Nephrology Pathology Flashcards
What is autosomal dominant polycystic kidney disease
Mutation on chromosome 16
Causes flank pain and subarachnoid haemorrhage
Charcots triad
Right upper quadrant pain, jaundice and rigors
What is acute cholangitis
Bile duct infection
necrotising enterocolity
bilious vomiting and rectal bleeding
signs of lithium toxicity
slurred speech
coarse tremor
dry mouth
more thirst
increased urination
stage 1 CKD characteristics
creatinine rise of x1.5 and urine output of <0.5ml/kg for 6 hours
stage 2 CKD characteristics
creatinine rise x2
urine output of <0.5 over 12 hours
stage 3 CKD characteristics
creatinine rise x3
urine output <0.3 over 24 hours
why should NSAIDS (naproxen) be avoided in AKI
because they cause vasoconstriction of the afferent renal arterioles - cause toxicity
renal failure, low o2, low RR
which painkiller can cause this
opiates
what can be the side effects of renal cell carcinoma
obstruction of the gondola vein can cause varicocele
patient presents with jaundice, fatigue and anorexia
what can it be
autoimmune heptatitis
management of autoimmune hepatitis
immunosuppressant azathioprine
where do loop diuretics work
loop of henle
thiazide diuretics - where do they work
work on the DCT
what are kidney stones
severe acute flank pain
radiates to the groin
nausea
vominiting
management of kidney srtones
NSAIDS for pain
under 5mm wait and watch
over 5mm and asymptomatic wait and watch
investigations of kidney stones
non contrast CT KUB - within 24 hours
ultrasound in children and pregnant women
aldosterone antagonist - spinolactone
where does it work
works on the collecting duct
preventing reoccurrence of kidney stones
calcium
what is haemolytic urinic syndrome
e.coli
signs: jaundice
pallor, bruising and oliguria
what does haemolytic urinic syndrome do
apoptosis of the Renal epithelium cells
platelet plus and mini clots form in the kidneys
circulatory platelets decrease
damage to the kidney
investigation for haemolytic urinic syndrome
urine dip - proteinuria and heamturia
and bloods
treatment haemolytic urinic syndrome
not antibiotics - expresses more of the toxins so give supportive treatment
diabetic nephropathy
increase in glucose
damages kidneys
features of diabetic nephropathy
asymptomatic
thickened GBM
kimmel-wilson nodules
disruption of podocytes
polycystic kidney disease - what is it
genetic
polycystin proteins prevent cell proliferation
protein cysts develop
they fill with fluid and forw
these cysts can obstruct blood flow and can cause hypertension as it actives RAAS
autosomal dominant PKD what is it
hypertension
kidney stones
recurrent UTIs
flank pain haematruria
can cause liver cysts
do ultrasound
autosomal recessive PKD
can cause renal failure before birth
foetus produces less urine
potter sequence
can cause varices
what is nephrotic syndrome
protein loss
proteiuria
less albumin in the blood
more lipids in the blood
what is nephritic syndrome
inflammation
haematruia
hypertension
nephrotic syndrome - what is ir
podocytes get damaged
proteins get into the urine
this causes less albumin to be in the blood lower oncotic pressure
water leaks into tissues
oedema and lipids in blood increase
features of nephrotic syndrome
oedema
frothy urine
muehrckes lines - lines on nails
protein in urine
PCR >300mg
minimal change disease - what is it
common in children
cytokines in the podocytes causes swelling of the face
associated with upper RTI
treatment for minimal change disease
corticosteroids
fluid restriction and low salt
cyclophosphamide - give if they are not responding to rest of the treatment
Focal Segmental Glomerulosclerosis what is it
scar tisse in the glomeruli of the kidneys
Membranous Glomerulonephritis - what is it
immune complexes deposit in the basement membrane
antibodies against the podocytes
Membranoproliferative glomerulonephritis what is
nephritic syndrome
inflammation of the glomerulus
RBCS leak out
causes blood In urine
GFR decreases as there’s decrease in renal function due to inflammation
RAAS is activated
features of nephritic syndrome
coco cola coloured urine
protein in urine
fatigue
nausea
IgA neuropathy Bergers - what is it
type 3 hypersensitivity
deposit of magnesia
happens after UTI or GI infection due to increase in antibodies
Post Streptococcal
Glomerulonephritis - what is it
children are affected
type 3 hypersensitivity
immune sustem damafes GBM
6 weeks after impetigo infection
Rapidly Progressive
(Crescentic) Glomerulonephritis - what is it
damage to GBM causes RBC and WBC and plasma proteins to enter Bowmans capsule
Rhabdomyolysis - what is it
injury
causes muscles to break down
myoglobin is released
this is toxic to the kidneys
causes acute kidney injury
features of rhabdomyolosis
muscles aches
pains
oedema
fatigue
confusion
what is acute tubular necrosis
ischeamia of nephrotoxins - due to lead
myoglobin
features of acute tubular necrosis
oliguria
raised urea and creatinine
acute interstitial nephritis
common in drug users
inflammation of the interstitial
hypersensitivity to drugs or infection
features of acute interstitial nephritis
fever
rash
slow progressing AKI
white cells in the urine
what is pre renal acute kidney injury
lack of blood flow to the kidneys
anything that causes hypovolaemia
like dehydration etc
heart failure
stenosis
what is renal AKI
damage to the kidneys
rhabdomyolysis
what is post renal AKI
kidney stones
cancer
anything that grows
criteria for AKI
RISE IN CREATINING 25 IN 48 HOURS
RISE IN CREATININE OF 50% IN 7 DAYS
URINE OUTPUT LESS THAT 0.5/KG/HOUR FOR 6 HOURS
risk factors for AKI
kidney failiure
heart failure
diabetes insipidus
liver disease
drugs
features of AKI
oedema
arrhythmia
managemen for AKI
stop AKI
s- septic screen
T- toxic screen, stop the toxins
O - optimise volume status
P-prevent hard
medications to stop in AKI
diuretics
ACE Inhibs
metformin
NSAIDS
Lithium
digoxin
what is CKD
chronic reduction in the kidney function
loss of appetitie
nausea
oedema
hypertension
complications of CKD
loss of calcium cause bone disease - secondary hyperparathyroidism - calcium is being lost so it is taken from bone s
diabetes insipidus - cranial
ADH is not being released
nephrogenic diabetes insipidus
kidneys are resistant to ADH - lithium causes the resistence
what is Henoch-Schonlein
Purpura
seen in children
purpuric rash over butt and lower limbs
abdo pain
arthralgia
heamaturia
gosspature syndrome - what is it
anti GBM antibodies -
having high levels of urea and creatinine along with high potassium levels show what?
poor renal function = CKD
especially if the person has had it ongoing for a while
what investigation is done to test for CKD?
renal biopsy
what is the most common form of PKD
PKD 1 autosomal dominant
tumour marker for liver cancer?
AFP - alpha fetoprotein
ca 19-9 - marker for?
pancreatic and gallbladder cancer
CEA marker for?
colorectal cancer
nephrotic syndrome - what is it
kidneys pass too much protein into the urine
mainly due to damage to the blood vessels that filter the blood and urine and excrete the waste
presents with a classic triad - frothy urine, less albumin and puffy eyes and swollen ankles
minimal change disease
there is damage to the glomeruli which can lead to nephrotic syndrome
- most common cause behind nephrotic syndrome
what is tumour lysis syndrome
generally happens after chemotherapy
the cancer cells are broken down and this releases a lot of intracellular content into the circulation like nucleic acids
this gets broken down to uric acid and phosphate
this uric acid can cause acute kidney injury
which can cause anuria
the raised phosphate can reduce the CA ions
where does a renal cell carcinoma arise from
proximal renal tubular epithelium
most common composition of renal stone?
calcium oxate
causes of AKI
pre renal - blood supply issues/ dehydration/hypotension/ JVP pressure is increased
post renal - blockage leaving the kindeys - kidney stones
what happens to urine levels in pre renal AKI
urine osmolality increases
post renal Aki features
protenuria
flank pain due to kidney stones
AKI symptoms
dehydration - dry membranes
thirst
postural drop
overload - raised JVP
bibasal crackles
investigation for AKI
ultrasound to see stones
CT KUB and urinalysis
changes in AKI in the blood
increased plasma urea and creatinine
hyperkalameia
increased plate phosphate
decreased calcium
low plasma sodium
metabolic acidosis
SEPSI 6
TAKE 3 - TAK BLOOD, URINE
GIVE 3 - ANTIBIOTICS
MANAGEMENT of AKI
stop any nephrotoxic drugs
catherisation
symptoms of CKD
coma, seizures
dizziness
how is CKD diagnosed
monitor eGFR
U&E blood test ( 2 tests done 3 months apart)
proteinuria check albumin:creatinine ratio
what are the indications for dialysis
Acidosis
Electrolyte abnormalities
I
O
U
what are AV fistulas and complications
AV fistulas are an abnormal connection between an artery and vein - the blood flows directly from an artery into a vein, bypassing the capillaries
increased blood flow and pressure in the veins - swelling, pain, and the formation of aneurysms
sometimes made surgically to provide vascular access for dialysis in kidney failure.
AV fistulas allow for a high blood flow rate, making it easier and safer for dialysis to be performed.
AV fistulas can have complications such as infection, clotting, bleeding, and aneurysm formation.
side effect of renal transplant
tacrolimus - can cause a tremor
what PKD
autosomal dominant condition that causes cysts on the kindneys
can cause pain and put pressure on the nephrons
PKD symptoms
dysruia
flank pain
renal colic
polyuria
fever
haematuria
all these can be due to the cysts putting pressure on the kidney
investigation of PKD
generally found by accident
ultrasonographic screening
if <30 and family history with >3 or more cysts
management of PKD
ACE inhibitors to control BP
tolvaptan (vasopressin)
avoid NSAIDS
renal stones investigation
NON contrats CT KUB
then ultrasound KUB
hypercalacemua can cause renal stones
main causes of renal stones
hyper calcium
hyperparathyroidism
cancer
management of renal stones
NSAIDS - diclofenac
of IV paracetamol
metocloprmie for vomiting
tamsulosin - for helping the passage of stones
renal stones management based on stone size
stones<5mm, pass spontaneously
stones >5mm - surgery
shockwave
or nephrectomy
symptoms of rabhomyolyss
dark urine
fever
Nasseau
altered mental status
muscle weakness
abdo pain
CK levels will be high
skin changes - ischamia
investigation for rhambomyolosus
serum CK stays high in the blood for longer
myoglobinurea - myoglobin in the urine
gives a red/brown colour
Urea and electrolyse will show hyperkalaemia
complications of rhabdomyolysis
high potassium and phosphate
but low calcium levels
pyelonephritis investigation
mid stream urine sample
E.COli most likely cause
raised CRPs will be seen in blood tests
management of pyelonephritis
be careful of sepsis
1st line antibiotics - 7/10 days
cefalexin
co amoxiclav
trimethoprim ( do not give with methotrexate)
ciprofloxacin
for women - give nitrofuratonin (can cause pulmonary fibrosis)
most common type of Renal cancer
renal cell carcinoma - clear cell
mainly involves renal vein invasion
can cause left sided varicocele
complications of renal cancer
hypertension
high calcium levels
staffers syndrome - abnormal liver tests
hyper calcaemia
polychthaema - to many hb - causes itching
most common site of metastases is the lungs
when os renal cancer referred
over 45 with unexplained haematruia
refer with 2 ww
management of renal cell cancer
surgery
radial nephrectomy
less invasive procedure - percutaneous cyrotherapy
