Renal Flashcards
raised anion gap metabolic acidosis suggests…
Salicyclate poisoning
Patients receiving large volumes of NaCl solution are at increased risk of which metabolic derangement?
Hyperchloraemic metabolic acidosis
What is the recommended maintenance fluid requirement per day?
25-30 ml/kg/day
What is the normal expected urine output?
0.5ml/kg/hr
Give common symptoms of CKD.
Fatigue, itch, N&V, oedema
What is the main cause of death in CKD?
Cardiovascular disease
How can you predict the risk of a patient developing ESRD?
Kidney Failure Risk Equation
What are the top 3 causes of CKD?
Diabetes, Hypertension, PKD
What are the mainstays of CKD treatment?
BP management, reducing CV risk, managing complications
What are the BP targets in CKD?
< 140/90 in CKD ACR < 70
< 130/80 in CKD + Diabetes or ACR > 70
How should CV risk be managed in CKD?
Atorvastatin 20mg
What is the Hb target in CKD?
100 - 120
How should renal anaemia be managed in CKD?
Replace Iron/B12/Folate then give EPO if still anaemic
What dietary advice should be given in CKD?
K+ restriction → vegetables, potatoes, chocolate, crisps
Diary restriction → milk, cheese, eggs are high in phosphate
What are the options in ESRD?
Supportive
Haemodialysis/ Peritoneal dialysis
Kidney transplantation
What are the options in ESRD?
Supportive
Haemodialysis/ Peritoneal dialysis
Kidney transplantation
Which medications are usually given after kidney transplantation?
tri-therapy of steroid, calcineurin inhibitor (eg. tacrolimus), anti-proliferative (eg. mycophenolate)
How can you differentiate between AKI and CKD?
CKD - readings should be taken at least 90 days apart
On USS, kidneys will likely be normal in AKI but small & scarred in CKD
What is meant by a stage 1 AKI?
Cr 1.5-1.9 times baseline or < 0.5mls/kg/hr for 6-12 hours
What is meant by a stage 2 AKI?
Cr 2-2.9 times baseline or < 0.5mls/kg/hr for > 12 hours
What is meant by a stage 3 AKI?
Cr > 3 times baseline or < 0.3mls/kg/hr > 24 hours or anuric > 12 hours
What are the 3 main groups of causes of AKI?
Pre-renal, renal, post-renal
Give pre-renal causes of AKI.
Usually due to hypotension - volume loss or redistribution eg. haemorrhage, vomiting, sepsis or decreased cardiac output
Give renal causes of AKI.
Acute tubular necrosis, Acute interstitial nephritis, vasculitis, GN, myeloma, coagulopathy
How can you test for renal AKI?
Urinalysis
Give post-renal causes of AKI.
Obstruction of the urinary tract or a major vessel
What investigation should be used if considering post-renal causes of AKI?
USS
What is the management of AKI?
Mainly supportive (fluids, K monitoring, stop nephrotoxics) and identify cause
Give indications for urgent dialysis.
Resistant hyperkalaemia
Pulmonary oedema
Uraemic pericarditis
Severe acidosis
White cell casts in urine suggest…
Acute interstitial nephritis
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis (FSGS) or membranous glomerulopathy
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
‘Muddy brown casts’ in urine suggests…
Acute tubular necrosis
What is Alport Syndrome?
X-linked dominant disease - progressive renal failure, SNHL and retinitis pigmentosa
What is the most common viral infection in solid organ transplant recipients?
CMV
Nephritic syndrome days after UTRI suggests…
IgA nephropathy
Which type of GN does not respond to steroids?
FSGS
Nephritic syndrome weeks after URTI suggests…
Post-streptococcal GN
Give differentials of crescenteric GN.
GPA, EGPA, Goodpasture’s syndrome
Which metabolic derangement may result from excess of NaCl fluid?
Hyperchloraemic acidosis
Which ECG finding is suggestive of hypocalcaemia?
Prolonged QT interval
Which ECG finding is suggestive of hypercalcaemia?
Short QT interval
Vasculitis + collapse of nasal bridge suggests…
GPA
Nephrotic syndrome + malignancy suggests…
Membranous nephropathy
CKD with large kidneys suggests…
HIV nephropathy
What is the prognosis for HSP with renal involvement?
2/3 make full recovery
What is the treatment for HUS?
Supportive
