How many grams of proteinuria is in: - Microalbuminuria - Asymptomatic - Heavy - Nephrotic

Microalbuminuria 30-300mg Asymptomatic 1g Nephrotic >3g

Renal Flashcards by Imogen Smedley

Total body water = 2/3 X + 1/3 Y

2/3 ICF + 1/3 ECF

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Is potassium / sodium / chloride high inside or outside the cell?

Potassium higher inside cell

Sodium / chloride higher outside cell

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What effect does PTH have on calcium and phosphate?

Increases Ca and decreases phosphate

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What should be measured on examination for a PTX presenting with haematuria?

Blood pressure

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What is the 1st line investigation (other than bloods) for haematuria?

<50yr 1st line renal US

>50yr flexible cystoscopy

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How many grams of proteinuria is in:

Microalbuminuria
Asymptomatic
Heavy
Nephrotic

Microalbuminuria 30-300mg
Asymptomatic <1g
Heavy >1g
Nephrotic >3g

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NSAIDs should always be stopped in AKI except…

Aspirin in cardiac dose 75mg

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Potassium greater than what is life-threatening?

6.5

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Are the QRS broad or narrow in hyperkalaemia?

Broad

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What is the management of hyperkalaemia?

10ml 10% calcium gluconate (protects myocardium) + 10 units insulin + 50ml 50% dextrose +- NEB SABA

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What is the definition of an AKI?

Creatinine rise >26.4 in 48hr
OR
Creatinine >50% baseline in 7 days 
OR
UO <0.5ml/kg/hr

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What drugs should be stopped immediately if you suspect in AKI?

NSAID, ACEI, ARB, aminoglycoside, diuretic, metformin, contrast agents

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What are the 3 types of AKI?

Pre-renal, renal, post-renal

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What type of AKI can sepsis cause?

Pre-renal (due to hypotension)

Cardiogenic shock, anaphylaxis also cause AKI through hypotension

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Volume depletion causes what type of AKI? Give an example of something causing volume depletion

Pre-renal

D&V, haemorrhage, burns

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What type of AKI can NSAIDs/ ACEI/ ARB cause and through what mechanism?

Pre-renal through volume depletion

Gentamicin does it through renal cause

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What causes “dark smokey grey urine”?

Rhabdomyolisis

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Hypo or hyperkalaemia in rhabdomyolysis?

Hyper

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Name 3 causes of rhabdomyolysis?

Fall with a long lie
Crush injury
Status epilepticus
PWID collapse

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What blood test for rhabdomyolysis?

Creatinine kinase

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Name 3 causes of post-renal AKI

Calculi
Urethral stricture
BPH/prostate Ca blocking urethra
Pelvic malignancy

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What type of AKI does rhabdomyolsis cause?

Renal

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What type of AKI can malignant HTN cause?

Renal

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Describe the JVP in dehydration / fluid overload?

Dry can’t see

Raised overloaded

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Presentation of AKI - fluid overload or dehydration?

Either / both

What is urine output for an AKI?

<0.5ml/kg/hr for 6hr

If you see protein on urinalysis, what Ix should you do next?

UPCR

What Ix if suspect AKI due to obstruction?

Does a CT KUB have contrast?

No | contrast nephrotoxic

What is a stage 1 AKI?

1-1.9X creatinine or | UO <0.5ml/kg/hr for 6hr

What is a stage 2 AKI?

2-2.9X creatinine or | UO <0.5ml/kg/hr for 12hr

What is a stage 3 AKI?

3X creatinine or need for RRT or UO <0.3ml/kg/hr for 12hr

What is the 1st line Mx of AKI?

250ml crystalloid fluid bolus | reassess + repeat, seek senior help if >1L with no response

What is the Mx of HUS?

Plasma exchange + FFP

What are the indications for dialysis in AKI?

- Refractory K >6.5 or initial >7 - Pulmonary edema - Stage 4/5 CKD - Intrinsic renal disease - Creatinine >300 - Uremic comp

How long abnormalities present for Dx of CKD?

3mth | measure eGFR 3mth apart

If detect initial abnormal eGFR - should repeat in X to rule out rapid progression

2wk

Erythropoetin stimulates ____ production

RBC

What is the cause of renal artery stenosis?

Atherosclerosis

ACEI are contraindicated in bilateral RAS - T or F?

True

Lupus renal disease - what drug do you always give

Hydroxychloroquine

DM nephropathy - patients should be screened annually using what

Urine albumin creatinine ratio ACR

1st line Mx of diabetic nephropathy

ACEI

What is the 1st sign of diabetic nephropathy?

Proteinuria

CKD is usually asymptomatic - T or F

True

What is GFR in CKD

Below 60

"Low appetite, N&V, yellow skin, pericardial rub, pericarditis, itch, flap, tremor, encephalopathy"

Uraemia

Brown granular casts

Acute tubular necrosis

Red cell casts

Nephritic syndrome

White cell casts

Interstitial nephritis or UTI

Is urea a good marker of renal function?

Poor marker of renal function, varies with hydration / diet, levels vary throughout the day

What type of anaemia is seen in CKD?

Normocytic normochromic anaemia

Do all PTx with CKD get a renal US on initial investigation?

Only if accelerated progression / visible or persistent non-visible haematuria / suspect obstruction GFR <30 / FH PCKD

If renal US abnormal in CKD, what scan is done next?

What size are kidneys in CKD?

Initially large then small

What size are kidneys in GN?

Small

What are the criteria for referral in CKD?

``` GFR <30 Suspect genetic cause Suspect RAS HTN uncontrolled on 4 drugs ACR>70 Decrease of eGFR of 15 or 25% in 1yr ```

What are the stages of CKD?

``` 1 normal eGFR >70 + other evidence CKD 2 mild eGFR 60-89 + other evidence CKD 3a 45-59 moderate 3b 30-44 4 15-29 severe 5 <15 or on dialysis ```

All CKD PTx get a statin - T or F

I think so

What are the extra immunisations for PTx with CKD?

Influenza + pneumococcus

1st line Mx of hypertensive nephropathy

ACEI | 2nd ARB

Mx of metabolic acidosis in CKD?

Oral sodium bicarbonate

Mx of anaemia in CKD?

Fe + Epo IJ

What vit is supplemented in CKD?

Vit D

What is definition of kidney failure?

GFR<15 or need for RRT

What is osteomalacia?

Severe vit D deficiency (in CKD high phos levels drag Ca out bones) (supplement calcitriol)

Type of hyperparathyroidism in CKD?

Secondary | tertiary after years

1st and 2nd line Mx of CKD mineral bone disease?

1st reduced dietary intake of phosphate | 2nd phosphate binders (sevelamer)

Rugger jersey spine

(secondary) | Hyperparathyroidism

Is interstitial nephritis a type of glomerulonephritis?

No separate thing | inflam of interstitium not glomerulus

Cresenteric on film

Rapidly progressive GN

Ab against type IV collagen

Goodpasture’s syndrome

What is the auto Ab in Goodpasture's?

Anti-GBM Ab glomerular basement membrane

Goodpasture's = X + Y

AKI + haemoptysis

Post-strep GN nephrotic or nephritic?

Nephritic

Goodpasture's - nephrotic or nephritic

Nephritic

FSGS - nephrotic or nephritic

Nephrotic

Membranous nephropathy - nephrotic or nephritic

Nephrotic

Rapidly progressive GN - nephrotic or nephritic?

Nephritic

Minimal change disease - nephrotic or nephritic

Nephrotic

What is the commonest nephrotic syndrome in adults?

Focal segmental glomerulosclerosis

What is the commonest GN overall?

Membranous nephropathy

What is the commonest nephrotic syndrome in children?

Minimal change disease

There is normal renal function in minimal change disease - T or F

True

On what test can minimal change disease be diagnosed?

Electron microscopy

What is the Mx of minimal change disease?

PO CCS

What is the Mx of FSGS?

PO CCS

What are the features of nephrotic syndrome?

Proteinuria >3g frothy urine Peripheral edema (incl face in child) Hypercholesterolemia Serum albumin <25

What auto Ab is seen in membranous nephropathy?

PLA-2

What type of GN may be idiopathic or caused by malignancy, lupus, rheumatoid arthritis or drugs eg gold?

Membranous

Berger's disease AKA

IgA nephropathy

What are the features of nephritic syndrome?

HTN + haematuria | proteinuria <3g/24hr

What is the commonest primary GN?

IgA nephropathy

IgA nephropathy - peak age - what auto Ab - nephritic or nephrotic - what is common PC

20s IgA1 Nephritic Macroscopic haematuria following URTI

What infections trigger post-strep GN?

Tonsillitis / impetigo

Why are complement levels checked in kidney disease?

Low in SLE

What test checks for strep?

ASO titre

Commonest renal carcinoma type?

Clear cell

Paraneoplastic effect from RCC?

Polycythemia (secrete epo) | Hypercalcaemia (parathyroid hormone like substance

Paraneoplastic syndrome of RCC; >ALP liver dysfunction without liver met

Stauffer’s syndrome

Cannonball metastasis to lungs (CXR multiple round lesions)

Renal Cell Carcinoma

What test is diagnostic of renal cell carcinoma?

CT (enhances) | Other renal primaries are rare + don’t enhance on CT