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Phase 2a - conditions > Renal > Flashcards

Renal Flashcards

1
Q

What is renal colic?

A

A symptoms caused by kidney stones.

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2
Q

Where are three common locations for renal stones?

A

Peli-uteric brim
Pelvic brim
Vesico-uteric brim

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3
Q

What are the most common contents of kidney stones?

A 
Calcium oxalate 
Calcium phosphate 
Uric acid 
Struvite 
Cystine
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4
Q

What are the risk factors for kidney stones?

A 
Anatomical abnormalities 
Hypertension 
Gout 
Dehydration 
High calcium intake
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5
Q

What are the symptoms of kidney stones?

A

Asymptomatic
Renal colic
UTI symptoms
Haematuria

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6
Q

What is the presentation of renal colic?

A 
Rapid onset 
Unilateral loin pain 
Radiates to groin/testes/labia 
Nausea 
Vomiting 
Spasmodic/colicky pain
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7
Q

What are the differential diagnoses for renal colic?

A

Ruptured AAA
Diverticulitis
Appendicitis
Peritonitis

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8
Q

What investigations should be carried out in renal stones?

A 
Blood tests - raised calcium/phosphate/urate
Urine dipstick - usually +ve for blood 
MSU 
CT KUB scan - gold standard 
X-Ray/ultrasound
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9
Q

What is the management for renal colic?

A

Analgesia

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10
Q

How do you manage stones of different sizes?

A

<5mm 90% will pass spontaneously - watchful waiting

>5mm needs action to remove it.

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11
Q

What are the possible methods of kidney stone removal?

A

ESWL (shockwave therapy)

Surgery

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12
Q

What actions can be taken to prevent kidney stones?

A

Over hydration
Low salt diet
Reduce BMI
Active lifestyle

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13
Q

What are the possible complications of kidney stones?

A

Infection
Occlusion of kidney outflow
Chronic renal damage

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14
Q

What is pyonephrosis?

A

Infection and obstruction of the kidney.

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15
Q

What are the risks of pyonephrosis?

A

Systemic sepsis

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16
Q

How do you treat pyonephrosis?

A

IV antibiotics

Drainage

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17
Q

What are the three possible criteria for diagnosing an AKI?

A

Rise in creatinine >48micromol/l in 48 hours
Rise in creatinine >1.5x baseline
Urine output <0.5mL/kg/h for >6 hours

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18
Q

What is creatinine?

A

A muscle breakdown product that is filtered freely though the glomerulus.

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19
Q

Why is creatinine a marker for kidney injury?

A

It is normally removed from the blood by the kidneys - so if it rises then it shows that it is not being removed effectively anymore.

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20
Q

Why may the creatinine level be misleading?

A

In a person with low muscle mass the creatinine in their blood is reduced. It will not rise as much as you expect in kidney injury - can be missed.

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21
Q

What groups of people may have a low creatinine?

A

Elderly/frail
Amputees
Liver disease

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22
Q

Is creatinine a 100% accurate of GFR?

A

No. 15% is secreted into the kidney tubules. So creatinine clearance > GFR.

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23
Q

What are the risk factors for an AKI?

A 
> 75 years old 
CKD
Cardiac failure 
Diabetes 
Drugs 
Sepsis
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24
Q

What are the three divisions of the causes of AKI?

A

Pre-renal
Renal
Post renal

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25
Q

What are the pre-renal causes of AKI?

A

Any causes of renal hypoperfusion - hypotension, hypovolaemia, renal artery stenosis.

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26
Q

What are the renal causes of AKI?

A 
Acute tubular necrosis 
Autoimmune 
Glomerulonephritis 
Drugs 
Vasculitis
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27
Q

What are the post renal causes of AKI?

A

Any causes of urinary tract obstruction - stones, malignancy.

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28
Q

What investigations should be carried out in suspected AKI?

A 
Urine dipstick (the MSU if indicated)
Bloods - U&amp;E, FBC, LFT, clotting, autoantibodies
Imaging - ultrasound, CT.
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29
Q

What is the presentation of a patient with AKI?

A 
Depends on the cause. 
Nausea
Vomiting 
Dehydration 
Confusion
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30
Q

What is the management of an AKI?

A

Manage blood volume status - fluids
Stop nephrotoxic drugs
Treat cause.

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31
Q

What are the possible complications of an AKI?

A

Hyperkalaemia
Pulmonary oedema
Uraemia
Acidaemia

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32
Q

What are the causes of renal failure?

A 
Diabetes
Hypertension 
Glomerulonephritis 
Obstructive uropathy 
Congenital causes - polycystic kidney disease.
33
Q

What is chronic kidney disease?

A

Impaired renal function for > 3 months

34
Q

At what point in CKD do symptoms usually arise?

A

Stage 4 (GFR <30)

35
Q

What are the possible symptoms and signs in CKD?

A 
Bilaterally small kidneys 
Malaise 
Polyuria/nocturia 
Fatigue 
Nausea 
Vomiting 
Pruritus
36
Q

What two measures are used to determine the stage of CKD?

A

GFR

Albuminuria

37
Q

What is a normal measure of albuminuria?

A

<3

38
Q

What is severe increase in albuminuria?

A

> 30

39
Q

What is a normal GFR?

A

> 90

40
Q

What is a stage 2 CKD GFR?

A

60-89

41
Q

What is a stage 3 CKD GFR?

A

30-59

42
Q

What is a stage 4 CKD GFR?

A

15-29

43
Q

What is stage 5 CKD GFR?

A

<15

44
Q

What health care provision typically manages CKD?

A

GP up to stage 4

Nephrologist for end stage

45
Q

How can you limit the progression of chronic kidney disease?

A

Tight blood pressure control (ACEi etc)
Renal bone disease control
Reduce cardiovascular risl (statins/aspirin)
Diet modifications - low protein, K+ restriction.

46
Q

What symptoms may been controlling in CKD?

A

Anaemia
Acidosis
Hyperkalaemia
Oedema

47
Q

What treatment is offered in end stage kidney disease?

A

Renal replacement therapy

48
Q

At what GFR is renal replacement therapy typically started?

A

8-10ml/min

49
Q

What are the two forms of dialysis?

A

Haemodialysis

Peritoneal dialysis

50
Q

What is the mechanism of heamodialysis?

A

Blood is passed over semi-permeable membrane against dialysis fluid in the opposite direction. the toxins in the blood diffuse out.

51
Q

What are the problems with haemodialysis?

A

Hypotension
Time consuming
Blood access problems - infection, thrombosis.

52
Q

What is the mechanism of peritoneal dialysis?

A

Peritoneum is used as a semipermeable membrane. Fluid is inserted into peritoneal cavity, toxins diffuse over, fluid is then removed.

53
Q

What are the problems with peritoneal dialysis?

A

Peritonitis
Exit site infection
Loss of membrane function over time.

54
Q

What is the best form of renal replacement therapy.

A

Transplant

55
Q

What are the risks of dialysis?

A

Cardiovascular risks.

56
Q

What is possible complications of transplant?

A 
Surgical risks - bleeding, infection etc. 
Delayed graft function 
Rejection 
Infection 
Malignancy 
Cardiovascular disease
57
Q

What treatment is required post transplant.

A

Immunosuppression

58
Q

What are the differences between acute and chronic kidney disease?

A

Small kidneys v normal
Anaemia v no anaemia
Diabetes v no diabetes
high BP v low BP

59
Q

What is glomerulonephritis?

A

Inflammation of the glomerulus

60
Q

What is the presentation of glomerulonephritis?

A

Nephrotic syndrome
Nephritic syndrome
Asymptomatic

61
Q

What are the physiological effects of glomerulonephritis?

A

Restricts blood flow –> raised BP
Damage to filtration –> protein and blood in urine
Loss of filtration capacity –> AKI

62
Q

What investigation should be carried out in glomerulonephritis?

A

Bloods - ALL
Urine - dipstick, MSU
Imaging - ultrasound
Biopsy

63
Q

Name 3 specific types of glomerulonephritis?

A

IgA nephropathy
SLE
ANCA associated vasculitis

64
Q

What is the physiology of nephrotic syndrome?

A

Inflammation resulting in loss of podocyte extensions.

65
Q

What is the nephrotic syndrome triad?

A

Proteinuria (>3.5g/day) - frothy urine
Hypoalbuminuria
Oedema

66
Q

What are the primary causes of nephrotic syndrome?

A

Minimal change disease

Membranous nephropathy

67
Q

What are the secondary causes of nephrotic syndrome?

A

Hep B/C

Diabetic nephropathy

68
Q

What do investigations in nephrotic syndrome show?

A

Urine dipstick - +++ protein
Bloods - low albumin
Then biopsy

69
Q

How do you manage nephrotic syndrome?

A

Steroids
Diuretics
ACEi
treat cause

70
Q

What are the complications of nephrotic syndrome?

A

Infections (loss of Ig in urine)

Thromboembolism

71
Q

What is the pathophysiology of nephritic syndrome?

A

Inflammation of the endothelium.

72
Q

What is the presentation of nephritic syndrome?

A

Haematuria
Proteinuria
Hypertension

73
Q

What do investigation on nephritic syndrome show?

A

Dipstick - +++ blood

MSU - Red cell casts

74
Q

What is the most common inheritance of polycystic kidney disease?

A

Autosomal dominant

75
Q

What is the gene mutation in polycystic kidney disease?

A

PKD1 - most common

PKD2

76
Q

What is the presentation of polycystic kidney disease?

A 
Bilateral kidney enlargement 
Loin pain 
Haematuria
Hypertension 
Renal colic 
UTIs and pyelonephritis
77
Q

What are the investigations of polycystic kidney disease?

A

Ultrasound

Screening should be offered to all first degree relatives

78
Q

What is the management of polycystic kidney disease?

A 
No cure
Education 
Manage hypertension 
Treat infections
Analgesia 
Dialysis for end stage renal failure.
79
Q

What investigations can be carried out to test fluid status?

A 
Blood pressure
Jugular venous pressure
Pulse pressure 
Tissue turgor 
Urine output

Phase 2a - conditions (11 decks)

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