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Renal Flashcards

1
Q

AKI diagnosis

A

Rise in creatinine of 26umol/L or more in 48hrs OR
>50% rise in creatinine over 7 days OR
fall in urine output to <0.5ml/hr for more than 6 hours

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2
Q

Prerenal causes of AKI

A

Ischaemic
Hypovolaemia (secondary to D%V, haemorrhage, burns, insufficient input, sepsis, post surgical)
Renal artery stenosis

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3
Q

Renal causes off AKI

A

Intrinsic damage to glomeruli, renal tubules or interstitium eg
- glomerulonephritis
- acute tubular necrosis
- acute interstitial nephritis
- rhabdomyolysis
- tumour lysis syndrome

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4
Q

Post renal causes of AKI

A

Obstruction post renal
- kidney stone in ureter or bladder
- benign prostatic hyperplasia
- external compression of the ureter

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5
Q

Assessment in AKI?

A
  1. is it acute or chronic?
  2. Are they volume depleted (postural hypotensi, reduced JVP, incr pulse, poor skin turgor)
  3. is there GU tract obstruction? (suprapubic discomfort/palpable bladder, enlarged prostate, catheter, complete anuria)
  4. Rarer cause? proteinuria or haematuria, or vasculitic rash
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6
Q

Drugs which should be stopped in AKI (may worsen renal function)

A

NSAIDs (except cardioprotective aspirin)
Aminoglycosides
ACE inhiitors
ARBs
Diuretics

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7
Q

Drugs should consider stoppnig in AKI as risk of drug toxicity

A

Metformin
Lithium
Digoxin

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8
Q

Features of acute interstitial nephritis

A

Fever, rash, arthralgia
Eosinophilia
Hypertension
Sterile pyuria and white cell casts

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9
Q

Normal plasma osmolality hyponatraemia

A

Pseudohyponatraemia: hyperproteinuria or hypertriglyceridaemia cause apparent low Na. Eg myeloma
TURP syndrome: large bolumes glycine used for irrigation, so water also absorbed and drop in plasma Na, with no drop in osmolality
Osmolality is NORMALLY REDUCED. and then look at fluid status

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10
Q

Causes of hypovolaemic hyponatraemia with high urine Na (>20mM)

A

Renal loss
Diuretics
Addison;s
Osmolar diuresis eg glucose
Renal failure

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11
Q

Causes of hypovolaemic hyponatraemia (low urine Na (<20mM)

A

Extra-renal loss eg diarrhoea, vomiting, fistula, small bowel obstruciton, burns

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12
Q

Causes of euvolaemic hyponatraemia

A

urine osmolality >500: SIADH
If urine osmolality <500: water overload, severe hyperthyroidism, glucocorticoid insufficiency

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13
Q

Causes of hypervolaemic hyponatraemia

A

Cardiac failure
Cirrhosis
Renal failure
Nephrotic syndrome

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14
Q

Management of hyponatraemia

A

replace sodium at same rate as loss
If chronic then 10mmM/day
If acute 1mM/hour
Asymptomatic and chronic: fluid restriction
Symptoms/acute/dehydrated: cautious rehydration w 0.9% NaCl
If hypervolaemic consider furosemide
emergency (seizures, coma), consider hypertonic saline

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15
Q

Causes of SIADH

A

Resp: SCLC pneumonia, TB
CNS: meninogencephalitis, head injury, SAH
Endo: hypothyroidism
Drugs: cyclophosphamide, SSRIs

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16
Q

Presentation of hyponatraemia depending on Na concentration

A

<135: nausea and vomiting, anorexia, malaise
<130: headache, confusion, irritability
<125: seizures, non cardiogenic pulmonary oedema
<115: coma and death

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17
Q

Presentation of hypernatraemia

A

Thirst
Lethargy
Weakness
Irritability
Confusion, fits, coma
Signs of dehydration (NORMALLY)

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18
Q

Causes of hypovolaemic hypernatraemia

A

Diarrhoea, vomiting
Diuretics incl osmotic diuresis (eg DM)
Sweating, burns

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19
Q

Causes of euvolaemic hypernatraemia

A

Decr fluid intake
diabetes insipidus
fever

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20
Q

Causes of hypervolaemic hypernatraemia

A

Hyperaldosteronism (incr BP, decr K, decr H)
Hypertonic saline

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21
Q

Diabetes insipidus symptoms and why

A

Polyuria
Polydipsia
Dehydration
Lack of production or action of ADH = failure to concentrate urine

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22
Q

Ix in diabetes insipidus

A

Plasma osmolality high
Low urine osolality
Elevated 24hr urine volume, esp nocturia
High/high normal plasma sodium
Water deprivation test:failure to concentrate urine on deprivation. If cranial, will successfully concentrate when given desmopressin, if nephrogenic then will not

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23
Q

Nephrogenic causes of diabetes insipidus

A

Hypercalcaemia
lithium
Post obstructive uropathy
Polycystic kidney disease
Amyloid

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24
Q

Cranial causes of diabetes insipidus

A

Idiopathic
congenital
tumours
trauma eg head injury
Infiltration of pituitary eg sarcoid
Vascular: haemorhage
Meningoencephalitis

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25
Symptoms of hypokalaemia
Muscle weakness paralytic ileus hypotonia hyporeflexia cramps tetany palpitaitons arrhytmias polyuria, polydipsia (nephrogenic DI)
26
ECG changes in hypokalaemia
Flattened/inverted T waves Prominent U waves ST depression Long PR interval Long QT interval
27
CAuses of hypokalaemia
Internal distribution: alkalosis, incr insulin, beta agonists Incr excretion: D&V, renal tubular acidosis, diuretics, Conn's syndrome, Cushing's syndrome Decr input: inappropriate fluid management, anorexia
28
replacement of potassium
ORally: can give supplements >80mmol/day If severe or symptoms: IV cautiously, 10mmol/hr max Anything more definitely need cardiac monitoring replace Mg
29
Differentials for hypertension and hypokalaemia
Conn's syndrome (hyperaldosteronism) Cushing's syndrome (hyperglucocorticoid) Phaeochromocytoma (excess metanephrines)
30
Ix for hypertension and hypokalaemia
Conn's: aldosterone: renin ration Cushing's: overnight dex suppression test, 24hr urine cortisol excretion Phaeo: urine metanephrines
31
Symptoms hyperkalaemia
Fast, irregular pulse palpitations chest pain weakness
32
ECG hyperkalaemia
Tented T waves Flattened p waves incr PR interval Wide QRS Sine wave pattern, progressing to V fib
33
Artefactual causes of hyperkalaemia
Haemolysis EDTA contamination from lavender bottle Taken from drip arm
34
Internal distribution causes for hyperkalaemia
Acidosis decr insulin cell death/tissue trauma/burns/tumour lysis syndrome digoxin poisoning suxamethonium
35
Incr input causes hyperkalaemia
Excess K therapy Massive transfusion
36
Decreased K excretion causes of hyperkalaemi
AKI Addison's ACE inhibitors
37
Management of K acutely
Calcium gluconate IV Insulin dextrose Salbutamol nebs Calcium resonium PR
38
when is hyperkalaemia emergency
Evidence of myocardial instability on ECG K+ >6.5
39
Trousseau's sign
Inflated BP cuff causes hand wrist flexion, MCP flexion and finger extension = hypocalcaemia
40
Chvostek's sign
Tap on masster muscle and facial muscles contract or twitch in response = sign of hypocalcaemia
41
Symptoms of hypocalcaemia
Spasms muscles perioral paraesthesia ancious feeling seizures muscle tone increase -> colic, wheeze, dysphagia confusion dermatitis, impetigo herpetiformis Cardiomyopathy
42
Causes of hypocalcaemia if incr phosphate
Chronic kidney disease Hypoparathyroidism Decr magnesium acute rhabdomyolysis
43
Causes of hypocalcaemia if normal or low phosphate
osteomalacia Active pancreatitis Respiratroy alkalosis
44
Presentation of hypercalcaemia
Stones: renal stones, nephrogenic DI, nephrocalcinosis Bones: bone pain, pathological fractures Moans: depression, confusion Groans: abdo pain, nausea and vomiting, constipation, pancreatitis, peptic ulcer disease Incr BP Decr QT interval
45
differentials for hypercalcaemia with high phosphate and high ALP
Bone mets (thyroid, breast, lung, kidney, prostate colon common) Sarcoidosis THyrotoxicosis Lithium
46
Differentials for hypercalcaemia with high phosphate and normal ALP
Myeloma Hyper vitamin D Sarcoidosis Milk alkali syndrome
47
Causes of hypercalcaemia with normal or decreased phosphate
Primary or tertiary hyperparathyroidism Familial benign hypercalciuria Paraneoplastic
48
Presentation of nephrotic syndrome
Oedema. Periorbital and genital included Frothy urine Breathlessness with pleural effusion, high JVP Signs of hypovolaemia/intravasc depletion: tachycardia, cold peripheries, oliguria Signs of dyslipidaemia: xanthomata, xanthelasma Signs of infeciton Muehrcke's lines= multiple transverse white lines on nail, assoc w hypoalbuminaemia
49
Defining values of nephrotic synddrome
Heavy proteinuria (>3.5g//day) Hypoalbuminaemia (<30g/L) And peripheral oedema
50
Management of nephrotic symptoms
Treat symptoms, and then dependent oon specific cause Low salt diet, fluid restriciton, loop diuretic, K sparing diuretic. Monitor daily weight Minimal change disease = start children straight away on steroids membranous disease = ACE inhibitors
51
Differentiating between CKD and AKI
Renal ultrasound likely to show small kidneys bilaterally in CKD Hypocalcaemia due to lack of vitamin D suggests chronic
52
Causes of CKD
Common: diabetes, hypertension Others: glomerulonephritis, RAS, polycystic disease, drugs, pyelonephritis, SLE, myeloma, amyloidosis
53
Drugs good for CKD
ACEi/ARB SGLT2i Finerenone (monitor K+ carefully)
54
Renal features of APKD
ABdo pain Abdo mass HAematuria Recurrent UTI Renal impairment Renal stones POlyuria
55
Extra renal features of APKD
Hypertension Liver partic cysts SAH Valvular defects Herniae Other cysts eg intestine, pancreas
56
Alport's dyndrome
Mostly X linked inheritance Haematuria, proteinuria, progressive renal failure Sensorineural deafness Lens dislocaion and cataracts retinal flexks Females may have haematuria only
57
Acute tubular necrosis
Most common cause of intrinsic AKI Ischaemic damage or direct toxicity to tubular epithelial cells Urinalysis: muddy brown casts are pathognomonic Mx: correcting underlyin cause, remove nephrotoxins, and potentially need haemofiltration until recovery
58
Absolute indications for dialysis
Refractory hyperkalaemia Severe intractable metabolic acidosis Intractable fluid overload and pulmonary oedema Uraemic complications eg pericarditis, encephalopathy and seizures
59
Key differentials for nephritic syndrome
SLE HSP Goodpasture's disease (GBM) Rapidly progressive glomerulonephritis Post-strep glomerulonephritis ALport's syndrome IgA nephropathy Membranoproliferative glomerulonephritis
60
Pulmonary renal syndromes
Anti-glomerular basement membrane disease Granulomatosis with polyangitis Microscopic polyangitis
61
Haemolytic uraemic syndrome key triad
Haemolytic anaemia (jaundice) Thrombocytopenia Renal failure (oliguria) Following E.coli 0157 infection
62
ACE inhibitors in AKI
Should be held As angiotensin II constricts efferent arteriole and helps to maintain renal perfusion, so blocking this can reduce renal perfusion = not good
63
Dehydration urea and creatinine
Urea rise proportionally higher than creatinine

Year 6 (9 decks)

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