Nephrology Flashcards
Drugs causing acute interstitial nephritis
Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide
Systemic disease causing acute interstitial nephritis
SLE
Sarcoidosis
Sjorgen’s syndrome
Infections causing acute interstitial nephritis
Hanta virus
Staphylococci
Features acute interstitial nephritis
Fever
Rash
Arthralgia
Hypertension
Blood tests acute interstitial nephritis
Eosinophilia
Mild renal impairmentU
Urine acute interstitial nephritis
Sterile pyuria
White cell casts
Demographic tubulointerstitial nephritis with uveitis
Young females
Symptoms tubulointerstitial nephritis with uveitis
Fever
Weight loss
Painful, red eyes
Urinalysis tubulointerstital nephritis with uveitis
Positive with leukocytes and protein
Best way to differentiate AKI and CKD
Ultrasound - CKD have bilaterally small kidneys
Causes of CKD without bilaterally small kidneys
- Autosomal dominant polycytic kidney disease
- Diabetic nephropathy
- Amyloidosis
- HIV assocaited nephropathy
Blood tests suggesting CKD rather than AKI
Hypocalcaemia
AKI criteria
Rise in serum creatinine of 26 micromol/L or greater in 48 hours
50% or greater rise in creatinine known or presumed to have happened within past 7 days
Fall in urine output to less than 0.5ml/kg/hour for more than 6 hours
Investigation AKI
If no cause or risk of urinary tract obstruction, renal ultrasound within 24 hours of assessment
Drugs that should be stopped in AKI as may worsen renal function
NSAIDs
Aminoglycosides
ACE inhibitors
ARBs
Diuretics
Drugs that should be stopped in AKI due to toxicity
Metformin
Lithium
Digoxin
Indications for RRT in AKI
- Not responding to medical treatment
- Complications
Complications of AKI
Hyperkalaemia
Pulmonary oedema
Acidosis
Uraemia (pericarditis, encephalitis)
How to differentiate between pre-renal uraemia and acute tubular necrosis?
- In pre-renal uraemia, urine sodium <20mmol/L and urine osmolality >500. In ATN, urine sodium >40 and urine osmolality <350
- In pre-renal uraemia, good response to fluid challenge. In ATN, poor response
- In pre-renal uraemia, serum urea:creatinine ratio raised. In ATN, normalN
Stage 1 AKI
Increase in creatinine 1.5-1.9x baseline, or
Increase in creatinine ≥26.5, or
Reduction in urine output to <0.5ml/kg/hour for ≥6 hours
Stage 2 AKI
Increase in creatinine to 2.0 - 2.9x baseline, or
Reduction in urine output <0.5ml/kg/hour for ≥12 hours
Stage 3 AKI
Increase in creatinine ≥3.0 times baseline, or
Increase in creatinine to ≥353.6, or
Reduction in UO to <0.3ml/kg/hour for ≥24 hours. or
Initiation of RRT, or
In patients <18, decrease in eGFR to <35
Criteria for referral to nephrologist AKI
Renal transplant
ITU patient with unknown cause of AKI
Vasculitis, glomerulonephritis, tubulointerstitial nephritis, myeloma
AKI with no known cause
Inadequate response to treatment
Complications of AKI
Stage 3 AKI
CKD stage 4 or 5
Qualify for RRT
ADPKD type 1 vs 2
ADPKD 1 more common, presents with renal failure earlier