Renal Flashcards
How is measurement of proteinuri often done?
Often done by albumin/creatinine ration or protein creatinine ratio
A PCR and ACR of what is approximately equal to 1g of protein per 24 hours
o A PRCR of 100 or ACR of 70 is
Definitive diagnosis of glomerulonephritis?
Renal biopsy
What does ANA look at?
Lupus
What does ANCA blood test look at?
Small vessel vasculitis
What does the anti GBM antibody look at?
Good pastures syndrome
Goodpastures treatment
Plasma exchange- Seperate out all the good plasma proteins and then reduce level of specific antibody
Immunosuppress
What is the most common type of glomerulonephritis?
IgA nephropathy
What happens in memberanous nephritis
Immune complex deposition in the GBM
What antibody is found in 60-80% of cases of membranous nephritis?
Anti-PLA2R
Why is an Ace Inhibitor good for perserving kidney function in patients while decreasing BP
Selectively lowers the intraglomerular pressure
So ACEi are renoprotective
How do aminoglyclosides cause nephrotoxcity?
Directly nephrotoxic causing acute tubular necrosis
How do amphotericin cause nephrotoxcity?
Directly nephrotoxic
How does cytotoxic chemotherapy cause nephrotoxcity?
Associated with renal tubilar damage
How do diuretics cause nephrotoxcity?
Lead to volume depletion
How do immunsuppressants cause nephrotoxcity?
Cause renal vasoconstriction producing ischaemia
How do lithium salts cause nephrotoxcity?
Can cause tubulointerstital damage and CKD with long term use. However, it should only be suspended if known lithium overdose or toxic levels due to its importance in the treatment of BPD.
How do NSAIDs/Cox2 inhibitors cause nephrotoxcity?
Renal blood flow often relies on prostaglandins. NSAIDs and COX-2 inhibitors reduce prostaglandin synthesis and cause renal hypoperfusion and AKI
How does radiocontrast media cause nephrotoxcity?
A high ionic load can produce renal vasoconstriciton leading to ischaemia
How does sepsis affect the kidneys?
Endotoxins and inflammatory mediators from infection can dmagae the renal vascular endotherlium resulting in thrombosis
How does rhabdomylosysis affect the kindeys?
Myoglobin released from damaged muscles percipitates in renal tubiles and also reduces blood flow in the outer medulla
When should you not use the MDRD, CKD-EPI or eGFR to estimate renal function?
Extremes of weight
Childrne
Catabolic states
What is CKD classified according to?
the eGFR
Albumin
How to stabolise the myocardium in hyperkalaemia?
Calcium gluconate 10%
How can you drive potassium into the cell?
Nebulised salbutamol and soluble insulin and glucose
What should you look at to diagnose AKI?
Creatinine
Risk factors for AKI
Elderly
Cardiac failure
CKD
Diabetes
Nephrotoxic medication
What fluid to give is someone is hypovalemic?
Hartmann’s
What is used to stabilise myocardium in hyperkalaemia?
Calcium gluconate or calcium chloride
What pushes potassium back into the cells in hyperkalaemia
Insluin and dextrose
Salbutamol
How is AKI divided?
Pre-renal
Renal
Post-renal
What is pre-renal aki?
Things that occur before kidney. Usually in blood vessels
What is renal AKI?
Things in the kidney
Most common is acute tubular necrosis
The hallmark of intrinsic renal AKI is structural damage. It may be categorised according to the location of the pathology:
Vasculature
Glomerular
Tubulointerstitial
WHat are some extra renal manifestations of autosomal dominant polycystic kidney disease?
Liver cyst
Cerebral berry aneurys
Cysts
What are problems of calcium based phosphate binder?
Hypercalacaemia and vascular calcification
What are the four Hs that cause focal segmental glomerulopathy?
Huh?- Idiopathic
Hurt kiney- Secondary to other neurpathies
HIV
Heroin
What is Henoch Scholein purpura?
IgA mediated small vessel vasculitis
Treatment of henoch scholein purpra
Analgesia for athralgia
Treatment of nephropathy is normally supportive
Inital managemengt of CKD-mineral bone disease?
Correct hyperphosphataemia first before a phosphate binder
Pneumonic for drugs to stop in AKI?
DAMN AKI
Diruetics
Aminoglyclacides and Ace-I
Metformin
NSAIDS
Features of henoch scholein purpura?
palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
abdominal pain
polyarthritis
features of IgA nephropathy may occur e.g. haematuria, renal failure
Management of minimal change disease?
Oral corticosteroids
Cyclophosphamide is next step for steroid resistance cases
Membranous glomerulonephritis histology?
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
What does the pattern of a rise in creartinine and urea but the rise in urea being much bigger than the rise in creatinine suggest?
Dehydration
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
Causes of a raised anion gap metabolic acidosis
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
Management of hyperkalaemia that helps remove potassium from the body?
calcium resonium (orally or enema)
enemas are more effective than oral as potassium is secreted by the rectum
loop diuretics
dialysis
haemofiltration/haemodialysis should be considered for patients with AKI with persistent hyperkalaemia
What is dialysis disequilibrium syndrome caused by?
Cerebral oedema
Gold standard for bladder diagnosis?
Cytososcopy
What is amyloidosis?
extracellular deposition of an insoluble fibrillar protein termed amyloid
Medication for diabetic nephropathy?
ACE inhibitor or angiotensin-II receptor antagonist
