Renal Flashcards
3 types of kidney stones
Calcium oxalate: radio opaque. Also most common
Struvite: radio opaque
Urate: non radio opaque
Fever
Point tenderness- Murphy’s kidney punch positive
Vomiting
(3ps- purging pyrexia pain)
Pyelonephritis
Severe loin to groin pain
Nausea
Vomiting
Nephrolithiasis
Rule of thumb for CT-KUB and renal ultrasound
CT-KUB for kidney pathologies
Renal U/S for below kidney
IgA Nephropathy vs Post Strep nephritis
Post Strep infection: renal onset is WEEKS post infection.
IgA Nephropathy: days after infection or SYNPHARYNGITIC. Recurrence is likely.
Transitional zone hyperplasia
BPH
Three cardinal symptoms of an UTI
Fever
Urgency
Dysuria
(FUD + suprapubic pain + haematuria = cystitis)
Kimmelstiel-Wilson nodules
Diabetic nephropathy
Solid organ cancers with nephrotic syndrome
Membranous GN
Name 5 functions of the kidney
Excretion of water and waste products Red blood cell production Bone and calcium and phosphate metabolism Blood pressure control Water pH and electrolyte balance
Multiple round cannonball metastasis in lungs:
Renal Cell carcinoma
Top 8 common causes of Chronic Kidney Disease:
- DM
- HTN
- GN
- PCKD
- Reflux Nephropathy
- Vascular - infarcts or stenosis
- Obstruction - BPH, calculus
Most common signs and symptoms of CKD
Common: asymptomatic, fatigue, HTN, oedema (respiratory crackles, increase JVP, peripheral oedema)
Less common: uraemia, n/v, LOA, decrease urine output
Very uncommon: asterixis, pruritus, pleurisy, hiccups (due to irritation of diaphragm from toxic urea build up)
Top 5 complications of CKD
- Electrolyte dyscrasia (in particular K+, HCO3-)
- HPT / fluid overload
- Anaemia
- CKD - MBD (metabolic bone disease) osteodystrophy
- - high phosphate, leading to low serum Ca, ppt
- -Vit D to a lesser extent, decreases Ca absorption - Cardiovascular risk management
Management of CKD top priorities
- HTN control and MANAGE DM/ PCKD/ UTI
- ACEi/ARB
- Prevent insults
- Treat complications
- Preparation of dialysis - discuss dialysis transplant etc.
Indications for dialysis
AEIOU Intractable Acidosis Electrolyte disarray (K+, Na+, Ca++) Intoxicants (methanol, Li, ASA) Intractable fluid overload Uraemia symptoms (nausea, seizure, pericarditis)
What 3 conditions are associated with PCKD (dominant)?
Mitral valve prolapse
Hepatic cysts - pancreas, ovary, testes
Berry aneurysm –> subarachnoid Hx (thunderclap headache)
Investigations for ESRF?
eGFR, UEC
Urinary ACR (urinary albumin)
Blood pressure
First sign of decreased function of kidneys?
Microalbuminaemia
Unable to be picked up with dipstick
Post renal transplant three classes of drugs:
Calcineurin inhibitor (tacrolimus)
Anti-metabolite (azathioprine, mycophenolate)
Prednisolone
Treatment of CKD
Treat reversible cause Limit progression - Hypertension (ACE/ARB) - renal bone disease - give phosphate binders, VIt D analogue, avoid in food Symptom control -treat anaemia - treat acidosis - treat oedema - treat hyperkalaemia Dialysis and transplantation
Treatment of Hyperkalaemia [K+]5.0
Calcium gluconate - stabilises heart membrane
Insulin dextrose - increase intracellular uptake
SABA - increase intracellular uptake
Frusemide - increase excretion
Resonium - K+ gut binder, increase excretion
Types of Dialysis
Haemodialysis
- Non-tunnelled catheter (10 days, 1 use)
- Tunnelled catheter - permacath (weeks to months)
- Fistula
Peritoneal Dialysis
- Tenckhoff catheter
Complications of CKD (top 5)
Renal bone disease (initiated by phosphate retention)
Vascular calcification (calcification of arteries, CAD–> decrease efficacy of BB and NO as smooth muscle loss)
Anaemia of CKD (Starts in Stage III, normocytic normochromic anaemia. Treat by correcting B12, Fe, folate first then give EPO)
HTN (Caused by sodium retention, treat with ACEi/ARB)
Uraemia (anorexia, nausea, vomiting, lethargy, confusion, twitching, convulsions, coma, sallow look, Uraemic pericarditis and encephalopathy)
HIGH urea and normal creatinine indicate what?
GIT bleeding - increase protein breakdown with nitrogenous waste but normal kidney function.
Ddx: Ulcer
Female presents with HTN, hypokalaemia and metabolic alkalosis.
Conn’s syndrome - hyperaldosteronism.
Mechanism: H+ K+ intracellular/extra cellular exchange.
Elevated catecholamines in 24 hour urine
Phaeochromocytoma
ED with severe headache, , fundal haemorrhage and papilloedema and BP of 220/45
Malignant hypertension
Two main causes of renal stenosis
Fibromuscular dysplasia + artherosclerosis
Earliest manifestation of diabetes on renal function?
Increased glomerular filtration rate
- vascular dysfunction, capillary hypertension
(Microalbuminaemia also)
Long term dialysis associations
Carpal tunnel syndrome
Bleeding tendency
Bone fracture
Aluminium toxicity
Treatment of nephrotic syndrome
Anti coagulation due to procoagulable state
Pyelonpehritis empirical treatment
Gentamicin and Ampicillin
If mild - treat with cephalexin, augmentin in out patient
Signs and symptoms of Prostate hypertrophy
FUNWISE Frequency Urgency Nocturia Weakness Intermittent stream Straining Emptying incompleteness
Presentation of bladder cancer - and cell type
Haematuria and constitutional symptoms. Cancer of the transitional cell type, commonly caused by environmental exposure.
Gold standard Ix: cystoscope can also use IV pyelogram showing filling defect. Can also use mycobacterium + chemo to treat.
Complication: Metastases + obstruction
Most common kidney stones in the world
Calcium most common in developed world
Struvite most common in developing world (from recurrent UTI)
Pure uric acid stones cannot be seen on imaging
Risk factor of kidney stones.
Chronic dehydration LOW calcium diet High protein alcohol diet Recurrent UTIs Multiple Myeloma Hypercalcaemia
