Renal Flashcards
What are the causes of chronic kidney disease?
Diabetes Hypertension Age-related Glomerulonephritis Polycystic kidney disease Meds: NSAIDs, PPI and lithium
What are the risk factors of chronic kidney disease?
Older age Hypertension Diabetes Smoking Use of medications
What is the presentation of chronic kidney disease?
Usually asymptomatic
Pruritus Loss of appetite Nausea Oedema Muscle cramps Peripheral neuropathy Pallor Hypertension
What are the investigations of chronic kidney disease?
eGFR: 2 tests 3 months apart
Proteinuria: >3mg/mmol
Haematuria
Renal US
What is the scoring system for chronic kidney disease?
G score based on eGFR:
G1: >90 G2: 60-89 G3a: 45-59 G3b: 30-44 G4: 15-29 G5: <15
What is the diagnosis of chronic kidney disease?
at least an eGFR of <60 or proteinuria
How do you treat hypertension in chronic kidney disease and what is the therapeutic blood pressure aim?
ACEi are first line
Offered to:
Diabetes+ACR>3mg
HTN+ACR>30mg
All patients with ACR>70mg
Aim to keep blood pressure <140/90
Serum potassium needs to be monitored because CKD and ACEi cause hyperkalaemia
What is anaemia of chronic kidney disease?
Damaged kidney cells in CKD causes a drop in EPO so there’s a drop in RBC and subsequent anaemia.
What is the management of anaemia in chronic kidney disease?
EPO stimulating agent such as exogenous EPO
IV iron
What are the features of renal bone disease?
Osteomalacia (softening)
Osteoporosis (brittle)
Osteosclerosis (hardening)
What are the x-ray changes seen in renal bone disease?
Spine xray shows sclerosis of both ends of the vertebra and osteomalacia in the center of the vertebra.
Known as “rugger jersey” spine
What is the management of renal bone disease?
Active forms of vit D (calcitrol)
Low phosphate diet
Bisphosphonates for osteoporosis
What are the features of nephritic syndrome?
Haematuria
Oligouria
Proteinuria <3g/24hr
Fluid retention
What is the criteria for nephrotic syndrome?
Peripheral oedema
Proteinuria >3g/24hr
Serum albumin <25g/L
Hypercholestrolaemia
How do you treat most glomerulonephritis?
Immunosuppression (e.g steroids)
Blood pressure control by blocking the RAS system (ACEi or ARBs)
What is the presentation of nephrotic syndrome?
Oedema and frothy urine (proteinuria).
What is the most common cause of nephrotic syndrome in children and the treatment?
Minimal change disease
Usually idiopathic and treated with steroids
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
What is IgA nephropathy (AKA Berger’s disease)?
Most common cause of primary glomerulonephritis.
Peak age is 20s
Histology shows IgA deposits and glomerular mesangial proliferation
What is membranous glomerulonephritis and give the cause?
Most common type of glomerulonephritis overall
Bimodal peak in age 20s and 60s
Histology shows IgG and complement deposits on basement membrane
Majority idiopathic
Can be secondary to malignancy, rheumatoid disorders and drugs (NSAID)
What is post streptococcal glomerulonephritis?
Patients typically under 30.
Presents as:
- 1-3 weeks after streptococcal infection
- Develop a nephritis syndrome
- Usually a full recovery
What is the difference between goodpasture syndrome and granulomatosis with polyangiitis?
Good pasture syndrome:
- AKI
- Haemoptysis
- Anti-GBM antibodies
Wegener’s granulomatosis:
- AKI
- Haemoptysis
- ANCA antibodies
- Wheeze, sinusitis and saddle shaped nose
What is polycystic kidney disease?
Genetic condition where the kidneys develop multiple fluid filled cysts. There is an autosomal dominant and recessive types.
What are the extra-renal manifestations of polycystic kidney disease?
Cerebral aneurysms
Hepatic, splenic, pancreatic, ovarian and prostatic cysts
Cardiac valve disease (Mitral regurg)
Colonic diverticula
Aortic root dilation
What is the management of polycystic kidney disease?
Tolvaptan (vasopressin receptor antagonist)
What is renal carcinoma?
Most common type of kidney tumour.
It is a type of adenocarcinoma that arises from renal tubules
What is the presentation of renal cell carcinoma?
Haematuria
Flank pain
Palpable mass
What are the types of renal cell carcinomas?
Clear cell (80%)
Papillary (15%)
Chromophobe (5%)
Wilm’s tumour specific in <5yr
What is the spread of renal cell carcinoma?
Cannonball metastases in the lungs
What is the management of renal cell carcinomas
Partial nephrectomy
Radical nephrectomy
Arterial embolisation
Percutaneous cryotherapy
Radiofrequency ablation
Chemo+Radio
What is buerger’s disease?
Also known as thromboangitis obliterans
Inflmmatory condition that causes thrombus formation in the small and medium-sized blood vessels
What is the presentation of buerger’s disease?
Painful blue discolouration to fingertips or tips of the toes
Pain worse at night
Corckscrew collaterals on angiograpm
What is the treatment of buerger’s disease
Stop smoking
IV iloprost
What is rhabdomyolysis?
Where skeletal muscle tissue breaks down and releases breakdown products into the blood.
Myoglobin
Potassium
Phosphate
CK
What are the causes of rhabdomyolysis?
Prolonged immobility
Extremely rigorous exercise
Crush injuries
Seizures
What are the signs and symptoms ofrhabdomyolysis?
Muscle aches and pain Oedema Fatigue Confusion Red-brown urine
What are the investigations in rhabdomyolysis?
CK high
Myoglobinurea (red-brown urine)
AKI and hyperkalaemia (U+E and ECG)
What is the management of rhabdomyolysis?
IV fluids
IV sodium bicarbonate
IV mannitol
Treat complications
What is the histopathological finding on kidney biopsy of end stage renal disease secondary to diabetic nephropathy?
Kimmelstiel-Wilson nodules
What must be done prior to starting definitive treatment for nephrotic syndrome?
Renal biopsy
What is the age of presentation of polycystic kidney disease?
Dominant: age 15-30 with renal failure and hypertension (most common 30-40)
Recessive: neonatal
Most common site for a renal stone?
Vesicoureteric junction
What is the presentation of IgA nephropathy?
Visible haematuria 1-2 days after an URTI in young males
Which drugs should be stopped in an AKI?
NSAIDs (Except aspirin if for cardio) Aminoglycosides e.g gentomycin ACEi ARBs Diuretics
Which medication is contraindicated in patients with renovascular disease?
ACEi
Which condition has a poor response to fluid challenge?
Acute tubular necrosis
What does CKD do to HbA1c?
Makes it falsly low
