Renal Flashcards
Most common nephrotic syndrome in children?
Minimal change disease
Most common nephrotic syndrome in adults?
Focal segmental glomerulonephritis
IgG and complement deposition on basement membrane?
Membranous glomerulonephritis
IgA deposits and glomeruleral mesangial proliferation?
IgA nephropathy
Nephritic syndrome 1-3 weeks after an URTI?
Post strep glomerulonephritis
Antibodies in goodpasture syndrome?
Anti-GBM antibodies (agianst type IV collagen)
Common drug causes of acute interstitial nephritis?
NSAIDs
PPIs
Penicillin
Px of interstitial kidney disease?
Hypertension + AKI
Other features:
- Eosinophilia
- Rash
- Fever
eGFR stages?
G1 >90
G2 60 – 89
G3a 45 – 59
G3b 30 – 44
G4 15 – 29
G5 <15
When to give an ACEi in CKD?
- Diabetes + ACR>3
- Hypertension + ACR>30
- ACR >70
What is the pathology and results in type 1 acute tubular acidosis?
Distal tubule can’t excrete H+ resulting in:
- Hypokalaemia
- Metabolic acidosis
- High urinary pH
What is the pathology and results in type 2 acute tubular acidosis?
Proximal tubule unable to reabsorb bicarbonate resulting in:
- Hypokalaemia
- Metabolic acidosis
- High urinary pH
Condition related with type 2 acute tubular acidosis?
Fanconi’s syndrome
Mx of type 1, type 2 and type 4 acute tubular acidosis?
Type 1 & 2 -> Oral bicarbonate
Type 4 -> Fludrocortisone + bicarbonate maybe if high potassium
What is pathology and results of type 4 acute tubular acidosis?
Reduced aldosterone due to adrenal insufficiency resulting in:
- Hyperkalaemia
- High Cl-
- Metabolic acidosis
- Low urinary pH
NICE criteria for AKI?
- Rise in creatinine of >25micromol/L in 48h
- Rise in creatinine of >50% in 7 days
- Urine output < 0.5ml/kg/hr for >6hr
What can cause an AKI?
Pre-renal -> inadequate blood supply
Renal -> Glomerulonephritis, interstitial nephritis, acute tubular necrosis
Post-renal -> obstruction
Common pre-renal AKI causes?
Fluid loss - blood, sweat, vomit, diarrhoea
Sepsis - peripheral vasodilation
Common post-renal AKI causes?
Obstruction due to:
- Prostate enlargment
- Urethral stricture
- Stones
- Tumours
Mx of pre-renal AKI?
Fluids (crystalloid - 0.9% NaCl for volume resuscitation)
Stop bad drugs (anti-hypertensives & nephrotoxic)
Control loss of fluid – anti-emetics & mx underlying cause
Monitor urine output
BP not improving -> HDU + ensure enough fluid + vasopressors
Mx of post-renal AKI?
Imaging (USS) -> looking for hydronephrosis (ureter enlargement upwards)
Relieve the obstruction:
- Stenting with cystostomy
- Nephrostomy
Fluid balance chart as polyuria after obstruction
When to start acute haemodialysis?
When to acute haemodialysis?
- Hyperkalaemia (>6)
- Uraemic pericarditis (urea >40)
- Acidaemia
- Pulmonary oedema
Nephritic syndrome px?
- Acute decline in kidney function
- Oliguria (reduce urine output)
- Oedema caused by fluid retention
- Hypertension
- Active urinary sediment
o RBCs, RBC Casts
o (Non-visible haematuria)
Nephrotic syndrome px?
Nephrotic syndrome:
- Proteinuria > 3g/day
- Hypoalbuminemia (<30) -> oedema
- Hypercholesterolemia
- Normal renal function
Mnemonic for myeloma?
C - calcium (elevated)
R - renal failure
A - anaemia
B - bone lesions / pain
Blood results in myeloma?
FBC - low WCC
Calcium - Raised
ESR - raised
Plasma viscosity - raised
Initial Ix mnemonic for myeloma?
B - Bence-Jones protein (on urine electrophoresis)
L - Serum-free Light-chain assay
I - Serum Immunoglobulins
P - Serum Protein electrophoresis
Confirm Dx in myeloma?
Bone marrow biopsy
Imaging to assess bone lesions (MRI > CT > skeletal survey)
X-ray signs in myeloma?
Punched out lesions
Lytic lesions
“Raindrop skull”
Complications of AKI?
Hyperkalaemia
Fluid overload -> heart failure & pulmonary oedema
Metabolic acidosis
Uraemia -> encephalopathy or pericarditis
Indications for acute dialysis mnemonic?
AEIOU
A - Acidosis (pH <7.15)
E - Electrolyte abnormalities (K+ >7 or >6.5 if unresponsive to mx)
I - Intoxication (overdose of certain medications)
O - Oedema (pulmonary oedema)
U - Uraemia (urea>40) -> Pericarditis or encephalopathy px
For all, this is when severe and unresponsive to other Mx
Indication of long-term dialysis?
CKD stage 5 (end-stage renal failure)
Acute indication continuing long-term
Options for maintenance dialysis?
Continuous ambulatory peritoneal dialysis
Automated peritoneal dialysis
Haemodialysis
What are some downsides of peritoneal dialysis?
Bacterial peritonitis
Peritoneal sclerosis
Ultrafiltration failure
Weight gain
Usual immunosuppressant regime in renal transplant patient?
Tacrolimus
Mycophenolate
Prednisolone
Usual immunosuppressant regime in renal transplant patient?
Tacrolimus
Mycophenolate
Prednisolone
Glomerulonephritis which present with nephrotic syndrome?
Minimal change
Focal segmental glomerulosclerosis
Membranous nephropathy
Who does ADPKD and ARPKD affect?
ADPKD affects adults (>30y)
ARPKD affects neonates (oligohydramnios in pregnancy)
What inheritance in Alport syndrome and andreson Fabry’s syndrome?
X-linked
Alport syndrome px?
Haematuria
Sensorineural deafness
Ocular defects
Mild proteinuria
Mx of Alport syndrome?
Antihypertensives & ACEi
What BP to aim for in CKD?
<140/90 if CKD
<130/80 if CKD + diabetes
Stages of hyperkalaemia?
Normal K+ = 3.5 – 5
Hyperkalaemia = >5.5
Life-threatening = >6.5
Severe = >9
What ions are primarily extra-cellular and what ions are primarily intra-cellular?
ECF: Na+, Cl-, HCO3-
ICF: K+, Mg2+
6 functions of the kidney?
- Water balance / salt balance
- Maintain plasma volume / osmolarity
- Acid-base balance
- Excretion of metabolic waste
- Secretes renin & erythropoietin
- Converts VitD to active form
What causes haemolytic uraemic syndrome?
Triggered by shiga toxin
- This is produced by e. coli and shigella
Px of haemolytic uraemic syndrome?
Triad of:
- Haemolytic anaemia
- Acute kidney injury
- Low platelet count
Occurs around 5 days after gastroenteritis often with bloody diarrhoea
AKI px:
- Haematuria, anuria, abdo pain, lethargy, hypertension, bruising, confusion
Mx of haemolytic uraemic syndrome?
Medical emergency, 10% mortality
Mx - supportive
- Anti-hypertensives, blood transfusions, dialysis
Causes of rhabdomyolsis?
Prolonged immobility
Extremely rigorous exercise
Crush injuries
Seizures
Px of rhabdomyolosis?
- Muscle aches and pain
- Oedema
- Fatigue
- Confusion
- Red-brown urine
What do muscle cells release in rhabdomyolysis?
Myoglobin -> AKI as toxic to kidneys
Potassium -> hyperkalaemia
Phosphate
Creatine kinase
Mx of rhabdomyolysis?
IV fluids
Consider:
- IV sodium bicarbonate - reduces toxicity of myoglobin on kidneys
- IV mannitol - increases GFR and reduces oedema (hypovolaemia is a contra-indication)
Mx any hyperkalaemia
