Renal Flashcards
What are the 5 complications for renal failure?
Potassium Fluid state Anaemia Bone density Uraemia
when are you classed with stage 5 CKD
when GFR less than 15 ml/min
How should you monitor CKD?
eGFR
main medication to help CKD
ACEi
if a patient talks about a sore throat and then getting kidney failure straight away.. what does this point to
IgA nephropathy
if a patient talks about a sore throat and then getting kidney failure 2 weeks later… what does this point to
Post-strep nephropathy
Which GNs are mostly nephrotic?
Minimal change
Focal sclerosing
Membranous
Which GNs are mostly nephritic?
crescent associated GN
IgA nephropathy
Post strep (diffuse proliferative)
Treatment of CKD with ACEi is contraindicated in
Bilateral renal artery stenosis
in severe CKD where fluid overload can be a problem - which drug should you use to treat them and why
high dose frusemide - because it needs to enter a functional renal tubule to exert its effect
how do you define chronic kidney disease
GFR less than 60ml/min for more than 3 months (microalbuminaemia, proteinuria, glomerular haematuria, pathological abnormality, anatomical abnormality)
2 main causes of CKD in Australia
Diabetic nephropathy
Glomerulonephritis
What percentage of body water is intracellular?
67%
What percentage of body water is interstitial?
22%
What percentage of body water is intravascular?
11%
If you give 3L of saline, where will it distribute to?
Extracellular space: 2L to interstitial and 1L intravascular
If you give 3L of 5% dextrose, where will it distribute to?
Equally between all spaces: 2L intracellular and 1L extracellular (666ml interstitial and 333ml intravascular)
If you lose 3L of fluid through diarrhoea, which compartments will lose the fluid?
Diarrhoea is sodium rich, thus all loses will be extracellular (2L interstitial and 1L intravascular)
If you lose 3L of fluid through fasting, which compartments will lose the fluid?
Equally between all spaces: 2L intracellular and 1L extracellular (666ml interstitial and 333ml intravascular)
eGFR is only accurate when…
Creatinine is in a steady state (if rising - overestimates, falling - underestimates)
How can you tell by a clinical test if AKI is glomerular in origin?
Haematuria with abnormal RBC morphology
If the urine is normal or pretty bland - what does it suggest as a cause of AKI?
pre-renal or acute tubular necrosis
how can you tell the difference between pre renal AKI and ATN?
pre renal AKI - concentrating ability still intact
Clues pointing to CKD over AKI
- pre existing illness
- DM, HTN, age, vascular disease
- small, echogenic kidneys by ultrasound
- endocrine abnormalities
how do you decide whether a patient with AKI requires dialysis?
AEIOU
Acidosis Electrolyte imbalance - hyperkalaemia Intoxication Oedema Uraemia
AKI staging is based on what 2 criteria
creatinine and urine output
3 key assessments in someone with AKI
volume status
urine studies
renal ultrasound
Define AKI
1.5 x increase in creatinine from most recent baseline
OR
6 hours of oliguria
management of hyponatraemia
if dehydrated- replace fluid with normal saline
normal volume - fluid restrict or increase free water clearance
volume overloaded - fluid and Na restriction, diuretics
what is the difference is pathology between macro and micro haematuria
micro = need to consider glomerular causes
macro = NOT going to be glomerulonephritis
Painless, macroscopic haematuria. What is the Dx?
Cancer until proven otherwise
What percentage of creatinine is reabsorbed in the kidney?
None
Which substance is responsible for constriction of the efferent arteriole in the kidney?
Angiotensin II
Define oliguria
Less than 500ml of urine per day
Define anuria
Less than 100ml of urine per day
Staging for CKD
Normal eGFR over 90 Mild 60-90 Moderate 30-59 Severe 15-29 Kidney failure less than 15
