Renal Flashcards
nephrotic synd
proteinuria
hypoalbuminaemia
oedema
nephritic synd
haematuria
HTN
causes of a nephrotic syndrome
mimimal change disease
focal segmental glomerulosclerosis
membranous glomerulonephritis
minimal change disease
nephrotic picture
commonest cause in children
focal segmental glomerulosclerosis
nephrotic picture
commonest cause in adults
causes of focal segmental glomerulosclerosis
idiopathic
HIV
heroin
membranous glomerulonephritis
nephrotic picture
2nd commonest cause in adults
causes of membranous glomerulonephritis
infections
rheumatoid drugs
malignancy
rule of 1/3 in membranous glomerulonephritis
1/3 resolve
1/3 resolve to cytotoxics
1/3 develop CKD
causes of a mixed nephritic/nephrotic syndrome
diffuse proliferative glomerulonephritis
membranoproliferative glomerulonephritis
diffuse proliferative glomerulonephritis
- mixed nephritic/nephrotic syndrome
post-strep infection in a child (1-2 w later)
membranoproliferative glomerulonephritis
- mixed nephritic/nephrotic syndrome
type 1: cryoglobulinaemia (hep C)
type 2: partial lipodystrophy
causes of a nephritic syndrome
rapidly progressive glomerulonephritis
IgA nephropathy
rapidly progressive glomerulonephritis
- nephritic syndrome
aggressive and can cause ESRF in a few days
causes of rapidly progressive glomerulonephritis
goodpastures syndrome (anti GBM disease)
- autoantibodies to type iv collagen
- causes pulmonary haemorrhage and rapidly progressive glomerulonephritis
Mx rapidly progressive glomerulonephritis
aggressive immunosuppression - high dose IV steroids and cyclophosphamide
where do carbonic anhydrase inhibitors work
the proximal convoluting tubule
mode of action of carbonic anhydrase inhibitors
facilitate Na/H exchange in the PCT
example of an osmotic diuretic
mannitol
where do osmotic diuretics work
PCT and the thin loop of Henle
mode of action of osmotic diuretics
they stay in the filtrate and inhibit the reabsorption of water to maintain urine output
examples of loop diuretics
furosemide, bumetanide
where do loop diuretics work
ascending loop of henle
mode of action of loop diuretics
block Na/K/Cl triple transporter
where do thiazide diuretics work
distal convoluting tubule
example of thiazide diuretic
bendroflumethiazide
mode of action of thiazide diuretics
block Na/Cl transporter
where do aldosterone antagonists work
cortical collecting tubule
example of aldosterone antagonist
spironolactone
s/e of spironolactone
hyperkalaemia
gynaecomastia
definition of AKI
- absolute increase in creatinine by >26.4 micromol/L
- increase in creatinine by >50%
- reduction in urine output (<0.5 ml/kg/h)
nephrotoxic drugs
ACEi
NSAIDs
aminoglycosides (e.g. gentamicin)
diuretics
presentation of AKI
reduced urine output fluid overload rise in K, urea, creatinine arrhythmias features of uraemia - pericarditis, encephalopathy
what is a ‘pre-renal’ AKI
ischaemia or lack of blood for to the kidneys
pre-renal causes of AKI
hypovolaemia
renal artery stenosis
hypotension
what is a ‘renal’ AKI
intrinsic damage to the glomeruli, renal tubules or kidneys themselves
renal causes of AKI
glomerulonephritis
acute interstitial nephritis
acute tubular necrosis
rhabdomyolysis
what is a ‘post-renal’ AKI
obstruction to the urine coming out of the kidneys
post-renal causes of AKI
kidney stones
BPH
bladder/cervical/prostate ca
Ix of AKI
urinalysis +/- MSU
venous blood gas
ECG
renal USS
Mx AKI
Fluids!!!
stop any nephrotoxic drugs
Mx of hyperkalaemia if persistent
mild hyperkalaemia Mx
(5.5 - 6)
calcium resonium - binds to K
moderate hyperkalaemia Mx
(6 6.5)
insulin/dextrose infusion
severe hyperkalaemia Mx
(>6.5)
(any ECG changes) - IV calcium gluconate
IgA nephropathy presentation
- nephritic syndrome
young man presenting a couple of days after URTI with episodic macroscopic haematuria
Mx IgA nephropathy
supportive!
steroids shown not to be effective
commonest cause of glomerulonephritis
IgA nephropathy
what is acute interstitial nephritis
renal inflammation localised to the renal interstitium
the main cause of acute interstitial nephritis
DRUGS!!!!
- NSAIDs
- allopurinol
- furosemide
- penicillin
- rifampicin
presentation of acute interstitial nephritis
mild renal impairment fever rash arthralgia eosinophilia HTN
Ix acute interstitial nephritis
bloods - U&Es
+/- renal biopsy
Mx acute interstitial nephritis
- stop offending medicine
- supportive - fluid and electrolyte balance
- steroids - if not resolving
causes of acute tubular necrosis
renal ischaemia (shock, sepsis) aminoglycosides myoglobin (2 to rhabdo) uric acid (2 to gout) light chain proteins (2 to myeloma)
presentation of acute tubular necrosis
features of AKI
“muddy brown casts” in urine
Mx acute tubular necrosis
supportive - fluid and electrolyte balance
Mx rhabdomyolysis
IV fluids
+/- urinary alkalinisation (IV sodium bicarb)
main causes of CKD
diabetic nephropathy chronic glomerulonephritis chronic pyelonephritis HTN polycystic kidneys
stage 1 CKD
normal eGFR > 90 ml/min
signs of kidney damage on other tests
stage 2 CKD
eGFR 60-90 ml/min
signs of kidney damage on other tests
stage 3a CKD
eGFR 45-59 ml/min
stage 3b CKD
eGFR 30-44 ml/min
stage 4 CKD
eGFR 15-29 ml/min
stage 5 CKD
eGFR <15 ml/min
established kidney failure - dialysis or transplant needed
types of dialysis
haemodialysis
peritoneal dialysis
haemodialysis
arteriovenous fistula
- takes 6w to mature
peritoneal dialysis
solute is remvoed across the peritoneal membrane
Continuous Ambulatory Peritoneal Dialysis (4 bags/day)
or
Automated Peritoneal Dialysis (1 bag/day)
Mx of CKD
limit disease progression
BP reduction - ACEi or ARB
Renal bone disease - Alfacaldiol or Phosphate binders
CVS - statin
Anaemia of Chronic disease - IV iron or erythropoietin injection
presentation of ADPKD
HTN recurrent UTIs renal stones haematuria CKD
extra-renal manifestations of ADPKD
liver cysts
berry aneuryms
mitral valve prolaspe
cysts in other organs
Ix ADPKD
- renal US
- CT abdo/pelvis
- Genetic testing
Mx ADPKD
symptomatic Tx - complications as they arise
Screening test for relatives of ADPKD
abdo US
presentation autosomal recessive ADPKD
renal masses & renal failure detected on prenatal US
ESRF develop in childhood
