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finals > renal > Flashcards

renal Flashcards

1
Q

causes of AKI

A

pre renal - infection, hypotension, hypercalcaemia, drugs, heart failure, liver failure renal artery occlusion
renal - glomerulonephritis,CKD, nephrotoxics, rhabdomyolysis, myeloma, malignant HTN, autoimmune disease, haemolytic uraemic syndrome
post renal:
obstructive: blocked catheter, BPH, prostate ca, ureter strictures, clot, renal calculi
neuro: MC, cord compression, cauda equina, post-op retention

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2
Q

definition of aki

A

a rise in serum creatinine >25mmol over 48 hours or by 50% in 5 days
or
a reduction in urine output to less than 0.5ml/kg/hour for more than 6 hours

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3
Q

aki stage 1 criteria

A

1.5-2 x rise in creatinine

<0.5ml/kg/hr over 6 hours UO

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4
Q

aki stage 2 criteria

A

2-3 x rise in creatinine

<0.5ml/kg/hr over 12 hours UO

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5
Q

aki stage 3 criteria

A

creatinine over 350
or >3 x rise in creatinine
or anuria or <0.5ml/kg/hr for over 12 hours

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6
Q

4 complications of AKI

A
  1. hyperkalaemia
  2. metabolic acidosis
  3. uraemia
  4. fluid overload
  5. death + multi organ failure
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7
Q

diagnosis of AKI

A
  1. U+E and urine output
  2. history! pre renal: dehydration, hypoperfusion, infection
    renal: rashes, change in meds, weight loss, post-renal:urinary symptoms
  3. examination: BP,HR, temp, abdo, assess fluid status - overloaded or dehydrated?
  4. check meds and stop nephrotoxics
  5. investigate for cause:
    FBC + infection screen
    calcium - raised do myeloma screen
    CK for rhabdomyolysis
    VBG for metabolic acidosis
    CXR to look for fluid overload - fluid restrict
    urinalysis (+?immunology screen)
    USS KUB
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8
Q

ABCDE of AKI

A 
assess meds
boost bp
calculate fluid balance
dip urine
exclude obstruction
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9
Q

management of hyperkalameia

A

protect the heart: IV calcium gluconate 30ml 10%
10 units actrapid in 10% dextrose over 15 mins
can give salbutamol

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10
Q

raised calcium in AKI

A

do myeloma screen!

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11
Q

when is dialysis indicated in AKI

A

aki stage 3

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12
Q

when to call the med reg for AKI

A 
aki stage 3
hyperkalaemia
resistant oedema
renal transplant patient
underluing CKD stage 4/5
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13
Q

symptoms of uraemia

A 
nausea
itching
vomiting
fatigue
anorexia
muscle cramps
confusion
increased thirst
visual disturbance
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14
Q

drugs to stop in aki

A

nephrotoxics: acei, arb, gentamicin
renally excreted drugs: metformin, LMWH in stage 2+3
drugs that accumulate: opioids, digoxin, lithium
stop diuretics in dehydration
continue diuretics in fluid overload

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15
Q

CKD staging

A 
1 egfr >90
2 60-90
3a 45-59
3b 30-44
4 15-29
5 <15 (established renal failure - dialysis)
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16
Q

name 7 findings on blood results in CKD

A 
low egfr
high creatinine
high urea
low vit D 
high phosphate
low calcium
low Hb
high K+
metabolic acidosis
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17
Q

name 6 complications of CKD

A 
hypertension
fluid accumulation
osteoporosis
vitamin d deficient
anaemia
metabolic acidosis
hyperkalaemia
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18
Q

indications for dialysis

A

stage 5 ckd

or aki with uraemia symptoms, unresponsive to tx

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19
Q

what are the 2 types of dialysis and how do they work

A

peritoneal dialysis: catheter inserted into peritoneal space and dextrose fluid inserted into peritoneum and peritoneum acts as a filter either continuously or over night

haemodialysis - either with av fistula or with tunnelled catheter in subclavian or jugular veing +into right atrium

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20
Q

name 3 complications of peritoneal dialysis

A

weight gain from absorbing dextrose
bacterial peritonitis
peritoneal sclerosis
functional failure over time

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21
Q

name 4 complications of an AV fistula

A

aneurysm
infection
thrombosis
steel syndrome

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22
Q

how long does an AV fistula take to be ready to use

A

4 months

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23
Q

what 3 drugs are given post renal transplant

A

tacrolimus
mycophenolate
prednisolone
plus immunosuppression

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24
Q

where is renal transplant placed and which vessels are they anastamosed to

A

iliac fossa

internal iliac vessels

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25
Q

characteristics of nephritic syndrome

A

low urinary protein <3g
micro or macroscopic haematuria
oliguria (reduced urine output)
oedema

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26
Q

characteristics of nephrotic syndrome

A

high proteinuria >3g
low albumin
peripheral oedema!!
high cholesterol

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27
Q

management of igA nephropathy

A

acei and steroids

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28
Q

what is henoch schonlein purpura

A 
systemic variant of IgA nephropathy where IgA deposits in kidneys, skin, GI tract and joints causing...
nephritic glomerulonephritis
intermittent polyarthritis
GI bleeding
non blanching petechial rash on legs
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29
Q

presentation of henoch schonlein purpura

A

glomerulonephritis = haematuria, oedema, reduced urine output
intermittent joint pains
non blanching petechial rash

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30
Q

presentation of henoch schonlein purpura

A

glomerulonephritis = haematuria, oedema, reduced urine output
intermittent joint pains
non blanching petechial rash
abdo pain/ anaemia (GI bleeding)

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31
Q

how do you diagnose HSP

A

positive IgA and C3 in skin
IgA deposits on renal biopsy
usually just a clinical diagnosis

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32
Q

how do you manage HSP

A

Ace inhibitors and steroids

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33
Q

causes of nephritic syndrome

A

IgA nephropathy
HSP
post strep glomerulonephritis
goodpastures disease

34
Q

presentation of post strep glomerulonephritis

A

2 weeks after sore throat or skin infection with a group a beta haemolytic strep
strep deposits in glomerulus = inflammation = nephritis

mg = supportive and abx if active infection

35
Q

presentation of goodpastures disease

A

antibodies against type 4 collagen found in alveoli and glomerular membrane means you get a nephritis and aki and also pulmonary haemorrhage

so pt might present with haematuria, low urine output, high blood pressure, sob haemoptysis

36
Q

how do you manage goodpastures disease

A

renal: often need dialysis at presentation due to severe reduction in egfr, plasma exchange, steroids and cyclophosphamide
pulm: o2

37
Q

name the causes of nephrotic syndrome

A

primary renal:
minimal change disease (kids)
focal segmental glomerulosclerosis (adults)
membranous nephropathy

systemic: diabetic nephropathy, SLE, myeloma, amyloidosis, pre eclampsia

38
Q

pathophysiology of nephrotic syndrome

A

damaged or abnormal podocytes = larger membrane gaps = protein leakage

39
Q

management of nephrotic syndrome

A
  1. reduce oedema!!
    fluid and salt restriction, po/iv furosemide, daily weights with aim of 0.5-1kg weight loss daily,
  2. treat underlying cause:
  3. lower proteinurea with acei/arb
  4. VTE prophylaxis
  5. give pneumococcal vaccine bc increased infection risk due to immunoglobulins lost in urine
40
Q

why should you only lower weight loss (fluid) by 0.5-1kg per day in nephrotic syndrome

A

because a rapid decrease in extravascular volume could cause AKI

41
Q

how do you determine the cause of nephrotic syndrome

A

renal biopsy

42
Q

how do you treat minimal change disease

A

po prednisolone to induce remission at 1mg/kg for 4-16 weeks

if has a relapse give immunosuppression with cyclophosphamide

43
Q

how do you manage focal segmental glomerulosclerosis

A

reduce bp

steroids

44
Q

how does lupus nephritis present

A

lupus plus nephrotic sydrome
get autoantibodies deposited in kidneys
tests: ANA, anti-dsDNA, C3 and C4

45
Q

how do you manage diabetic nephropathy

A

aim Hba1c <53
reduce BP and give acei renal protection
statins
annual albumin:creatinine ratio screen

46
Q

how is lupus nephritis managed

A

high dose pred

cyclophosphamide / rituximab

47
Q

pathophysiology behind myeloma glomerulonephritis

A

light chains deposit in renal tubules causing obstruction and damage to glomerulus

48
Q

pathophysiology behind myeloma glomerulonephritis

A

light chains deposit in renal tubules causing obstruction and damage to glomerulus
causes proteinuria and hypercalcaemia

49
Q

what is haemolytic uraemic syndrome

A

haemolysis of red cells in the small vessels causes an AKI, glomerulonephritis with proteinuria or haematuria, and low platelets

50
Q

what are the 3 pillars of haemolytic uraemic syndrome

A

microangiographic haemolytic anaemia
aki with haematuria/proteinuria
low platelets

51
Q

name 2 causes of haemolytic uraemic syndrome

A

e.coli infection

pregnancy

52
Q

how do you manage haemolytic uraemic syndrome

A

supportive
plasma exchange
manage AKI
never give antibiotics as makes it worse

53
Q

how does haemolytic uraemic syndrome present

A

anaemia symptoms

aki symptoms

54
Q

how do you diagnose haemolytic uraemic syndrome

A

fbc: Hb<100, low platelets, may be raised WCC
u+e: AKI
blood film: schistocytes (fragmented cells from haemolysis)
do stool culture and PCR looking for evidence of shiga toxin producing e.coli

55
Q

how does thrombotic thrombocytopenic purpura present

A 
fever
microemboli in cerebral circulation = fluctuating neuro signs
headache
palsy
AKI from emboli in renal tract
low platelets
haemolytic anaemia
56
Q

how do you manage TTP

A

haematological emergency so contact on call reg
plasma exchange / infusion
steroids and rituximab for relapses

57
Q

name causes of TTP

A

pregnancy
post viral
SLE
drugs eg ciclosporin, COCP, anti virals

58
Q

what organism is associated with haemolytic uraemic syndrome

A

shiga toxin producing e.coli triggers an autoimmune response = HUS

59
Q

how is TTP different to HUS

A

both have aki, low platelets due to clumping and clotting, and a haemolytic anaemia but TTP has additional fever with fluctuating neuro signs due to emboli in cerebral circulation obstructing and then passing so may have headaches and palsys

60
Q

how does aldosterone work in the kidney

A

causes net reabsorption of sodium and excretion of potassium

61
Q

hypokalaemia
metabolic acidosis
high urinary pH
what is the cause

A

either type 1 or type 2 renal tubular acidosis

both genetic so generally present in younger kids

62
Q

what causes type 1 renal tubular acidosis and what do you find on investigation

A

genetic problem with H+ ATPase pump or H/K ATPase
caused by: SLE, sjorens, lithium, hyperthyroid, primary billiary sclerosis
inv: high urinary pH (bc not excreting acid) hypokalaemia, metabolic acidosis

63
Q

what causes type 2 renal tubular acidosis and what is found on investigation

A

genetic problem in proximal tubules meaning bicarb is unable to be re absorbed so high amounts of bicarb is excreted so cant neutralise H+ so get metabolic acidosis, hypokalaemia and high urinary pH

64
Q

what causes type 4 renal tubular acidosis and what would you find on investigation

A

caused by low aldosterone (ie adrenal insufficiency (addisons), spironolactone, SLE, diabetes
aldosterone normally causes reabsorption of water and sodium and excretion of potassium and hydrogen ions
so if aldosterone is low then potassium and hydrogen ions will be reabsorbed and sodium and water excreted

so therefore would get a hyperkalaemic metabolic acidosis, dehydration and a low (acidotic) urinary pH due to reduced ammonia production

65
Q

how do you manage type 4 renal tubular acidosis

A

fludrocortisone - to boost BP
sodium bicarb to correct acidosis
manage hyperkalaemia!!

66
Q

name 2 complications of UTI in pregnancy

A

preterm delivery

intrauterine growth restriction

67
Q

what is the first line management of pyelonephritis in pregnancy

A

cefalexin

68
Q

which antibiotics are first line in pyelonephritis

A

co-amox TDS for 7 days or ciprofloxacin BD 7 days

69
Q

cp of pyelonephritis

A 
fever
rigors
back pain
dysuris or recent cystitis
vomiting
white cell casts in urine
70
Q

what is the cause of pyelonephritis

A

ascending infection with e.coli

71
Q

what investigation should you do in pyelonephritis and when should you do it

A

MSU culture and sensitivity, do before giving abx

72
Q

what makes a UTI ‘complicated’

A 
recurring
pregnant
being male
non responsive to tx
atypical organism on culture
persistent haematuria
73
Q

difference in management of UTI in men and women

A

women 3 days

men 7 days

74
Q

causes of hydronephrosis

A

vesicoureteric reflux
urethral strictures
renal calculi
any form of obstruction eg bph

75
Q

what is vesicoureteric reflux and who is it more common in

A

more common in kids

when there is a structural abnormality that causes backflow of urine from the bladder to the kidneys

76
Q

complications of vesicoureteric reflux

A

recurrent uti
pyelonephritis
hydronephrosis
renal scarring –> HTN

77
Q

how do you diagnose vesicoureteric reflux

A

micturiating cystourethrogram

DMSA scan to look for renal scarring

78
Q

how do you investigate recurrent UTI

A

USS renal tract to look for abnormalities

79
Q

how does prostatitis present

A 
pain in rectum, pelvis, perineum, scrotum, penis, lower back
fever 
nausea and vomiting
dysuria, frequency, anuria
swollen tender prostate on PR
80
Q

how do you manage prostatitis

A

4 week course of po ciprofloxacin (better than trimethoprim or nitro bc penetrates seminal fluid better)

finals (18 decks)

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