Renal Flashcards
How is Acute Kidney Injury defined?
Rapid (<7 Days) and sustained (>24 Hrs) reduction in Renal Faiure resulting in Oliguria and a rise im serum Creatinine and Urea.
What are the effects caused by an AKI?
Fluid - Oliguria, Hypervolaemia
Electrolyte - Hyperkalaemia
Acid-Base - Metabolic Acidosis
How is Chronic Kidney Disease defined?
>3 Months
Abnormal structure or function
GFR <60ml/min for >3 Months
Which symptoms will a patient with an AKI typically present with?
Depends on Cause
Oliguria/Anuria
Nausea/Vomiting
Dehydration
Confusion
Which signs will a patient with an AKI typically present with?
HTN
Distended Bladder
Dehydration (Postural Hypo)
Fluid Overload (JVP, Oedema)
Pallor, Rash, Bruising
How would you classify the causes of an AKI?
Pre-Renal - Hypoperfusion
Renal - Cellular Damage
Post-Renal - Obstruction
What are the causes of a Pre-Renal AKI?
Hypovolaemia - Renal Loss (Diuretics, DKA), Extrarenal Loss (Vomiting, Diarrhoea, Bleeding etc.)
Systemic Vasodilation - Sepsis
Decreased Cardiac Output - Heart Failure, MI
Intrarenal Vasoconstriction - Cardiorenal/Hepatorenal Syndromes
Renal Artery Stenosis +- ACEi
What are the main causes of Renal AKIs?
Tubular - Acute Tubular Necrosis (Ischaemia, Nephrotoxic Agents)
Glomerular - Glomerulonephritis
Interstitial - Interstitial Nephritis
Vascular - Vessel Obstruction
What are the Post-Renal causes of an AKI?
Luminal - Stones
Mural - Malignancy
Extrinsic - Retroperitoneal Fibrosis
Which drugs can cause Renal AKIs?
Commonly
Paracetamol
NSAIDs
ACE Inhibitors
Aminoglycosides
What are the Vascular Causes of an AKI?
Large Vessel Occlusion - ie. Thrombosis
Small Vessel (Microangiopathy) - HUS, TTP, DIC
What is Haemolytic Uraemic Syndrome?
Microangiopathy characterised by:
Progressive Renal Failure
Microangiopathic Haemolytic Anaemia
Thrombocytopaenia
What causes HUS?
E.Coli 0157:H7 Gastroenteritis, typically in children
Endothelial Damage
Thrombosis, Platelet. Consumption, Fibrin strand deposition, Thrombocytopenia
RBC Destruction - Anaemia & Schistocytes.
What is Thrombotic Thrombocytopenic Purpura?
Disorder characterised by the formation of thrombi in small-vessels.
How does TTP typically present?
Pentad:
Haemolytic Anaemia, Uraemia, Thrombocytopenia (HUS)
+ Fever
+ Neurological Sx (Seizures, Hemiparesis, Decreased GCS, Vision Defects)
What is Glomerulonephritis?
Inflammation of the Glomerui and Nephrons.
How does Glomerulonephritis typically present?
No ‘Typical’ Presentation - Wide spectrum of disease
Loss of barrier function - Proteinuria, Haematuria
Loss of filtering capacity - Reduced Excretion.
How does Nephrotic Syndrome Present?
Proteinuria
Low Serum Albumin
Oedema
Why does Hyperlipidaemia often occur in Nephrotic Syndrome?
Hypoalbuminaemia increases Lipid production in the Liver as a compensatory mechanism.
What are the most common causes of Nephrotic Syndrome?
Adults - Membranous Glomerulonephritis / Diabetes Mellitus
Children - Minimal Change Disease
Also: SLE, Amyloidosis, HBV/HCV
How does Nephritic Syndrome typically present?
Hypertension
Haematuria
Oedema
(Oliguria)
What are the most common causes of Primary Glomerulonephritis?
Berger’s Disease (IgA Nephropathy)
Henoch-Schonlein Purpura
Anti-GBM (Goodpasture’s)
Post-Strep
What are the most common causes of Nephritic Syndrome?
IgA Nephropathy
Post-strep
Vasculitis
SLE
Anti-GBM DIsease
How does IgA Nephropathy typicallhy present?
Soon after URT Infection
Episodic Haematuria
How does Henoch Schonlein Purpura typically present?
Purpuric Rash on Extensors
Haematuria
Polyarthritis
How does Anti-GBM (Goodpasture’s) Disease typically present?
Haematuria
Haemoptysis
How does Post-Streptococcal Glomerulonephritis typically present?q
1-2 weeks after a throat/skin infection.
Nephritic Syndrome
How would you investigate Glomerulonephritis?
Bloods - FBC, U&Es, CRP, Complement, Autoantibodies (SLE)
Urine - Protein, Blood
Renal USS +/- Biopsy
How would you manage a case of Glomerulonephritis?
Refer
Manage BP
ACE Inhibitors or Angiotensin Receptor Blockers
Steroids/Immunosuppression
Treat Cause
What are the main causes of Acute Tubular Necrosis?
Ischaemia (Hypovolaemia, Low CO, Sepsis, DIC)
Nephrotoxic Agents (Drugs, Rhabdomyolysis, Myeloma)
How does Myeloma present?
CRAB
HyperCalcaemia
Renal Failure - Raised Urea & Creatinine
Anaemia
Bone Lesions & Pain
Which complications can occur as a result of an AKI?
Uraemia
Hypervolaemia
Hyperkalaemia
Hyperphosphataemia
Metabolic Acidosis
CKD
How should you manage an AKI?
Volume Status
Stop Nephrotoxic Drugs
Treat the cause
Manage Complications
Renal Replacement Therapy (If complications are refractory to medical therapy)
Which complications can occur as a result of CKD?
Acidosis
Hyperkalaemia
Anaemia
Osteomalacia
CVD
Uraemia
Death
How should you manage a patient with CKD?
Limit Progression (BP, Glucose, CVS Risk Factors, Dietary)
Symptomatic - (EPO, Sodium Bicarbonate, Diuretics)
RRT (Transplant, Haemodialysis)
How should you treat Renal Osteodystrophy?
Calcichew (Ca Supplements)
Calcium Acetate (Phosphate Binding)
Calcimimetic (Reduces PTH)
Which organisms most commonly cause UTIs?
E.Coli
Staph saprophyticus
Proteus mirabilis
Enterococci
Klebsiella
Candida albicans
Pseudomonas aeruginosa
What are the presenting symptoms of a UTI?
Cystitis - FUND HIPS
Prostatitis - Low Backache, Suprapubic Pain,
Acute Pyelonephritis - High Fever, Rigors, Vomiting
General - Fever, Abdo Pain, Foul-Smelling Urien
How should you manage a patient with a UTI?
Cefalexin & Nitrofurantoin
Pregnant: Cefalexin & Co-Amoxiclav
Trimethoprim
What is Polycystic Kidney Disease?
Fluid-filled cysts growing on the Kidneys
Autosomal Dominant
Clinically silent, eventually causes HTN, Calculus formation, Renal Failure, SAH
How does a Renal Cell Carcinoma typically present?
Haematuria
Loin Pain
Abdominal Mass
How should you investigate a possible Renal Cell Carcinoma?
BP (Increased renin release)
Polycythaemia (Bleeding)
Haematuria
‘Cannon-Ball Metastases’
CT/MRI
IV Urogram
How does Renal Artery Stenosis typically present?
Hypertension refractory to treatment in younger people.
Decreased Renal Function after ACE inhibitor/ARb treatment.
How should you investigate a possible case of Renal Artery Stenosis?
US Measurement of Kidney Size
CT/MRI Angiogram
Digital Subtraction Renal Angiography
