Renal Flashcards
What medication is indicated in CKD?
ACEi due to following mechanism:
ACE inhibition -> decreased ATII -> efferent arteriole dilation and fall in intraglomerular capillary pressure -> decreased filtration of protein -> decreased proteinuria
*Particularly useful in patients who also have diabetes and hypertension
What is acute interstitial nephritis?
Marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules
Causes:
* Drugs (most common cause, particularly antibiotics): penicillin, rifampicin, NSAIDs, allopurinol, furosemide
* Systemic disease: SLE, sarcoidosis, and Sjögren’s syndrome
* Infection: Hanta virus , staphylococci
Features:
* fever, rash, arthralgia
* eosinophilia
* mild renal impairment
* hypertension
What is the typical presentation of IgA nephropathy?
Nephritic syndrome, usually presenting a couple of days following an upper respiratory tract infection
What is the typical presentation of post-streptococcal glomerulonephritis?
Oliguria, visible haematuria, proteinuria and hypertension two weeks following a febrile illness.
Typically this happens 7-14 days following a group A beta-hemolytic Streptococcus infection, usually described as a sore throat.
What is done to screen for diabetic nephropathy?
Urinary albumin:creatinine ratio (ACR)
Should be an early morning specimen
ACR > 2.5 = microalbuminuria
What is the management of diabetic nephropathy?
- Dietary protein restriction
- Tight glycaemic control
- BP control: aim for < 130/80 mmHg
- ACE inhibitor or angiotensin-II receptor antagonist - should be started if urinary ACR of 3 mg/mmol or more (do not do dual therapy)
- Control dyslipidaemia e.g. Statins
What is the unit volume per unit weight per day of recommended maintenance fluid volume?
25-30 ml/kg/day of water
How should you treat anaemia in CKD?
Correct iron deficiency before starting erythropoiesis-stimulating agents
What is the criteria for diagnosing an AKI?
- Rise in creatinine of 26µmol/L or more in 48 hours OR
- > = 50% rise in creatinine over 7 days OR
- Fall in urine output to < 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR
- > = 25% fall in eGFR in children / young adults in 7 days.
What ECG change can uraemia cause?
Widespread PR depression and ST elevation - pericarditis is a manifestation of uraemia
What features suggest CKD over AKI?
Hypocalcaemia (due to lack of vitamin D) is seen in CKD
Most patients with CKD have bilateral small kidneys, with exceptions of:
* autosomal dominant polycystic kidney disease
* diabetic nephropathy (early stages)
* amyloidosis
* HIV-associated nephropathy
What are the side effects of lithium?
LITHIUM
Leucocytosis
Insipidus (nephrogenic)
Tremor
Hypothyroidism
Increase Urine
Mothers (teratogenic)
Others: GI upset, weight gain, T-wave inversion, eyebrow hair loss
What electrolyte imbalance does renal tubular acidosis cause?
Hyperchloraemic, normal anion gap metabolic acidosis
Deficiency in what protein causes a hypercoagulable state in nephrotic syndrome?
Antithrombin III
In which condition do you see muddy brown casts?
Acute tubular necrosis which is commonly caused by ischaemia or toxins
What are features of anti-GBM disease?
Previously known as Goodpasture’s syndrome (autoimmune condition against type IV collagen)
- pulmonary haemorrhage
- rapidly progressive glomerulonephritis - proteinuria + haematuria
*Type IV collagen is found in both the lungs and kidneys
What is the most common extra-renal manifestation of ADPKD?
Liver cysts (70%) may cause hepatomegaly
*Berry aneurysms (only 8%) - can cause SAH
What urine sample results would you expect in acute tubular necrosis?
Raised urinary sodium with low urine osmolality - inability to retain sodium or concentrate urine
Raised fractional sodium excretion
Brown muddy granular casts
What is the diagnostic criteria for AKI?
- Rise in creatinine of 26µmol/L or more in 48 hours OR
- > = 50% rise in creatinine over 7 days OR
- Fall in urine output to < 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR
- > = 25% fall in eGFR in children / young adults in 7 days.
In HSP, what is monitored to detect progressive renal involvement post-discharge?
Blood pressure
Urinalysis
