Renal Flashcards by Hamish Halliday

Most common nephrotic syndrome in children?

Minimal change disease

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Most common nephrotic syndrome in adults?

Focal segmental glomerulonephritis

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IgG and complement deposition on basement membrane?

Membranous glomerulonephritis

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IgA deposits and glomeruleral mesangial proliferation?

IgA nephropathy

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Nephritic syndrome 1-3 weeks after an URTI?

Post strep glomerulonephritis

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Antibodies in goodpasture syndrome?

Anti-GBM antibodies (agianst type IV collagen)

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Common drug causes of acute interstitial nephritis?

NSAIDs
PPIs
Penicillin

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Px of interstitial kidney disease?

Hypertension + AKI

Other features:
- Eosinophilia
- Rash
- Fever

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eGFR stages?

G1 >90
G2 60 – 89
G3a 45 – 59
G3b 30 – 44
G4 15 – 29
G5 <15

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When to give an ACEi in CKD?

Diabetes + ACR>3
Hypertension + ACR>30
ACR >70

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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

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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

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Condition related with type 2 acute tubular acidosis?

Fanconi’s syndrome

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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

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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

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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

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What can cause an AKI?

Pre-renal -> inadequate blood supply

Renal -> Glomerulonephritis, interstitial nephritis, acute tubular necrosis

Post-renal -> obstruction

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Common pre-renal AKI causes?

Fluid loss - blood, sweat, vomit, diarrhoea
Sepsis - peripheral vasodilation

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Common post-renal AKI causes?

Obstruction due to:
- Prostate enlargment
- Urethral stricture
- Stones
- Tumours

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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

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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?

1. Water balance / salt balance 2. Maintain plasma volume / osmolarity 3. Acid-base balance 4. Excretion of metabolic waste 5. Secretes renin & erythropoietin 6. 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