renal Flashcards
what is stage 1 AKI
creatinine 1.5x of baseline and urine output is less than 0.5ml/kg in 6 hours
what is stage 2 AKI
creatinine 2x of baseline and urine output is less than 0.5ml/kg in 12 hours
what is stage 3 AKI
creatinine 3x of baseline and urine output is less than 0.5ml/kg in 24 hours
What are the pre-renal causes of AKI
shock: distributive, cardiogenic, hypovolaemic and renal artery stenosis
What are the renal causes of AKI
acute glomerulonephritis, interstitial nephritis
Post-renal causes of AKI
mural: tumours, luminal: stones and compression: BPH
Fractional excretion is normal
pre-renal cause of AKI
fractional excretion is elevated
renal cause of AKI
treatment for post renal AKI
catheterise
first line management for AKI
sit patient up and give furosemide and diamorphine
ECG findings for hypokalaemia
QT prolongation, PR prolongation, t wave inversion and st depression
ECG findings for hyperkalaemia
PR prolongation, small p waves and tall tented t waves, wide QRS complexes
which electrolyte abnormality can be caused by deep hypothermia
hypokalaemia
hypovolaemic, hyponatraemic and abnormal renal function tests
diarrhoea
pt in shock, hypernatraemic and needed ABCDE. resp compromise what is the maintenance
IV crystalloid bolus, if not enough give 2000ml of fluid resus
pt is shock, hypernatraemic but did not need ABCDE what is the maintenance
IV maintenance fluids
high potassium, with fist pumping, delayed analysis or excessive tourniquet use
pseudohyperkalaemia
treatment for hypokalaemia severe
IV potassium chloride and treat low magnesium and low glucose
treatment for hypokalaemia mild
oral release potassium
treatment for hyperkalaemia
10% calcium gluconate solution, 10ml over 10mins, insulin, salbutamol and glucose
Can you give potassium as a bolus dose
no it can cause arrythmias
patient presents with:
osteopenia, cardiovascular defects, oedema, electrolyte abnormalities, anaemia, leg restlessness and sensory neuropathy
chronic end stage kidney disease
patient with chronic kidney disease presents with egfr of 25
stage 4
patient with chronic kidney disease presents with egfr of 45
stage 3a
patient with chronic kidney disease presents with egfr of 69
stage 2
patient with chronic kidney disease presents with egfr of 78
stage 2
treatment for chronic kidney disease: oedema
fluid and salt restrict and furosemide
treatment for chronic kidney disease: hypocalcaemia
alphacalciferol
treatment for chronic kidney disease: hyperphosphatemia
selvemer
treatment for chronic kidney disease: anaemia
monthly subcutaneous erythropoetin injections
constant abdominal pain, early satiety and hepatomegaly
autosomal dominant polycystic kidney disease
abdominal mass, flank pain and painless haematuria in a 3 year old
wilm’s nephroblastoma
investigation if there is no obvious cause of AKI
renal ultrasound
first line treatment with CKD in a patient is polycystic kidney disease
tolvaptan: vasopressin receptor 2 antagonist
which is more abrupt: nephrotic or nephritic
nephritic
which has HTN nephrotic or nephritic
nephritic
which has proteinuria nephrotic or nephritic
nephrotic
which has red cell casts in urine nephrotic or nephritic
nephritic
which has oliguria nephrotic or nephritic
nephritic
which has hypoalbuminaemia nephrotic or nephritic
nephrotic
which has more oedema nephrotic or nephritic
nephrotic
example of a nephritic
IgA nephropathy, goodpasstures syndrome
example of a nephrotic
glomerulonephritis
which glomerulonephritis is associated with SLE
membranous glomerulonephritis
difference in renal ultrasound between; diabetic nephropathy and chronic kidney disease
former has bilaterally enlarged kidney while latter than shrunken
when would you seem hyaline casts in the urine
loop diuretics like furosemide
holliday seager formula
to calculate the maintainence dose for IV fluids in young adults
frank haematuria after a respiratory tract infection
nephritic: IgA nephropathy
most common viral infection in solid organ transplant recipients
CMV
with severe vomiting, what is the chloride
hypercholraemic
with severe vomiting, what is the potassium
hypokalaemic
raised creatinine kinase, raised potassium and immobility and AKI
rhabdomyolysis
which bipolar medication can cause polyuria
lithium
potassium in AKI
hyperkalaemia
if there is hypocalcaemia is it AKI or CKD
CKD
when should metformin be stopped according to egfr rate
less than 30
when should we be cautious with metformin associated with HbA1c levels
less than 45mmol/L
target and treatment for blood pressure in pt with type 2 diabetes and chronic kidney disease
130/80 and ACEi like ramipril
who would you see with minimal change disease
normotensive children, no renal histological cnahges and no blood in urine
renal failure, ocular abnormalities and sensorineural hearing loss
alport syndrome?
thrombocytopaenia and normoncytic anaemia following a diarrhoeal illness
haemolyic uraemic syndrome
Urine investigation to confirm the diagnosis of CKD
urine albumin:creatinine ratio is more than 3
fluid requirement for potassium mmol/kg/day
1mmol.kg/day
abdo pain, arthritis, purpuric rash and preceding respiratory illness
Henoch-Schonlein purpura
how can you tell if a condition is pre-renal based on osmolality
more than 500mOsm/kg
which medication can cause hyperkalemia:
allopurinol
ramipril
amlodopine
propanol
ramipril
which SSRI can cause hyponatraemia
sertraline
Which conditions can cause a normal anion gap with metabolic acidosis
Addisons disease, Bicarb loss, Chloride, Drugs
Which conditions can cause a metabolic acidosis with an raised anion gap
lactic acidosis and aspirin overdose
how do we diagnose acute tubular necrosis
urinary sodium more than 40
brown granular casts in urine
acute tubular necrosis
sodium and urine:creatinine ratio in pre-renal AKI
low urinary sodium, and high urea:creatinine ratio
biopsy finds podocyte effacement on biopsy
consistent with the diagnosis of minimal change disease
mesangial expansion found on biopsy
diabetic nephropathy
eosinophillic casts in urine
tubulointersitial nephritis. penicillin can cause this, fever, eosinophilia and rash
side effect of amytriptylline
urinary retention
side effect of verampril
headache, dizziness and peripheral oedema
diagnosis of CKD using egfr
Repeat eGFR of <60 at three months
which type of dialysis is needed everyday
peritoneal
dialysis that needs good renal function
peritoneal
dialysis that is more commonly used
haemolysis
dialysis that is more commonly used
haemolysis
side effect of amiodarone
thyrotoxicosis, increase in T4 not T3
men type 1
pituitary tumours and pancreatic tumours
men type 2
phaechromocytoma
difference between conservative treatment for urge and stress incontinence
stress: pelvic floor training
urge: bladder retraining
