1= creatinine increase >/= 1.5 x baseline or urine output /= 2 x baseline or urine output /= 12h 3= creatinine increase >/= 3 x baseline or urine output /= 24h or anuria 12h

renal Flashcards by Emily Fothergill

AKI criteria

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

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RF AKI

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

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categories causes AKI

pre renal
renal
post renal

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pre-renal causes AKI

inadequate blood supply: dehydrattion, hypotension/shock, HF

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renal causes AKI

glomerulonephritis
interstitial nephritis
acute tubular necrosis

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post renal causes AKI

obstructive uropathy = kidney stones, cancer, BPH

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mx AKI

pre-renal =IV fluids
stop nephrotoxic meds
relieved obstruction

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complications AKI/ AKI mx

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

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sx CKD

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

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ix CKD

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

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stages CKD

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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when is CKD diagnosed

eGFR </= 60 or proteinuria

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ESRF

eGFR <15

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AKI stages

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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complications CKD

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

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renal bone disease

osteomalacia
osteoporosis
osteosclerosis

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XR renal bone disease

‘rugger jersey’ spine

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mx CKD

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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indications for dialysis

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

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maintenance dailysis options

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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complications peritoneal dialysis

bacterial peritonitis
peritoneal sclerosis
ultrafiltration failure
wt gain
psychososcial

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where is AV fistula

radio-cephalic
brachio-cephalic

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features AV fistula O/E

check for skin integrity, aneurysm
palpable thrill
machinery murmur

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complications AV fistula

aneurysm
infection
thrombosis
stenosis
STEAL syndrome
high output HF

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renal transplant matching

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

renal transplant procedure

leave own kidneys in hockey stick incission

after renal transplant meds

lifelong immunosuppression tacrolimus, mycophenolate, pred

kidney transplant complications

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

what is nephritic syndrome

kidney inflammation

common features nephritis syndrome

haematuria oliguria proteinuria fluid retention

nephrotic syndrome criteria

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

commonest cause nephrotic syndrome children

minimal change disease

commonest cause nephrotic syndrome adults

focal segmental glomerulosclerosis

types glomerulonephritis

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

cause minimal change disease

idiopathic

features membranous glomerulonephritis

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

features IgA nephropathy

=bergers 20y IgA deposits and glomerular mesangial proliferation

features post strep glomeruloneohritis

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

features goodpastures syndrome

anti-GBM Ab haemoptysis AKI

features rapidly progressive glomerulonephritis

histology=crescentic acutely ill secondary to goodpastures

mx glomerulonephritis

steroids reduce BP: ACEi or ARB

how does DM cause diabetic nephropathy

high glucose causes glomerulosclerosis

ix findsings diabetic nephropathy

proteinuria

sx acute interstitial nephritis

AKI HTN

cause aute interstitial nephritis

acute hypersensitivity rxn to NSAIDs/abx or infection

mx acute intersitital nephritis

tx cause steroids

sx chronic tubulointerstitial nephritis

CKD

cause chronic tubulointerstitial nephritis

AI infection iatrogenic granulomatous disease

mx chronic tubulointerstitial nephritis

tx cause steroids

features acute tubular necrosis

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

causes acute tubular necrosis

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

mx acute tubular necrosis

fluids tx cause

what is renal tubular acidosis

metbaolic acidosis due to pathology of tubules

what is T1 renal tubular acidosis

distal tubule unable to excrete H+

causes T1 renal tubular acidosis

genetic SLE sjogrens primary biliary cirrhosis hyperthyroid SC anaemia marfans

sx T1 renal tubular acidosis

FTT CKD hyperventilation osteomalacia

ix findings T1 renal tubular acidosis

low K metabolic acidosis urinary pH >6

mx T1 renal tubular acidosis

oral bicar

what is T2 renal tubular acidosis

proximal tubule unable to reabsorb bicarb

cause T2 renal tubular acidosis

fanconis syndrome

ix finsings T2 renal tubular acidosis

lo K metabolic acidosis urinary pH >6

mx T2 renal tubular acidosis

oral bicarb

what is T3 renal tubular acidosis

combination T1 and 2

what is T4 renal tubular acidosis

due to low aldosterone

causes T4 renal tubular acidosis

adrenal insufficiency ACEi spironolcatone SLE DM HIV

ix findings T4 renal tubular acidosis

high K high Cl metabolic acidosis low urinary pH

mx T4 renal tubular acidosis

fludrocortisone sodium bicarb

cause haemolytic uraemic syndrome

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

bacteria causing HUS

e.coli shigella

features HUS

haemolytic anaemia AKI thrombocytopenia

sx HUS

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

mx HUS

anti HTN blood transfusion dialysis

what is rhabdomyolysis

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

causes rhabdomyolysis

prolonged immobility rigorous exercise crush injuries seizures

sx rhabdomyolysis

muscle ache oedema fatigue confusion red-brown urine

ix findingds rhabdomyolysis

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

mx rhamdomyolysis

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

causes increased K

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

ECG signs increased K

tall peaked T flat/absent P broad QRS

mx increased K

<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

why do you give insulin dextrose infusion in high K

insulin drives K into cells

why do you give calcium gluconate in high K

stabilises heart muscle

effect salbutamol on K

reduces by driving K into cells

how does oral calcium resonium affect K

slow decrease

genes in AD polycystic kidney disease

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

extra renal features polycystic kideny disease

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

genes autosomal recessive PKD

chrom 6

features autosomal recessive PKD

rare and more severe oligohydramnios in fetus ESRF before adult

mx PKD

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