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Z Year3 Conditions > RENAL > Flashcards

RENAL Flashcards

1
Q

What is acute kidney injury (AKI)?

A

Syndrome of decreased renal function measured by serum creatinine or urine output, occurring over hours-days

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2
Q

What is creatinine in AKI?

A

> 1.5x baseline within 7 days

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3
Q

What is urine output in AKI?

A

<400ml/day

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4
Q

What is a pre-renal cause of AKI?

A

decreased blood flow to the kidney

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5
Q

What is a post-renal cause of AKI?

A

internal/external obstruction of urine

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6
Q

What are examples of pre-renal causes of AKI?

A
  1. Hypovolemia
    - Haemorrhage Diarrhoea
  2. Renal artery stenosis
    - Acei, ARBs
  3. Hypotension:
    - Sepsis
    - Heart failure
    - Burns
    - Surgery
    - NSAIDs
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7
Q

Why do NSAIDs cause hypotension?

A

decrease in prostaglandins which results in vasodilation

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8
Q

What are internal post-renal causes of AKI?

A
  1. Renal caliculi

2. Urethral stricture

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9
Q

What are external post-renal causes of AKI?

A
  1. Pelvic malignancy

2. BPH

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10
Q

What are the glomerular renal causes of AKI?

A
  1. Glomerulonephritis

2. Haemalytic Uraemic Syndrome (HUS)

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11
Q

What is HUS?

A

triad of microangipathic haemolytic anaemia, thrombocytopaenia and AKI- associated with shiga-toxin producing E.Coli infections- can precipitate AKI because glomeruli become clogged with platelets and damaged RBCs - children

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12
Q

What are the vascular renal causes of AKI?

A

vasculitis e.g. granulomatosis with polyangiitis (Wegners)

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13
Q

When is AKI more common?

A

elderly and co-morbidities eg diabetes

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14
Q

What are the tubular renal causes of AKI?

A
  1. Acute tubular necrosis !!

2. Multiple myeloma

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15
Q

What are causes of acute tubular necrosis?

A
  1. Ischaemic causes eg thromboembolism, nephrotoxic drugs, rhabdomyolysis
  2. Due to pre-renal AKI causes eg hypotension, sepsis
    - Brown parts in urine
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16
Q

What are the interstitial disease renal causes of AKI?

A
  1. Acute interstitial nephritis
    - immune-mediated tubulointerstitial injury
    - due to drug hypersensitivity reaction
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17
Q

How does acute interstitial nephritis present?

A
  1. rash
  2. fever
  3. arthralgia
  4. eosinophiluria
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18
Q

What is the presentation of AKI?

A
  1. malaise
  2. anorexia
  3. vomiting
  4. pruritis
  5. drowsiness
  6. oliguria
  7. coma
    - Cause specific
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19
Q

What is important to ask in AKI history?

A
  1. started nephrotic drugs

2. recent allergic reactions, burns or major surgery

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20
Q

What are the functions of the kidney?

A
  1. maintaing acid-base balance
  2. maintaing water balance
  3. electrolyte balance
  4. toxin removal
  5. blood pressure control
  6. making Erythropoeitin
  7. Vitamin D metabolism
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21
Q

What are complications of AKI?

A
  1. Metabolic acidosis
  2. Hyperkalaemia, hyperphosiamia
  3. Hyper or hypo volemia
  4. Ureamia: increase risk of encaphalopathy and pericarditis
  5. Hypertension
22
Q

What are the investigations for AKI?

A
  1. Bloods: LFTs, FBC, U + Es bicarbonate, blood film
  2. Urinanalysis
  3. ECG
  4. CXR
  5. USS
  6. Renal biopsy
23
Q

What is the management of renal causes of AKI?

A

Refer to specialist: likely biopsy

24
Q

What is the management of pre-renal AKI?

A

manage volume depletion

25
Q

What is the management of post-renal AKI?

A

Catheter, urological intervention

26
Q

What else do you need to consider with renal management?

A
  1. A: acidosis ABG/VBG= monitor acidosis
  2. W: monitoring fluid balance to ensure no fluid overload
  3. E: potassium levels/ ECG= ensure no hyperkalaemia, Hyperkalaemic= sign on an ECG? Tented t-waves
  4. T: Urea
27
Q

When would you need to consider renal replacement therapy?

A
  1. hyperkalaemia, pulmonary oedema are not being controlled by medical management
  2. severe metabolic acidosis, uraemic complications
28
Q

What is the management of hyperkaelaemia?

A
  1. Normal saline
  2. calcium gluconate IV (10ml of 10%) - to prevent cardiac arrhythmias
  3. 50ml 50% dextrose with 5U actrapid insulin over 15 mins - to drive potassium into cells
  4. Then nebulised salbutamol
29
Q

What is the management of metabolic acidosis?

A

IV sodium bicarbonate

30
Q

What is the management of pulmonary oedema?

A
  1. Oxygen
  2. IV diamorphine: relives anxiety and breathlessness
  3. IV GTN
  4. Frusemide
31
Q

What is the definition of chronic kidney disease (CKD)?

A
  1. Kidney damage (proteinuria/haematuria)
  2. OR GFR <60ml/min/1.73m2
    - FOR 3 Months
32
Q

What are the stages of CKD?

A
  • risk increases with age

- severity with decreasing eGFR

33
Q

What are the glomerular causes of CKD?

A
  1. Glomerulonephritis
  2. DIABETES
  3. Amyloidosis
  4. SLE
34
Q

What are the vascular causes of CKD?

A
  1. HYPERTENSION
  2. Heart failure
  3. TTP
35
Q

What are the tubular/interstitial causes of CKD?

A
  1. Interstitial nephritis
  2. pyelonephritis
  3. medication
36
Q

What are the obstruction causes of CKD?

A
  1. Kidney stones
  2. BPH
  3. Multiple myeloma
37
Q

What are the medication causes of CKD?

A

NSAIDs and some antibiotics

38
Q

What are the congenital causes of CKD?

A
  1. PCKD

2. Alport syndrome

39
Q

What is the presentation of chronic kidney disease?

A
  1. Pruritis
  2. Nausea and Vomiting
  3. Anorexia
  4. Oedema
  5. Polyuria (start) /oliguria (end)
  6. Shortness of breath (pulmonary oedema)
  7. Bruising
    - Cause specific
    - Can be asymptomatic as well and aki
40
Q

What are the investigations for CKD?

A
  1. Bloods
  2. Urinalysis
  3. CXR
  4. Renal US
  5. Renal biopsy
41
Q

What bloods do you do for CKD?

A
  1. U+ E important for eGFR
  2. glucose to check for underlying diabetes
  3. Ca, phosphate
  4. Autoantibodies
42
Q

What is renal osterodystrophy?

A

kidneys unable to maintain levels of calcium and phosphate

43
Q

What do you look for un urinalysis for CKD?

A
  1. granular casts (degenerated tubular cells seen in CKD)
  2. haematuria
  3. proteinuria
44
Q

Why do you do a CXR for CKD?

A

may detect osteomalacia- sign of renal osteodystrophy which is a complication of CKD

45
Q

What can an US show for CKD?

A
  1. kidney atrophy
  2. obstructive causes of CKD
  3. asymmetrical small consider renovascular disease
46
Q

How do you investigate eGFR?

A

serum electrolytes, urea and creatinine

47
Q

What is the definition of glomerulonephritis?

A

inflammation of the glomeruli leading to nephritic/nephrotic syndrome

48
Q

What are the two main symptoms of glomerularnephritis?

A
  1. proteinuria

2. haematuria

49
Q

What does IgA nephropathy cause?

A

nephritic syndrome

50
Q

What are the main symptoms of nephritic syndrome?

A
  1. Haematuria (cococola coloured urine)
  2. Oedema
  3. Hypertension
  4. Oliguria

Z Year3 Conditions (13 decks)

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