Renal Flashcards by Elliot Colman

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.

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What are the effects caused by an AKI?

Fluid - Oliguria, Hypervolaemia

Electrolyte - Hyperkalaemia

Acid-Base - Metabolic Acidosis

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How is Chronic Kidney Disease defined?

>3 Months

Abnormal structure or function

GFR <60ml/min for >3 Months

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Which symptoms will a patient with an AKI typically present with?

Depends on Cause

Oliguria/Anuria

Nausea/Vomiting

Dehydration

Confusion

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Which signs will a patient with an AKI typically present with?

HTN

Distended Bladder

Dehydration (Postural Hypo)

Fluid Overload (JVP, Oedema)

Pallor, Rash, Bruising

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How would you classify the causes of an AKI?

Pre-Renal - Hypoperfusion

Renal - Cellular Damage

Post-Renal - Obstruction

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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

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What are the main causes of Renal AKIs?

Tubular - Acute Tubular Necrosis (Ischaemia, Nephrotoxic Agents)

Glomerular - Glomerulonephritis

Interstitial - Interstitial Nephritis

Vascular - Vessel Obstruction

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What are the Post-Renal causes of an AKI?

Luminal - Stones

Mural - Malignancy

Extrinsic - Retroperitoneal Fibrosis

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Which drugs can cause Renal AKIs?

Commonly

Paracetamol

NSAIDs

ACE Inhibitors

Aminoglycosides

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What are the Vascular Causes of an AKI?

Large Vessel Occlusion - ie. Thrombosis

Small Vessel (Microangiopathy) - HUS, TTP, DIC

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What is Haemolytic Uraemic Syndrome?

Microangiopathy characterised by:

Progressive Renal Failure

Microangiopathic Haemolytic Anaemia

Thrombocytopaenia

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What causes HUS?

E.Coli 0157:H7 Gastroenteritis, typically in children

Endothelial Damage

Thrombosis, Platelet. Consumption, Fibrin strand deposition, Thrombocytopenia

RBC Destruction - Anaemia & Schistocytes.

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What is Thrombotic Thrombocytopenic Purpura?

Disorder characterised by the formation of thrombi in small-vessels.

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How does TTP typically present?

Pentad:

Haemolytic Anaemia, Uraemia, Thrombocytopenia (HUS)

+ Fever

+ Neurological Sx (Seizures, Hemiparesis, Decreased GCS, Vision Defects)

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What is Glomerulonephritis?

Inflammation of the Glomerui and Nephrons.

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How does Glomerulonephritis typically present?

No ‘Typical’ Presentation - Wide spectrum of disease

Loss of barrier function - Proteinuria, Haematuria

Loss of filtering capacity - Reduced Excretion.

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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**