Renal Flashcards
What is AKI?
Decreased renal function occurring over hours or days
How is AKI measured?
Serum creatinine or urine output
What are the commonest causes of AKI?
Pre-renal: sepsis, hypovolaemia, cardiogenic shock, MI
Renal: glomerulonephritis, drug toxicity, infiltration, vasculitis
Post-renal: obstruction due to stone, malignancy, stricture, cloth, prostatic hypertrophy, retro-peritoneal fibrosis
What investigations should be done for AKI?
Urine dipstick USS within 24 hours Check liver function Check platelets Investigate for intrinsic disease e.g. Immunoglobulins
What are the 3 types of AKI volume status?
Hypovolaemia
Euvolaemia
Fluid overloaded/hypervolaemia
Name the triad for nephrotic syndrome.
Proteinuria
Peripheral oedema
Hypoalbuminaemia
Name the triad for nephritic syndrome.
Haematuria
Hypertension
Renal failure
What is Goodpasture’s Syndrome/anti-GBM disease?
Body produces autoantibodies to type IV collagen in the basement membrane - causes glomerulonephritis. Can also cause pulmonary haemorrhage due to basement membrane damage in lungs.
Anti-GBM antibodies present.
What is IgA nephropathy?
Form of nephritic syndrome, IgA deposition in the mesangium leads to glomerular damage.
Occurs a few days after URTI.
Name 3 forms of nephrotic glomerulonephritis.
Minimal change glomerulonephritis
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
What is Alport Syndrome?
X-linked condition where there is abnormal type IV collagen, can lead to end stage renal failure.
What is PRCA, a rare cause of anaemia in CKD?
Pure red cell aplasia - severe reticulocytopenia and reduced RBC production
What eGFR value indicates that a patient is unsuitable for CT?
eGFR<40 means the patient is unsuitable for CT, this is because the contrast is nephrotoxic. A good reason for checking U+Es is to see the patient’s kidney function and whether they can have CT.
What are the 4 types of graft for a kidney transplant?
Brainstem death with CV support
Non heart-beating donor
Live related
Live unrelated
What medication would a post-op renal transplant patient be on?
Steroids (usually prednisolone)
Tacrolimus or ciclosporin (calcineurin inhibitors)
Mycophenolate (antimetabolites)
Most patients are on the ‘triple therapy’ of prednisolone, mycophenolate and tacrolimus.
Name some post-op complications of a renal transplant.
Bleeding
Graft thrombosis
Infection
Urinary leaks
What are the 3 layers of the glomerulus?
Leaky endothelium Basement membrane (slightly negative charge) Foot processes of podocyte cell
What stimulates the release of ADH from the posterior pituitary?
Increased plasma osmolality or decreased BP.
Which organ is responsible for hydroxylation of vitamin D?
The kidney - alpha-hydroxylation of vitamin D which is controlled by parathyroid hormone.
What are the 5 types of diuretics?
Carbonic anhydrase inhibitors Loop diuretics Thiazide diuretics K+ sparing diuretics Osmotic diuretics
Which enzyme is responsible for bicarbonate reabsorption in the PCT?
Carbonic anhydrase (catalyses the conversion of CO2 and water with bicarbonate and H+).
What is the anatomical position of the kidneys?
Retroperitoneal
Extend fro, T12-L3, R kidney is slightly lower due to presence of the liver.
Adrenal glands sit immediately superior.
Name the 4 layers surrounding the kidneys (from deep to superficial).
Renal capsule
Peri-renal fat
Renal fascia
Para-renal fat
Which diuretic is commonly associated with a side effect of gynaecomastia?
Spironolactone (K+ sparing diuretic)
Name some risk factors for AKI
Increased age Diabetes mellitus Prolonged immobilisation (rhabdomyolysis) Dehydration Sepsis Heart failure Liver disease Peripheral vascular disease Essentially, the risk is higher in those with more pre-existing conditions
What is the sepsis 6 bundle?
Give O2 to maintain sats >94% Give fluid challenge Give empirical antibiotics Take blood cultures Measure serum lactate Monitor urine output closely
Why are patients with nephrotic syndrome at increased risk of pulmonary embolism?
Due to imbalance of thrombotic and antithrombotic factors in the clotting cascade - clotting factors are lost in the urine.
What does frothy urine indicate?
Heavy proteinuria
What drug is known for turning urine orange/red?
Rifampicin - used in the treatment of TB
In patients with diabetic-induced CKD, what antihypertensive should they be given even if they have normal BP?
ACEi/ARB
What is APCKD and what is it’s genetic pattern?
Adult polycystic kidney disease
Autosomal dominant
Condition where cysts form on the kidneys, can lead to CKD
Why antibody is associated with small vessel vasculitis?
ANCA
Which antibodies can be present in SLE?
ANA
Anti-dsDNA
What is the mainstay of management for AKI?
Treat underlying cause e.g. give fluids, manage obstruction, stop nephrotoxic drugs. Regardless of mechanism of injury, there is a need to manage fluid balance, acidosis and hyperkalaemia as well as recognise patients who may need RRT.
What are the 3 stages of AKI?
1 - creatinine 1.5x normal, GFR decrased by > 25%
2 - creatinine 2x normal, GFR decreased by > 50%
3 - creatinine 3x normal, GFR decreased by > 75%
Why do you get an acidosis and hyperkalaemia with AKI?
Acidosis due to reduced renal excretion of organic acids. The increase in H+ causes H+ to be taken up by cells, which in turn causes K+ to be secreted by cells via H+ K+ exchanger. Can lead to life-threatening arrhythmias.
