Nephrology Flashcards
Classify the different stages of AKI
Stage 1:
• Creatinine ↑ >26umol/dL in 48hrs
• Creatinine ↑ x1.5–2 in 7d
• Urine output <0.5ml/kg/hr 6–12hrs
Stage 2:
• Creatinine ↑ x2–3 in 7d
• Urine output <0.5ml/kg/hr ≥12hrs
Stage 3: • Creatinine ↑ >3x in 7d • Urine output <0.3ml/kg/hr in 24hrs • Anuria for ≥12hrs • New need for renal replacement
What are some sx of severe AKI (3)
Sx of complications:
Uraemia (vom/pruritis/pericarditis/encephalitis)
Hyperkal
Pulm Oedema (fluid overload – unless was pre-renal cause)
List some causes of renovascular obstrn in Pre-Renal AKI (3)
Renal aa stenosis ± thrombosis
Embolus
Ao dissection
What would the urine osmolality/Na be in:
Early Pre-Renal AKI
Late
Early: High osmolality / Low Na (kidneys can still conc)
Late (ATN): Low osmolality / High Na (lost ability to conc)
What are the renal causes of AKI (3)
Acute tubular necrosis (85%) Interstitial Nephritis (10%) Glomerular disease (5%)
List some causes of ATN (1;3;3)
Prolonged Pre-Renal cause (prolonged poor perfusion)
Drugs:
Aminoglycosides / Cephalos
NSAIDs
Contrast
Toxins:
HUS
Myoglobinuria
Heavy metals
What Ix are done into CKD?
Bloods:
FBC/UEs/LFTs/Glucose
Ca/Phos/PTH
Urinary:
Dip + MCS
24hr urinary protein/CrCl
Imaging: Renal USS (?Obstructive) CXR (?Pulm Oedema) DTPA scan (nuclear) Bone imaging (renal bone diease screen)
Invasive: Renal biopsy
Outline the management steps of CKD
1st line: Control BP/DM
ACEis / Statins / Low-dose aspirin
2nd line: Control complications
EPO recombinant / Ca+VitD supps / K restriction
3rd line: Renal replacement therapy (symp CKD5)
Describe the effects on Vit D / Ca / PTH in CKD
Vit D ↓ = Ca↓ / Phos↑ = Osteomalacia
Osteomalacia = PTH↑ (2º + 3º long-term)
3º HyperPTH = ↑Ca (Hypercalcaemia)
How is renal bone disease treated? (3)
Restrict dietary phosphate
Phosphate binders (CalciChew)
VitD/Ca supps (AdCal)
What are the features of renal aa stenosis? (3)
Resistant HTN
Worsening renal func after ACEis (if bilat)
Acute pulm oedema
How is renal aa stenosis managed?
Medical:
Aspirin
Statins
Antiplatelets
Surgical:
Angioplasty / stenting
List the causes of AKI
Pre-Renal:
Shock
Renovascular obstrn
Renal:
ATN
Interstitial nephritis
Glomerular disease
Post-Renal:
Ureteric obstrn
Outline the steps of management for hyperkalaemia (7)
- ECG
- Ca gluconate
- 10Units Actrarapid IV + 50% 50ml glucose
- Salbutamol neb
- Ca resonium
- Bicarb
- Dialysis
ALSO loop diuretics
STOP Nephrotoxics
TREAT CAUSE
List the features of hyperkalaemia (MURDER)
Mm weakness Urine: oligo/anuria Resp distress Decreased cardiac contractility ECG changes Reflexes - hypo/areflexia
List the DDx causes of hyperkalaemia (MACHINE)
Medications A Cellular destrn (haemolysis, tumour lysis, burns, trauma) Hypoaldosteronism Intake excess (inc. IV fluids) Nephrons – renal failure Excretion impaired
What tests should be included when assessing a pt for renal transplant?
Blood Grp
HLA matching
Virology/TB status (immunosupp)
What are the complications of renal transplant?
Operative: bleeding/thrombosis/infection /urine leak Rejection Ciclo/tacrolimus toxicity Infection Malignancy (skin/anal/lymphoma)
What are the haematological effects of uraemia?
Platelet dysfunc
Haemolysis
Marrow suppression
What are the (2º) causes of glomerulonephritis (NSAID HSP)
Neoplasm SLE Amyloid Infection Diabetes HSP
What further Ix can be done into UTIs?
USS (hydronephrosis)
CT/IV Urography (exclude structural abns)
List some causes of sterile pyuria (5)
Recently treated UTI
Bladder cancer
Appendicitis
TB
Chlamydia
What advice can be given for UTIs (5)
Plenty fluids Frequent voiding (esp post-sex) Avoid spermicides Avoid constipation
