Renal Flashcards
1
Q
AKI
definition
A
an acute drop in kidney function
diagnosed by measuring the serum creatinine
2
Q
AKI
NICE criteria for AKI
A
- rise in Cr of ≥ 25 micromol/L in 48 hours
- Rise in creatinine of ≥ 50% in 7 days
- Urine output of < 0.5ml/kg/hour for > 6 hours
3
Q
AKI
RFs
A
- CKD
- Heart failure
- Diabetes
- Liver disease
- Older age (>65 years)
- Cognitive impairment
- Nephrotoxic meds: NSAIDS and ACEi
- Use of a contrast medium: during CT scans
4
Q
AKI
how can causes be split up
A
pre-renal
renal
post-renal
5
Q
AKI
pre-renal causes
A
most common. Due to inadequate blood supply to kidneys reducing the filtration of blood
- dehydration
- hypotension (shock)
- HF
6
Q
AKI
renal causes
A
intrinsic disease in kidney leading to reduced filtration of blood:
- glomerulonephritis
- interstitial nephritis
- acute tubular necrosis
7
Q
AKI
post renal causes
A
obstruction to the outflow of urine from the kidney causing back pressure into the kidney
- kidney stones
- masses such as cancer in the abdo or pelvis
- ureter or uretral strictures
- enlarged prostate or prostate cancer
8
Q
AKI
inx
A
urinalysis for protein, blood, leucocytes, nitrites and glucose
US: look for obstruction if suspected
9
Q
AKI
what do leucocytes and nitrites suggest
A
infection
10
Q
AKI
what does protein in the blood suggest
A
acute nephritis
but can be +ve in infection
11
Q
AKI
what does glucose suggest in the urinalysis
A
diabetes
12
Q
AKI
mnx
A
correct underlying cause:
- fluid rehydration with IV fluids in pre-renal AKI
- stop nephrotoxic medications
- relieve obstruction in post renal AKI: e.g. insert catheter for a pt in retention from an enlarged prostate
13
Q
AKI
complications (4)
A
- hyperkalaemia
- fluid overloads, HF, pulmonary oedema
- metabolic acidosis
- uraemia (high urea)
14
Q
AKI
what can uraemia lead to
A
encephalopathy or pericarditis
15
Q
CKD
what is it
A
a chronic reduction in kidney function
16
Q
CKD
causes
A
- Diabetes
- Hypertension
- Age-related decline
- Glomerulonephritis
- Polycystic kidney disease
- Medications: NSAIDS, PPIs and lithium
17
Q
CKD
RFs
A
- Older age
- Hypertension
- Diabetes
- Smoking
- Use of medications that affect the kidneys
18
Q
CKD
presentation
A
usually asymptomatic
- Pruritus (itching)
- Loss of appetite
- Nausea
- Oedema
- Muscle cramps
- Peripheral neuropathy
- Pallor
- Hypertension
19
Q
CKD
how to test eGFR
A
using a U&E blood test
20
Q
CKD
how many eGFR tests are required to confirm dx
A
2
3m apart
21
Q
CKD
inx
A
- eGFR
- urine albumin:creatinine ratio shows proteinuria (≥ 3mg/mmol is significant)
- urine dipstick: haematuria (1+ of blood)
- renal US
22
Q
CKD
what is the G score
A
based on the eGFR
23
Q
CKD
G1
A
eGFR >90
24
Q
CKD
G2
A
eGFR 60-89
25
CKD
G3a
eGFR 45-59
26
CKD
G3b
eGFR 30-44
27
CKD
G4
eGFR 15-29
28
CKD
G5
eGFR <15 (known as “end-stage renal failure”)
29
CKD
what is the A score
based on the albumin : creatinine ratio
30
CKD
A1
< 3mg/mmol
31
CKD
A2
3 – 30mg/mmol
32
CKD
A3
> 30mg/mmol
33
CKD
what is needed for a dx of CKD
eGFR of <60 or proteinuria (≥ 3mg/mmol)
34
CKD
complications (5)
- Anaemia
- Renal bone disease
- Cardiovascular disease
- Peripheral neuropathy
- Dialysis related problems
35
CKD
when does NICE suggest referral to a specialist
- eGFR < 30
- ACR ≥ 70 mg/mmol
- Accelerated progression: decrease in eGFR of 25% or 15 ml/min in 1 year
- Uncontrolled hypertension despite ≥ 4 antihypertensives
36
CKD
what are the aims of mnx
- Slow the progression of the disease
- Reduce the risk of cardiovascular disease
- Reduce the risk of complications
- Treating complications
37
CKD
how would you slow the progression of the disease
- optimise diabetic control
- optimise hypertensive control
- treat glomerulonephritis
38
CKD
how would you reduce the risk of complications
- exercise, maintain a healthy weight, stop smoking
- dietary advice about phosphate, Na, K + water intake
- offer atorvastatin 20mg for primary prevention of CVD
39
CKD
how would you treat complications
- Metabolic acidosis: PO sodium bicarb
- Anaemia: iron + EPO
- renal bone disease: vit D
- end stage renal failure: dialysis, renal transplant
40
CKD
which pts are offered ACEi to treat HTN
- Diabetes plus ACR > 3mg/mmol
- Hypertension plus ACR > 30mg/mmol
- All patients with ACR > 70mg/mmol
41
CKD
what is the aim BP
<140/90
(or < 130/80 if ACR > 70mg/mmol).
42
CKD
what needs to be monitored
serum K because CKD and ACEi both cause hyperkalaemia
43
CKD
why is there anaemia of CKD
- healthy kidney cells produce EPO (hormone that stimulates production of RBCs)
- damaged kidney cells produce less EPO
- therefore drop in RBCs and subsequent anaemia
44
CKD
how can anaemia of CKD be treated
with erythropoiesis stimulating agents such as exogenous erythropoietin
45
CKD
why are blood transfusions limited in anaemia of CKD
they can sensitise the immune system (allosensitisation)
so that transplanted organs are more likely to be rejected
46
CKD
what should be treated before offering erythropoetin
iron deficiency
47
CKD
what is renal bone disease aka?
CKD mineral bone disorder (CKD-MBD)
48
CKD
what are 3 features of renal bone disease
- osteomalacia (softening)
- osteoporosis (brittle bones)
- osteosclerosis (hardening)
49
CKD
what are the spinal x-ray changes in someone with renal bone disease
'rugger jersey' spine (stripes found on a rugby shirt)
sclerosis of both ends of the vertebra (denser white)
osteomalacia in the centre of the vertebra (less white)
50
CKD
renal bone disease: why is there high serum phosphate
reduced phosphate excretion
51
CKD
renal bone disease: why is there low active vit D
because the kidney cannot metabolise vit D to its active form as effectively
52
CKD
renal bone disease: what is Active vit D essential in
- calcium absorption from the intestines and kidneys
| - bone turnover
53
CKD
renal bone disease: why does secondary hyperparathyroidism occur
because the parathyroid glands react to low serum Ca and high serum phosphate by excreting more PTH
this leads to increased osteoclast activity which leads to the absorption of Ca from bone
54
CKD
renal bone disease: why does osteomalacia occur
due to increased turnover of bones without adequate Ca supply
55
CKD
renal bone disease: why does osteosclerosis occur
occurs when the osteoblasts respond by increasing their activity to match the osteoclasts
by creating new tissue in the bone. But due to low Ca level, this new tissue is not properly mineralised
56
CKD
renal bone disease: why does osteoporosis occur
due to other RFs such as ages and use of steroids
57
CKD
mnx of renal bone disease
- active forms of vit D (alfacalcidol + calcitriol)
- low phosphate diet
- bisphosphonates to treat osteoporosis
58
Acute Tubular Necrosis
what is it
damage and death (necrosis) of the epithelial cells of the renal tubules
59
what is the most common cause of AKI
acute tubular necrosis
60
Acute Tubular Necrosis
why does damage to the kidney cells occur
due to ischaemia or toxins
61
Acute Tubular Necrosis
is it reversible
yes because epithelial cells have the ability to regenerate
usually takes 7-21d to recover
62
Acute Tubular Necrosis
causes from ischaemia (3)
- shock
- sepsis
- dehydration
63
Acute Tubular Necrosis
causes from toxins (3)
- radiology contrast dye
- gentamycin
- NSAIDs
64
Acute Tubular Necrosis
pathognomonic finding specific to it
'muddy brown casts' found on urinalysis
65
Acute Tubular Necrosis
urinalysis findings
- muddy brown casts
| - renal tubular epithelial cells in the urine
66
Acute Tubular Necrosis
trx
the same as with other causes of an AKI
- supportive mnx
- IV fluids
- stop nephrotoxic medications
- treat complications
67
Renal Transplant
how many years of life is added compared with just using dialysis in end stage kidney failure
10 years
68
Renal Transplant
how are patients and donor kidneys matched
based on the HLA type A, B and C on Ch6
they don't have to fully match but the less they match, the more likely the transplant is to fail
69
Renal Transplant
procedure
pt's own kidneys are left in place
the donor kidney's blood vessels are connected (anastomosed) with the patient's pelvic vessels, usually the external iliac vessles
the donor kidney's ureter is anastomosed directly with the pt's bladder
70
Renal Transplant
where is the donor kidneyplaced
anterior in the abdomen and can be palpated in the iliac fossa
71
Renal Transplant
what incision is used
hockey stick incision
there will be a hockey stick scar
72
Renal Transplant
how to reduce the risk of transplant rejection
life long immunosuppression regime:
- Tacrolimus
- Mycophenolate
- Prednisolone
other possible immunosuppressants:
- Cyclosporine
- Sirolimus
- Azathioprine
73
Renal Transplant
complications relating to the transplant (3)
- transplant rejection (hyperacute, acute, chronic)
- transplant failure
- electrolyte imbalances
74
Renal Transplant
complications related to immunosuppressants
- IHD
- T2DM (steroids)
- infections more likely
- inidal infections (PCP. CMV, PJP, TB)
- non-Hodgkin's lymphoma
- skin cancer (SCC)
75
Glomerulonephritis
define nephritis
inflammation of the kidneys
not a syndrome or diagnosis
76
Glomerulonephritis
define nephritic syndrome or acute nephritic syndrome
a group of symptoms. not a diagnosis. Has no set criteria
- haematuria
- oliguria
- proteinuria
- fluid retention
77
Glomerulonephritis
what amount of protein in the urine points towards nephritic syndrome
<3g/24hrs
78
Glomerulonephritis
define nephrotic syndrome
a group of symptoms without specifying the underlying cause
they must fulfil this criteria:
- peripheral oedema
- proteinuria (>3g/24hrs)
- serum albumin <25g/L
- hypercholesterolaemia
79
Glomerulonephritis
what is Glomerulonephritis
an umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron
80
Glomerulonephritis
define interstitial nephritis
inflammation of the space between cells and the tubules (interstitium) within the kidney
81
Glomerulonephritis
what are the 2 types of interstitial nephritis
acute interstitial nephritis
chronic tubulointerstitial nephritis
82
Glomerulonephritis
define glomerulosclerosis
the pathological process of scarring of the tissue in the glomerulus
not a diagnosis
83
Glomerulonephritis
what can glomerulosclerosis be caused by (3)
- any type of glomerulonephritis
- obstructive uropathy (blockage of urine outflow)
- focal segmental glomerulosclerosis
84
Glomerulonephritis
name some specific types
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulonephritis
- IgA nephropathy (AKA mesangioproliferative glomerulonephritis or Berger’s disease)
- Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)
- Mesangiocapillary glomerulonephritis
- Rapidly progressive glomerulonephritis
- Goodpasture Syndrome
85
glomerulonephritis
what are most types treated with
- immunosuppression (e.g. steroids)
| - BP control by blocking the renin-angiotensin system (ACEi or ARB)
86
glomerulonephritis
what might frothy urine suggest
proteinuria --> nephrotic syndrome
87
glomerulonephritis
what may nephrotic syndrome predispose pts to
- thrombosis
- HTN
- high cholesterol
88
glomerulonephritis
what is the most common cause of nephrotic syndrome in children
cause and trx
minimal change disease
idiopathic
steroids
89
glomerulonephritis
what is the most common cause of nephrotic syndrome in adults
focal segmental glomerulosclerosis
90
glomerulonephritis
what is IgA nephropathy aka
Berger's disease
91
glomerulonephritis
what is the most common cause of primary glomerulonephritis (not caused by another disease)
IgA nephropathy (Berger's disease)
92
glomerulonephritis
what is the peak age of presentation of IgA nephropathy (Berger's disease)
20s
93
glomerulonephritis
what does histology show in IgA nephropathy (Berger's disease)
IgA deposits and glomerular mesangial proliferation
94
glomerulonephritis
what is the most common glomerulonephritis overall
membranous glomerulonephritis
95
glomerulonephritis
what is the peak age in Membranous glomerulonephritis
bimodal peak in age in the 20s and 60s
96
what does histology show in Membranous glomerulonephritis
IgG and complement deposits on the basement membrane
97
what are the causes of Membranous glomerulonephritis
70% are idiopathic
can be secondary to malignancy, rheumatoid disorders and drugs (NSAIDs)
98
what is Post streptococcal glomerulonephritis aka
diffuse proliferative glomerulonephritis
99
how old are patients usually in Post streptococcal glomerulonephritis
<30
100
how does Post streptococcal glomerulonephritis present
- 1-3w after streptococcal infection (e.g. tonsillitis or impetigo)
- nephritic syndrome
- usually a full recovery
101
Ddx for a patient with acute renal failure and haemoptysis
- Goodpasture syndrome
| - Wegener's granulomatosis
102
pathophysiology of Goodpasture syndrome
Anti-GBM antibodies attack glomerulus and pulmonary basement membranes
this causes glomerulonephritis and pulmonary haemorrhage
103
what antibody is Goodpasture syndrome associated with
anti-GBM antibodies
104
what antibody is Wegener's granulomatosis associated with
ANCA
105
how may a pt with Wegener's granulomatosis present
- haemoptysis
- acute renal failure
- wheeze
- sinusitis
- saddle-shaped nose
106
what does histology show in rapidly progressive glomerulonephritis
crescentic glomerulonephritis
107
how does rapidly progressive glomerulonephritis present
a very acute illness with sick pts
but responds well to trx
108
cause of rapidly progressive glomerulonephritis
often secondary to Goodpasture's syndrome
109
Haemolytic Uraemic Syndrome
classic triad
1. haemolytic anaemia
2. AKI
3. low platelet count
110
Haemolytic Uraemic Syndrome
what is it
when there is thrombosis in small blood vessels throughout the body
usually triggered by the shiga toxin
111
Haemolytic Uraemic Syndrome
how does thrombocytopenia happen
the formation of blood clots consumes platelets
112
Haemolytic Uraemic Syndrome
how does anaemia happen
the blood clots within the small vessels chop up the RBCs as they pass by (haemolysis) causing anaemia
113
Haemolytic Uraemic Syndrome
how does AKI occur
the blood flow through the kidney is affected by the clots and damaged RBCs leading to AKI
114
Haemolytic Uraemic Syndrome
what produces the shiga toxin
e.coli 0157 (most common)
Shigella
115
Haemolytic Uraemic Syndrome
what increases the risk of developing HUS
use of abx and anti-motility medications such as loperamide to treat gastroenteritis
116
Haemolytic Uraemic Syndrome
presentation
e.coli 0157 causes brief gastroenteritis with bloody diarrhoea
5d after:
- reduced urine output
- haematuria or dark brown urine
- abdo pain
- lethargy + irritability
- confusion
- HTN
- bruising
117
Haemolytic Uraemic Syndrome
mnx
medical emergency
supportive mnx:
- antihypertensives
- blood transfusions
- dialysis
118
Hyperkalaemia
main complication
cardiac arrhythmias such as ventricular fibrillation
119
Hyperkalaemia
causes (5) (from conditions)
- AKI
- CKD
- Rhabdomyolysis
- adrenal insufficiency
- tumour lysis syndrome
120
Hyperkalaemia
causes (5) (from medications)
- aldosterone antagonists (spironolactone + eplerenone)
- ACEi
- Angiotensin II receptor blockers
- NSAIDs
- potassium supplements
121
Hyperkalaemia
diagnosis
U&E blood test
but pay attention to Cr, urea, eGFR for kidney failure
122
Hyperkalaemia
what may lead to a falsely elevated potassium
haemolysis (breakdown of RBCs) during sampling
123
Hyperkalaemia
what inx is required with a K >6mmol/L
an ECG
124
Hyperkalaemia
| what are the ECG changes
- tall peaked T waves
- flattening or absence of P waves
- broad QRS complexes
125
Hyperkalaemia
mnx for K ≤ 6 mmol/L with otherwise stable renal function
- don't need urgent trx
| - change in diet + meds
126
Hyperkalaemia
mnx for pts with potassium ≥ 6 mmol/L and ECG changes
urgent treatment
127
Hyperkalaemia
mnx for pts with potassium ≥ 6.5 mmol/L regardless of the ECG
urgent trx
128
Hyperkalaemia
what is the mainstay of trx
insulin (actrapid 10U) + dextrose infusion (50ml of 50%)
IV calcium gluconate
129
Hyperkalaemia
what does the insulin and dextrose infusion do
drives carbohydrates into cells and takes K with it, reducing the blood K
130
Hyperkalaemia
what does calcium gluconate do
stabilise the cardiac muscle cells and reduces the risk of arrhythmias
131
Hyperkalaemia
what other options lower the K (apart from insulin, dextrose + calcium gluconate)
- neb salbutamol
- IV fluids
- PO calcium resonium
- sodium bicarb
- dialysis
132
Hyperkalaemia
how does neb salbutamol work
temporarily drives K into cells
133
Hyperkalaemia
| how do IV fluids help
- increases urine output
which encourages K loss from the kidneys
134
Hyperkalaemia
how does PO calcium resonium work
draws K out the gut and into the stools
works slowly and suitable for milder cases
135
Hyperkalaemia
how does sodium bicarb work
for acidotic patients with renal failure
it drives K into cells as the acidosis is corrected
136
Hyperkalaemia
when would dialysis be required
in severe or persistent cases associated with renal failure
137
what trx do you give before a CT scan with IV contrast to someone with CKD
IV 0.9% NaCl
| volume expansion reduces risk of contrast nephropathy
138
Renal Tubular Acidosis
what is it
metabolic acidosis due to pathology in the tubules of the kidney
there are 4 types
139
Renal Tubular Acidosis
what are the tubules responsible for
balancing H+ and HCO3- between the blood and urine
and maintaining a normal pH
140
Renal Tubular Acidosis
which types are most relevant in clinical practice and may come up in exams
type 1 and 4
141
Renal Tubular Acidosis
what is type 1
the distal tubule is unable to excrete H+
142
Renal Tubular Acidosis
causes of type 1
- genetic: autosomal + recessive
- SLE
- Sjogren's syndrome
- PBC
- hyperthyroidism
- sickle cell anaemia
- Marfan's syndrome
143
Renal Tubular Acidosis
type 1 presentation
- failure to thrive in children
- hyperventilation to compensate for the metabolic acidosis
- CKD
- bone disease (osteomalacia)
144
Renal Tubular Acidosis
inx findings in type 1
- hypokalaemia
- metabolic acidosis
- high urinary pH>6
145
Renal Tubular Acidosis
trx in type 1
PO bicarbonate
146
Renal Tubular Acidosis
what is type 2
the proximal tubule is unable to reabsorb HCO3- from the urine into the blood
XS HCO3- is excreted in the urine
147
Renal Tubular Acidosis
what is the main cause of type 2
Fanconi's syndrome
148
Renal Tubular Acidosis
inx findings in type 2
- hypokalaemia
- metabolic acidosis
- high urinary pH>6
149
Renal Tubular Acidosis
trx of type 2
PO bicarbonate
150
Renal Tubular Acidosis
what is type 3
a combination of type 1 and 2 with pathology in the proximal and distal tubule
rare
151
Renal Tubular Acidosis
what is type 4 caused by
reduced aldosterone:
- adrenal insufficiency
- ACEi + spironolactone
- SLE, diabetes, HIV affect the kidneys
152
Renal Tubular Acidosis
what is the most common type
type 4
153
Renal Tubular Acidosis
Type 4 inx findings
- hyperkalaemia
- high chloride
- metabolic acidosis
- low urinary pH
154
Renal Tubular Acidosis
mnx of type 4
- fludrocortisone
- sodium bicarb
- trx of the hyperkalaemia may be required
155
pt presents with haematuria following a URTI. What is it
IgA nephropathy
156
classic presentation of a pt with acute interstitial nephritis
- non-oliguric acute renal failure
- hypersensitivity triad: rash, fever, eosinophilia
- triggered by medication
157
presentation of a pt with acute glomerulonephritis
- haematuria
- oligouria
- HTN
- mil/mod proteinuria
158
peritoneal dialysis fluid is cloudy. pt presents with fever and abdo pain. What is the most likely organism
staph epidermidis from translocated skin flora
159
what antibodies will be raised in post-strep glomerulonephritis
anti-streptolysin O antibodies
160
what are contraindications for a renal transplant
- cancer
- active infections
- severe co-morbidity
161
PKD
what is it
a genetic condition where the kidneys develop multiple fluid filled cysts
162
PKD
what findings outside the kidneys is PKD associated with
- hepatic cysts
| - cerebral aneurysms (SAH!)
163
PKD
what may be felt on examination
palpable enlarged kidneys
164
PKD
what are the types
autosomal dominant
autosomal recessive
165
PKD
dx
US and genetic testing
166
PKD
what genes are affected in the autosomal dominant type
PKD-1: Ch16 (85% cases)
PKD-2: Ch4
167
PKD
autosomal dominant type extra-renal manifestations
- cerebral aneurysms
- hepatic, splenic, pancreatic, ovarian + prostatic cysts
- cardiac valve disease (mitral regurg)
- colonic diverticula
- aortic root dilatation
168
PKD
autosomal dominant type complications
- chronic loin pain
- HTN
- CVD
- gross haematuria (cyst ruptures)
- renal stones
- end-stage renal failure
169
PKD
what is the autosomal recessive type caused by
a gene on Ch6 (rarer and more severe)
170
PKD
how does autosomal recessive type often present as
in pregnancy with oligohydramnios as the fetus does not produce enough urine
171
PKD
why do neonates present with resp failure shortly after birth in the autosomal recessive type
oligohydramnios leads to underdevelopment of the lungs
172
PKD
what dysmorphic features are present in the autosomal recessive type
- underdeveloped ear cartilage
- low set ears
- flat nasal bridge
173
PKD
what may pts have before reaching adulthood in autosomal recessive type
end stage renal failure
174
PKD
medication mnx in autosomal dominant PKD
Tolvaptan (vasopressin receptor antagonist)
| can slow the development of cysts and progression of renal failure
175
PKD
supportive mnx for complications
- antihypertensives
- analgesia (renal colic)
- abx
- drainage of infected cysts
- dialysis
- renal transplant
176
PKD
monitor
- US
- bloods for renal function
- BP
- MR angiogram to dx intracranial aneurysms
177
PKD
why avoid contact sport
risk of cyst rupture
178
what is fibromuscular dysplasia
a group of non-atherosclerotic, non-inflammatory arterial diseases that most commonly involve the renal and carotid arteries
179
'string of beads’ appearance on MRI angiography
what is it
fibromuscular dysplasia
180
Dialysis
what is it
a method for performing the filtration tasks of the kidneys artificially in patients with end stage renal failure or complications of renal failure
removes excess fluid, solutes and waste products
181
Dialysis
indications for acute dialysis in pt with a severe AKI
AEIOU
- acidosis
- electrolyte abnormalities
- intoxication of certain meds
- Oedema
- uraemia sx e.g. seizures, reduced consciousness
182
Dialysis
indications for long term dialysis
- end stage renal failure (CKD stage 5)
| - any of the acute indications continuing long term (AEIOU)
183
Dialysis
what are the 3 main options for dialysis in pts requiring it long term
- continuous ambulatory peritoneal dialysis
- automated peritoneal dialysis
- haemodialysis
184
Dialysis
what is peritoneal dialysis
uses the peritoneal membrane as the filtration membrane
a special dialysis solution containing dextrose is added to peritoneal cavity
Ultrafiltration occurs from the blood, across the peritoneal membrane, in to the dialysis solution
dialysis solution is then replaced, taking away the waste products that have filtered out of the blood into the solution
185
Dialysis
what is used for inserting and removing dialysis solution in peritoneal dialysis
Tenckhoff catheter
186
Dialysis
what is continuous ambulatory peritoneal dialysis
the dialysis solution is in the peritoneum at all times.
187
Dialysis
what is automated dialysis
A machine continuously replaces dialysis fluid in the abdomen overnight to optimise ultrafiltration
188
Dialysis
complications of peritoneal dialysis
- bacterial peritonitis
- peritoneal sclerosis
- ultrafiltration failure
- weight gain
- psychosocial effects
189
Dialysis
what is ultrafiltration failure (in peritoneal dialysis)
pt absorbs dextrose in the filtration solution
which reduces the filtration gR aking ultrafilrtation less effective
190
Dialysis
how can weight gain occur? (in peritoneal dialysis)
as they absorb carbs in the dextrose solution
191
Dialysis
what is haemodialysis
their blood is filtered by a haemodialysis machine
192
Dialysis
options for haemodialysis
They need good access to an abundant blood supply:
- tunnelled cuffed catheter
- arterio-venous fistula
193
Dialysis
what is a tunnelled cuffed catheter (haemolysis)
a tube inserted into the subclavian or jugular vein with a tip that sits in the superior vena cava or right atrium
194
Dialysis
what does the Dacron cuff on the tunnelled cuffed catheter do
promotes healing and adhesion of tissue to the cuff, making the catheter more permanent
provides a barrier to bacterial infection.
195
Dialysis
what is the main complication of tunnelled cuffed catheters
infection and blood clots within the catheter
196
Dialysis
what is an AV fistula
an artificial connection between an artery to a vein
bypasses the capillary system and allows blood to flow under high pressure from the artery directly into the vein
197
Dialysis
name some options of AV fistulas
- Radio-cephalic
- Brachio-cephalic
- Brachio-basilic (less common and more complex operation)
198
Dialysis
how would you examine an AV fistula
- skin integrity
- aneurysms
- palpable thrill (a fine vibration felt over the anastomosis)
- machinery murmur on auscultation
199
Dialysis
AV fistula complications
- Aneurysm
- Infection
- Thrombosis
- Stenosis
- STEAL syndrome
- High output heart failure
200
Dialysis
AV fistula complications: what is STEAL syndrome
inadequate blood flow to the limb distal to the AV fistula.
The AV fistula “steals” blood from the distal limb
201
Dialysis
AV fistula complications: how does STEAL syndrome cause distal ischaemia
the blood is diverted away from where is was supposed to supply and flows straight into the venous system
202
Dialysis
AV fistula complications: why is there high output heart failure
- rapid return of blood to the heart
- increased pre-load in the heart (how full the heart is before it pumps). - This leads to hypertrophy of the heart muscle and heart failure.
203
Dialysis
can you take blood from a fistula
NO
This is a lifeline for the patient to allow them access to dialysis. If it gets damaged it will set them back and you will be in big trouble.
204
what is the most common cause of glomerular pathology and CKD in the UK
diabetic nephropathy
205
Diabetic Nephropathy
what is glomerulosclerosis
The chronic high level of glucose passing through the glomerulus causes scarring
206
Diabetic Nephropathy
why is there proteinuria
damage to the glomerulus allows protein to be filtered from blood to urine
207
Diabetic Nephropathy
diabetics should have regular screening for diabetic nephropathy by testing what?
albumin:creatinine ratio and U&Es.
208
Diabetic Nephropathy
what is the trx of choice in diabetics for BP control
ACEi
209
Diabetic Nephropathy
pt has diabetic nephropathy but a normal BP, should you start ACEi
yes
210
Interstitial Kidney Disease
what is interstitial nephritis
inflammation of the space between cells and tubules (the interstitium) within the kidney
211
Interstitial Kidney Disease
what is glomerulonephritis
inflammation around the glomerulus
212
Interstitial Kidney Disease
what are the 2 types of interstitial nephritis
- acute interstitial nephritis
| - chronic tubulointerstitial nephritis
213
Interstitial Kidney Disease
presentation of acute interstitial nephritis
- AKI
- hypertension
generalised hypersensitivity reaction:
- rash
- fever
- eosinophilia
214
Interstitial Kidney Disease
what is acute interstitial nephritis
acute inflammation of the tubules and interstitium
usually caused by a hypersensitivity reaction
215
Interstitial Kidney Disease
cause of acute interstitial nephritis
a hypersensitivity reaction to:
- Drugs (e.g. NSAIDS or abx)
- Infection
216
Interstitial Kidney Disease
mnx of interstitial nephritis
- treat underlying cause
| - steroids
217
Interstitial Kidney Disease
what is chronic tubulointerstitial nephritis
chronic inflammation of the tubules and interstitium.
218
Interstitial Kidney Disease
presentation of chronic tubulointerstitial nephritis
CKD
219
Interstitial Kidney Disease
cause of chronic tubulointerstitial nephritis
large number of underlying autoimmune, infectious, iatrogenic and granulomatous disease causes
220
Interstitial Kidney Disease
mnx of chronic tubulointerstitial nephritis
- treat underlying cause
| - steroids
221
Rhabdomyolysis
what is it
skeletal muscle tissue breaks down and releases breakdown products into the blood
222
Rhabdomyolysis
triggers
extreme underuse or overuse or a traumatic injury
223
Rhabdomyolysis
what does muscles cell death (apoptosis) release
- myoglobin (causing myoglobinurea)
- potassium
- phosphate
- creatine kinase
224
Rhabdomyolysis
what is the most immediately dangerous breakdown product and why
Potassium
hyperkalaemia can cause cardiac arrhythmias that can potentially result in a cardiac arrest
225
Rhabdomyolysis
why does AKI occur
the breakdown products are filtered by the kidney and cause injury to the kidney
Myoglobin is particular toxic to the kidney in high concs
226
Rhabdomyolysis
causes
- prolonged immobility
- extremely rigorous exercise
- crush injuries
- seizures
227
Rhabdomyolysis
signs + sx
- muscle aches + pain
- oedema
- fatigue
- confusion
- red-brown urine
228
Rhabdomyolysis
what is the key inx in establishing dx
Creatine kinase (CK)
229
Rhabdomyolysis
what causes the urine to be a red-brown colour
myoglobinurea (myoglobin in the urine)
230
Rhabdomyolysis
inx
- CK
- urine dipstick (+ve for blood)
- U&E: AKI, hyperkalaemia
- ECG: hyperkalaemia
231
Rhabdomyolysis
mnx
- IV fluids
- consider IV sodium bicarb (to make urine more alkaline)
- consider IV mannitol
- treat complications esp hyperkalaemia
232
Rhabdomyolysis
why would you consider IV mannitol as trx
- to increase GFR to help flush the breakdown products
| - reduce oedema surrounding muscles + nerves
233
Rhabdomyolysis
what arrhythmia can hyperkalaemia cause
ventricular fibrillation
234
what is a common side effect of tacrolimus
tremor
235
difference in presentation between IgA nephropathy and post-streptococcal glomerulonephritis
igA: 1-2 days after a URTI
| post-strep: 1-2 weeks
236
lady trying to conceive and has G6PD deficiency
she has a UTI. what do you prescribe
Cefalexin
| nitrofurantoin is CI'd with G6PD deficiency
237
drug which causes acute interstitial nephritis
PPIs
238
sudden headache. PMH: autosomal dominant kidney disease
what is it
subarachnoid haemorrhage
APKD is associated with subarachnoid haemorrhage
