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Med Finals - Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Define acute kidney injury

A

An acute drop in the function of the kidney - diagnosed by measuring serum creatinine.

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2
Q

Criteria for AKI

A

Rise in creatinine of >25 micromonl/L in 48 hours
Rise in creatinine >50% in 7 days
Urine output <0.5ml/kg/hour for >6 hours

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3
Q

Risk factors for AKI

A

CKD
HF
Diabetes
Liver disease
Older age
Cognitive impairment
Nephrotoxic medication - NSAIDs, ACEi
Contrast medium

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4
Q

Pre-renal causes of AKI

A

Inadequate blood supply
Dehydration
Hypotension
HF

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5
Q

Renal causes of AKI

A

Intrinsic disease in the kidney
Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis

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6
Q

Post renal causes of AKI

A

Obstruction to the outflow of urine causing back pressure on kidney
Stones
Masses - cancer
Ureter or uretral strictures
Enlarged prostate

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7
Q

Investigations in AKI

A

Urinalysis
Leucocytes and nitrites - infection
Protein and blood - acute nephritis
Glucose - diabetes
US - look for obstruction, CTKUB

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8
Q

Management of AKI

A

Fluid rehydration
Stop nephrotoxic meds
Relieve obstruction

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9
Q

Complications of AKI

A

Hyperkalaemia
Fluid overload
Metabolic acidosis
Uraemia

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10
Q

Define chronic kidney disease

A

Describes the chronic reduction in kidney function - tends to be permanent and progressive

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11
Q

Causes of CKD

A

Diabetes
Hypertension
Age related
Glomerulonephritis
Polycystic kidney disease
Meds - NSAIDs, PPIs, Lithium

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12
Q

Risk factors for CKD

A

Age
HTN
Diabetes
Smoking
Nephrotoxic meds

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13
Q

Clinical signs of CKD

A

Pruritus
Loss of appetite
Nausea
Oedema
Muscle cramps
Peripheral neuropathy
Pallor
Hypertension

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14
Q

Investigations in CKD

A

eGFR
Proteinuria - urine albumin : creatinine ratio
Haematuria
Ultrasound

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15
Q

Stages of CKD G sreco

A

G score - eGFR
G1 - >90
G2 - >60
G3a - >45
G3b - >30
G4 - >15
G5 - <15

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16
Q

Stages of CKD A score

A

A score - Albumin : creatinine ratio
A1 - <3
A2 - 3 - 30
A3 - >30

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17
Q

Complications of CKD

A

Anaemia
Renal bone disease
Cardiovascular disease
Dialysis related

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18
Q

Management of CKD

A

Aims:
Slow progression - optimise diabetes and HTN, treat glomerulonephritis
Reduce risk of CVD - Exercise, weight, smoking
Reduce risk of complication - Diet, water, atorvastatin
Treat complication - Sodium, iron, vit D, dialysis, transplant

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19
Q

Define dialysis

A

Method of performin 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

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20
Q

Indications for acute dialysis

A

AEIOU
Acidosis - sever and not responding
Electrolyte abnormalities - severe and unresponsive hyperkalaemia
Intoxication - overdose of
Uraemia symptoms - seizure, reduced consciousness

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21
Q

Indications for long term dialysis

A

End stage renal failure - CKD stage 5
Any acute indication continuing long term

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22
Q

Main types of dialysis

A

Continuous ambulatory peritoneal dialysis
Automated peritoneal dialysis
Haemodialysis

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23
Q

Define peritoneal dialysis

A

Uses peritoneal membrane as filtration membrane.
Dialysis solution added to peritoneal cavity
Filtration occurs from the blood into the dialysis solution which is then replace.
Requires permanent tenckhoff catheter into peritoneal cavity
Continuous - happens constantly
Automated - occurs overnight

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24
Q

Complications of peritoneal dialysis

A

Bacterial peritonitis
Peritoneal sclerosis
Ultrafiltration failure
Weight gain
Psychosocial effects

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25
Define haemodialysis
Blood filtered by machine - 4 hours a day for 3 days a week. Good blood supply required so have a tunnelled cuffed catheter or AV fistula
26
Complications of AV fistula
Aneurysm Infection Stenosis STEAL syndrome High output heart failure
27
Define nephritis
Generic term for inflammation of the kidneys
28
Define nephritic syndrome
Group of symptoms that fit a clinical picture of having inflammation of their kidney.m
29
Features of nephritic syndrome
Haematuria - micro or macro Oliguria - reduced output Proteinuria Fluid retention
30
Define nephrotic syndrome
A group of symptoms that indicate an underlying disease
31
Features of nephrotic syndrome
Peripheral oedema Proteinuria Serum albumin Hypercholesterolaemia
32
Define glomerulonephritis
Umbrella term for conditions that cause inflammation of or around the glomerulus and nephron
33
Define interstitial nephritis
Describes the situation where there is inflammation of the space between cells and tubules (interstitium).
34
Define glomerulosclerosis
A pathological process of scaring of the tissue in the glomerulus - not a diagnosis but describes the dammage
35
Examples of glomerulonephritis
Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis IgA nephropathy - Berger's disease Post streptococcal glomerulonephritis Mesangiocapillary glomerulonephritis Rapidly progressive glomerulonephritis Goodpasture syndrome
36
Generic management of most glomerulonephritis's
Immunosuppression - steroids Blood pressure control
37
Classic presentation of nephrotic syndrome
Oedema Frothy urine - proteinuria (Thrombosis, HTN, high cholesterol)
38
Define diabetic nephropathy
Most common cause of glomerular pathology and CKD in the UK. High levels of glucose passing through the glomerulus causes scarring - leads to proteinuria identified on albumin creatinine ratio
39
Management of diabetic nephropathy
Oprimise blood sugars ACE inhibitors for HTN control
40
Presentation of acute interstitial nephritis
AKI and hypertension Acute inflammation of tubules and iterstitium Rash Fever Eosinophilia Hypersensitivity reaction to NSAIDs or infection
41
Define acute tubular necrosis
Damage and death of the epithelial cells of the renal tubules caused by ischaemia or toxins.. Most common form of AKI. This is a reversible disease as the epithelial cells can regenerate (7-21 days)
42
Causes of acute tubular necrosis
Ischaemia Shock Sepsis Dehydration Damage Radiology contrast Gentamycin NSAIDs
43
Urinalysis of acute tubular necrosis
Muddy brown casts Renal tubular epithelial cells
44
Management of acute tubular necrosis
Supportive IV fluids Stop nephrotoxic Treat complication
45
Define renal tubular acidosis
Metabolic acidosis due to pathology in the tubules of the kidney
46
Main types of renal tubular acidosis
Type 1 - Unable to excrete hydrogen from distal tubule Type 2 - Unable to reabsorb bicarbonate in proximal tubule Type 3 - mix of type 1 and 2 (very uncommon) Type 4 - Reduced aldosterone (most common)
47
Management of renal tubular acidosis
Type 1 + 2 + 3 - bicarbonate Type 4 - fludrocortisone, bicarbonate and manage hyperkalaemia
48
Define haemolytic Uraemic syndrome
Occurs when there is a thrombosis in small blood vessels through out the body - often triggered by shiga toxin - type of e.coli Thrombosis causes low platelets, chops up RBCs and decreases blood flow to kidneys Triad of haemolytic anaemia, AKI and low platelets
49
What is the triad of haemolytic uraemic anaemia
Haemolytic anaemia AKI Low platelets
50
Classic presentation of HUS
Brief gastro enteritis with bloody diarrhoea Around 5 days later - HUS Reduced urine output Haematuria or dark brown urine Abdo pain Lethargy Confusion Hypertension Bruising
51
Management of haemolytic uraemic syndrome
Medical emergency! Antihypertensive Blood transfusion Dialysis
52
Define rhabdomyolysis
Condition where skeletal muscle breaks down and releases breakdown products into blood. Caused by extreme underuse or overuse and traumatic injury - fall with long lie
53
Causes of rhabdomyolysis
Prolonged immobility - fall with long lie Extremely rigorous exercise Crush injuries Seizures
54
Clinical signs of rhabdomyolysis
Muscle aches and pains Oedema Fatigue Confusion Red-brown urine
55
Investigations in rhabdomyolysis
Cratinine kinae Myoglobinurea UE! - Hyperkalaemia ECG
56
Management of rhabdomyolysis
IV fluids! Sodium bicarbonate - Raise urine pH and reduce toxicity of myoglobin on kidneys MAnnitol - increase GFR Manage complications - hyperkalaemia
57
Define hyperkalaemia
Raised serum potassium
58
Causes of hyperkalaemia
AKI CKD Rhabdomyolysis Tumour lysis syndrome Aldosterone antagonists ACE inhibitors Angiotensis II receptor blockers NSAIDs Potassium supplement
59
Signs of hyper kalaemia on ECG
Tall tented T waves Flat or absent P wave Broard QRS
60
Signs of hypo kalaemia on ECG
Flat or inverted T waves Increased P wave amplitude Narrow QRS Prolonged QT
61
Management of hyperkalaemia
IV calcium gluconate Insulin and dextrose Neb salbutamol Calcium resonium Sodium bicarbonate Dialysis
62
Define polycystic kidney disease
Both autosomal dominant and recessive types causing a condition where the kidnets develop multiple fluid filled cysts. Kidney function is significantly impaired
63
Investigations in polycystic kidney disease
Ultrasound Genetic testing Renal function monitoring
64
Extra-renal manifestations of polycystic kidney disease
Cerebral aneurysms Hepatic, splenic, pancreatic, ovarian and prostatic cysts Cardiac valve disease - mitral regurgitation Colonic diverticula Aortic root dilatation
65
Complications of polycystic kidney disease
Chronic loin pain HTN CVD Gross haematuria - cyst rupture, resolves in few days Renal stones End-stage renal failure
66
Management of PCKD
Tolvaptan - vasopressin receptor antagonist, slows development of cysts and progression of renal failure Supportive management of complications Genetic counselling Avoid contact sports Avoid anti-inflammatorys and anticoaglants

Med Finals - Medicine (10 decks)

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