Nephrology Flashcards
What are the features of AKI?
➜ Acutely raised creatinine with reduced urine output
- ⬆︎ creatinine of ≥ 26.5µmol/L from baseline within 48h;
OR
- ⬆︎ creatinine of ≥ 50% from baseline within 7 days;
OR
- ⬇︎ in urine output < 0.5ml/Kg/h for 6h.
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.
What are the features of CKD?
➜ Chronically ↓ eGFR and/or proteinuria.
Minimum of 3 months:
- eGFR < 60
- Proteinuria (ACR) > 3mg/mmol
Describe what is Goodpasture syndrome?
- Autoimmune disease;
Characterized by:
➔ Glomerulonephritis
➔ Pulmonary alveolar haemorrhage
What are the symptoms of Goodpasture syndrome?
- Haematuria
- Hemoptysis
- Impaired renal function tests
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
In rhabdomyolysis what are the components released (from the muscles) into the bloodstream?
- Myoglobin
- Potassium
- Creatine kinase
What are the symptoms of rhabdomyolysis?
- Myoglubinuria
(dipstick would pick up blood with no red cells) - Hyperkalaemia
- AKI (acute tubular injury)
- ⬆︎ creatine kinase
What are the causes of rhabdomyolysis?
➔ Prolonged immobilisation
- Muscle ischaemia ➝ rhabdomyolysis
➔ Trauma
➔ Severe exhertion or dehydration (marathon runner)
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
What is the Rx of acute tubular necrosis?
Treat the causeShock
- Fluids
- Fluid balance management
Nephrotoxic
- Stop the causative drug
What is the cause of acute interstitial nephritis?
Immune-mediated tubulointerstitial injury initiated by:
- Drugs
- Infection
What are the features of acute interstitial nephritis?
➔ Acute kidney injury in a euvolaemic patient.
- Mild eosonophilia
- Urine dipstick: bland/normal
What are the drugs that can cause acute interstitial nephritis?
- NSAIDs
- Antibiotics (penicillins, cephalosporim, rifampicin)
- Proton pump inhibitors
How is the diagnosis of acute interstitial nephritis made?
Definitive Dx: renal biopsy
What is the Rx of acute interstitial nephritis?
Oral prednisolone.
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
