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Renal Flashcards

1
Q

Urine abnormalities

7 appearances; 2 vol defn

A

Turbidity - cloudy may indicate infection, contamination, etc

pH - low, acidic may indicate uric acid

Blood - indicates haematuria, haemoglobinuria, myoglobinuria

Protein - proteinuria = ACR of >30mg/mmol; may indicate renovascular, glomerular or tubulo-interstitial disease OR protein overflow (e.g. myeloma)

Glucose - screen for diabetes

Ketones - DKA, hyperemesis in pregnancy, starvation

Nitrites/leucocytes - infection

Volume Defns:
Oliguria = <400ml/day (adults)
Polyuria = >3L/day

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2
Q

Glomerulonephritis

Defn 1; Class 2; Types 4; Sx 4; Ix 4; Mx 4

A

DEFn = Immune mediated disorders leading to inflammation of glomeruli/kidney

CLASSES:
1º = no underlying cause
2º = as part of other conditions (e.g. SLE, PAN)

TYPES

  1. Minimal change (often in children)
  2. Diffuse (affects all glomeruli)
  3. Focal (affects only some glomeruli)
  4. Segmental (affects only part of the glomerulus)

PRESENTATION AS:

  1. Asymptomatic haematuria +/- proteinuria
  2. Nephrotic syndrome (proteinuria, oedema, hypoalbunaemia)
  3. Nephritic syndrome (haematuria, oedema, uraemia)
  4. Acute/chronic renal failure

Ix:

  • Biopsy
  • Autoantibodies
  • Serum complement (low in SLE)
  • Serum immunoglobulins (myeloma)

Mx (depends on type):

  • Steroids
  • Immunoglobulin
  • Antithrombotics
  • Dialysis
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3
Q

Nephrotoxic medications

8

A

NSAIDs

ACE-inhibitors

Pencillamine

Gold

Phenytoin

Abx (inc aminoglycosides, tetracyclines, penicillins, sulphonamides, rifampicin)

Diuretics

Lithium

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4
Q

Interstitial nephritis

=, Causes, Sx, Mx

A

= inflammation of renal interstitium (not glomeruli)

Usually due to drugs but can be due to infection/conditions like SLE, etc

Sx:
AKI, fever, rash

Mx:
Steroids may help

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5
Q

Renal vein thrombosis

=, Sx, Ix, Mx

A

= occlusion of one or both of the renal veins (e.g. due to nephrotic syndrome, renal cancer, etc)

Acute or chronic, may be asymptomatic or painful/reduced renal function, etc

Ix:
May need Doppler USS, CT/MRI to diagnose

Mx:
May need warfarin/streptokinase, sometimes surgical management

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6
Q

Renal artery stenosis

=, —>, Sx, Mx

A

= reduced blood supply to kidney due to atherosclerosis (usually) or fibromuscular hyperplasia (uncommon)

—> HTN and hyperaldosteronism

Small kidney

May need angioplasty to correct

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7
Q

APKD

=, inh, Sx, —>

A

= Adult polycystic kidney disease

Inheritance: Autosomal dominant

Cysts in kidney as well as elsewhere, e.g. in liver, berry aneurysms

Can lead to:
Recurrent UTIs
End-stage renal failure

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8
Q

Renal stones

Types; Sx; Mx - 1º or 2º care if admission

A

Types:
Most are calcium (80%) - of which 60% are calcium oxalate
(Others include uric acid, struvite, cystine)

Typical Sx:
Severe loin to groin pain

1º care:
If no admission, analgesia and imaging within 24 hours

Analgesia: NSAIDs (any route) and IV paracetamol if needed

Admit if:

  • Shock, fever, signs of infection
  • Increased risk of AKI, e.g. CKD or unilateral kidney
  • Dehydrated
  • Uncertain diagnosis

2º care:

  • Usually non-contrast CT, USS (e.g. if pregnant/child), ureteroscopy
  • Conservative Mx (e.g. watchful waiting if <5mm diameter, MET - medically expulsive therapy - alpha blocker
  • Stone removal: ESWL (extracorporeal shock wave lithotripsy - non-invasive, stones broken and pass themselves), Ureteroscopy with laser to break stone, Percutaneous nephrolithotomy, Open surgery (1-5% of cases, e.g. when treatment fails, complications, severe intra-renal abnormalities, etc)
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9
Q

AKI causes

Class 3

A

PRE-renal:
Hypovolaemia
Shock
Cardiac failure

RENAL:
Nephropathy
GN
Myeloma
Drugs

POST-renal:
Stones
BPH

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10
Q

AKI

=; Sx 6; Detect 3; Mx 6

A

= acute loss of kidney function

Sx:
Nausea, vomiting, dehydration, confusion, hypertension, fluid overload

Detection - 3 ways in an adult:

  • Cr rise 26 in 48h
  • Cr rise 50% in 7d
  • UO drop to <0.5ml/kg/h (for >6h)

Mx:
1. Admission if infected kidney, no cause found, USS to r/o obstructive cause, etc

  1. Supportive
  2. Stop nephrotoxic drugs
  3. Monitor U&E, including K
  4. Optimise fluid balance
  5. May need renal replacement therapy
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11
Q

CKD

=; —> 2; Causes 4; Sx 7

A

= chronic loss of kidney function

Increased risk of —> CVD, as well as progression to end-stage renal failure

Many causes, eg:

  1. Old age
  2. HTN
  3. DM
  4. GN

Vague presentation:

  1. Malaise
  2. Tiredness
  3. Vomiting
  4. Ankle swelling
  5. Weakness
  6. Anorexia
  7. Dyspnoea
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12
Q

CKD - traditional staging

Stages 1 - 5; evidence of kidney damage 4

A
  1. Normal GFR with other evidence of chronic kidney damage
  2. GFR 60-89 with other evidence of chronic kidney damage
    3a. GFR 45-59
    3b. GFR 30-44
  3. GFR 15-29
  4. GFR <15

Evidence of kidney damage

  • Persistent microalbuminuria
  • Persistent proteinuria
  • Haematuria (after exclusion of other causes, e.g. bladder)
  • Structural abnormalities of the kidneys, e.g. on USS
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13
Q

CKD - GA staging

A

G 1-5 (same GFR as traditional staging)

A 1-3:

  1. ACR <3
  2. ACR 3-30
  3. ACR >30
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14
Q

GFR in CKD

A

Normal GFR is 125 in adult men/women

Low GFR —> repeat 12 hours later (meat free)

For Afro-Caribbean/African: eGFR x1.159

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15
Q

CKD

Ix 3; Mx 5

A

Blood changes in Ix:

  • U&E: High urea and Cr, low GFR
  • FBC: normocytic normochromic anaemia
  • Bone: low calcium/high PTH, phosphate, ALP

Mx:

  1. Treat cause
  2. Good BP control
  3. Nephrotoxic drugs - stop/reduce
  4. Monitor GFR
  5. RRT (renal replacement therapy)
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16
Q

CKD - when to refer

Main 3; total 9

A
  1. GFR <30
  2. GFR drop by 25% in a year (+ change in category)
  3. GFR drop by 15 in a year
  4. ACR 70 (unless diabetes)
  5. ACR w30 with haematuria
  6. Uncontrolled HTN
  7. Renal artery stenosis
  8. Genetic cause of renal disease
  9. Complications: anaemia, renal bone disease
17
Q

End-stage renal failure Mx

Dialysis 2; Renal transplant 3

A

DIALYSIS…

  1. Haemodialysis:
    Blood passed through external dialyser, substances pass out/in through artificial membrane.
    Problems may include vascular access and CV effects.
  2. Peritoneal dialysis:
    Pt’s own peritoneum used as membrane.
    Dialysate fluid passed into abdominal cavity for filtration, removed again 6-8 hours later.
    Problems may include leakage, peritonitis, electrolyte imbalance.

RENAL TRANSPLANT

  • Living or cadaver
  • Immunosuppressant therapy needed afterwards
  • Monitor for rejection, may need re-dialysis

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