Renal Flashcards
When is imaging and IV treatment required for pyelonephritis?
Image if stone/abscess or 3d of fever. IV if fever, sepsis, not tolerating orals. Urology required for men w pyelo.
When is eGFR less reliable for assessing kidney function? What are the indications for nephrology in CKD?
Pregnancy, high muscle mass, high protein intake, amputees, extremes of body size (due to BSA). Refer if eGFR < 30 , rapid decline in GFR 15mL or 25% in 1 year, persistent high albuminuria >30, HTN not responding to 3 agents.
What are 9 risk factors for CKD? What are the 4 commonest causes of CKD?
ATSI, Age >60, HTN, DM, smoking, BMI >30, Fhx of CKD, Hx of AKI, established CVD. Diabetes, GN, HTN, PCKD.
How is CKD defined?
3 months of eGFR < 60 or kidney damage: albuminuria, non-urological haematuria, structural disease, pathological disease.
What tests are indicated if CKD is diagnosed? What extra tests are considered?
Renal ultrasound, recheck eGFR + ACR in 1 week, FBE, ESR, CRP, fasting lipids, fasting glucose, urine microscopy for red cells and crystals. Consider autoimmune/rheum screen (Eg. ANA, ANCA, ENA); consider Hep B/C/HIV if at risk; consider SPEP + urine protein if >40 and suspect MM.
What is involved in a yellow management plan for CKD?
Yearly: BP, weight, smoking, eGFR, urine ACR, UEC, lipids, HbA1c if diabetic. Manage HTN, CVD risk, avoid nephrotoxins.
What is involved in an orange and red management plan for CKD?
Check FBE, Ca/Phos, PTH. Consider antiplatelet agent for CVD, adjust med doses. Red: check for oedema, discuss dialysis and transplant or advance care plan.
What are 6 aspects of lifestyle management in CKD?
Avoid smoking, Aim BMI < 25, limit alcohol, 150-300min moderate exercise, DASH diet for HTN - adequate protein and water to thirst; immunisations if diabetes or ESKD.
What medications are recommended for CKD? How are diuretics used? When are statins used?
ACE/ARB help - accept 25% reduction eGFR and 0.5 elevation of K (ok under 6). Flozins for eGFR 25-75 and macroalbuminuria. Diuretics okay, only frusemide if GFR < 45. Statins if > 50yo or diabetes/high CVD risk.
High CVD risk if GFR < 45.
What medications may need adjustment in the setting of CKD for a sick day?
SADMANS: sulfonylureas, ACE, diuretics, metformin, ARBs, NSAIDs, SGLT2 inhibitors.
What imaging is indicated for suspected renal colic? Age, recurrent, followup.
CTKUB gold standard, use if over 50. If < 50 or recurrent, can do U/S first. Followup can be CT, U/S or x-ray.
What are renal causes of proteinuria in kids and adults? What are systemic causes/other considerations?
Minimal change disease in both. Adult: focal segmental glomerulosclerosis, membranous nephropathy, post infectious GN. Systemic: diabetes, amylodosis, SLE, HTN, UTI, CCF, acute febrile illness.
What is the workup for haematuria? How is it monitored? When is referral required?
MCS, U/S, BP, ACR. If < 40 w blood alone, likely mild GN, monitor for resolution w dipsticks. Refer if protein, macroscopic or risk factors for cancer - Age >40, smoker, male, dye/chemical exposure.
