renal Flashcards
What are the 5 functions of the kidney?
Fluid balance Toxin secretion Controls anaemia Regulates acid-base balance BP control
What are the three types of renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Kidney transplant
What are the main causes of CKD?
Diabetes
Glomerulonephritis
Hypertension/renovascular disease
Which drug is given first line to prevent progression of CKD?
ACE-Is
What are the two mechanisms by which CKD causes anaemia?
Decreased absorption of iron from gut
Decreased EPO synthesis
How can anaemia in CKD be treated?
IV iron
Erythropoietin stimulating agents
How does CKD cause bone disorders?
Increased serum phosphate
Decreased hydroxylation of vitamin D
How do you treat bone disease in CKD?
Give phosphate binders if phosphate high
Vit D supplements (cholecalciferol)
Calcitriol given if PTH 3 times normal limit
Which drug used to tx infections falsely lowers eGFR?
Trimethoprim
Which common drugs cause hypokalaemia?
Loop and thiazide diuretics
Which common drugs cause hyperkalaemia?
Spironolactone
ACE-I
ARB
What triad of symptoms is associated with pyelonephritis?
Loin pain
Fever
Renal tenderness
Which cancer can px with a left sided varicocele on exam?
Renal cell carcinoma
What system is used to evaluate the risk of malignancy in renal cysts?
Bozniak classification
What are the criteria for stage 1 AKI?
Serum creatinine 1.5-1.9 x baseline
UO < 0.5ml/kg/hr for 6-12h
What are the commonest causes of AKI/
1) Sepsis
2) Major surgery
3) Cardiogenic shock
4) Hypovolaemia
5) Drugs
6) Hepatorenal syndrome
7) Obstruction
What is the most common cause of nephritic syndrome?
Post-streptococcal glomerulonephritis
What are the features of nephrotic syndrome?
Heavy proteinuria (>3g/24h) Hypoalbuminaemia Oedema Hyperlipidaemia Hypercoagubility
How is nephrotic syndrome managed?
1) Tx oedema - diuretics, fluid and salt restrict
2) Tx cause (adults = biopsy, children = tx as minimal change)
3) ACE-I t reduce proteinuria
What are the comps of nephrotic syndrome?
Infection
thromboembolism (need LMWH and warfarin)
Does diabetes cause a nephrotic or nephritic syndrome?
Nephrotic
Which drugs are nephrotoxic?
NSAIDs
ARBs
ACE-I
aminoglycosides
What are the indications for starting RRT?
Hyperkalaemia
Acidosis
Uraemic complications
Fluid overload
Which drugs do you stop in patients in or at risk of AKI/ prior to giving contrast?
DAMN Diuretics ACE-I/ARB Metformin NSAIDS
What is the time for peak creatinine post contrast?
72 hours
What is the threshold Hb level for transfusion?
70
What are the comps of myeloma?
Hypercalcaemia
Spinal cord compression
Hyperviscosity (reduced cognition, disturbed vision)
Acute renal injury
Factors affecting creatine level
Muscle mass
Drugs (e.g. trimethoprim)
What are the most common causes of rapidly progressing glomerulonephritis?
Small vessel/ANCA vasculitis
Lupus nephritis
Anti-GBM nephritis
What insulin/dextrose regime to you give in hyperkalaemia?
10u actrapid with 250ml 10% glucose
What do you do with LMWH dose if patient is in AKI?
Half dose
What do you do with LMWH dose for PE tx if pt just gone into AKI?
Switch to unfractionated heparin as easier to monitor APTT value and doesn’t require dose adjustment in renal failure
(LMWH requires factor 10a monitoring - not routinely done)
What do you do with furosemide if pt in AKI?
Diuretics not nephrotoxic
Decision to stop depends on volume status of patient (only stop if suspect hypovolaemia)
When should you stop amlodipine in AKI?
Only stop if BP low
How do you manage phenytoin levels in a patient in AKI?
Risk of toxicity therefore monitor levels
What do you do if a patient on gentamicin develops AKI?
Stop it and use another abx (e.g. tazocin, meropenem)
What to do with diclofenac in pt with AKI?
STOP
What to do with morphine sulphate if a patient develops AKI?
Stop as renally excreted (risk of resp and CNS depression)
Fentanyl (preferred) and oxycodone safe alternatives
Paracetamol also safe
What do you do with acyclovir dose if a pt develops AKI?
HALVE DOSE
renally excreted therefore can accumulate and cause neurological comps such as seizures
What to do with flucloxacillin dose in AKI?
Renally excreted therefore can accumulate and cause seizures
Consider cutting down
What do you do with prednisolone in a patient on long term steroids who develops AKI?
DOUBLE DOSE
Which group of patients will deteriorate rapidly when started on an ACE-I to preserve renal function?
Pt with renal artery stenosis
