Renal Flashcards
rise in creatinine AKI definition
25 mml/L in 48 hrs
over 50% in 7 days
rise in creatinine in past 48 hrs for diagnosis of AKI
25 microcol/L
rise in creatinine over past 7 days for diagnosis of AKI
over 50%
urine output for diagnosis of AKI
less than 0.5ml/kg/hr over minimum 6 hrs
renal causes of AKI
acute tubular necrosis
glomerulonpehritis
acute interstitial nephritis
haemolytic uraemic syndrome
rhabdomyolysis
pre renal causes of AKI
dehydration
shock eg sepsis, acute blood loss
heart failure
most common renal intrinsic cause of AKI
acute tubular necrosis
what cells are damaged in acute tubular necrosis
epithelial cells of renal tubules
medications that cause AKI
NSAIDs
gentamicin
diuretics
ACEi
how do ACEi affect the kidneys
they are reno protective
they are stopped in AKI as they reduce the filtration pressure, but are given to protect the kidneys in htn, diabetes, CKD
complications of AKI
fluid overload- pulmonary oedema
hyperkalemia
metabolic acidosis
uraemia
how is proteinuria quantified
urine albumin:creatinine
eGFR for diagosis of CKD
<60 ml/min for 3 months
urine albumin:creatinine for diagnosis of CKD
> 30 mg/mmol for 3 months
what medications help slow the progression of CKD
ACEi
SGLT-2 inhibitors
what medication are all patients with CKD put on
atorvastatin 20 mg
what happens to phosphate in CKD
what advice is given
rises
low phosphate diet and phosphate binders
what should be corrected before giving erythropoietin in CKD
iron deficiency
describe what happens in renal bone disease
calcium is low as the kidneys cant metabolise vitamin D into calcitriol
this causes a rise in PTH and activates osteoclasts, so calcium can be released from bones
when this is done with inadequate calcium supply, osteomalacia occurs
osteosclerosis also occur as osteoblasts match osteoclast activity, but without sufficient calcium this leads to unmineralised bone
pneumonic for indications for dialysis
AEIOU
acidosis
electrolyte imbalance
intoxication
oedema
uraemia
how might long term haemodialysis be carried out
tunnelled cuffed catheter
ateriovenous fistula
where is a tunnelled cuff catheter inserted
subclavian or jugular vein
how might you identify a ateriovenous fistula
aneurysm
palpable thrill
machinery murmur
what is steal syndrome
when the portion of the lim distal to an AV fistula doesnt receive enough blood leading to ischaemia
what does peritoneal dialysis occur through
a tenckhoff catheter
2 types of dialysis
haemo
peritoneal
most common AV fistula
radiocephalic
where is a donor kidney implanted
in the iliac fossa
what scar is seen in kidney transplant
hockey stick
tacrolimus side effect
tremor
cyclosporine side effect
gum hypertrophy
what is given after kidney transplant to prevent acute rejection
basiliximab
complications of immunosupression in kidney transplant
due to steroids:
cushings
diabetes
NHL
skin cancer
tremor (tacrolimus)
gum hypertrophy (cyclosporine)
nephritic syndrome features
heamaturia
oliguria
fluid retention
nephrotic syndrome triad
proteinuria
hypoalbuminaemia
oedema
what happens to cholesterol in nephrotic syndrome
rises
most common cause of nephrotic syndrome in children
minimal change disease
how is minimal change disease mx
steroids
causes of nephrotic syndrome
minimal change disease
membranous glomerulonephropathy
FSGS
membranoprolifertive glomerulonephritis
HSP
nephrotic syndrome inflammation occurs where
basement membrane
histology of IgA deposits and mesangial proliferation suggests
Bergers disease
other name for bergers disease
IgA nephropathy
histology of IgG and complement deposits on the basement membrane suggests
membranous nephropathy
histology of immune complex deposits and mesangial proliferation suggests
membranoproliferative glomerulonephritis
how long after infection does post strep glomerulonephritis occur
1-3 weeks
what is goodpastures syndrome
where there are anti glomerular basement membrane antibodies
goodpasture syndrome sx
acute kidney failure and haemoptysis
patient presents with AKI and haemoptysis
how do you reach a diagnosis
test for autoantibodies
anti GBM= goodpastures syndrome
p-ANCA= microscopic polyangiitis
c-ANCA= granulomatosis with polyangiitis
what are MPO antibodies
p ANCA
what are PR3 antibodies
c ANCA
p ANCA, AKI and haemoptysis diagnosis
microscopic polyangitis
c ANCA, AKI and haemoptysis diagnosis
granulomatosis with polyangiitis
what are microscopic polyangiitis and granulomatosis with polyangiitis
vasculitis
they can present with AKI and haemoptysis
the first is assoc w p ANCA
the second is assoc w c ANCA
how are nephrotic/nephritic syndromes definetively diagnosed
kidney biopsy
