Nephrology Flashcards
AKI Staging
Stage 1 - creatinine 1.5-2x increase (urine <0.5 for >6 hours)
Stage 2 - creatinine 2-3x increase (urine <0.5 for >12 hours)
Stage 3 - creatinine >3x increase (urine <0.3 for >24 hours OR anuric for 12 hours)
Main causes of pre renal AKI
Hypovolemia - secondary to dehydration, sepsis, diarrhoea and vomiting
Renal artery stenosis
Main causes of post renal AKI
Kidney stones
BPH
External compression of urethra
Investigations when suspecting AKI
Blood pressure - hypovolemia may present with low BP
Renal USS - to rule out obstructive cause
Urinalysis - look for blood/protein which may point to cause
Bloods - FBC, U&E etc need to know K+ levels
Which medications would you stop in the presence of an AKI?
NSAIDs
ACEi or ARBs
Diuretics
Gentamicin
Consider stopping - metformin, lithium, digoxin
Main points for management of AKI
If pre renal cause - give fluids Stop nephrotoxic drugs Manage hyperkalamia if present Refer to nephrology if deemed to be renal cause Refer to urology if post renal cause
Staging of CKD
Stage 1 - eGFR >90 (with signs of kidney damage on other tests)
Stage 2 - eGFR 60-90 (with signs of kidney damage on others)
Stage 3 - eGFR 30-60
Stage 4 - eGFR 15-30
Stage 5 - eGFR <15
When would you use a ACEi in a patient with CKD
Evidence of proteinuria
If ACR >70
If patient has coexistent HTN or diabetes
What type of anaemia is seen in patients with CKD
Normochromic, normocytic anaemia
At what stage of CKD would you expect to see anaemia due to reduced production of EPO
Stage 4
What is the cardiac risk factor associated with anaemia in CKD
Left ventricular hypertrophy
Management of anaemia in CKD
Erythropoietin and darbepoetin (EPO)
- need to assess iron status before EPO administration as it can cause iron deficiency
What type of hyperparathyroidism is typically seen in patients with CKD?
Secondary - high PTH, low calcium, high phosphate
Tertiary (in chronic renal failure) - very high PTH, high calcium, high phosphate
What is the relationship between phosphate and calcium in the body
Inverse relationship
As phosphate rises, calcium levels fall - this is because phosphorous binds to calcium reducing the available free calcium in the blood
Management of mineral bone disease in CKD
Reduce dietary phosphate
Phosphate binders e.g, sevelamer
Vitamin D replacement - alfacalcidol
Parathyroidectomy - in extreme cases
Features of autosomal dominant polycystic kidney disease (ADPKD)
Hypertension Recurrent UTIs Abdominal pain Early satiety - as kidneys occupy large volume of abdomen Renal stones Haematuria CKD
Extra-renal manifestations of ADPKD
Liver cysts - can cause hepatomegaly
Berry aneurysms - can cause subarachnoid haemorrhage
Cardiovascular manifestations - mitral valve prolapse, aortic dissection
Rarely presents with cysts in pancreas, spleen, thyroid, oesophagus, ovaries
Nephrotic Syndrome Triad
Proteinuria
Hypoalbuminaemia
Oedema - due to hypoalbuminaemia
Complications of nephrotic syndrome
Increased infection risk - due to urinary IgG loss
Increased thromboembolism risk - due to urinary antithrombin III loss
Hyperlipidemia
Hypocalcaemia- due to urinary Vit D loss
Types of Nephrotic Syndrome
Minimal change disease Membranous glomerulonephritis Focal segmental glomerulosclerosis Amyloidosis Diabetic nephropathy
Most common area prone to thrombosis in nephrotic syndrome
Renal vein thrombosis
Most common type of nephrotic syndrome in children
Minimal change disease
Type of nephrotic syndrome typically presenting in young adults
Focal segmental glomerulosclerosis (FSGS)
Type of nephrotic syndrome typically associated with lupus
Membranous glomerulonephritis
