Renal Flashcards
What are some causes of haematuria?
UTI, menstruation Malignancy IgA nephropathy, Alport syndrome, glomerulonephritis PCKD Anticoagulation
What increases the risk of UTI?
Incontinence, constipation
Dehydration, obstruction
DM, immunosuppression, catheter, renal tract malformation, pregnancy
What is the classification for AKI?
- Creatinine 1.5-1.9 x baseline
Oliguria <0.5ml/kg/hr for 6-12hrs - Creatinine 2-2.9 x baseline
Oliguria <0.5ml/kg/hr for >12hrs - Creatinine >3 x baseline
Oliguria <0.3ml/kg/hr for 24hrs OR anuria for 12hrs
What are some pre-renal causes of AKI?
D+V, haemorrhage, pancreatitis
Cardiogenic shock, MI
Sepsis, drugs
NSAIDs, ACEi, ARBs
What are some renal causes of AKI?
Glomerulonephritis, acute tubular necrosis
Sarcoid, infection
HUS, DIC, TTP
What are some post-renal causes of AKI?
Stone, malignancy, stricture, clot
BPH
When should AKI be referred to renal?
Not responding to treatment
Hyperkalaemia, acidosis, fluid overload
Stage 3
Possible intrinsic renal disease
What is the general management of AKI?
Stop nephrotoxic drugs
Stop drugs with increased risk of renal complications
Avoid contrast
When and how should hyperkalaemia be treated?
K+ >6.5mmol/L or ECG changes
- Calcium gluconate
- IV insulin
- Salbutamol
- Refer to renal
What is the classification of CKD?
- > 90
- 60-89
3a. 45-59 (mild-moderate)
3b. 30-44 (moderate-severe) - 15-29 (severe)
- <15 (kidney failure)
What are some causes of CKD?
Glomerular - minimal change, membranous, DM, amyloid
Interstitial - UTI, stones, pyelonephritis, sarcoid
Vessels - vasculitis, heart failure, TTP
Congenital - Alport’s, Fabry disease
What should be included in a renal history?
Eyes, skin, joints
Symptoms of fluid overload
Symptoms of anaemia
What are some signs of CKD?
Peripheral oedema, bruising, uraemic flap
Anaemia, rash
JVP
Transplant scar, fistula
When should CKD be referred to renal?
Stages 4 and 5
Proteinuria and haematuria
BP not controlled with 4 drugs
Genetic causes of CKD
What is the management of CKD?
BP <140mmHg ACEi or ARB HbA1c <53 Statin and aspirin Exercise, lose weight, low salt, smoking cessation
What are some complications of CKD?
Anaemia, oedema, bone mineral disorders, cardiovascular disease
What are some complications of haemodialysis?
Infection, thrombosis, block
Steal syndrome - hand ischaemia
Dysequilibrium - cerebral oedema
What are some contraindications to renal transplant?
Cancer + mets, infection, HIV + viral replication, unstable cardiovascular disease
What drugs are used for immunosuppression following transplant?
Monoclonal antibodies
Calcineurin inhibitors - tacrolimus
Antimetabolites - mycophenolic acid
Glucocorticosteroids
What are the symptoms and signs of nephritic syndrome?
Haematuria, oliguria, hypertension, proteinuria
What are some causes of nephritic syndrome?
IgA nephropathy HSP Post-streptococcal glomerulonephritis Anti-GBM disease Rapidly progressive glomerulonephritis
What are some features of IgA nephropathy?
IgA deposition in mesangium
Asymptomatic haematuira
Slow indolent disease
ACEi or ARB
What are some features of Henoch-Scholein purpura?
Small vessel vasculitis IgA deposition in skin/joints/gut/kidney Purpuric rash on extensors Flitting polyarthritis Abdo pain
What are some features of post-streptococcal glomerulonephritis?
Occurs after throat or skin infection
Strep antigen deposition in glomerulus - immune complex formation and inflammation
Treatment is supportive, antibiotics
What are some features of anti-GBM disease?
Auto-antibodies to type IV collagen found in glomerular basement membrane
Renal - oliguria, haematuria, AKI, renal failure
Lung - pulmonary haemorrhage (SOB, haemoptysis)
Treatment - plasma exchange, steroids, cyclophosphamide
What are some features of rapidly progressive glomerulonephritis?
Umbrella term for aggressive glomerulonephritis
Small vessel vasculitis, lupus, anti-gbm
Renal failure over days/weeks
Breaks in GBM - influx of inflammatory cells
Crescents seen on renal biopsy
Steroids and cyclophosphamide
What is nephrotic syndrome?
- Proteinuria >3g/24hr (P:CR >300mg/mmol)
- Hypoalbuminaemia <30g/L
- Oedema
What are some causes of nephrotic syndrome?
Minimal change disease Focal-segmental glomerulosclerosis Membranous nephropathy Membranoproliferative glomerulonephritis DM, SLE, myeloma, amyloid, pre-eclampsia
What are some features of minimal change disease?
Does not cause renal failure
Effacement of podocytes seen on electron microscopy
Prednisolone 1mg/kg to induce remission
If frequent relapses requires immunosuppression
What are some features of focal-segmental glomerulosclerosis?
May be secondary to HIV, heroin, lithium
At risk of CKD and renal failure
ACEi and BP control
Steroids for primary disease
What are some features of membranous nephropathy?
Indolent disease
Diffusely thickened GBM
ACEi and BP control
May be secondary to malignancy, hepatitis, malaria, SLE, RA, sarcoid
What are some features of membranoproliferative glomerulonephritis?
Immune complex deposition or genetic mutation in complement pathway
ACEi and BP control
What is the management of nephrotic syndrome?
Treat underlying cause - biopsy, steroids
Reduce proteinuria - ACEi/ARB
Reduce oedema - fluid and salt restriction, loop diuretics
Reduce complications - LMWH, pneumococcal vaccine
What tests should be done for suspected glomerulonephritis?
FBC, UEs, LFTs, CRP ANA, ANCA, anti-dsDNA, anti-GBM Urine microscopy, bence-jones, P:CR CXR USS and biopsy
What is acute tubulointerstitial nephritis?
Immune reaction to drugs, infection or an inflammatory condition
Rash, fever and eosinophilia
How do reactions to radio contrast present?
Nephropathy 48-72 hours after IV contrast
Prevent with pre-hydration with IV crystalloid
What is the inheritance and presentation of ADPKD?
Autosomal dominant
Renal - loin pain, visible haematuria, hypertension
Extrarenal - liver cysts, intracranial aneurysms, mitral valve prolapse, ovarian cysts
How is ADPKD diagnosed?
USS
15-39 years: >3 cysts
40-59 years: >2 cysts
What is tuberous sclerosis?
Harmatoma formation in skin, brain, eyes, heart and lungs
Autosomal dominant
Replacement of renal tissue –> renal failure
What is Von-Hippel Lindau?
Multisystem cancer syndrome due to uncontrolled activation of growth factors
Autosomal dominant
Renal cysts and clear cell carcinome
What is Alport syndrome?
Type IV collagen mutation
X-linked recessive
Haematuria, proteinuria and progressive insufficiency
High tone sensorioneural hearing loss
What is Fabry disease?
Lysosomal storage disorder
X-linked recessive
Proteinuria and renal failure
Lipid deposits seen in urine
What is cystinuria?
Cystine is not reabsorbed - stone formation
Autosomal recessive
Treat with diet and increased fluid intake
