Renal Flashcards
Non-drug causes of ATN
- Infections: “BLeSS”
Brucella, leptospirosis, staph, strep - Immune: SLE and Glomerulonephrites
Drug causes of Acute Tubulointerstitial NEPHRITIS
- NSAIDs
- Antibiotics: “CRPS” =
Cephalosporins, Rifampicin, Penicillin, Sulphonamides (?via formation of crystals and block the tubules) - Diuretics: furosemide and thiazides.
Acute Tubulointerstitial Nephritis (acute TIN)
- Clinical features
- Management
- Rash, fever, systemic illnesses. EOSINOPHILIA and raised IgE. Also eosinophils in the urine
- Prednisolone
Commonest organism in UTI:
- Generally - multi organism or not?
- Post-instrumentation
- Honeymoon UTI
- E.coli
- Proteus spp
- Staph. Saprophyticus
DVT management
5/7 of LMWH subcutaneously, and introduce warfarin during this time.
Maintain LMWH until INR is >2..
If severe renal failure, use unfractionated heparin (UFH) IV for better control of plasma levels.
What to give to reverse unfractionated heparin
Protamine sulphate
Renal vein thrombosis
- Causes
- Symptoms
- Investigation
- Management
- Usually post-nephrotic syndrome (due to hypercoagulable state), especially Membranous Glomerulonephritis
Renal Cell Carcinoma - Sudden onset loin pain and renal function deterioration, may get PE, Haematuria, (palpable kidney)
- CT or MR. (Venography less sensitive)
- Anticoagulate with warfarin for 3-6/12
Renal artery stenosis
- Clinical features
- Investigations
- Management
- Uncontrollable HTN, worsened renal function with ACEi and ARBs.
Flash pulmonary oedemaS, normal LVF on echo.
Small kidney
Weak other pulses (+bruit) - Renal angio is gold standard, if nothing shows up on CT/MR. Also Doppler.
- Comprehensive drug regimens…
Angioplasty
Stent
Revascularisation surgery
Complications of nephrotic syndrome
“LIT”
Lipids high
Infections
Thrombi
Management of Membranous glomerulonephropathy
Fluid restrict…
Steroids and cyclophosphamide
Causes of Membranous Glomerulonephritis
Malignancies
Drugs (gold, penicillamine, captopril)
Infections: HEPATITIS B, Syphilis,
Autoimmune: rheumatoid arthritis, SLE, thyroid disease
Management of Nephrotic Syndrome
- Fluid restrict
- Diuretic (furosemide, can also give spironolactone)
- ACEI or A2A reduces proteinuria (? Reduces GFR)
- Treat underlying cause
- Maintain normal nutrition
Acute renal failure management
- ABC approach, and correct the pre- and post-renal problems, as well treat exacerbating factors
- Arrange urgent USS and senior help
- Stop nephrotoxic drugs, and Metformin
- Complications
Indications for acute dialysis
- Pulmonary oedema refractory to medical treatment
- Uraemic pericarditis or encephalopathy
- Severe acidosis (metabolic)
- Hyperkalaemia
Complications of peritoneal dialysis
Peritonitis (>60% Staph infection, then G-ves)
Port exit site infection
OBESITY - raises lipids in patients already hyperlipidaemia
Catheter malfunction
Membrane dysfunction
Complications of Dialysis
Cardiovascular:
- IHD/heart failure/strokes etc. - Main cause of mortality
- Anaemia
- Bleeding tendency (give desmopressin in acute setting)
Malnutrition
Renal bone disease in CRF
Infection (granulocyte dysfunction due to uraemia)
AMYLOIDOSIS (beta-microglobulin), causing CTS, arthralgia etc.
Acquired renal cysts
Malignancies
Acute rejection features and Treatment
<6/12 after transplant
Rising creatinine
Fever, graft site pain
(Tubular damage)
Mx= methylprednisolone
Chronic rejection features and treatment
> 6/12 “interstitial fibrosis plus tubular atrophy” (IFTA, vascular changes also seen)
Gradual increase creatinine and proteinuria.
Unresponsive to increased immunosuppression
Alpert syndrome
- Aetiology
- Clinical features
- Management
- X-linked condition, missing goodpastures antigen
- Haematuria, proteinuria, progressive renal failure
Extra-renal manifestations: sensorineural hearing loss, ocular defects (lenticonus - bulging of lens capsule on slit-lamp) - Treat as for CRF
ACEi can slow renal progression
