Renal Flashcards
learn info from renal booklet
What 4 diseases should you specifically ask for in a family history for a patient with renal problems
Kidney disease, heart disease, diabetes, high blood pressure
What symptoms might a patient with renal disease present with? (7)
Dyspnoea, leg swelling, nausea and/or vomiting, ENT symptoms, constitutional symptoms, lower urinary tract symptoms, flank pain
List up to 8 signs of advanced renal disease (these are rare)
Brown nails, Yellow-brown discolouration of the skin from uraemia, Muscle wasting (from undernutrition), Uraemic frost (urea crystals on skin from sweat), Hyperreflexia, Pericardial rub, GI ulceration, Bleeding
List 6 blood tests used to assess renal function
FBC, U and Es, CRP, Haematinics (iron, B vitamins), Bone profile, HbA1c
What is included in the bone profile blood test
Calcium,
Phosphate,
PTH,
Alkaline Phosphatase
What is the value of normal anion gap
8 to 12
What is the most usual cause of hypernatremia
Usually due to water deficit (dehydration)
how can hypernatraemia cause bleeding and thrombosis?
Create vascular shear stress
List symptoms of hypernatraemia (10)
Thirst, Apathy, Irritability, Weakness, Confusion, Reduced consciousness, Seizures, Hyperreflexia, Spasticity, Coma
What are the 2 main types of diabetes insipidus
Cranial (impaired release of ADH),
Nephrogenic (resistance to ADH)
Give 5 causes of reduced release of ADH
Cerebral vasculitis (eg SLE) Cerebral sarcoid or TB, Trauma, Meningitis or encephalitis, Tumours, (VITAMIN CDEF)
What are the symptoms of hyponatraemia.
Decreased perception, gait disturbance, yawning, nausea, reversible ataxia, headache, apathy, confusion, seizures, coma
Give 4 causes of pseudo-hyponatraemia
High lipids,
Hyperglycaemia,
Uraemia,
Myeloma
List 6 risk factors for AKI
Diabetes,
CKD,
Ischaemic heart disease or congestive cardiac failure, Aged over 75,
Sepsis,
Medications such as ACE inhibitors and angiotensin receptor blockers NSAIDs or antibiotics
Give 3 vascular causes of AKI
Vasculitis,
Malignant Hypertension (BP >180/120)
Thrombotic Thrombocytopenic Purpura Haemolytic Uraemic Syndrome (i.e. TTP HUS)
List 4 potential sources of endogenous nephrotoxins
Haemolysis,
Rhabdomyolysis,
Myeloma,
Intra-tubular crystals
What are the indications for renal replacement therapy in AKI? (5)
Hyperkalaemia or metabolic acidosis refractory to medical therapy, Anuric on diuretics, Uraemic pericarditis, Uraemic encephalopathy, Dialysable toxin
List 3 signs of uraemic encephalopathy
Vomiting,
Confusion,
Drowsiness or Reduced Consciousness
List 5 complications of nephrotic syndrome
Venous ThromboEmbolism, Hypertension, High risk of infection, Hyperlipidaemia Progression of CKD,
4 causes of nephrotic syndrome
Minimal change disease (most common cause in children),
Focal Segmental Glomerulosclerosis,
Membranous Nephropathy,
MembranoProliferative GlomeruloNephritis (most commonly presents as nephritic syndrome)
3 diseases that may cause nephrotic range proteinuria but not necessarily the nephrotic features
Amyloidosis,
Myeloma,
Diabetes
How can nephritic syndrome present
AKI, Incidental dipstick findings, Mild to moderate oedema, Hypertension, Visible haematuria
List 3 types of small vessel vasculitis causing nephritic syndrome (anca associated vasculitis)
Granulomatosis with polyangiitis (GPA),
Microscopic PolyAngiitis (MPA),
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)
Causes of nephritic syndrome
ANCA vasculitis, Post infectious glomerulonephritis, IgA nephropathy, Anti-GBM disease /Goodpasture syndrome, Thin basement membrane disease, Lupus nephritis (can be nephrotic) Alport syndrome,
What are the symptoms of IgA nephropathy?
Episodic gross haematuria during or directly after upper respiratory tract or gastrointestinal infections or strenuous exercise
What’s the pathophysiology of Goodpasture’s syndrome?
Autoantibodies against type IV collagen affecting basement membrane in lungs and glomerulus particularly
What’s the inheritance pattern for Alport syndrome?
X linked
What age group are usually affected in post infectious glomerulonephritis?
Kids aged 3 to 12
What type of bacteria can cause nephritis as a post-infective syndrome?
Group A beta- haemolytic streptococci (1 to 2 weeks after tonsillitis or pharyngitis, 3 to 4 weeks after impetigo or cellulitis)
2 blood tests to estimate kidney damage
Albumin-Creatinine ratio (ACR), estimated GFR or creatinine
Complications of chronic kidney disease (5)
Anaemia of chronic disease, Mineral and bone disease, Secondary and tertiary hypoparathyroidism, Hypertension, Cardiovascular disease, Malnutrition or sarcopenia
5 direct complications of late stage CKD
Electrolyte disturbances, fluid overload, metabolic acidosis, uraemic pericarditis
Why is it important to reduce cardiovascular risk in CKD patients?
Cardiovascular disease is an important complication of CKD is the number 1 cause of mortality
How do you reduce cardiovascular risk?
Start on statin, control blood pressure, improve diabetic control, advise weight loss and exercise, smoking cessation!!
How do you slow the progression of CKD?
Reduce proteinuria with ACE inhibitors or angiotensin receptor blockers, monitor blood tests, control blood pressure
What should CKD patients limit in their diet?
Phosphate and potassium (avocados, bananas, brown bread, cola)
When would you suspect diabetic nephropathy in a diabetic patient?
Raised urine albumin: creatinine ratio,
Long-standing or poorly controlled diabetes,
Evidence of other microvascular disease (retinopathy, peripheral neuropathy)
5 investigations for chronic hypertension (to diagnose cause)
24-hour urinary metanephrines, Aldosterone:renin ratio, Cortisol and Dexamethasone suppression test, TSH, MRA
Endocrine causes of hypertension (4)
Hyperthyroidism, (Adrenal:) Cushing's syndrome, Primary aldosteronism, Pheochromocytoma (starts in adrenal gland)
What is the most common cause of polycystic disease? (be specific)
(type 1 PKD is most common)
PKD 1 mutation on chromosome 15
(so inheritance is autosomal dominant like type 2)
What is Tolvaptan used for?
For CKD in Polycystic Kidney disease to slow progression
Factors contributing to development of anaemia in CKD (8)
Decreased production of erythropoietin from the kidney
Absolute iron deficiency (poor absorption and malnutrition)
Functional iron deficiency (inflammation, infection)
Blood loss
Shortened Red Blood Cell survival
Bone marrow suppression from uraemia
Medication induced
Deficiency of Vit B12 and folate
What Haemoglobin level should you aim for in CKD?
Aim for Hb 100 to 120 for CKD
3 types of abnormalities that would allow you to diagnose Mineral bone diease in a CKD pt
- Calcium, phosphate, alkaline phosphatase, PTH or vitamin D metabolism
- Vascular and/or soft tissue (calcification)
- Bone turnover, metabolism, volume, linear growth or strength
List ways CKD can cause mineral bone disease (5)
Increased Fibroblast Growth Factor-23 Increased Alkaline Phosphatase and PTH Increased Phosphate Decreased Serum Calcium Decreased 1,25 – Vitamin D
List 3 causes of abnormal bone turnover states
Adynamic bone disease (Low turnover)
Osteomalacia “
Osteitis Fibrosa (High turnover state)
How does the liver regulate Vitamin D?
25 alpha-hydroxylase in liver metabolises VitD3 to 25(OH)VitaminD / calcidiol
How does PTH affect the kidney?
Increases calcium reabsorption,
Increases metaboism of Vitamin D into its active form (1,25 dihydroxy Vitamin D)
Potential complications of peritoneal dialysis (7)
Drainage problems, Malposition, Leaks, Hernias, Hydrothorax, Encapsulating peritoneal sclerosis if long term use, Infection -> peritonitis
Potential complications of haemodialysis (8)
- Infection/Bacteraemia
- Haemodynamic instability
- Reactions to dialysers
- Haematomas/risk of bleeding
- Muscle cramps
- Anaemia due to clotted lines/Haemolysis
- AVF steal syndrome
- SVCO from central lines
When would you consider active conservative management over Renal Replacement Therapy?
Patient over 80
OR
WHO performance score 3 or more (3 = Capable of only limited self-care, confined to bed or chair more than 50% of waking hours)
Which drugs are used before kidney transplant to limit risk of hyperacute rejection?
Methylprednisolone in combination with any of the following:
Basiliximab and Thymoglobulin;
less commonly used are alentuzumab and rituximab
5 types of drugs used to maintain kidney transplant
Steroids,
Calcineurin inhibitors (tacrolimus, cyclosporine, voclosporin),
Antimetabolite medications (mycophenolate, azathioprine),
Rapamycin inhibitors (sirolimus and everolimus)
T-cell regulation: Belatacept and belimumab
What monitoring will a renal transplant patient require long term?
GFR, CNI levels, proteinuria, Calcium, phosphate and PTH, Lipids and glucose. Screening for infections and malignancy (3x more likely to get cancer)
