Renal Flashcards

1
Q

Definition and detection of AKI

A
  • rise in creatinine from baseline of >50% within 7 days -suspect of oligouria <0.5ml/kg/hr -check creatinine in all ill patients, especially if elderly, or confused -particularly if suspecting sepsis, HF, liver failure, hypotension, dehydration, diabetes -particularly if on nephrotoxic drugs
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2
Q

Nephrotoxic drugs

A

stop the DAMN drugs Diuretics ACEi and ARBs Metformin- not nephrotoxic, accumulates + causes lactic acidosis NSAIDs

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3
Q

Indications for dialysis in AKI

A

AEIOU Acidosis pH<7.1 Electrolytes e.g. refractory hyperkalaemia Intoxications e.g. salicylate, lithium Overloaded with fluid Uraemia symptoms e.g. encephalopathy

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4
Q

Emergency treatment of hyperkalaemia

A

Calcium glauconite to stabilise myocardium- 10ml of 10% slow IV Glucose and insulin IV- 10 units, in 50ml 50% glucose over 15 minutes Salbutamol

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5
Q

Causes of CKD

A

HIDDEN hypertension Infection e.g. ureteric reflux in children Diabetes Drugs e.g. analgesic nephropathy, NSAIDs, lithium Exotics e.g. SLE Nephritis, Glomerulonephritis

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6
Q

Indications for dialysis in CKD

A

Progressive decline in renal function <15ml/min Symptomatic uraemia despite conservative treatment Volume overload despite fluid restriction and Diuretics Other- pericarditis, Bone Disease, hyperkalaemia despite treatment

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7
Q

What is CAPD?

A

Tenckhoff catheter into abdomen Less expensive than haemodialysis More convenient as low tech- holidays Relatively easy to teach May have to stop due to peritonitis Fibrosis may reduce permeability 3 litres of fluid, 4 times a day with 30min exchanges Can cause diaphragm splinting, can’t use in COPD

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8
Q

What is removed in CAPD?

A

Urea, creatinine, potassium and phosphate pass along their concentration gradient- isotonic fluid Water is removed down an osmotic gradient, by including some bags of hypertonic fluid with a high glucose and polymer gradient

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9
Q

Peritoneal dialysis peritonitis

A

Cloudy effluent- urgent MC&S and culture from ‘first cloudy bag’ Abdominal pain +/- fever Exit site infection (take swab) If I’ll, take blood cultures Gram +ve staph or strep- intraperitoneal vancomycin Gram -ve or pseudomonas- IV ciprofloxacin Uncertain- use both

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10
Q

Questions to ask in CKD?

A

What are your energy levels like? Do you get breathless? Do you suffer from itching? (Hyperphosphataemia/ hyperuracaemia) Do you have joint pain/ gout? Do you get numb or tingling feet?

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11
Q

Three causes of fatigue in CKD

A

Anaemia- normochromic normocytic Anaemia of chronic disease Solute retention- many retained solutes are cerebral depressants Psychosocial- loss of employment, feeling trapped by chronic disease

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12
Q

Three causes of breathlessness in CKD

A

Anaemia, fluid overload, heart failure (CAD and hypertension are common)

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13
Q

Peripheral neuropathy in CKD

A

Retention of beta-2-microglobulin leading to amyloidosis of peripheral nerves Underlying diabetes is a common cause of CKD and causes neuropathy

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14
Q

Features of CKD

A

BIG BEAN Breathless Itching Gout Bone pain Energy levels low Ankle swelling/ anaemia Neuropathy

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15
Q

4 features of renal bone disease

A

Osteoporosis

hyperparathyroidism

osteomalacia

osteosclerosis

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16
Q

Features of renal bone disease

A

Often assymptomatic

low back pain/ vertebral crush fracture

brachydactyly (short stubby fingers)

osteolysis of terminal phalanges tuft (acronecrosis)

17
Q

Features of nephrotic Syndrome?

A

Proteinuria >3g per 24hrs, makes urine frothy

hypoalbuminaemia <30g/dl

oedema (loss of protein on optic pressure allows salt and water into extra cellular space; increased salt and water retention by Kidney)

hypercholesterolaemia as Liver makes more cholesterol-linked to compensatory increase in albumin synthesis

Loss of antithrombin 3- increased thrombin activity- hypercoagulable

18
Q

Main cause of nephrotic Syndrome in children

A

Minimal change disease

Idiopathic, steroid responsive

doesnt progress to CKD

19
Q

Main causes of nephrotic Syndrome in adults

A
  • glomerulosclerosis especially due to diabetes
  • membranous Glomerulonephritis- usually idiopathic.
20
Q

Treatment of nephrotic syndrome

A

Oedema- Diuretics and salt retention

minimal change Glomerulonephritis- steroids +/- cyclophosphamide

ACEi reduces protein excretion- lowers glomerular filtration pressure

anticoagulation

statins

21
Q

Features of nephritic syndrome

A

HOST

Hypertension

Oliguria

Smoky Brown haematuria with red cell casts

Trace of oedema

22
Q

Causes of acute nephritis

A

post streptococcal

IgA nephropathy- post strep

vasculitis e.g. SLE

23
Q

Investigations in nephritic symdrome

A

Throat swab, ASO titres, 24hr urinary protein

24
Q

Urea

A

Excreted mainly by kidneys

large renal reserve- rises late in disease

rise with: dehydration, HF, Diuretics, high protein diet, GI bleed, catabolic states (trauma, infection, fever)

low in: liver disease, over hydration

25
Creatinine
levels vary depending on muscle mass low in- elderly high- young athletes rise late in renal decline
26
CKD stages
27
Blood test acute vs chronic renal failure
Normochromic, normocytic anaemia hypocalcaemia hyperphosphataemia
28
Prevent renal bone disease
Dietary phosphate restriction phosphate binders alphacalcidol to correct activated vitamin D deficiency calcium supplements
29
How do you monitor renal bone disease?
30
Causes of hyperkalaemia
The hyperkalemia MACHINE Medications – ACE Inhibitors, NSAIDS, potassium-sparing diuretics Acidosis – Metabolic and respiratory Cellular destruction – burns, traumatic injury, hemolysis Hypoaldosteronism – Addison’s Intake- excessive Nephrons- renal failure Excretion – Impaired
31
How do ACEi cause acute renal failure?
pre-renal efferent Arterial vasodilation, reducing GFR
32
How do NSAIDs cause acute renal failure
Prerenal- inhibition of prostaglandin mediated affording arteriole vasodilation renal- direct nephrotoxic
33
Early complications of ATN
hyponatremia hypokalaemia hypovolaemia
34
CKD stages