Renal Flashcards
What monitors BP in the kidney? and what are the specialist cells in it?
What happens if a low BP is detected? and how does it help this?
Juxtaglomerular apparatus
Macula densa
Releases Renin which starts the RAAS system to increase BP through the increase of cardiac output and blood volume.
What is Acute kidney injury determined by?
Decreased eGFR, increased creatinine and urea
What 3 conditions are associated with intrinsic kidney damage?
Hypertension
Diabetes mellitus
Glomerular disease
What 9 drugs are nephrotoxic?
ACEI ARB NSAIDs bisphosphonates calcineurin inhibitors (ciclosporin) diuretics lithium mesalazine
What 4 conditions are associated with obstructie uropathy?
Structural renal tract disease
bladder voiding problems - neurogenic bladder or BPH
Urinary division surgery, recurrent urinary tract calculi
What is the pathophysiology behind renal bone disease and what is it a complication of?
Less phosphate is being removed renally so its concentration increases whilst calcium decreases triggering PTH release so calcium is removed from the bones meaning the bones are left weak.
Complication of CKD
What is the treatment of renal bone disease?
Vitamin D or calcium supplementation
Phosphate binders and dietary restrictions
PTH reducing drugs - cinacalcet
Parathyroidectomy
What can increased urea be a sign of?
Reduced eGFR - CKD
What are the possible complications of CKD
Anaemia - B12, folate, iron and erythropoietin deficiency
Renal acidosis - can lead to bone resorption (hyperkalaemia)
AKI
CV disease - strokes
Peripheral neuropathy
End stage renal disease
What findings would warrant a investigation for CKD?
eGFR <60mL/min/1.73
Persistent haematuria (UTI ruled out)
proteinuria (ACR>3)
Urine sediment abnormalities (RBC, WCC)
What symptoms and signs should make you suspect a AKI?
Vomiting/Nausea or diarrhoea with evidence of dehydration
Reduced urine output or change in colour
confusion, fatigue, drowsiness
What are examples of pre-disposing AKI risk factors?
Low eGFR g5+ Vascular, cardiac or liver disease diabetes polypharmacy previous AKI
What are the examples of precipitation AKI risk factors?
Hypovolaemia - low BP
Sepsis
Nephrotoxins - diuretic, ACEI/ARB, NSAIDs, contrast
Recent surgery
What are the 3 main causes for pre-renal AKI?
Hypovolemia - blood loss or blood is in body just wrong place
Reduced cardiac output
haemodynamic disturbances
Why do NSAIDs increase risk of AKI?
Block dilation of afferent arteriole
Why do ACEI/ARBs increase risk of AKI?
Block constriction of efferent arteriole
What are the 4 causes of post renal AKI?
Malignancy
BPH
Stones/strictures
Neuropathic bladder
What is haemolytic uraemic syndrome
Acute onset of microangiopathic haemolytic anaemia, thrombocytopenia and AKI
What is the most common cause of haemolytic uraemic syndrome?
Shiga toxin infection - e.coli, shigella or citrobacter
What is SLEs effect on the kidney?
small vessel vasculitis
What is the difference between nephritis and nephrotic syndrome?
Nephrotic:
- high proteinuria, oedema, hypoalbuminemia, hyperlipidaemia, damage to GBM/podocytes
Nephritic:
- haematuria, proteinuria, hypertension, reduced renal function
- Due to inflammation
What are the 5 types of nephrotic syndrome and who are they most common in?
Minimal change - children
Membranous nephropathy - adults
focal segmental glomerulosclerosis - african adults
Diabetic glomerulopathy
Renal amyloidosis - infection AA or myeloma AL
What are the 3 types of nephritic syndrome and who are they most common in?
IgA nephropathy and IgA vasculitis - children (most common form of glomerular nephropathy)
Anti-GBM disease - old children and older adults
If unsure how to treat a glomeurular disease what should you guess?
IMMUNOSUPPRESANTS
What is type 1 renal Tubular Acidosis?
What does it cause and what are complications of it?
What are the causes?
Inability to secrete H+ into the distal tubule
Causes hypokalaemia
Complications = Nephrocalcinosis and renal stones
Causes = RA, SLE, Sjorjen’s, Idiopathic, analgesia
What is type 2 renal tubular acidosis?
what does it cause?
What is a complication?
What can cause it?
Decreased HCO3- due to reabsorption in the proximal tubule
Causes hypokalaemia
Complications = osteomalacia
Causes = Fanconi syndrome, Wilsons disease, carbonic anhydrase inhibitors, idiopathic
