Renal Flashcards
Causes of hypernatraemia? (4)
How may this present in an infant?
Rx?
Dehydration (e.g. D&V, high fever)
Osmotic diuresis (e.g. DKA)
Diabetes insipidus
Excessive saline infusion
In an infant: jittery, increased muscle tone, hyperreflexia, sunken fontanelles, drowsiness, eventually coma
Rx: Oral rehydration solution 1st line
Slow infusion IV 0.9% NaCl if cannot tolerate oral (D&V), sepsis/shock suspected, or if oral not working
Drugs to stop in AKI as they will cause worsening? (3)
DAAAMN
Diuretics
ACEI/Aminoglycoside/ARB
Metformin
NSAIDs
Drugs that may have to be stopped in AKI as they will build up?
Metformin
Digoxin
Lithium
Is aspirin safe in AKI?
At cardioprotective dose 75mg
Is paracetamol safe in AKI?
Yes
Is warfarin safe in AKI?
Yes
Are statins safe in AKI?
Yes
Is clopidogrel safe in AKI?
Yes
Are B Blockers safe in AKI?
Yes
Diagnosis of AKI?
4 symptoms, 3 bloods
Symptoms:
- oliguria
- oedema
- arrhythmias (from K/acid build up)
- features of uraemia (pericarditis, encephalopathy)
Bloods:
- rise in serum creatinine by 26 mol/l in 48 hours
- rise in serum creatinine by 50% in 7 days
- fall in urine output less than 0.5 ml/kg/hr for 6 hours
What usually increases during an AKI?
Things that the kidney normally excretes
- K
- Creatinine
- Urea
Also usually acidosis
SE of EPO therapy?
Why might someone not respond?
- Accelerated hypertension (encephalopathy and seizures)
- Bone ache
- Flu-like symptoms
- Pure red cell aplasia
- Iron deficiency due to increased erythropoiesis
Non-responsive:
- iron deficiency
- inadequate dose
- infection
- hyperparathyroid bone disease
Alport’s Syndrome:
- inheritance?
- presentation?
- diagnosis?
- why might a transplant fail in an alport’s pt?
X-linked dominant
In childhood:
- microscopic haematuria
- progressive renal failure
- bilateral sensorineural deafness
- Lenticonus: lens protrudes into anterior chamber (needs glasses)
- Retinitis pigmentosa
Diagnosis:
- genetic testing
- renal biopsy: EM - longitudinal splitting of lamina dense of GBM, causing ‘basket-weave’ appearance
Fail: due to anti-GBM antibodies against normal GBM
Minimal change disease:
- presentation? (1)
- renal biopsy? (2)
- Management?
- Nephrotic syndrome (normotension)
Biopsy:
- LM: normal glomeruli
- EM: fusion of podocytes, effacement of foot processes
Rx:
- Oral pred + urgent referral
- Cyclophosphamide if resistant
Why can nephrotic syndrome cause blood clots?
What must happen?
How can it cause infection?
How can it cause hypocalcaemia?
Clots:
- ATIII and plasminogen lost to urine
- Can cause DVT and renal vein thrombosis
- LMWH
Infection: Ig lost to urine
Hypocalcaemia: VitD and binding protein lost in urine
ADPKD:
- presentation? (4)
- extra-real manifestations? (4)
As a young adult:
- hypertension
- abdo pain
- CKD
- loin mass
- haematuria
Extra-renal:
- liver cysts (most common) - hepatomegaly
- berry aneurysm
- mitral/tricuspid incompetence
- pancreatinc/splenic cysts
IgA nephropathy vs post-strep glomerulonephritis?
IgA:
- 1-2 days after URTI
- haematuria
- caused by IgA
Post-strep:
- 1-2 weeks after URTI
- Proteinuria
- haematuria
- low complement count
- caused by IgG, IgM and C3 deposition in glomeruli
Caused by GAS
Renal biopsy of post-strep?
- Acute, diffuse, proliferative glomerulonephritis
- Endothelial proliferation with neurtophils
- EM: subaopithelial ‘humps’ caused by lumpy immune complex deposition
- IF: granular or ‘starry sky’ appearance
How to tell intrinsic AKI from pre/post renal?
Protein present in intrinsic
How to tell primary from secondary hyperaldosteronism?
Pt with refractory hypertension, low K and high Na (since high aldosterone)
Look at renin activity. If renal artery stenosis then low afferent blood flow will stimulate renon release and cause they hyperaldosteronism
3 things renal artery stenosis can cause?
Renal artery stenosis due to atherosclerosis is most common cause of renal vascular disease (90%), what is next most common cause?
- hypertension
- CKD
- flash pulmonary oedema
Fibromuscular dysplasia
50 y/o patient with progressive weakness, and dyspnoea, hepatomegaly, reduced renal function, T2DM, COPD, no FHx?
Diagnosis?
Amyloidosis
Rectal biopsy - congo red staining shows apple-green birefringence
What should you think of in young woman who develops AKI in response to ACEI?
What is seen on renal USS?
What is seen on duplex scan?
What is next Ix?
Fibromuscular dysplasia
USS: normal kidneys and urinary system
Duplex: stenotic arteries
MR angiography: ‘string of beads’ appearance
HSP:
- what is it?
- features? (4)
- treatment?
- IgA small-vessel vasculitis after URTI - degree of overlap with IgA nephropathy
- palpable purpuricrash with localised oedema over buttocks, extensors and legs
- abdo pain
- polyarthritis
- features of IgA nephropathy (haematuria, renal failure)
Rx: supportive. Good prognosis