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GP FELLOWSHIP RNZGP > Renal > Flashcards

Renal Flashcards

1
Q

CKD evaluation investigations

A
  • US KUB
  • urine ACR
  • Fasting lipids
  • Fasting glucose
  • Urine MCS
  • FBC, CRP, ESR
  • Repeat EUCs 1 week
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2
Q

Other than CKD, Causes for proteinuria (Other than CKD)

A
  • UTI
  • Heavy exercise (transient)
  • CCF
  • acute febrile illness (transient)
  • NSIADS
  • menstruation
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3
Q

Causes of proteinuria

A
  • Diabetic nephropathy
  • Hypertensive nephropathy /nephrosclerosis
  • PKD
  • Minimal change disease
  • Multiple myeloma
  • Nephrotic syndrome (Focal segmental glomerulosclerosis (FSGS) , minimal change disease)
  • Amyloidosis
  • CCF
  • Rhabdo
  • UTI
  • Exercise
  • Menstruation
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4
Q

How to detect proteinuria (albuminuria)

A
  • Urine ACR (First void ACR !!! is best)
  • Repeat ACR (always do one) first void to confirm

(dipstick not sensitive enough)

Confirmed if 2/3 positive
CKD if present for 3 months

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5
Q

Special case CKD investigations

A

When suspecting autoimmune cause: SLE (joint pain,
- ANA
- ENA
- Complement
- Anti- glomerular basement membrane antibody
- Anti- neutrophil cytoplasmic antibody

Risk factors for hepatitis
- HIV, HBC, HCV

> 40 % MM suspected
- Serum protein electrophoresis

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6
Q

Diabetic medication cautions in CKD

A

SGLT2s
- Dapglifozin: Contraindicated eGFR< 25

Metformin:
- Reduce dose eGFR 30-60
- Contraindicated <30
- Temporarily stop in periods of illness

DPP4s
- No dose adjustment needed for linagliptin (GOOD)

Sulphonylureas
- Dose reduce <30
- increased hypo risk

GLP1s
- Contraindicated <30

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7
Q

Antihyperglycaemic choice 2nd line (following metformin) for CKD

A

SGLT2 PREFERRED
(dapaglifozin,)
Note: dose reduce if eGFR < 45
Empagliflozin can be used until >25

OR

GLP1
(Liraglutide, dulaglutide, semaglutide)

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8
Q

Microalbuminuria levels
(ACR mg/mmol)
(mg/day)

A

Male:
2.5 - 25

Female:
3.5 - 35

mg/day= 30-300

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9
Q

Macroalbuminuria

A

Male: >25
Female: >35

> 300 mg/day

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10
Q

What is a kidney health check & how often

A

eGFR
ACR
BP

1-2 yrs

(annually for HTN or DM)

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11
Q

Indications for kidney health check

A
  • HTN
  • Diabetes
  • CVD
  • family hx renal failure
  • obesity
  • smoking
  • ASTI >30
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12
Q

Raised ACR what to do?

A

Repeat ACR
Within 3 months
First void best

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13
Q

Reduced eGFR what to do? (and cut off)

A

<60 = Repeat within 7 days

NOTE:
Then if stable but reduced: repeat twice in 3 months

If >20% reduction then consider AKI (d/w nephrologist)

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14
Q

Indications for nephrology referral in CKD

A
  • eGFR <30
  • ACR >30
  • sustained decreased eGFR (25%/yr OR >15 /yr
  • HTN on >3 agents
  • Albuminuria and haematuria
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15
Q

Haematuria and renal impairment causes

A
  • Glomerularnephritis: IgA or PSGN
  • Hypertensive nephropathy
  • Analgesic nephropathy (eg paracetemol)
  • Malignancy
  • MM
  • PKD
  • Angiomyelolipoma
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16
Q

CKD treatment goals (for KFP)

A
  • BP <130/80
  • Annual influenza/pneumococcal (for DM or ESKD)
  • etOH <2/d
  • salt <6g/day
  • HBa1c <7
  • PA: 150-300 moderate intensity
  • LIPIDS:
    statin if >50
    or <50 with DM, CVD, Ischaemic stroke, high risk CVD
  • Ferritin >100
17
Q

eGFR reduction with ACEi/ARB

A

<25% within 2 months

If >25% then cease & refer to nephrologist

18
Q

Special investigations for CKD evaluation (for cause)

A

Signs of systemic disease (rash, pulmonary symptoms, arthritis)
- ANA, ENA, complement
- Anti- neutrophil cytoplasmic antibody
- Anti- GBM antibody

HIV/HCV/HBV serology

> 40 and concerns for MM: serum and urine protein electrophoresis

19
Q

SICK DAY medications to avoid

A

(SADMANS)

S: Sulfonylureas
A: ACEi
D: Diuretics
M: Metformin
A: ARB
N: NSAIDs
S: SGLT2

20
Q

Cyst number for cut off for PKD

A

<39 yrs: 3 in total

40-59: 2 in each kidney

> 60: 4 in each kidney

21
Q

Renal stone prevention advice

A
  • Maintain hydration aiming for clear urine
  • Low sodium
  • Low oxalate intake
  • Low protein
  • Limits sugary beverages
  • Healthy BMI (weight loss)
22
Q

Nephritic syndrome features

A

Haematuria
Protein +
HTN
Low urine volume

23
Q

Nephritic syndrome associated diseases

A

PSGN
IgA nephropathy
Rapidly progressive glomerularnephritis
HSP

24
Q

Nephrotic sydnrome features

A

Protein+++
Frothy urine
oedema

25
Q

Albumin and haematuria - what to do ?

A

Refer to renal physician

26
Q

Risk factors for urothelial carcinoma

A

> 40
Smoker
Male
Industrial dyes
Cyclophosphamide

27
Q

Kidney stone gold standard Scan

A

CT KUB

28
Q

If you see stone on CT KUB what test do you also order?

A

XRAY KUB to see if radiolucent so you work out whether you can just do XRAY for FU scan

29
Q

UROLITHIASIS: indications for urgent referral

A
  • Single kidney
  • Septic
  • Renal Failure
  • Uncontrollable pain
  • Complete urinary obstruction
  • Pre-existing CKD
  • Stone >7mm
30
Q

UROLITHIASIS: Immediate and long term investigations

A

CTKUB (and xray KUB)
EUC
MSU
Serum calcium
Serum urate
Stone analysis
24 urine collection for volume, calcium, oxalate, citrate and uric acid

31
Q

Diet advice to reduce UROLITHIASIS

A
  • Low salt
  • Low oxalate
  • Low Protein
  • Low high fructose drinks and foods
  • Enough water to ensure clear urine
  • Normal calcium intake
32
Q

UROLITHIASIS: management at discharge?

A
  • NSAID: celecoxib 200mg daily
  • Tamsulosin 400mcg daily
  • Paracetemol
  • STRAIN URINE - allow for stone analysis
  • Return if fever
  • GP 4 weeks for repeat CT KUB
33
Q

Cystitis in pregnancy 1st line

A

Nitrofurantoin 5 days

34
Q

UTI children 1st line

A

Bactrim

35
Q

Causes of haematuria

A
  • Glomerular nephritis: IGA nephropathy
  • HTN nephropathy
  • UTI /pyelo
  • PKD
  • Stone
  • Analgesic nephropathy
  • Angiomyolipoma
36
Q

Aboriginal & TSI CKD screening - how often to do kidney health check (hint <30 and over 30)

A
  • <30 then screen ANNUALLY for RISK FACTORS (smoking, family hx, diabetes, obesity)
  • If Risk factor then Kidney health check every 2 years

> 30 every TWO YEARS

37
Q

First line investigations for CKD newly diagnosed…

A
  • Renal US
  • FBC, CRP, ESR
  • Urine ACR & repeat eGFR
  • Lipids
  • Glucose
  • Urine microscopy, red cells and casts & crystals

GP FELLOWSHIP RNZGP (20 decks)

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