Nephrology Flashcards
What is counted in eGFR?
Age
Gender
Ethinicity
Cr clearance
What are 2 measures of kidney function/
Creatine clearance (eGFR) ALb:Cr ration
What are 5 functions of kidney?
Blood volume control Toxin excretion RBC production Vit D metabolism Acid base regulation
What BP is aimed for in diabetics?
140/90
How is BP managed in diabetic nephropathy?
ACEi or ARB or CCB then A&C then A & C & D
Why does CKD cause anaemia?
CKD caused by increaed liver toxins reducing bowel absorbtion and caused by decreaed erythropoetin
WHat stage CKD to refer to nephrology?
4 Or Renal artery stenosis HTN on 4 agents A:Cr ratio >70
What are contraindications to kidney transplant?
CJD
Blood cancer
Other cancers if active or recent
What is main point of renal diet?
Low postassium
How is pain releif given in AKI?
Fentanyl
How does myeloma cause an AKI?
Cast nephropathy
What is eGFR of each stage or KD?
5-3a
5--- <15 4---15-40 3b--- 30-45 3a--- 45-60- ALL Stages of Kidney failure must have some sign of renal damage too (1 and 2) or reduction in function (3-5)
What is normal urine output?
0.5ml/kg/hour
How do you define an AKI?
Serum Cr >26,4 above baseline
Creatinine increase of over 50% or oligouria
What are the 3 subdivisions of AKI and give examples of each
Pre renal- under perfusion- CCF, D&V, hypovolaemia, se[sis, bleeding)
Renal- Glomerular disease, Drugs
Post Renal- Calculi, Tumours, BPH, urinary retention
What is most common cause of nephropathy in adults?
IgA (post UTI)
Which nephropathy has IgG deposits?
Membranous Glomerulonephropathy
complement activated against GBM
Thickened GBM on microscopic analysis
What are vasculitis causes of nephropathy and what are autoabs??
Wegeners- cANCA
Microscopic Polyangitis - pANCA
How are vasculitic and Goodpasture’s managed?
Steroids
Cyclophosphamide
What autoab is seen in goodpastures?
antiGBM
What is the difference between IgA nephropathy and post infectious?
IgA is after GI infection
Post Infection is after strep pyogenes (URTI)
How is post infectious nephropathy managed?
conservatively, resolves after 2-3 weeks
What is the umbrella term for the effects of SLE, Hepatitis etc on the kidney that results in end stage failure?
Membranoproliferative Glomerularnephritis.
What is the definition of a proliferative glomerularnephritis?
Increased number of cells in glomerulus= presents with nephritis
Name 6 causes of nephritis (proliferative glomerularnephropathy)
IgA Wegeners Microscopic Polyangitis Goodpastures Post Infectious Membranoproliferative Glomerularnephritis
What is the definition of non proliferative glomerular nephropathy?
Lack of proliferative cells at glomerulus
Nephotic syndromes
Name 3 causes of nephrotic syndrome
Minimal change disease
Focal Segmental Glomerular Schlerosis (FSGS)
Membranous Glomerular Nephritis (MGN)
What is histology of minimal change disease?
Fused podocytes on electron microscopy
How is minimal change disease managed?
Prednisolone
What is the main cause of steroid resistant nephotic syndrome?
FSGS
What is the cause of FSGS?
Genetics
What is management of FSGS?
Diuretics for oedema
Antihypertensives
Statins
No steroids work, but some cytotoxics
How is FSGS ultimately managed?
Transplant
What are the causes of membranous glomerularnephritis?
Hep B SLE Malaria Penecillamine Idiopathic
What is pathophysiology of MGN?
Immune complex (IgG) deposition thickening basement membrane. Immunofluorescence demonstrates this
What is management of MGN?
Steroids slow disease process
What is prognosis of MGN?
1/3 progress
1/3 chronic
1/3 remission
Which 3 diseases can quickly progress to end stage crescenteric glomerularnepritis?
Wegeners
Goodpastures
Microscopic Polyangitis
How long after URTI infection does IgA nephropathy occur and how long does it last?
24-48 hours
several months recurrent
How is IgA nephropathy confirmed?
IgA deposits on membrane in biospy
How long does it take for post infectious glomerular nephritis to present?
2 weeks
How is diagnosis of post infectious made?
Proliferation of mesangial cellsm neutrophils and monocytes and bowmans space impaired on light microscopy- classic crescenteric glomerularnephritis
Why is there hyperlipidaemia in nephrotic syndrome?
Hypoalb causes liver to increase alb production, and there fore also increasing lipid production causing hyperlipidaemia
What is a key sign of nephritic syndrome?
RBC casts in urine indicating glomerular damage
Low urine output
What is seen in Alport’s Syndrome?
Abnormal collagen metabolism leading to abnormal GBM (basketweave)
More common in men
Presents in childhood with
- Microscopic haematuria
- Progressive renal failure
- Bilateral sensorineural deafness
- Lenticonus: protrusion of the lens surface into the anterior chamber
- Retinitis pigmentosa
- Renal biopsy: splitting of lamina densa seen on electron microscopy
How is Alport’s inherited?
X linked Dom
What prophylaxis is needed in nephrotic syndrome?
LMWH against VTE
How is Autosomal Dominamant PCKD screened for
USS
How is PCKD managed in adults?
For select patients, tolvaptan (vasopressin receptor 2 antagonist) may be an option. NICE recommended it as an option for treating ADPKD in adults to slow the progression of cyst development and renal insufficiency only if:
they have chronic kidney disease stage 2 or 3 at the start of treatment
there is evidence of rapidly progressing disease
What is Recessive PCKD?
Causes end stage renal failure in childhood, detected in prenatal USS or born and present with Potter’s Syndrome
What rate should maintenance fluids be given ar?
30 ml/kg for a 24 hours period
What are causes of acute tubular necrosis?
Ischaemia
Sepsis
Nephrotoxins- rhabdomyolitis, aminoglycosides, lead, contrasts
What are signs of ATN?
Brown casts in urine
Raised urea, creatinine and potassium (=SIGNS OF AKI)
What are the phases of ATN?
oliguric phase
polyuric phase
recovery phase
How do you distingiush between pre renal AKI and ATN?
PRE RENAL: Low urine sodium(<20) Good response to fluid challenge High urine osmolality Raised urea:cr ratio in blood
What is acute interstitial nephritis?
Large cause of AKI
Interstitial oedema and inflitrate
What causes acute interstitial nephritis (AIN)?
Most commonly drugs: penicillin, rifampicin, NSAIDs, allopurinol, furosemide
Systemic disease: SLE, sarcoidosis, and Sjögren’s
infection: Hanta virus , staphylococci
How does AIN present?
fever, rash (diffuse maculopapular), arthralgia eosinophilia mild renal impairment hypertension sterile pyuria white cell casts
What are Renal atherothrombus signs?
Livedo reticularis
White cell casts in urine
What are addiotional features seen in PCKD?
Hepatomegaly due to cysts Large kidneys causing large volume occupied and therefore early satiety Divertoculosis Ovarian cysts Intercranial aneurysms
What does nephrotic syndrome increase the risk of generally and specific to kidneys?
Hypercoagulable state
Therefore renal vein thrombosis
WHat constitutes hyperkalaemia?
> 6.5
If lower than this just do an ECG to assess
