Nephrology ILOs Flashcards
Define UTI, including complicated and uncomplicated
Uncomplicated occurs with structurally and functionally normal tissue, complicated occurs in the presence of underlying pathology
Give 3 causative organisms of UTIs
E. coli
Klebsiella
Enterococcus
Give 4 symptoms of a UTI
Dysuria
Urgency
Suprapubic pain
Pyrexia
Give 2 investigations and 2 treatments for UTIs
Urinalysis + culture
ABX + IV fluid
Define pyelonephritis and give 3 signs and symptoms
Severe infectious inflammatory disease of kidney
- Flank pain
- Costovertebral angle tenderness
- Fever
Give 2 management options for pyelonephritis
ABX
Supportive care
Give 3 risks of pyelonephritis
- UTI
- Diabetes
- Stress incontinence
Define AKI and give one pre-renal, renal and post-renal cause
Acute decline in kidney function leading to raised creatinine and/or decreased urine output
- Hypovolaemia
- Drugs
- Renal stones
Give 3 signs of an AKI
- Hypotension
- Reduced urine output
- Symptoms of pulmonary oedema
Give 3 investigations for an AKI
- U&Es ( increased creatinine, high K, metabolic acidosis)
- Blood culture for cause
- Urine culture
Give 3 management options for an AKI
- Fluid resuscitation
- Medication review and stop nephrotoxins
- Vasopressor support if still hypovolaemic
What is one life-threatening complication of an AKI which needs immediate correction?
Hyperkalaemia
Give 3 causes of CKD
- Diabetes
- Hypertension
- Polycystic kidney disease
Outline the pathology of CKD
Increased intra-glomerular pressure and increased angiotensin II production lead to collagen synthesis and renal scarring
Outline the stages of CKD
1: eGFR >90
2: eGFR = 60-89
3a: eGFR = 45-59
3b: eGFR = 30-44
4: eGFR = 15-29
5: eGFR <15
What 2 things may be seen on urinalysis in CKD?
Haematuria
Proteinuria
Give 4 management options of CKD
- ACEI/ARB
- Statin
- Glycaemic control
- Dialysis
Give 5 indications for renal replacement therapy
- Medically resistant hyperkalaemia
- Medically resistant pulmonary oedema
- Medically resistant acidosis
- Uraemic pericarditis
- Uraemic encephalopathy
Give 3 symptoms of uremia
Anorexia
Itch
Restless legs
At what eGFR does dialysis typically occur?
5-10 but most start when eGFR =7
Outline the 2 forms of dialysis
Haemodialysis: removes solute by diffusion and fluid by hydrostatic pressure
Peritoneal: peritoneum functions as filter
Give 2 pros and 2 cons of renal transplant
Pros: no dialysis, better life expectancy
Cons: immunosuppressive medication, increased infection
At what eGFR does glomerulonephritis occur and give 2 symptoms
eGFR <15
Visible haematuria
Synpharingitis (sore throat then Coca Cola urine)
Give 3 investigations for glomerulonephritis
- U and E’s
- Urine dip for blood
- Immunology, myeloma and HbA1c screen
Outline the 3 components of nephrotic syndrome
- 3.5g proteinuria per 24hr
- Serum albumin <30
- Oedema
Outline the 3 components of nephritic syndrome
- Hypertension
- Blood and protein in urine
- Declining kidney function
How does IgA nephropathy occur and what drug is used in it’s management?
IgA deposited in mesangial cells which disrupts filtration barrier
ACEI
What is membranous glomerulonephropathy?
Occurs in adults presenting with nephrotic syndrome
What occurs in minimal change disease I?
In children, podocytes fuse together
What occurs in minimal change disease II?
Acutely normal/reduced eGFR
Give 4 features of PKD
- Hypertension
- Impaired renal function
- Loin pain
- Haematuria
Which chromosomal gene mutations are implicated in PKD 1 and PKD 2 respectively?
16 and 4
Outline the pathophysiology of PKD
- Cysts gradually enlarge and normal tissue replaced
- Kidney volume increases and GFR decreases
Give 2 management options of PKD
Manage BP
Tolvaptan: vasopressin V2 receptor antagonist
What happens when a patient suffers from vesicle-ureteric reflux?
Retrograde passage of urine from bladder to upper tract = scarring
How does renovascular disease cause renal pathology?
Narrow renal arteries cause perfusion to fall = inflammation and fibrosis
What is amyloidosis and what are the two types?
Deposition of insoluble protein material in extracellular space
AA: systemic
AL: immunoglobulin due to haem. condition e.g. MM
How does SLE cause renal damage and what is the treatment?
Immune complexes activate complement (C4) causing renal damage
Tx: immunosuppression
