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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
Q

Define haemodialysis

A

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

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26
Q

Complications of AV fistula

A

Aneurysm
Infection
Stenosis
STEAL syndrome
High output heart failure

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27
Q

Define nephritis

A

Generic term for inflammation of the kidneys

28
Q

Define nephritic syndrome

A

Group of symptoms that fit a clinical picture of having inflammation of their kidney.m

29
Q

Features of nephritic syndrome

A

Haematuria - micro or macro
Oliguria - reduced output
Proteinuria
Fluid retention

30
Q

Define nephrotic syndrome

A

A group of symptoms that indicate an underlying disease

31
Q

Features of nephrotic syndrome

A

Peripheral oedema
Proteinuria
Serum albumin
Hypercholesterolaemia

32
Q

Define glomerulonephritis

A

Umbrella term for conditions that cause inflammation of or around the glomerulus and nephron

33
Q

Define interstitial nephritis

A

Describes the situation where there is inflammation of the space between cells and tubules (interstitium).

34
Q

Define glomerulosclerosis

A

A pathological process of scaring of the tissue in the glomerulus - not a diagnosis but describes the dammage

35
Q

Examples of glomerulonephritis

A

Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
IgA nephropathy - Berger’s disease
Post streptococcal glomerulonephritis
Mesangiocapillary glomerulonephritis
Rapidly progressive glomerulonephritis
Goodpasture syndrome

36
Q

Generic management of most glomerulonephritis’s

A

Immunosuppression - steroids
Blood pressure control

37
Q

Classic presentation of nephrotic syndrome

A

Oedema
Frothy urine - proteinuria
(Thrombosis, HTN, high cholesterol)

38
Q

Define diabetic nephropathy

A

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
Q

Management of diabetic nephropathy

A

Oprimise blood sugars
ACE inhibitors for HTN control

40
Q

Presentation of acute interstitial nephritis

A

AKI and hypertension
Acute inflammation of tubules and iterstitium
Rash
Fever
Eosinophilia
Hypersensitivity reaction to NSAIDs or infection

41
Q

Define acute tubular necrosis

A

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
Q

Causes of acute tubular necrosis

A

Ischaemia
Shock
Sepsis
Dehydration

Damage
Radiology contrast
Gentamycin
NSAIDs

43
Q

Urinalysis of acute tubular necrosis

A

Muddy brown casts
Renal tubular epithelial cells

44
Q

Management of acute tubular necrosis

A

Supportive
IV fluids
Stop nephrotoxic
Treat complication

45
Q

Define renal tubular acidosis

A

Metabolic acidosis due to pathology in the tubules of the kidney

46
Q

Main types of renal tubular acidosis

A

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
Q

Management of renal tubular acidosis

A

Type 1 + 2 + 3 - bicarbonate
Type 4 - fludrocortisone, bicarbonate and manage hyperkalaemia

48
Q

Define haemolytic Uraemic syndrome

A

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
Q

What is the triad of haemolytic uraemic anaemia

A

Haemolytic anaemia
AKI
Low platelets

50
Q

Classic presentation of HUS

A

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
Q

Management of haemolytic uraemic syndrome

A

Medical emergency!
Antihypertensive
Blood transfusion
Dialysis

52
Q

Define rhabdomyolysis

A

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
Q

Causes of rhabdomyolysis

A

Prolonged immobility - fall with long lie
Extremely rigorous exercise
Crush injuries
Seizures

54
Q

Clinical signs of rhabdomyolysis

A

Muscle aches and pains
Oedema
Fatigue
Confusion
Red-brown urine

55
Q

Investigations in rhabdomyolysis

A

Cratinine kinae
Myoglobinurea
UE! - Hyperkalaemia
ECG

56
Q

Management of rhabdomyolysis

A

IV fluids!
Sodium bicarbonate - Raise urine pH and reduce toxicity of myoglobin on kidneys
MAnnitol - increase GFR
Manage complications - hyperkalaemia

57
Q

Define hyperkalaemia

A

Raised serum potassium

58
Q

Causes of hyperkalaemia

A

AKI
CKD
Rhabdomyolysis
Tumour lysis syndrome

Aldosterone antagonists
ACE inhibitors
Angiotensis II receptor blockers
NSAIDs
Potassium supplement

59
Q

Signs of hyper kalaemia on ECG

A

Tall tented T waves
Flat or absent P wave
Broard QRS

60
Q

Signs of hypo kalaemia on ECG

A

Flat or inverted T waves
Increased P wave amplitude
Narrow QRS
Prolonged QT

61
Q

Management of hyperkalaemia

A

IV calcium gluconate
Insulin and dextrose

Neb salbutamol
Calcium resonium
Sodium bicarbonate
Dialysis

62
Q

Define polycystic kidney disease

A

Both autosomal dominant and recessive types causing a condition where the kidnets develop multiple fluid filled cysts. Kidney function is significantly impaired

63
Q

Investigations in polycystic kidney disease

A

Ultrasound
Genetic testing
Renal function monitoring

64
Q

Extra-renal manifestations of polycystic kidney disease

A

Cerebral aneurysms
Hepatic, splenic, pancreatic, ovarian and prostatic cysts
Cardiac valve disease - mitral regurgitation
Colonic diverticula
Aortic root dilatation

65
Q

Complications of polycystic kidney disease

A

Chronic loin pain
HTN
CVD
Gross haematuria - cyst rupture, resolves in few days
Renal stones
End-stage renal failure

66
Q

Management of PCKD

A

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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