acidosis - Pulmonary oedema - Fluid overload with anuria

Describe what is **adynamic bone disease**?

- Disease due to low bone turnover;

What is the `cause` of **adynamic bone disease**?

➜ Oversuppression of PTH (overreplacement of Ca²⁺ and Vit D).

What are the `symptoms` of **adynamic bone disease**?

**In the context of end stage renal disease:** - Normal PTH - Normal / high Ca²⁺ - Normal / high phosphate - Normal / low ALP - Bone pain

What is the **management** of `renal obstruction / renal stones` done?

➜ **Urgent decompression:** - Percutaneous nephrostomy; - Ureteric stent; ➜ **Stones < 5 mm** - Increase fluid intake, likely to pass on its own; ➜ **Stone 5 -10 mm + distal location** - Alpha-blockers (tamsulosin) ➜ **Stone 5-10 mm + upper ureter or kidney** - Extracorporeal shock wave lithotripsy ➜ **Stone 5-20 mm** - Uterescopy with stenting ➜ **Stone > 20 mm** - Percutaneous nephrolithotomy