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Renal Flashcards

1
Q

Acute kidney injury
What is it

A

Acute deterioration in renal function and build up of waste products
Abrupt -1-7 dayy
Sustained >24 hours

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2
Q

RIFLE criteria

A

Risk: serum creat >1.5x increase
GFR >25-50% decrease
UO < 0.5ml/kg/hr for 6 hours

Injury: serum creat >2x increase GFR > 50-75% decrease
UO < 0.5ml/kg/hr for 12 h

Failure: creat 3x increase or >4mg/dL or decrease GFR> 75%
UO < 0.3ml/kg/hr or anuria for 12 h

Loss: persistent AKI complete loss function 4 weeks

ESRF: complete loss >3 m

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3
Q

AKIN criteria

A
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4
Q

AKIN criteria

A
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5
Q

KDIGO definition AKI

A
  1. UP <0.5ml/kg/hr for 6 hours
  2. Serum creat >1.5x normal in last 7 days
  3. Serum creat >0.3mg/dL in 48 hours
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6
Q

Severity AKI

A

Stage 1: 1.5-1.9 x baseline cr
>0.3mg/dL increase from baseline

Stage 2: 2-2.9 increase baseline scr

Stage 3: > 3.0 x baseline scr or RRT

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7
Q

Risk factors for AKI

A

Sepsis
Age>65
Race
Pre existing CKD
Surgical patients
cVs disease
Liver failure pts
Diabetes
Oligouria
Nephrotoxins
Contrast

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8
Q

Indications for dialysis

A

A: refractor acidaemia <7.2
E: electrolyte abnormalities K>7
I: ingestions toxins BLAST: barbiturates, lithium, alcohol, salicylates, theophyline
O: oedema apo
U: uraemia pericarditis, encephalopathy

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9
Q

Causes of AKI

A

Pre renal: hypo perfusion

Renal: structural/ functional changes at nephron ATN

Post renal: obstruction

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10
Q

Causes of pre renal aki

A
  • dehydration: blood loss, diarrhoea, diuretic, vomting, sepsis
  • shock: hypotension
  • low effective: heart failure: liver failure
    Anatomical: renal artery stenosis
    Drug induced: nsaids, acei
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11
Q

Causes of Renal AKI

A

ATN: most common
Nephrotoxins: nsaids, contrast, allopurinol, gentamicin, furosemide, herbicides, heavy metal ACEi
Glomerulonephropathies: nephrotic vs nephritic syndrome
HUS
Rhabdo: myoglobin
Severe HTN

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12
Q

Post renal aki

A

Obstruction
Ureters: stone or structure, retroperitoneal fibrosis
Bladder: cancer
Prostate: BPH: cancer
Urethra: stricture
External mass/ LN

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13
Q

Complications of AKI

A

Volume overload: CHF, HTN, APO
Metabolic acidosis: reduced albumin, impaired insulin’s action increase bsl
Electrolyte: low na and high K
Pulmonary oedema: low albumin and reduced oncotic pressure
ALI: neutrophils
Uraemia: encephalopathy, confusion, seizures, pericarditis
Haematological: reduce RBC reduce epo
GI: ulceration and haemorrhage
Pharmacology: reduce vd under or over dosing

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14
Q

Phases of AKI

A

Phase 1: onset: insult renal blood flow 25% of normal, UO<0.5ml/kg/hr
Phase 2: oligouric: OU <400mls/ day
Increase in urea and creat, electrolyte abnormalities
Phase 3: polyuric in UO>400mls/ day. Hypotension hypovolaemia
Increase GFR
Phase 4: recovery: normalisation of GFr 80% electrolyte and fluid UO normal

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15
Q

Management of AKI

A

IVF
Maintain UO, diuretics mannitol
Monitor K
Acidosis
Relief onstruction IDC/ nephrostomy
Withhold Nephrotoxins
GIH prophylaxis

A address drugs withhold nephrotoxic
B blood pressure fluid and tropes
C calculate fluid balance
D. Dip urine
E exclude obstruction catheter

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16
Q

Urea creatinine ratio
What is it? What does it mean?

A

Both freely filtered at the glomerulus
Creatinine is not reabsorbed
Urea is reabsorbed by the tubules
Can be used as an indicator of renal failure
If issue is intrinsic to kidney urea is not reabsorbed therefore the ratio is closer to one

If the issue is pre-renal the kidney is still working and urea is reabsorbed therefore the creatinine and ratio is further away from one

Urea: creatinine
Pre renal >100:1 or bun: Creat >20:1
Renal <40:1 or bun: creat <10:1

Ensure units are same

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17
Q

AKI
How to distinguish cause renal vs pre renal
Creat: urea ratio
Urine Na
Fraction excreted na
Urine osmolalitu

A

Urea: creat pre renal >100:1 Renal <40:1
Urine Na pre renal <20mEq/l renal: >20mEq
FENa pre renal <1% and renal >2%
Urine osmolality >500 renal >350 mOsmol/l

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18
Q

Bun: creat ratio.
Causes of high

A

Drivers can use GPS
D: dehydration, pre renal, haemorrhage vomting
C: corticosteroids
G: GIH
P: protein rich diet
S: severe catabolic state

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19
Q

Bun: creat ratio.
Causes of low

A

I am SIMPLE SR

S: severe liver failure
I: intrinsic renal damage
m: malnutrition/ starvation
P: pregnancy
L: low protein intake
E:
S: siadh
R: rhabdo

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20
Q

What is most common inheritance of polycystic kidney disease

A

Autosomal dominant
But also can be recessive

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21
Q

Most common cause of death in PCKD

A

Cardiac cause of death

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22
Q

Most common presenting symptoms of PCKD

A

Hypertension

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23
Q

Associated disease PCKD

A

Berry aneurysm: 8-10%
Thoracic aortic and cervicocephalic artery dissection
Coronary A aneurysm
MV prolapse
Defective sperm motility and infertility

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24
Q

PCKD where do cysts form

A

Kidney 100%
Liver 80%
Seminal vesicles 40%
Spleen 3%

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25
PCKD diagnosis
On US in those at risk or with FH Age 15-39: at least 3 in total Age 40-59: at least 2 in each kidney age 60: at least 4 in each kidney If no family history >10 in total
26
Symptoms HUS
FAT RN F: fever A: microangiopathic anaemia T: thrombocytopenia R: renal failure N: neurological impairment
27
What causes HUS Main Others
Diarrhoea associated: verocytotoxin producing bacteria EColi 0157:H7 Non diarrhoea HUS: strep pneumonia, pregnancy, drugs, HIv
28
Investigations HUS
Microangiopathic haemolytic anaemia, ARF and thrombocytopenia Low plts Low HB schistocytes and spherocytes Increase reticulocytes Reduced haptoglobins Increase LDH Unconjugated hyperbilirubinaemia Urinary urobilinogen Variable neutrophilia Increase urea and crest Renal biopsy: thrombotic microangiopathic with swollen glomerular endothelial cells and red cells and plts in capillaries
29
Managed of HUS
Supportive ABX may worsen Plts contraindicated Plasmopheresis if unsure Plasma exchange and transfusion No evidence for steroids, heparin, aspirin Tx arf fluid restriction, antihypertensive, avoid Nephrotoxins
30
Renal cell carcinoma % all malignancy What syndrome associated with
3% 80% pts with von hippel Lindau disease
31
What is HSP Who most common in: age and gender
IGA vasculitis Immune mediated small vessel vasculitis IGA and complement C3 deposition in walls- inflammation Post URTI Children age 4-6 year Male> female
32
What difference petechia and purpura
Petechia: smaller <3mm non blanching Purpura: larger > 3mm
33
Symptoms of HSP
Purpura and petechia: LL and buttocks palatable Abdominal pain:50% GIh and intussception Joint pain: arthralgia and swelling, hips, legs, knees Frothy urine: proteinuria Haematuria: 50% Fever
34
Diagnosis HSP
Palpable purpura and 1 of Diffuse abdo pain Arthralgia Renal involvement Typical histopatholofy
35
Management HUS and prognosis
Supportive Panadol Pred 6montly BP urinalysis When normal x2 can be discharged Relapse 30-40% Renal failure 1%
36
What is most common cause of AKI in hospital
ATN
37
Causes of ATN
Ischaemic: prolonged hypotension, haemorrhage- this is most common cause Nephrotoxins; aminoglycosides, nsaids, acei, amphoceterin, cistoplatin, heavy metals, tacrilimus Pigments: myoglobin, hb
38
Most common cause of nephrotic disease in children
Minimal change diseases
39
Physiology of minimal change disease
Loss of glomerular foot processes
40
Symptoms of minimal change disease
Nephrotic syndrome 1. Proteinuria >3.5g/ day 2. Hypoalbuminaemia 3. Oedema 4. Hypercoagulability: reduced antithrombin 3 and protein S, losss in urine. Increase plt activation 5. Htn
41
Treatment minimal change disease
Prednisolone and dietary restrictions
42
Nephrotic syndrome six
1. Proteinuria >3.5g/ day 2. Hypoalbuminaemia <30 3. Oedema 4. Hyperlidipiademia 5. Hyper-coagulable
43
Nephritic syndrome is
Haematuria Htn Proteinuria <3.5g/day Oligouria Red cells casts
44
What is in urinalysis of nephritis syndrome
Red cell casts
45
Post strep glomerulonephritis Caused by Symptoms
Group A beta haemolytic streptococcus Nephritic Htn haematuria and periorbital oedema
46
Diagnosis of post strep glomerulonephritis
Asymptomatic, microscopic haematuria nephritic syndrome + evidence of recent strep infection GAS skin/ throat swab Low c3/ Ch50
47
Prognosis post strep glomerulonephritis Children and adults
Children: excellent complete recovery Adults: poorer prognosis more likely ckd, htn
48
5 causes of nephrotic disease
Minimal change nephropathy Focal segments glomerulosclerosis Membranous glomerulonephropathy Amyloidosis SLE
49
Most common cause of nephrotic syndrome in adults
Membranous glomerulonephropathy
50
Causes of nephritic syndrome
Immune complex disease Post strep glomerulonephritis IgA GN: Bergers disease Membranoproliferative GN Others: sle, bacterial endocarditis Pauci immune complex Granulomatosis and polyangitis: cANCA Eosinophilia granulomatosis and polyangitis: pANCA Anti GBM goodpastures Ab against type 4 collagen Lung and kidney hameoptysis and renal failure
51
Treatment of goodpastures
Plamsopheresis Get rid of antibodies Pred and immunosuppressant
52
General management of nephrotic syndrome
General supportive Salt and water restriction Duiresis: loop diuretics ACEi and ARB reduce proteinuria vte prophylaxis Pneumococcal vaccine and statin Specific Steroids —- immunosuppressant
53
What is ass allport syndrome
Hereditary disease Glomerulonephritis and sensorineural hearing loss Bilateral — progresses 85% boys hearing loss by 15 year
54
What acute renal injuries associated with rheumatic heart disease
Group a strep is cause Post strep glomerulonephritis
55
Treatment of scleroderma renal crisis
ACEi
56
Is acute renal artery occlusion painful or painless
Painful if acute painless is gradual
57
How does papillary necrosis present
Fever Flank pain Haematuria
58
Is acute renal failure often symptomatic
Acute renal failures is often asymptomatic until uraemia occurs
59
Pre renal cause of Aki is what percentage
70%
60
What % hospital acquired aki are pre renal
20%
61
% aki caused by intrinsic renal cause in community vs hospital acquired
20% vs 70%
62
Post renal % aki in community and hospital
10%
63
% community acquired aki are reversible
90%
64
What is most common cause of intrinsic renal failure
Tubular Acute tubular necrosis
65
4 types of intrinsic renal failure
Glomerular, tubular, interstitial, small vessel disease
66
What is most common cause of death associated acute renal failure
Sepsis / infection
67
Mortality rates in children with arf
25%
68
Second most common cause of death in ARF
Cardio/ resp
69
What drugs cause reduced GFR
ACEi, NSAIDS, ARBs
70
What electrolyte abnormality do ACEI cause
Hyperkalaemia Suppression or ag II Reduced aldosterone Reduced excretion K+
71
Do nsaids Selective and non selective effect kidney
Both COXi interfere with prostaglandin synthesis and can cause glomerular arteriolar vasoconstriction with diminished renal flow and GFR
72
Risk factors for getting contrast induced nephropathy
GFR<60 Pt factors: age >75 Diabetes Shock Hypotension CHF Sepsis Nephrotic agents
73
When should we repeat EUCs in patients high risk COntrast induced nephropathy
48-72 hrs peaks at 3 days post
74
What reduced incidence of contrast induced nephropathy
IV fluids
75
What % patients reciving dialysis get pericarditis
20%
76
What is uraemic pericarditis friction rub and ecg like compared to normal
Pericardial friction rub louder and often palpable Do not penetrate myocardium - nil ecg changes
77
AV fistula Natural vs Graft What has higher complications
Graft
78
What is most common av fistula complication
Low flow: thrombosis/ stenosis infection
79
What is most common av fistula infectious organism
Staph aureus

F24 (22 decks)

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