Renal Flashcards
Define acute kidney injury
An acute drop in the function of the kidney - diagnosed by measuring serum creatinine.
Criteria for AKI
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
Risk factors for AKI
CKD
HF
Diabetes
Liver disease
Older age
Cognitive impairment
Nephrotoxic medication - NSAIDs, ACEi
Contrast medium
Pre-renal causes of AKI
Inadequate blood supply
Dehydration
Hypotension
HF
Renal causes of AKI
Intrinsic disease in the kidney
Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis
Post renal causes of AKI
Obstruction to the outflow of urine causing back pressure on kidney
Stones
Masses - cancer
Ureter or uretral strictures
Enlarged prostate
Investigations in AKI
Urinalysis
Leucocytes and nitrites - infection
Protein and blood - acute nephritis
Glucose - diabetes
US - look for obstruction, CTKUB
Management of AKI
Fluid rehydration
Stop nephrotoxic meds
Relieve obstruction
Complications of AKI
Hyperkalaemia
Fluid overload
Metabolic acidosis
Uraemia
Define chronic kidney disease
Describes the chronic reduction in kidney function - tends to be permanent and progressive
Causes of CKD
Diabetes
Hypertension
Age related
Glomerulonephritis
Polycystic kidney disease
Meds - NSAIDs, PPIs, Lithium
Risk factors for CKD
Age
HTN
Diabetes
Smoking
Nephrotoxic meds
Clinical signs of CKD
Pruritus
Loss of appetite
Nausea
Oedema
Muscle cramps
Peripheral neuropathy
Pallor
Hypertension
Investigations in CKD
eGFR
Proteinuria - urine albumin : creatinine ratio
Haematuria
Ultrasound
Stages of CKD G sreco
G score - eGFR
G1 - >90
G2 - >60
G3a - >45
G3b - >30
G4 - >15
G5 - <15
Stages of CKD A score
A score - Albumin : creatinine ratio
A1 - <3
A2 - 3 - 30
A3 - >30
Complications of CKD
Anaemia
Renal bone disease
Cardiovascular disease
Dialysis related
Management of CKD
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
Define dialysis
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
Indications for acute dialysis
AEIOU
Acidosis - sever and not responding
Electrolyte abnormalities - severe and unresponsive hyperkalaemia
Intoxication - overdose of
Uraemia symptoms - seizure, reduced consciousness
Indications for long term dialysis
End stage renal failure - CKD stage 5
Any acute indication continuing long term
Main types of dialysis
Continuous ambulatory peritoneal dialysis
Automated peritoneal dialysis
Haemodialysis
Define peritoneal dialysis
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
Complications of peritoneal dialysis
Bacterial peritonitis
Peritoneal sclerosis
Ultrafiltration failure
Weight gain
Psychosocial effects
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
Complications of AV fistula
Aneurysm
Infection
Stenosis
STEAL syndrome
High output heart failure
Define nephritis
Generic term for inflammation of the kidneys
Define nephritic syndrome
Group of symptoms that fit a clinical picture of having inflammation of their kidney.m
Features of nephritic syndrome
Haematuria - micro or macro
Oliguria - reduced output
Proteinuria
Fluid retention
Define nephrotic syndrome
A group of symptoms that indicate an underlying disease
Features of nephrotic syndrome
Peripheral oedema
Proteinuria
Serum albumin
Hypercholesterolaemia
Define glomerulonephritis
Umbrella term for conditions that cause inflammation of or around the glomerulus and nephron
Define interstitial nephritis
Describes the situation where there is inflammation of the space between cells and tubules (interstitium).
Define glomerulosclerosis
A pathological process of scaring of the tissue in the glomerulus - not a diagnosis but describes the dammage
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
Generic management of most glomerulonephritis’s
Immunosuppression - steroids
Blood pressure control
Classic presentation of nephrotic syndrome
Oedema
Frothy urine - proteinuria
(Thrombosis, HTN, high cholesterol)
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
Management of diabetic nephropathy
Oprimise blood sugars
ACE inhibitors for HTN control
Presentation of acute interstitial nephritis
AKI and hypertension
Acute inflammation of tubules and iterstitium
Rash
Fever
Eosinophilia
Hypersensitivity reaction to NSAIDs or infection
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)
Causes of acute tubular necrosis
Ischaemia
Shock
Sepsis
Dehydration
Damage
Radiology contrast
Gentamycin
NSAIDs
Urinalysis of acute tubular necrosis
Muddy brown casts
Renal tubular epithelial cells
Management of acute tubular necrosis
Supportive
IV fluids
Stop nephrotoxic
Treat complication
Define renal tubular acidosis
Metabolic acidosis due to pathology in the tubules of the kidney
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)
Management of renal tubular acidosis
Type 1 + 2 + 3 - bicarbonate
Type 4 - fludrocortisone, bicarbonate and manage hyperkalaemia
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
What is the triad of haemolytic uraemic anaemia
Haemolytic anaemia
AKI
Low platelets
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
Management of haemolytic uraemic syndrome
Medical emergency!
Antihypertensive
Blood transfusion
Dialysis
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
Causes of rhabdomyolysis
Prolonged immobility - fall with long lie
Extremely rigorous exercise
Crush injuries
Seizures
Clinical signs of rhabdomyolysis
Muscle aches and pains
Oedema
Fatigue
Confusion
Red-brown urine
Investigations in rhabdomyolysis
Cratinine kinae
Myoglobinurea
UE! - Hyperkalaemia
ECG
Management of rhabdomyolysis
IV fluids!
Sodium bicarbonate - Raise urine pH and reduce toxicity of myoglobin on kidneys
MAnnitol - increase GFR
Manage complications - hyperkalaemia
Define hyperkalaemia
Raised serum potassium
Causes of hyperkalaemia
AKI
CKD
Rhabdomyolysis
Tumour lysis syndrome
Aldosterone antagonists
ACE inhibitors
Angiotensis II receptor blockers
NSAIDs
Potassium supplement
Signs of hyper kalaemia on ECG
Tall tented T waves
Flat or absent P wave
Broard QRS
Signs of hypo kalaemia on ECG
Flat or inverted T waves
Increased P wave amplitude
Narrow QRS
Prolonged QT
Management of hyperkalaemia
IV calcium gluconate
Insulin and dextrose
Neb salbutamol
Calcium resonium
Sodium bicarbonate
Dialysis
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
Investigations in polycystic kidney disease
Ultrasound
Genetic testing
Renal function monitoring
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
Complications of polycystic kidney disease
Chronic loin pain
HTN
CVD
Gross haematuria - cyst rupture, resolves in few days
Renal stones
End-stage renal failure
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
