Oliguria and AKI Flashcards
What is the most common composition of kidney stones
Calcium oxalate
Give some of the compositions of kidney stones
Calcium oxalate, calcium phosphate, struvite, uric acid
What are staghorn kidney stones
Stones which fill numerous major and minor calices
What size diameter of kidney stones have a 95% chance of being passed
5 mm
What are the risk factors of kidney stones
Middle aged
Caucasian/Indian
Male
Diet high in meat and salt
How will patients present with kidney stones
Renal colic
What are the management options for renal stones
Conservative - let the stone pass on its own
Non-invasive - fragment the stone
Invasive
How can kidney stones cause pyelonephritis
They block the flow of urine making the likelihood of an infection greater
Name 2 inhibitors of kidney stone formation
GAGs
Tamm Horsfall protein
What type of catheterisation may be done is there are problems
Supra-pubic
When might suprapubic catheterisation be carried out
Prostrate problems, clots, masses, prolapse
What are some causes of haematuria
Obstruction - bladder cancer, stone, inflammation, BPH
Sickle cell anaemia
Glomerular disease - IgA nephropathy, vasculitis, glomerulonephritis
How can haematuria be detected
Visibly
Non-visible by microscopy or dipstick test
What is the difference in presentation of acute and chronic urinary retention
Acute = Painful Chronic = not painful
What is the consequences of acute urinary retention
There is a high pressure system causing urine to back up to the kidneys causing a change in the medullary concentration gradient leading to renal failure
What are the acute male causes of urinary retention
BPH, prostrate cancer, structure, prostrate infection
What are the acute female causes of urinary retention
Prolapse, pelvic mass, Botox treatment from stress urinary incontinence
What is DSD
Detrouser-sphincter dysynergia
This is where the bladder contracts but the sphincter doesnt relax
what is acute kidney injury
a decline in the GFR over a shot period of time giving a rise in serum creatinine
what are the 3 types of AKI
pre renal
intrinsic
post renal
what is pre renal AKI
where there is a reduction in the perfusion of the kidneys
what are the causes of pre Rena AKI
hypovolemia, cardiac failure, renal artery stenosis, tutors, stones, drugs
what are the afferent/efferent arterioles like in pre renal AKI
the afferent vasodilates and the efferent vasoconstrictions in order to try and increase the GFR
what drugs affect the vasoconstriction/dilations of the arterioles
NSAIDS inhibit vasoconstriction
ACE inhibitors inhibit vasodilation
what is the treatment for pre renal AKI
fluid resuscitation can reverse this as there is no cell injury
what is intrinsic AKI
where there is acute tubular necrosis in the kidney
what part of the nephron is most affected in intrinsic AKI
most metabolically active areas - PCT and ascending loop of henle
what causes intrinsic AKI
sepsis
nephrotoxins
ischaemia
what is rhabdomyolysis and how does it cause AKI
muscle necrosis causing the release of myoglobin - this toxic to tubule cells when filtered in the nephron causing intrinsic AKI
what is post renal AKI
where there is an obstruction to urinary flow after the urine has left the tubules
