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FINALS > Renal > Flashcards

Renal Flashcards

1
Q

What are some causes of haematuria?

A 
UTI, menstruation
Malignancy 
IgA nephropathy, Alport syndrome, glomerulonephritis 
PCKD
Anticoagulation
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2
Q

What increases the risk of UTI?

A

Incontinence, constipation
Dehydration, obstruction
DM, immunosuppression, catheter, renal tract malformation, pregnancy

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3
Q

What is the classification for AKI?

A
  1. Creatinine 1.5-1.9 x baseline
    Oliguria <0.5ml/kg/hr for 6-12hrs
  2. Creatinine 2-2.9 x baseline
    Oliguria <0.5ml/kg/hr for >12hrs
  3. Creatinine >3 x baseline
    Oliguria <0.3ml/kg/hr for 24hrs OR anuria for 12hrs
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4
Q

What are some pre-renal causes of AKI?

A

D+V, haemorrhage, pancreatitis
Cardiogenic shock, MI
Sepsis, drugs
NSAIDs, ACEi, ARBs

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5
Q

What are some renal causes of AKI?

A

Glomerulonephritis, acute tubular necrosis
Sarcoid, infection
HUS, DIC, TTP

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6
Q

What are some post-renal causes of AKI?

A

Stone, malignancy, stricture, clot

BPH

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7
Q

When should AKI be referred to renal?

A

Not responding to treatment
Hyperkalaemia, acidosis, fluid overload
Stage 3
Possible intrinsic renal disease

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8
Q

What is the general management of AKI?

A

Stop nephrotoxic drugs
Stop drugs with increased risk of renal complications
Avoid contrast

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9
Q

When and how should hyperkalaemia be treated?

A

K+ >6.5mmol/L or ECG changes

  1. Calcium gluconate
  2. IV insulin
  3. Salbutamol
  4. Refer to renal
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10
Q

What is the classification of CKD?

A
  1. > 90
  2. 60-89
    3a. 45-59 (mild-moderate)
    3b. 30-44 (moderate-severe)
  3. 15-29 (severe)
  4. <15 (kidney failure)
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11
Q

What are some causes of CKD?

A

Glomerular - minimal change, membranous, DM, amyloid
Interstitial - UTI, stones, pyelonephritis, sarcoid
Vessels - vasculitis, heart failure, TTP
Congenital - Alport’s, Fabry disease

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12
Q

What should be included in a renal history?

A

Eyes, skin, joints
Symptoms of fluid overload
Symptoms of anaemia

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13
Q

What are some signs of CKD?

A

Peripheral oedema, bruising, uraemic flap
Anaemia, rash
JVP
Transplant scar, fistula

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14
Q

When should CKD be referred to renal?

A

Stages 4 and 5
Proteinuria and haematuria
BP not controlled with 4 drugs
Genetic causes of CKD

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15
Q

What is the management of CKD?

A 
BP <140mmHg 
ACEi or ARB 
HbA1c <53 
Statin and aspirin 
Exercise, lose weight, low salt, smoking cessation
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16
Q

What are some complications of CKD?

A

Anaemia, oedema, bone mineral disorders, cardiovascular disease

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17
Q

What are some complications of haemodialysis?

A

Infection, thrombosis, block
Steal syndrome - hand ischaemia
Dysequilibrium - cerebral oedema

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18
Q

What are some contraindications to renal transplant?

A

Cancer + mets, infection, HIV + viral replication, unstable cardiovascular disease

19
Q

What drugs are used for immunosuppression following transplant?

A

Monoclonal antibodies
Calcineurin inhibitors - tacrolimus
Antimetabolites - mycophenolic acid
Glucocorticosteroids

20
Q

What are the symptoms and signs of nephritic syndrome?

A

Haematuria, oliguria, hypertension, proteinuria

21
Q

What are some causes of nephritic syndrome?

A 
IgA nephropathy 
HSP 
Post-streptococcal glomerulonephritis 
Anti-GBM disease 
Rapidly progressive glomerulonephritis
22
Q

What are some features of IgA nephropathy?

A

IgA deposition in mesangium
Asymptomatic haematuira
Slow indolent disease
ACEi or ARB

23
Q

What are some features of Henoch-Scholein purpura?

A 
Small vessel vasculitis 
IgA deposition in skin/joints/gut/kidney 
Purpuric rash on extensors
Flitting polyarthritis 
Abdo pain
24
Q

What are some features of post-streptococcal glomerulonephritis?

A

Occurs after throat or skin infection
Strep antigen deposition in glomerulus - immune complex formation and inflammation
Treatment is supportive, antibiotics

25
Q

What are some features of anti-GBM disease?

A

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

26
Q

What are some features of rapidly progressive glomerulonephritis?

A

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

27
Q

What is nephrotic syndrome?

A
  1. Proteinuria >3g/24hr (P:CR >300mg/mmol)
  2. Hypoalbuminaemia <30g/L
  3. Oedema
28
Q

What are some causes of nephrotic syndrome?

A 
Minimal change disease
Focal-segmental glomerulosclerosis 
Membranous nephropathy 
Membranoproliferative glomerulonephritis 
DM, SLE, myeloma, amyloid, pre-eclampsia
29
Q

What are some features of minimal change disease?

A

Does not cause renal failure
Effacement of podocytes seen on electron microscopy
Prednisolone 1mg/kg to induce remission
If frequent relapses requires immunosuppression

30
Q

What are some features of focal-segmental glomerulosclerosis?

A

May be secondary to HIV, heroin, lithium
At risk of CKD and renal failure
ACEi and BP control
Steroids for primary disease

31
Q

What are some features of membranous nephropathy?

A

Indolent disease
Diffusely thickened GBM
ACEi and BP control
May be secondary to malignancy, hepatitis, malaria, SLE, RA, sarcoid

32
Q

What are some features of membranoproliferative glomerulonephritis?

A

Immune complex deposition or genetic mutation in complement pathway
ACEi and BP control

33
Q

What is the management of nephrotic syndrome?

A

Treat underlying cause - biopsy, steroids
Reduce proteinuria - ACEi/ARB
Reduce oedema - fluid and salt restriction, loop diuretics
Reduce complications - LMWH, pneumococcal vaccine

34
Q

What tests should be done for suspected glomerulonephritis?

A 
FBC, UEs, LFTs, CRP
ANA, ANCA, anti-dsDNA, anti-GBM
Urine microscopy, bence-jones, P:CR
CXR
USS and biopsy
35
Q

What is acute tubulointerstitial nephritis?

A

Immune reaction to drugs, infection or an inflammatory condition
Rash, fever and eosinophilia

36
Q

How do reactions to radio contrast present?

A

Nephropathy 48-72 hours after IV contrast

Prevent with pre-hydration with IV crystalloid

37
Q

What is the inheritance and presentation of ADPKD?

A

Autosomal dominant
Renal - loin pain, visible haematuria, hypertension
Extrarenal - liver cysts, intracranial aneurysms, mitral valve prolapse, ovarian cysts

38
Q

How is ADPKD diagnosed?

A

USS
15-39 years: >3 cysts
40-59 years: >2 cysts

39
Q

What is tuberous sclerosis?

A

Harmatoma formation in skin, brain, eyes, heart and lungs
Autosomal dominant
Replacement of renal tissue –> renal failure

40
Q

What is Von-Hippel Lindau?

A

Multisystem cancer syndrome due to uncontrolled activation of growth factors
Autosomal dominant
Renal cysts and clear cell carcinome

41
Q

What is Alport syndrome?

A

Type IV collagen mutation
X-linked recessive
Haematuria, proteinuria and progressive insufficiency
High tone sensorioneural hearing loss

42
Q

What is Fabry disease?

A

Lysosomal storage disorder
X-linked recessive
Proteinuria and renal failure
Lipid deposits seen in urine

43
Q

What is cystinuria?

A

Cystine is not reabsorbed - stone formation
Autosomal recessive
Treat with diet and increased fluid intake

FINALS (19 decks)

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