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Renal Flashcards

1
Q

Incidence of AKI

A

10-20% hospital admissions
20-30% cardiac surgery patients.
50% ICU admissions

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2
Q

KDIGO stage 1 (AKI)

A

Serum Cr: 1.5-1.9 x baseline or >26.5 umol/L within 48h
Urine output: <0.5ml/kg/h for 6-12h

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3
Q

KDIGO stage 1 (AKI)

A

Serum Cr: 1.5-1.9 x baseline or >26.5 umol/L within 48h
Urine output: <0.5ml/kg/h for 6-12h

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4
Q

KDIGO stage 2 (AKI)

A

Serum Cr: 2-2.9 x baseline
Urine output: <0.5ml/kg/h for >12h

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5
Q

KDIGO stage 3 (AKI)

A

Serum Cr: >3 x baseline or > 353 umol or requiring renal replacement therapy
Urine output: <0.3ml/kg/h for >24h or anuric for >12h

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6
Q

Causes of pre renal AKI

A

Volume depletion: blood loss / dehydration / burns
Reduced BP: shock / medications
Reduced vascular perfusion: renal artery stenosis
Renal vasoconstriction: ACEi / NSAIDs

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7
Q

Urine dip and osmolality of pre renal AKI

A

No blood / no protein
Osmolality: can retain Na to concentrate urine = urine osm high, urine Na low

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8
Q

General symptoms of AKI

A

Oliguria / anuria
Abdo pain
Dizziness / headache
Nausea / vomiting

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9
Q

Symptoms of pre renal AKI

A

Signs of dehydration
Signs of shock

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10
Q

Management of AKI

A
  1. ABCDE
  2. Stop nephrotoxic drugs
  3. Assess and manage fluid status
  4. Assess and manage electrolyte imbalances
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11
Q

Management of pre renal AKI

A

Volume replacement (IV fluids) if volume depletion

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12
Q

Management of intra renal AKI

A

Consider fluid restriction and loop diuretic if overloaded

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13
Q

Management of post renal AKI

A

Consider urine drainage / catheter
Refer to urology

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14
Q

Risk factors for AKI

A

Underlying conditions: CKD, heart failure, liver disease, DM, cognitive impairment
Acute conditions: sepsis, cardiac surgery
Medications: ACEi, NSAIDs, PPIs, gentamicin, ciprofloxacin, allopurinol, penicillins, lithium, contrast medium
Dehydration: elderly, NBM

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15
Q

Complications of AKI

A

Hyperkalaemia
Fluid overload
Pulmonary oedema
Metabolic acidosis
Uraemia

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16
Q

Indications for dialysis

A

Life threatening, refractory AKI with complications

Severe hyperkalaemia / acidaemia / uraemia

Refractory pulmonary oedema

Toxins / drugs

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17
Q

Symptoms of severe hyperkalaemia

A

Chest pain
Palpitations
Dizziness

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18
Q

Management of severe hyperkalaemia

A
  1. 10ml 10% calcium gluconate = stabilise myocardium
  2. IV insulin +25g glucose = drive potassium into cells
  3. Salbutamol nebs = drive potassium into cells
  4. 1.4% sodium bicarbonate = correct acidosis
  5. Treat cause
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19
Q

Define chronic kidney disease

A

Progressive and irreversible deterioration of renal function >3m

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20
Q

Signs and symptoms of chronic kidney disease

A

Anaemia
Bone disease
Hyperkalaemia
Fluid overload
Early uraemia
Late uraemia
Metabolic acidosis

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21
Q

Classification system used for CKD needing RRT

A

Persistent albuminuria:
A1= <3mg/mmol
A2 = 3-30mg/mmol
A3= >30mg/mmol

GFR:
G1= >90
G5 = <15

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22
Q

How does diabetes reduce GFR

A

Glycation of efferent arteriole = increased pressure and sclerosis

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23
Q

How does diabetes reduce GFR

A

Glycation of efferent arteriole = increased pressure and sclerosis

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24
Q

How does HTN reduce GFR

A

Thickened walls of afferent arteriole = hypoperfusion

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25
How does chronic glomerulonephritis cause reduced GFR
Inflammation and damage to vessels
26
How does chronic pyelonephritis cause reduced GFR
Urinary reflux or recurrent infection
27
How does obstructive uropahty cause reduced GFR
Back up of pressure = hydronephrosis and damage -> neurogenic bladder, BPH, malignancy, stones
28
How does Polycystic kidney disease cause reduced GFR
Auto dominant form presents in adults Fluid filled cysts press on nephrons = atrophy Causes back pain, headaches and haematuria
29
Risk factors for CKD decline
HTN DM Smoking Infection NSAIDs / ACEis
30
Management of CKD
Risk reduction of CVD Treat / manage complications : anaemia / bone disease / oedema Manage medications Refer to nephrology if GFR <30
31
What is the difference between haemodialysis and peritoneal dialysis
Haemo: blood pumped out of the body through ‘artificial kidney’ Peritoneal: dialysate solution infused into peritoneal cavity (peritoneum acts as filtering membrane )
32
Complications of haemodialysis
Site infection Hypotension Air embolus N&V Endocarditis
33
Complications of peritoneal dialysis
Peritonitis Catheter problems Hernia Fluid retention Weight gain
34
Freq of haemodialysis
3x4h sessions each week
35
Freq of peritoneal dialysis
Continuous ambulatory = 4x20min each day while active Automated = overnight 3-5 exchanges over 8-10h
36
Criteria for suitability of kidney transplant
Generally fit for GA At least 5y left to live No malignancy No other significant comorbidities Good vascular supply to legs
37
Describe process of kidney transplant
Transplant placed in iliac fossa and anastomoses of vessels made Usually leave native kidney in place
38
Post kidney transplant treatment
Lifelong immunosuppression = tacrolimus or ciclosporin plus azathioprine 6m of steroids to prevent acute rejection eg prednisolone Aspirin, antihypertensives, PPI, bone protection
39
Immediate complications of kidney transplant
Graft thrombosis Ureteric leak / obstruction Bleeding Rejection
40
3-6m post transplant complications of kidney transplant
Rejection HTN Ileus Infection (urinary or resp)
41
Long term complications of kidney transplant
Cancer Interstitial fibrosis (secondary to ciclosporin / tacrolimus) Cardiac disease Infections
42
Treatment of transplant rejection
IV methylprednisolone and increase immunosuppressants
43
Why is nephrotic syndrome
Inflammed BM allows passage of proteins into nephron
44
Triad of findings in nephrotic syndrome
1. Heavy proteinuria 2. Hypoalbunimaemia 3. Oedema - periorbital, legs, scrotal, vaginal
45
Clinical manifestations in nephrotic syndrome
Peripheral and periorbital oedema (loss of albumin) Pleural effusion (loss of albumin) Hyperlipidaemia (loss of liporegulatory proteins) Hypercoagulability Infections (loss of immunoglobulins)
46
Primary causes of nephrotic syndrome
1. Minimal change disease 2. Focal segmental glomerulonephritis 3. Membranous glomerulonephritis
47
Secondary causes of nephrotic syndrome (damage due to underlying disease)
1. Diabetic nephropathy 2. SLE 3. Infection : hep B /C, HIV, malaria, syphilis 4. Drugs: penicillamine, gold, NSAIDs, iron 5. Amyloidosis 6. Myeloma 7. Pre eclampsia
48
Management of nephrotic syndrome
1. Reduce oedema : loop diuretics + fluid and salt reduction 2. Reduce proteinuria : ACEis / ARBs 3. Treat underlying cause : corticosteroids indicated in minimal change disease
49
Pathogenesis of nephritic syndrome
Inflammation damages glomerular capillary so RBCs leak into nephron Inflammation damages podocytes allowing protein to leak into nephron Inflammation causes reduced GFR leading to oliguria and HTN
50
Triad of findings in nephritic syndrome
1. Haematuria 2. Oliguria 3. Proteinuria
51
Clinical manifestation of nephritic syndrome
Volume overload / reduced GFR - oedema - hypertension -> seizures
52
Clinical manifestation of nephritic syndrome
Volume overload / reduced GFR - oedema - hypertension -> seizures
53
Causes of nephritic syndrome
1. Autoantigens (goodpastures disease): anti BM antibodies 2. ANCA-associated 3. Immune complexes
54
Causes of nephritic syndrome
1. Autoantigens (goodpastures disease): anti BM antibodies 2. ANCA-associated 3. Immune complexes
55
Management of nephritic syndrome
1. Goodpastures disease : plasmapheresis, corticosteroids, cyclophosphamide 2. ANCA-associated vasculitis : induce remission with corticosteroids and cyclophosphamide -> maintain with azathioprine 3. IgA nephropathy / post strep infection : ACEi/ARB
56
Symptoms of upper UTI (pyelonephritis)
Dysuria Frequency / urgency Flank / loin pain High grade fever, N&V +/- haematuria
57
Symptoms of lower UTI (cystitis)
Dysuria Frequency / urgency Suprapubic pain Foul smelling cloudy urine
58
Complications of upper UTI (pyelonephritis)
Sepsis AKI Perinephric abscess Renal papillary necrosis
59
Complications of cystitis (lower UTI)
Elderly : confusion +/- incontinence Young: vague, irritable, poor feeding
60
Investigations for UTI
1. Urine dip : leukocytes, nitrites 2. MSU for MCS: confirm Dx 3. Bloods: FBC, CRP / ESR, U&Es, culture 4. USS KUB
61
Management of upper UTI (pyelonephritis)
1. Admit 2. Analgesia 3. IV abx (ciprofloxacine or cefuroxime)
62
Management of lower UTI (cystitis)
1. Lifestyle : hydration, personal hygiene 2. Analgesia : NSAIDs, paracetamol 3. ABX (men 7d course, women 3d course)
63
Kidney causes of haematuria
UTI Stones Trauma Cancer (RCC or TCC)
64
Ureter causes of haematuria
Cancer (TCC) Stones
65
Bladder causes of haematuria
UTI Stones Trauma Cancer (TCC) Iatrogenic (catheter)
66
Bladder causes of haematuria
UTI Stones Trauma Cancer (TCC) Iatrogenic (catheter)
67
Prostate causes of haematuria
BPH Adenocarcinoma
68
Urethral causes of haematuria
Cancer Trauma
69
Investigations for haematuria
1. Hx and exam : remember DRE 2. Urinalysis : dip and MSU 3. Bloods: FBC, clotting, U&Es, PSA 4. Renal USS 5. Flexible cystoscopy : show bladder / urethral abnormalities 6. CT KUB : gold standard
70
Mode of action of spironolactone
Aldosterone antagonist which acts in the cortical collecting duct
71
Indications for spironolactone use
Ascites HTN Heart failure Nephrotic syndrome Conn’s syndrome
72
Adverse effects of spironolactone
Hyperkalaemia Gynaecomastia
73
Medications that are safe to continue in AKI
Paracetamol Warfarin Statins Aspirin Clopidogrel Beta blockers
74
When should patients with CKD be given an ACEi
If they have an ACR >30
75
Causes of acute interstitial nephritis
Penicillin Rifampicin NSAID Allopurinol Furosemide
76
What is important to do before starting EPO therapy in anaemia secondary to CKD
Check ferritin levels Adequate iron levels is crucial for efficacy of EPO therapy

Integrated Med (6 decks)

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