Renal Flashcards
Indication of dialysis
 Acidosis
Electrolyte abnormalities
Intoxication’s
Volume overload
Uremic symptoms
Toxins that causes an intrinsic renal failure
NSAIDs
Cisplatin chemotherapy
Amphotricine
Cyclosporine
Dialyzable substances (slime)
aspirin
Lithium
Isopropyl alcohol
Magnesium laxatives
Ethylene glycol
When to give renal replacement therapy
GFR<5ml/min
GFR 5-15ml/min with aeiou specialty hyperkalemia, and volume overload
Complications of chronic kidney disease
Anemia
Growth failure in children
Dyslipidemia
Bleeding
Infections(abnormal, neutrophil function)
Sexual dysfunction (erectile dysfunction, an ovulation )
Abnormal calcium and phosphate leads to secondary and tertiary hyperparathyroidism
Renal osteodystrophy
Ostitis fibrosa cystica ( from untreated, severe high PTH levels, bone cysts, brown tumors)
So we give phosphate binders
Phosphate binders
They bind phosphates in G.I. tract to decrease serum phosphate
Calcium carbonate
calcium acetate (phoslo)
Sevelamer(renagel)
Lanthanum
Drugs that worsen renal function
Loop thiazide
K sparing diuretics
ACE I
NSAID
Contrast
Calciphylaxis calcific, uremic arteropathy
Seen in chronic hyper phosphatemia in chronic kidney disease
Life-threatening complications of chronic kidney disease
Hyperkalemia
Pulmonary edema
Infections .
Advantages of hemodialysis
More efficient than peritoneal dialysis
High flow rates and efficient dialyzer shorten the period of time required for dialysis
can be initiated more quickly than peritoneal dialysis
Disadvantages of hemodialysis
Less similar to the physiology of natural kidney function
Hypotension
Hypo omolarity
requires vascular access
Advantages and disadvantages of peritoneal dialysis
Advantages :1mimics the physiology of normal kidney. 2.The patient can learn to perform dialysis on his own.
Disadvantages,
high glucose load
peritonitis
the patient must be highly motivated to self, administer it
cosmetics
Complications associated with hemodialysis
Hypotension
hypo osmolality
Hemolysis
Complications associated anticoagulation, hemorrhaged hematoma
Hemodialysis associated amyloidosis
first use syndrome (chest pain ,back pain)
Infection of vascular access 
Complications associated with peritoneal dialysis
Peritonitis,
inguinal, hernia,
hyperglycemia,
protein malnutrition
Nephrotic syndrome remission
No edema urine is proteins for 5 constitutive days
Relapse nephrotic
Syndrome
Edema or first moved in urine sample contains more than 2+ protein for 7constitutive days
Frequent relapsing nephrotic syndrome
More than two relapses within six months
Kidney biopsy considered in
Secondary nephrotic syndrome
child >10
Nephritic and any minimal change with resistance to steroid
Frequent relapsing
Hypertension
Low GFR /RPGN
Went to admit patients to hospital
A new case
Biopsy
Anasarca
Complications
Uremia and blood testing
• Renal dysfunction -> bleeding
• Poor aggregation and adhesion of platelets
• Caused by uremic toxins in plasma
• Uremic platelets work normally in normal serum
• Prolonged bleeding time
* Normal platelet count
• Normal coagulation testing
PT, PT
How to treat pt nephrotic with edema and hyperkalemia
- Lazix diuretics
2.Ventoline nebulizer shifts K inside cell
3.Calcium and insulin as well - Calcium glucanate
5 . Calcium resonium ,na resonium - Dialysis
acute intersitial nephritis
Clinical features:
Answer
1) Symptoms of intrinsic
acute kidney injury ( weight
gain ,edema ‚no urine
output)
2) symptoms of
allergic reactions: rash,
fever, eosinophilia
3) Pyuria & hematuria
acute interstitial nephritis
Inflammation of the interstituim, makes up 10 to 15% of acute kidney injury. - causes:
1)Allergic drug reactionsis the most common cause (sulfa, penicilins)
2) Infections (especially in children ) including strep, and legionella
3)Collagen vascular disease: sarcoidosis
4) autoimmune disease: SLE
causes of nephrotic syndrome
1) Primary: membranes
nephropathy most
common in adults,
FSGS ,Membrinoproliferative
GN, minimal change disease
most common in children
2) Secondary: systemic
disease such as SLE,
collagen vascular disease
HSP, PAN Amyloidosis,
cryoglobulinemia ,drugs and toxins, infection
Causes of Chronic kidney
disease
1) DM is the most common
cause
2) HTN (25%)
Causes of Elevated BUN:
1) Steroids
2) Gl/Soft tissue bleeding
3) High dietery protien intake
causes of renal papillary necrosis
POSTCARDS Pyelonephritis, obstruction, sickle cell disease tuberculosis cir rhosis analgesics, renal vein thrombosis ,diabetes, systemic vasculitis.
Clinical features of Chronic kidney disease:
1) CVS ( CHF, HTN, pericardits)
2) GI (uremia causes N/V)
3) CNS (restless leg, hypocalcemia
– tetany)
4) Hematological (Normocytic, normochromic anemia + platelet dysfunction due to uremia)
5) Endocrine ( 2ndry & 3 hyperparathyroidism,
Sexual dysfunction due to hypothalemic pitutary disturbance, pruritis)
6) Fluid & electrolyte (high K, P+,Mg, low Ca
Condition of hematuria
Defined as more than three erythrocytes HPF on urinalysis
Definition of proteinuria
Urinary excretion of more than 150 mg per day or more than 3.5 grams per day
Dialyzable substances:
(SLIME )
1) Salicylates
2)Lithuim
3) Isopropyl alcohol
4) magnesuim laxatives
5)Ethylene glycol
Effects of uremia:
1) platelet dysfunction
2) immune dysfunction
3) percarditis
4) encephalopathy
Electrolyte distrubance in AKI
1) Anion gap metabolic
acidosis
2) Hyperkalemia
(3) hypocalcemia
4)Hyperuricemia
5)hyperphosphatemia
6)Hyopnatremia if patient has fluid overload, hypernatremia if patient is hypovolemic.
FSGS
Nephrotic syndrome in
Black ppl. - Associated with
HT, & hematuria - Poor prognosis, resisistant to Steroids therapy - High reccurence rate after transplant
FSGS risk factors:
1) genetic 2) obesity 3)
drugs: Bisphosphonates
Goodpasture syndrome
Antibodies against Type
4 collagen in basement membrane of lungs and kidneys. - presents with proliferative GN usually cresentric, pulmonary hemorrhage, and IgG antibodies on basement membrane
Goodpasture syndrome
Microscopic findings
On light microscopy
Crescent on biopsy - linear immunofluorescence pattern
Herditary nephritis (Alport)
Collagen defect X-linked or Autosomal dominant
- presents with high frequency hearing loss, renal failure (features of pyuria, hematuria)
Herditary nephritis (Alport)
features on histology:
- basket weaving - Foamy tubular cells - GBM thickening or thinning
IgA nephropathy (berger disease)
- Most common cause of GROSS glomerular hematuria. - develops 1-3 days after URI
IgA nephropathy (berger disease on microscopy)
IgA & C3 depositis in mesanglum
Indications for urgent dialysis:
AEIOU Mnemonic ( refractory cases of) 1) Acidosis 2)
Electrolyte disturbance 3)
Intoxication with dialyzable substance 4) fluid overload
5) Uremia
Key features of nephrotic syndrome
1) protienuria 2)
hypoalbuminemia 3) edema
4) dyslipidemia, increased LDL and VLDL 5) increased risk of infection due to loss of immunoglobulins 6) increased hypercoagulability due to loss of anticoagulants
Lupus nephropathy histological feature:
Full house staining IgA,M
&G + C3 & 4
Membranoproliferative GN
Risk factors: (Hep. C & B, syphilis & lupus)
- Poor prognosis renal failure develops and
50% of patients. -
Common association with cryoglobuinemia - histological features tram track appearance AKA double contour
Membranous glomerulonephritis
- Most common cause of nephrotic syndrome in non-diabetic adults. -
Thickening of glomerual capillary walls - Survival rate
NOT changed by steroid therapy
membranous glomerulonephritis 1/3rd rule:
1/3 spontaneously recover
1/3 recover with treatment
1/3 progress to renal failure
minimal Change disease minimal
Most common cause of nephrotic syndrome in children. associated with Hodgkin and
non-Hodgkin’slymphoma and NSAIDs.
Minimal change disease on microscopy
Light M.: no changes
Electron M: Fusion/ effecement of foot processes
Poststreptococcal GN
Most common cause of nephritic syndrome develops. about 10 to 14 days after an infection primarily affects children. - Antistreptolysin-0 & anti-DNAase B -
Subepithelial hump, no
C3 and C4 in blood & hight neutrophil count
Pre-renal failure causes
1) Hypovolemia
2)congestive heart failure, cardio renal syndrome
3) hypotension
4) renal artery obstruction
5) cirrhosis hepatorenal syndrome
6) drugs ace inhibitors ,NSAIDs, cyclosporine
proteinuria classifications
1) glomerular: due to increased permeability, protein loss is more severe is the most common form.
2) Tubular: small proteins fail to be the absorbed by tubules, protein loss is less severe causes include sickle cell disease and interstital nephritis
3) Overflow proteinuria:
examples Bence Jones in multiple myeloma, myoglobin in rhabdomyolysis
4) Other causes of proteinuria:
UTI, pregnancy, fever heavy exertion
Renal tubular acidosis
disorder of renal tubules which leads to Nonanion gap hyperchloremic metabolic acidosis with normal GFR. characterized by a decrease in hydrogen excretion in urine leading to academia and urine alkalosis
Risk factors of membranous Infections:
1)hep. B & C, glomerulonephritis:
malaria, syphilis)
2) Drugs: (sulfa, captopril, gold)
3)Malignancy
4) Lupus
Treatment of symptomatic proteinuria
1) Treat underlying cause
2) ACE inhibitors decrease urinary albumin loss
3) diuretics
4) Treat hypercholesterolemia
5)anticoagulant for thrombosis vaccination
Type four RT
Results from conditions that cause hypoaldosteronism or increased renal resistance to aldosterone. - Common in interstitial renal disease and diabetic nephropathy.
- Hyperkalemia and acidic urine renal stones are rare.
Type one renal tubular acidosis
-Caused by inability to secrete hydrogen at the distal tubule, pH of urine cannot be lowered lower than 6. - increased excretion of ions results in : 1) decreased ECF volume
2) hypokalemia
3) renal stones
4) rickets and osteomalacia
Treatment: correct acidosis with sodium bicarbonate administer phosphate salts
Type two RTA
Defect in inability to the absorb bicarbonate at the proximal tubules results in increased excretion of bicarb and urine and metabolic acidosis - lose potassium and sodium in urine results hypokalemic hyperchloremic non-anion gap metabolic acidosis - nephrolithiasis and nephrocalcinosis do not occur. treatment:
1)managing the underlying causes
2) sodium restriction will increase sodium resorption and bicarb resorption
What is increased in rhabdomyolysis
1) PK
2) K+
3)hyperureicemia
4)Hypocalcemia
What is the most common cause of death in acute kidney injury
1) Infection 75% of all deaths 2) cardio respiratory complication
What is the most common clinical finding in patients with AKI
Weight gain and edema
What is the most sensitive
and specific test for microalbuminuria
Radio immunoassay
What is the most useful test if oliguria is present
FENa ( can determine if drop if oliguria in urine production is due to intrinsic and pre-renal injury)
What protein is urine dip stick most sensitive to
Albumin this can lead to false negative results when predominant urinary protein is globulin( i.e. light chains in myloma)
Whats the ideal marker of
GFR clearance?
Insulin
