Renal Flashcards
Criteria for Actute Kidney Injury?
Rise in creatinine ≥ 25 micromol/L in 48 hours
Rise in creatinine ≥ 50% in 7 days
Urine output of <.5mL/kg/hour for more than 6 hours
Risk factors for AKI?
Chronic kidney disease
Heart Failure
Liver disease
Diabetes
Nephotoxic medication
Contract agents (CT Scans)
Causes of Acute Renal Injury?
Pre-RenalMost common casue of AKI, due to inadequate blood supply to kidneys reducing filtration :
* Dehydration
* Hypotension (Shock)
* Heart Failute
Renal: instic causes => reduced filtradtion of blood
* Glomerular Nephritis
* Interstitial nephritis
* Acute tubular necrosis
Post-Renal: obstruction to outflow of urine from kidney
- Kidney Stones
- Masses (Cancers inabdo/pelvis)
- Ureter/Uretral strictures
- Enlarged prostate/prostate cancer
Investigations/Differential for Acute Renal Injury
Urinaysis for protein, blood, leucocytes, nitrates and glucose
- Leucocytes + Nitrates => Infection
- Protein + Blood => Acute nephritis (or Infection)
- Glucose => Diabetes
Management of AKI?
Fluid rehydration (Pre-renal cause)
Stop nephrotxoic medicaitons (NSAIDs/anithypertensives that reduce filtration pressure)
Relieve obstruction (Post-renal AKI)
Causes of Chronic Kidney Disease?
Diabtetes
Hyeprtension
Glomoerulonephritis
Polycystic Kidney Disease
NSAIDS/PPI/Lithium
Presentation of AKI?
Pruritis (ithcing)
Loss of apetitie
Nasuea
Edema
Muscle cramps
Peripheral Neuropathy
Pallor
Hypertension
Investigations for CKD?
eGFR: Checked via U/E blood test (2 required 3 months apart to diagnose CKD)
Protenuria: checked w/ urine albumin:creatinine ratio (>3 Significatnt)
Hematura: Urine dipstick (significant +1)
Renal Ultrasound
Management of CKD?
Atorvostatin for prevention of cardiovascular
ACE inhibitors
To limit complications
* Oral Sodium bicarbonate (Metobolic acidosis)
* Iron suppmentation (Anemia)- kidneys produce EPO
* Vit D (Renal bone disease)
* Dialysis (End stage)
* Renal Transplant
Complications of CKD?
Hypertension (Treated w/ ACE inhibitor)
Anemia
Renal Bone DIsease:
* high serum phosphate occurs due to reduced excretion
* low vitamin D bc kidney is essential to metabolizing vitamin D to its active form => low serum calcium
* Secondary hyperparathyroidism bc [parathyroids react to low serum calcium and high phosphate by excreting more PTH
Indications for Dialysis?
A- Acidosis (Severe/unresponsive to treatment)
E - Electrolyte abnormalities (Severe/unresponsive HYPERKALEMIA)
I - Intoxication (overdose of medication)
O - Oedema (severe/unresponsive pulmonary edema)
U - Urameia (Seizures/reduced consciousness)
Options for Hemodialysis?
Tunneled cuffed catheter: tube inserted into subclavian or jugular vein with a tip into the superior vena cava. Has two lumens one where blood exits the body (red) and one where blood enters the body (blue). Complications are infection/clots
AV Fistula: Bypasses capilary system allows for a permanent, l arge, easy access blood vessel w/ high pressure arterial blood flow. Requires surgery and a 4 week to 4 month maturation period. Typically performed between Radio-Cephalic or Brachio-Cephalic
Examination/Complications of an AV Fistula?
Typically performed between Radio-Cephalic or Brachio-Cephalic
Examination:
- Skin integrity
- Anuerysms
- Palpable Thrill
- Machinery murmur on ausclatation
Complications
- Anerrysm
- Infection
- Thrombosis
- Stenosis
- STEAL Syndrome: Inadeqwute blood flow to limb distal of ASV fistula => distal ischemia
- High output heart failure: Increased pre-load to heart=> Hypertrophy of heart muscle
Classification of Nephritic Syndrome?
Nephritic, unlike nephrotic has no set criteria however includes:
- Hematuria (Microscopic or Macroscopic)
- Oliguria
- Protenuria (< 3 g per 24 hours of Urine)
- Fluid Retention
Classification of Nephrotic Syndrome?
Nephrotic MUST fulfill the following:
- Peripheral Edema
- Protenuria (> 3 g per 24 hours of Urine)
- Serum Albumin < 25g per L
- Hypercholestermeia
Usually present with Edema, Frothy Urine (Protinurea)
Predispoisition to thrombosis, hypertension, high cholesterol
Treatment of Glomerulonephritis?
Immuosupression (Steroids)
Blood Pressure control (ACE/ARBs)
Most common cause of nephrotic syndrome in children?
Minimal Change Disease
(Idiopathic, treated sucessfully w/ steroids)
Most commone cause of Nephrotic Syndrome in Adults?
Focal Segmental Glomerulosclerosis
Most common cause of primary glomerulonephritis?
Demographic? Histology?
IgA Nephropathy (Berger’s Disease)
- Peak presentation is in the 20’s
- Histology shows IgA deposits and mesangial proliferation
Most common type of glomerulonephritis overall?
Demographic? Histology?
Mebranous Glomerulonephritis
- Bimodal peak in 20’s and 60’s
- Histology shows IgG and complement deposition on basement membrane
- ~70% indiopathic
- Can be secondary to maligannagyy, rheumatoid disease, NSAIDs
Presentation of post-streptococoal glomerulonephritis?
- Typically <30
- 1-3 weeks after streptococoal infection (tonsilitis/impetigo)
- Usually full recovery
Patient presenting with acute kidney failure + hemoptysis
Goodpasture’s Syndrome: Anti-GBM (Glomerular basement membrane) anitbodies attack glomerulus/pulmonary basement membranes => glomerulonephritis and pulmonary hemmorage
Most common cause of glomerular pathology + CKD?
Pathophysiology? Associated signs? Screening? Management?
Diabetic Nephropathy
- High levels of glucose passing through glomerulus => scarring (Glomerulosclerosis)
- Protinuria (Damage allows protein to be filtered from blood into urine)
- Albumin::Creatine ratio screening + U&Es
- Optomise blood sugars/BP. All should be put on ACE Inhibitors
Manifestation of Acute Instersitial Kidney Disease
Usually casued by hypersensitivity reaction to Drugs/Infection
Presents w/ fever, rash, eosinophillia
