Renal Flashcards
Define hyperkalaemia
Elevated serum potassium >5.5mM
What are the stages of hyperkalaemia?
Mild: 5.5-6.0mM
Moderate: 6.1-6.9mM
Severe: >7mM
Give causes of hyperkalaemia
Excess intake (potassium supplements, massive blood transfusions)
Release from intracellular fluid (rhabdomyolysis, burns, crush injury, tumour lysis syndrome)
Inadequate excretion (renal impairment, medications - ACEi, ARBs, NSAIDs, K sparing diuretics)
Pseudohyperkalaemia (haemolysis during venepuncture)
How can hyperkalaemia present?
Asymptomatic N&V Diarrhoea Hypotonia Muscle weakness Hyporeflexia Paraesthesia Cardiac arrhythmias
What are the classical changes seen on an ECG which are indicative of hyperkalamia?
Flattened P waves
Tall tented T waves
Wide QRS - becoming sinusoidal
What are the three components of the management of hyperkalaemia?
Myocardial protection
Drive potassium into ICF
Potassium elimination
What drugs are used to protect the myocardium during hyperkalaemia?
Calcium gluconate/chloride (10ml of 10% by slow IV injection)
What can be used to drive potassium into the ICF?
Salbutamol 5mg nebs
Insulin-dextrose infusion
Sodium bicarbonate
How can potassium be eliminated?
Calcium resonium
When should RRT be considered in a patient with hyperkalaemia?
Serum potassium >6.5mM and refractory to medical management
What are the complications of hyperkalaemia?
Cardiac arrhythmias - VF
Cardiac arrest
Define nephritis
Inflammation of the kidneys
What are the features of nephritic syndrome?
Haematuria
Oliguria
Proteinuria (<3g per 24 hours)
Fluid retention
What criteria must be fulfilled before a patient can be said they have nephrotic syndrome?
Peripheral oedema
Proteinuria >3g in 24 hours
Serum album <30g per litre
Hypercholesteraemia
Define interstitial nephritis
Inflammation of the space between the cells and tubules
What are the two types of interstitial nephritis?
Acute interstitial nephritis
Chronic interstitial nephritis
Define glomerulosclerosis
Describes the pathological process of scarring of the tissue in the glomerulus
What can cause glomerulosclerosis?
Any type of glomerulonephritis
Obstructive uropathy
Focal segmental glomerulosclerosis
How can most types of glomerulonephritis be treated?
Immunosuppression
Blood pressure control using ACEi/ARBs
How might a patient present with nephrotic syndrome?
Oedema
Frothy urine
What does nephrotic syndrome predispose a patient too?
Thrombosis
Hypertension
High cholesterol
What is the most common cause of nephrotic syndrome In children?
Minimal change disease
Describe minimal change disease
Usually idiopathic
Treated successfully with steroids
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulonephritis
What is the most common cause of primary GN?
IgA nephropathy
What is the peak age of presentation of IgA nephropathy?
20s
What is the classical histology appearance of IgA nephropathy?
IgA deposits and glomerular mesangiall proliferation
What is the most common type of glomerulonephritis overall?
Membranous glomerulonephritis
When are the peaks in membranous glomerulonephritis?
20s and 60s
What does histology show in membranous glomerulonephritis?
IgG and complement deposits on the basement membrane
What are the causes of membranous glomerulonephritis?
Idiopathic 70%
Secondary to malignancy, rheumatoid disorders and drugs
Describe post streptococcal glomerulonephritis
Patients are generally <30 years
1-3 weeks after a streptococcal infection
Develop a nephritic syndrome
Usually make a full recovery
Describe Goodpasture’s syndrome
Anti-GBM attack the glomerulus and pulmonary basement membrane
Glomerulonephritis + pulmonary haemorrhage
What histology is suggestive of rapidly progressive glomerulonephritis?
Crescentic glomerulonephritis
What can rapidly progressive glomerulonephritis present secondary too?
Goodpasture’s syndrome
Granulomatosis with polyangiitis
What is the most common cause of glomerular pathology and chronic kidney disease in the UK?
Diabetic nephropathy
In patients with diabetes, how should they be regularly screened to detect diabetic nephropathy?
ACR + U&Es
How should a patient with diabetic nephropathy be managed?
Optomise blood sugar control
Optomise BP - using ACEi
What drug should be started in all patients with diabetic nephropathy regardless of their BP?
ACEi
How does acute interstitial nephritis present?
AKI
HTN
What can cause acute interstitial nephritis?
Hypersensitivity reaction to drugs/infection
What features may be associated with acute interstitial nephritis?
AKI +…
Rash
Fever
Eosphilia
How can acute interstitial nephritis be managed?
Treat the underlying cause
Steroids - reduce inflammation, improve recovery
How does chronic interstitial nephritis present?
Chronic kidney disease
What are potential causes of chronic interstitial nephritis?
Autoimmune
Infectious
Iatrogenic
Granulomatous disease