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renal Flashcards

1
Q

AKI criteria

A

increase in creatinine >/= 25mmol over 48h
increase in creatinine >/= 50% in 7d
urine output <0.5ml/kg for 6h

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2
Q

RF AKI

A

CKD
HF
DM
liver disease
>65 y
cognitive impairment
nephrotoxic meds - NSAIDs, ACE i
scan with contrast

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3
Q

categories causes AKI

A

pre renal
renal
post renal

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4
Q

pre-renal causes AKI

A

inadequate blood supply: dehydrattion, hypotension/shock, HF

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5
Q

renal causes AKI

A

glomerulonephritis
interstitial nephritis
acute tubular necrosis

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6
Q

post renal causes AKI

A

obstructive uropathy = kidney stones, cancer, BPH

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7
Q

mx AKI

A

pre-renal =IV fluids
stop nephrotoxic meds
relieved obstruction

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8
Q

complications AKI/ AKI mx

A

increased K
fluid overload/HF/pulmonary oedema
metabolic acidosis
uraemia->encephalopathy/pericarditiis

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9
Q

sx CKD

A

asx
pruritis
reduced appetite
nausea
oedema
muscle cramps
peripheral neuropathy
pallor
HTN

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10
Q

ix CKD

A

eGFR
urime albumin:creatinine ration (ACR)
urine dipstick=haematuria
renal USS

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11
Q

stages CKD

A

G1: eGFR >90
G2: eGFR 60-89
G3a: eGFR 45-59
G3b: eGFR 30-44
G4: 15-29
G5: eGFR <15=ESRF

A score (ACR): A1=<3mg/mmol, A2=3-30, A3= >30

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12
Q

when is CKD diagnosed

A

eGFR </= 60 or proteinuria

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13
Q

ESRF

A

eGFR <15

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14
Q

AKI stages

A

1= creatinine increase >/= 1.5 x baseline or urine output <0.5mg/kg/hr for over 6h
2= creatinine increase >/= 2 x baseline or urine output <0.5mg/kg/hr for >/= 12h
3= creatinine increase >/= 3 x baseline or urine output <0.3mg/kg/hr for >/= 24h or anuria 12h

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15
Q

complications CKD

A

anaemia: as kidney produses EPO
renal bone disease
CVD
peripheral neuropathy

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16
Q

renal bone disease

A

osteomalacia
osteoporosis
osteosclerosis

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17
Q

XR renal bone disease

A

‘rugger jersey’ spine

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18
Q

mx CKD

A

specialist when eGFR <30/ACR >/= 70 or eGFR reduced by 25%/15 in 1yr or uncontrolled HTN

dietary advice
20mg artorvastatin
ACEi
monitory K complications

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19
Q

indications for dialysis

A

acute=acidosis, electrolyte abnomralities (k), intoxication/OD, pulmonary oedema, ureaemia sx (seizures, reduced cosnciousness)
long term=ESRF

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20
Q

maintenance dailysis options

A

continuous ambulatory peritoneal dialysis
automated peritoneal dialysis
haemodialysis ( 4h 3d/wk) through tunneled cuffed catheter (subclavian or jugular vein) or AV fistula

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21
Q

complications peritoneal dialysis

A

bacterial peritonitis
peritoneal sclerosis
ultrafiltration failure
wt gain
psychososcial

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22
Q

where is AV fistula

A

radio-cephalic
brachio-cephalic

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23
Q

features AV fistula O/E

A

check for skin integrity, aneurysm
palpable thrill
machinery murmur

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24
Q

complications AV fistula

A

aneurysm
infection
thrombosis
stenosis
STEAL syndrome
high output HF

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25
Q

renal transplant matching

A

using human leukocyte Ag type A, B , C on chrom 6

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26
Q

renal transplant procedure

A

leave own kidneys in
hockey stick incission

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27
Q

after renal transplant meds

A

lifelong immunosuppression
tacrolimus, mycophenolate, pred

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28
Q

kidney transplant complications

A

transplant=rejection, failure, electrolyte imbalances
immunosuppression=IHD, T2DM, unusual infection, non hodgkin lymphoma, skin cancer (SCC)

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29
Q

what is nephritic syndrome

A

kidney inflammation

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30
Q

common features nephritis syndrome

A

haematuria
oliguria
proteinuria
fluid retention

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31
Q

nephrotic syndrome criteria

A

peripheral oedema
proteinurial >3g/24h
serum albumin <25g/L
hypercholesterolaemia

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32
Q

commonest cause nephrotic syndrome children

A

minimal change disease

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33
Q

commonest cause nephrotic syndrome adults

A

focal segmental glomerulosclerosis

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34
Q

types glomerulonephritis

A

minimal change disease
focal segmental glomerulosclerosis
membranous glomerulonephritis
IgA nephropathy=Bergers
post strep glomerulonephritis
mesangiocapillary glomerulonephritis
goodpasture syndrome
rapidly progressibe glomerulonephritis

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35
Q

cause minimal change disease

A

idiopathic

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36
Q

features membranous glomerulonephritis

A

20y and 60y
IgG deposiits
can be secondary to malignancy, rheum, NSAIDs

37
Q

features IgA nephropathy

A

=bergers
20y
IgA deposits and glomerular mesangial proliferation

38
Q

features post strep glomeruloneohritis

A

=diffuse prolifertive
<30y
1-3w after tonsillitis/impetigo

39
Q

features goodpastures syndrome

A

anti-GBM Ab
haemoptysis
AKI

40
Q

features rapidly progressive glomerulonephritis

A

histology=crescentic
acutely ill
secondary to goodpastures

41
Q

mx glomerulonephritis

A

steroids
reduce BP: ACEi or ARB

42
Q

how does DM cause diabetic nephropathy

A

high glucose causes glomerulosclerosis

43
Q

ix findsings diabetic nephropathy

A

proteinuria

44
Q

sx acute interstitial nephritis

45
Q

cause aute interstitial nephritis

A

acute hypersensitivity rxn to NSAIDs/abx or infection

46
Q

mx acute intersitital nephritis

A

tx cause
steroids

47
Q

sx chronic tubulointerstitial nephritis

48
Q

cause chronic tubulointerstitial nephritis

A

AI
infection
iatrogenic
granulomatous disease

49
Q

mx chronic tubulointerstitial nephritis

A

tx cause
steroids

50
Q

features acute tubular necrosis

A

AKI
reversible in 7-21 d
urinalysis=muddy brown casts

51
Q

causes acute tubular necrosis

A

ischaemia due to shock/sepsis/dehydration
toxins/dye
gentamicin, NSAIDs, lithium, heroin

52
Q

mx acute tubular necrosis

A

fluids
tx cause

53
Q

what is renal tubular acidosis

A

metbaolic acidosis due to pathology of tubules

54
Q

what is T1 renal tubular acidosis

A

distal tubule unable to excrete H+

55
Q

causes T1 renal tubular acidosis

A

genetic
SLE
sjogrens
primary biliary cirrhosis
hyperthyroid
SC anaemia
marfans

56
Q

sx T1 renal tubular acidosis

A

FTT
CKD
hyperventilation
osteomalacia

57
Q

ix findings T1 renal tubular acidosis

A

low K
metabolic acidosis
urinary pH >6

58
Q

mx T1 renal tubular acidosis

A

oral bicar

59
Q

what is T2 renal tubular acidosis

A

proximal tubule unable to reabsorb bicarb

60
Q

cause T2 renal tubular acidosis

A

fanconis syndrome

61
Q

ix finsings T2 renal tubular acidosis

A

lo K
metabolic acidosis
urinary pH >6

62
Q

mx T2 renal tubular acidosis

A

oral bicarb

63
Q

what is T3 renal tubular acidosis

A

combination T1 and 2

64
Q

what is T4 renal tubular acidosis

A

due to low aldosterone

65
Q

causes T4 renal tubular acidosis

A

adrenal insufficiency
ACEi
spironolcatone
SLE
DM
HIV

66
Q

ix findings T4 renal tubular acidosis

A

high K
high Cl
metabolic acidosis
low urinary pH

67
Q

mx T4 renal tubular acidosis

A

fludrocortisone
sodium bicarb

68
Q

cause haemolytic uraemic syndrome

A

shiga toxin (e.coli, shigella) causes thrombosis small blood vessels -> haemolytic anaemia, AKI, thrombocytopenia

69
Q

bacteria causing HUS

A

e.coli
shigella

70
Q

features HUS

A

haemolytic anaemia
AKI
thrombocytopenia

71
Q

sx HUS

A

sx 5d after diarrhoea
decreased urine output
haematuria
abdo pain
lethargy
confusion
HTN
bruising

72
Q

mx HUS

A

anti HTN
blood transfusion
dialysis

73
Q

what is rhabdomyolysis

A

due to muscle cells breaking down and releaseing myoglobin leading to AKI
K, phosphate, CK also released

74
Q

causes rhabdomyolysis

A

prolonged immobility
rigorous exercise
crush injuries
seizures

75
Q

sx rhabdomyolysis

A

muscle ache
oedema
fatigue
confusion
red-brown urine

76
Q

ix findingds rhabdomyolysis

A

increased CK at 12h
urine dipstick=blood
U+Es
ECG

77
Q

mx rhamdomyolysis

A

IV fluids +/- IV bicarb +/- IV mannitol

78
Q

causes increased K

A

AKI
CKD
rhabdomyolysis
adrenal insufficiecy
tumour lysis syndrome
spironolactone
ACEi
ARB
NSAIDSs

79
Q

ECG signs increased K

A

tall peaked T
flat/absent P
broad QRS

80
Q

mx increased K

A

<6=monitor
>/= 6 and ECG changes:insuline and dextrose infusion and calcium gluconate
>/= 6.5 = insuline and dextrose infusion and calcium gluconate

other tx: nebulised salbutamol, IV fluids, oral calcium resonium, sodium bicarb, dialysis

81
Q

why do you give insulin dextrose infusion in high K

A

insulin drives K into cells

82
Q

why do you give calcium gluconate in high K

A

stabilises heart muscle

83
Q

effect salbutamol on K

A

reduces by driving K into cells

84
Q

how does oral calcium resonium affect K

A

slow decrease

85
Q

genes in AD polycystic kidney disease

A

PKD-1 on chrom 16
PKD-2 on chrom 4

86
Q

extra renal features polycystic kideny disease

A

cerebral aneurysm
hepatic/splenic/pancreatic/ovarian/prostatic cysts
CVD-mitral regurg
colonic diverticula
aortic root dilatation

87
Q

genes autosomal recessive PKD

88
Q

features autosomal recessive PKD

A

rare and more severe
oligohydramnios in fetus
ESRF before adult

89
Q

mx PKD

A

tolvaptan: vasopressin receptor antagonist-slows progression
mx complications - anti HTN, analgesia, dialysis

finals (31 decks)

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