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Hark and Paul's clinical review > Renal > Flashcards

Renal Flashcards

1
Q

What are the complications of CKD?

A

“A B C D E P”
A = anaemia, arthritis, acidosis, anorexia
B = BP, bleeding, bone disease
C = cholesterol elevation, cardiac failure, constipation
D = planning dialysis
E = endocrine problems (ED, amenorrhea, infertility) , entrapment neuropathy
P = pruritus, peripheral neuropathy, pancreatitis, PUD, platelet dysfunction

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2
Q

What are the symptoms of nephrotic syndrome?

A

PHO

Proteinuria (>3.5g/24hrs)
Hypoalbuminemia (<30g/L)
Oedema; and Hyperlipidaemia

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3
Q

What are the symptoms of nephritic syndrome?

A

Haematuria

Hypertension

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4
Q

What are the GN’s that cause nephrotic syndrome?

A 
FOCME MINI MEMBRANO
Focal segmental
Membranous
Minimal change
Membranoproliferative

SECONDARY CAUSES:

  • Systemic - SLE, DM, secondary membranous nephropathy (due to cancer), amyloid, MM
  • Infection - HBV, HIV, IE
  • Drugs - NSAIDs
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5
Q

What are the GN’s that cause nephritic syndrome?

A

POST RAPID DIFFUSE IGA

Post streptococcal
Rapidly progressive
Diffuse proliferative
IgA nephropathy

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6
Q

What is your approach to managing CKD?

A
  1. Diagnose cause; classify severity
  2. Address underlying etiology
  3. Treat acute symptoms
  4. Manage CKD, prevent progression
  5. Manage complications
  6. Long term issues - transplantation
  7. Social issues
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7
Q

What investigations for CKD?

A
  • renal function: EUC, CMP, urine protein/casts, urine ACR
  • renal structure: U/S, CT KUB, cystoscopy
  • underlying disease: renal biopsy, ANA, hepatitis, HIV, EPG/IEPG
  • complications: FBC, iron studies, CMP, Vit D, PTH
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8
Q

What are the indications for acute/urgent dialysis?

A
  • refractory hyperkalemia
  • metabolic acidosis
  • fluid overload
  • uremic symptoms (encephalopathy, pericarditis, coagulopathy)
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9
Q

How to prevent progression of CKD?

A
  • diet: salt restriction
  • normalize calcium and phosphate
  • ACEi
  • control BP
  • control BSL
  • immunosuppressives in diseases like SLE
  • preserve vessels in preparation for dialpysis
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10
Q

What is the main factor in mortality in CKD?

A

Cardiovascular disease

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11
Q

What are the complications of CKD?

A
  • anemia
  • bone disease
  • cardiovascular disease
  • calciphylaxis: calific obstruction of blood vessels
  • infection risk increased
  • neuropathy, encephalopathy
  • nutrition
  • fluid status/overload
  • sexual dysfunction and fertility (anovulatory in CKD)
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12
Q

What are the advantages of peritoneal dialysis?

A
  • simple
  • cardiovascularly safe
  • freedom of diet/fluid intake
  • no heparin
  • independence
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13
Q

What are the advantages of haemodialysis?

A
  • large volumes can be filtrated
  • efficient solute removal
  • no protein loss
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14
Q

What are the issues or disadvantages with PD?

A
  • requires good hygiene
  • patient education
  • manual dexterity/vision/function
  • needs residual urine output
  • catheter malfunction
  • may worsen DM due to the dextrose in the dialysate
  • infection: peritonitis, site infection
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15
Q

What are the issues with haemodialysis?

A
  • disruption to life
  • cardiovascular instability
  • heparin exposure
  • infection
  • amyloidosis
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16
Q

What are the GFR’s fir each stage of kidney disease?

A
  1. > 90
  2. 60-90
  3. 30-60
  4. 15-30
  5. <15
17
Q

When to start dialysis?

A

When eGFR 8-11 (usually uremic symptoms by this time)

18
Q

What are causes of worsening renal function in a transplanted kidney?

A

Consider pre renal and post renal causes
Immediate:
- hyper acute rejection, thrombosis

1-12 weeks:
- rejection, CNI toxicity, infection (CMV, BK), recurrence of primary disease

> 3 months:
- as above plus drugs, sepsis, etc

19
Q

What are long term problems after renal transplant?

A
  • malignancy
  • hypercalcemia (tertiary PTH)
  • steroid complications
  • HTN
  • anemia
20
Q

How to investigate and manage CMV disease in renal transplant?

A

Ix:

  • CMV DNA PCR
  • biopsy

Mx:

  • reduce immunosupression
  • avoid rejection
  • eliminate virus with ganciclovir
21
Q

5 absolute contraindications to renal transplant

A
  1. Malignant disease (requires 2 years of remission after treatment before transplant is considered)
  2. Severe IHD
  3. Active vasculitis or anti-GBM disease
  4. Occlusive aorto-iliac disease
  5. Sepsis
22
Q

Target aim in anaemia due to renal failure

A

Between 100-120
EPO treatment is effective
Use IV iron replacement to keep ferritin >200 and transferrin saturation >20%

23
Q

5 types of renal osteodystrophy

A
  1. Hyperparathyroid bone disease
  2. Osteoporosis with decreased BMD
  3. Osteomalacia
  4. Osteosclerosis
  5. Adynamic bone disease

Hark and Paul's clinical review (12 decks)

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