Renal Flashcards
metformin and AKI
stop metformin as it can cause lactic acidosis
drugs safe to continue in AKI?
paracetamol
warfarin
statin
aspirin at cardioprotective dose
clopi
beta blocker
acute interstitial nephritis presents with
allergic type picture
urinary WCC and eosinophilia
features of acute interstitial nephritis?
fever
rash
arthralgia
eosinophilia
Focal segmental glomerulosclerosis
nephrotic
peripheral oedema
high grade proteinuria
goodpasture syndrome
pulmonary haemorrhage and glomerulonephritis
Renal Biopsy
FSGS
focal and segmental sclerosis and hyalinosis on light microscopy
effacement of foot processes on electron microscopy
prevention of contrast induced nephropathy
1L of 0.9% sodium chloride
volume expansion
withold metformin for how long?
48 hours and until renal function shown to be nornal
Mainstay mx of rhabdomyolysis?
IV fluid rehydration
> normal saline
why normal saline > hartmann
IV hartmann contains potassium
why does hypocalcaemia occur in rhabdo?
myoglobin binds to calcium
why does spironolactone cause gynaecomastia?
inhibits free testosterone from binding to androgen receptors in cells located in the breast
between IV calcium gluconate and IV insulin/dextrose infusion what is given first?
in severe hyperkalaemia
IV calcium gluconate is given first for stabilisation of the cardiac membrane
ascites management?
spironolactone
fluid overload
Mx ascites
spironolactone
large volume paracentesis
albumin infusion
prphylactix ciprofloxacin
how is dehydration characterised?
urea that is proportionally higher than rise in creatinine
most common cause of peritonitis
coagulase negative staphlyococcus epidermis
peritonitis
BNF recommends ?
Vancomycin or (teicoplanin)
+ ceftazidime added to dialysis fluid / vancomycin
pts on long term immunosuppresion are at risk of?
skin malignancy
squamous cell carcinoma
Renal transplant
> ciclosporin
tacrolimus
steroids
ciclosporin MOA?
inhibits calcineurin
phosphatase involved in t cell activation
MMF MOA?
mycophenolate mofetil
blocks purine synthesis by inhibition of IMPDH
> proliferation of B and T cells
s/e GI and marrow suppression
Sirolimus
blocks T cell proliferation
> IL 2 receptor
selective inhibitors of IL-2 receptor
daclizumab
basilximab
causes of haematuria?
transitional cell carcinoma of the bladder
stones
BPH
urethritis
neal causes
in pts with suspected anaemia of chronic disease
management?
check iron status prior to commencing EPO
recommended fluid challenge?
500mL normal saline
renal cause of AKI
acute tubular necrosis
kidneys not able to concentrate or retain sodium
urine osmolality is low
urine sodium is HIGH
Membranous glomerulonephritis histology
++ PLA2
basement membrane thickening on light microscopy
subepithelial spikes on silver staisn
goodpastures is ?
nephritic
sterile pyuria and white cell casts?
acute interstitial nephritis
How does insulin/dextrose work?
in hyperkalaemia management?
drives potassium from extracellular > intracellular (insulin)
activating the Na-K-ATPase on cell membranes
SGLT-2 moa?
blocking reabsorption of glucose in the proximal tubule
lowers renal glucose threshold
> glycosuria
reduce sodium reabsorption → natriuresis
Alport’s syndrome
x linked dominant
microscopic haematuria,
bilateral sensorineural deafness,
lenticonus
IgA nephropathy
1-3 days - very acute
only haemutria
eGFR od 68 and no features / symptoms of CKD
do not diagnose stage 1 / 2 without abnormality on imaging or symptoms
CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR
what to look at?
urinalysis
renal USS
when is renal replacement therapy indicated in AKI?
not responsive to medical management
> hyperkalaemia
pulmonary oedema
uraemia
Alfacalcidol is used as a vitamin D supplement in end-stage renal disease
why?
does not need kidney activation
adult polycystic kidney disease
screening?
USS abdo
two cysts, unilateral or bilateral, if aged < 30 years
two cysts in both kidneys if aged 30-59 years
four cysts in both kidneys if aged > 60 years
diarrhoea
acid-base
normal anion gap metabolic acidosis
excessive bicarbonate loss via the GI tract
A reduced anion gap is normally caused by?
loss of albumin
more cations - calcium
Class 1 antigens : HLA
A
B
C
HLA class 2
DP
Dq
DR
when HLA matching for a renal transplant the relative importance of the HLA antigens are as follows
DR > B > A
Hyperacute rejection (minutes to hours)
ABO /HLA
type 2 hypersensitivity
thrombosis and ischaemia and necrosis of transplanted organ
> only mx is removal of graft
Acute graft failure (< 6 months)
HLA mismatch
cell mediated- cytotoxic t cell
rising creatinine pyuria and proteinuria
preferred method of access for haemodialysis
arteriovenous fistula
should severe hyperkalaemia be treated
regardless of symptoms and no ECG changes?
yes
staging of AKI
creatinine?
1: 1.5-1.9
2:2.0-2.9
3: 3x baseline or >354umol/l
daily maintenance fluid requirement for water in adults
25-30ml/kg/day
approximately ________of glucose to limit starvation ketosis
50-100 g/day
