Renal Flashcards
Define AKI
rise in serum creatinine >50% in 7 days
Rise in serum creatinine >25micromol/l in 48hrs
urine output <0.5ml/kg/hr for >6hrs
Risk factors for AKI
CKD Heart failure diabetes liver disease over 65 NSAIDs, ACEI contrast medium
pre-renal AKI
inadequate blood supply
- dehydration
- shock
- heart failure
renal causes of AKI
Glomerulonephritis
interstitial nephritis
ATN
post-renal AKI
obstruction to outflow of urine
- calculi
- masses, strictures, BPH
Investigating AKI
urinalysis - blood, leucocytes, nitrites and glucose
USS
treating AKI
stop nephrotoxic medication
Fluid rehydration
catheter if obstruction
DAMN drugs
diuretics
ACEI/ARB
metformin - lactic acidosis
NSAIDs
preventing contrast induced nephropathy
pre and post contrast IV 0.9% saline
complications of AKI
hyperkalaemia
fluid overload, pulmonary oedema
metabolic acidosis
uraemia
what can uraemia lead to?
encephalopathy or pericarditis
treating hyperkalaemia
IV calcium gluconate
insulin/dextrose
salbutamol
calcium resonium/dialysis
hyperkalaemia is
K > 5.5
first thing to do in hyperkalaemia
ecg
ecg findings hyperkalaemia
tall tented t waves
wide QRS
absent p waves
K requirements per day
1mmol/kg/day
what fluid to avoid in hyperkalaemia
hartmanns
how long for AV fistula to mature?
6-8 weeks
differentiate between AIN and ATN
AIN has raised WCC (eosinophils) on urine dip
alport syndrome
renal failure, sensorineural hearing loss and ocular abnormalities
nephrotic syndrome criteria
proteinuria >3g/24 hour
oedema
hypoalbuminaemia <30g/l
findings in diabetes insipidus
high serum osmolality, low urine osmolality
treating cranial and nephrogenic diabetes insipidus
cranial = desmopressin nephrogenic = TZD
cancer risk in transplant patients
SCC - skin cancer
immunosuppression following transplant
ciclosporin/tacrolimus with monoclonal antibody
add steroids >1 rejection episode
detecting diabetic nephropathy
ACR in early morning urine annually
when to start ACEI in CKD
if ACR >70mg/mmol
medication used for spironolactone gynaecomastia
epleranone
goodpastures investigation
anti-GBM antibodies
how many stages for AKI?
3
what can saline cause?
hyperchloraemic acidosis
resus fluids
500ml 0.9% saline over 15 mins/STAT
define CKD
abnormal kidney structure or function >3 months
eGFR and CKD
1 = >90 2= 60-90 3a = 45-59 3b = 30-44 4 = 15-30 5 = <15
ACR and CKD
A1 = <3 A2 = 3-30 A3 = >30
causes of CKD
diabetes glomerulonephritis PKD drugs and toxins heart failure
kidneys in CKD
bilaterally small
Why is it important not to combine ACEI and ARB?
risk of hyperkalaemia
management of CKD
DM, bp, weight control ACEI/ARB fluid and diet restriction EPO - anaemia phosphate binders vit D supplement sodium bicarbonate 20mg atorvostatin RRT
presentation of CKD
asymptomatic pruritus loss of appetite nausea oedema peripheral neuropathy hypertension
using eGFR to diagnose CKD
2 tests 3 months apart
complications of CKD
acidosis electrolyte imbalance renal bone disease CVD dialysis uraemia
When to refer CKD to a specialist
eGFR <30ml/min
ACR >70mg/mmol
accelerated decline
uncontrolled HTN 4 anti-hypertensives
CKD - hyperparathyroidism
secondary due to high serum phosphate
low active vitamin D
high PTH
most common nephropathy in children
minimal change disease
underlying causes of nephrotic syndrome
HSP
diabetes
HIV
FSGS
urinalysis - minimal change
small molecular weight proteins
hyaline casts
treating minimal change
CCS high dose 4 weeks
low salt diet, diuretics, albumin infusions
presentation of minimal change
oedema (periorbital and peripheral), frothy urine, proteinuria and low albumin
treating steroid resistant minimal change
ACEI
cyclosporine, tacrolimus, rituximab
complications of nephrotic syndrome
hypovolaemia thrombosis infection renal failure relapse
indications for acute dialysis
acidosis hyperkalaemia uraemia - seizures intoxication oedema
indications for long term dialysis
ESRF = CKD5
3 main options for maintenance dialysis
continuous ambulatory peritoneal dialysis
automated peritoneal dialysis
haemodialysis
catheter used in peritoneal dialysis
tenckhoff
how does peritoneal dialysis work?
filtration membrane = peritoneal membrane
dialysis solution with dextrose added to peritoneal cavity
ultrafiltration from blood to dialysis solution
complications of peritoneal dialysis
SBP
peritoneal sclerosis
ultrafiltration failure
weight gain
typical haemodialysis regime
4 hours a day, 3 days a week
2 options for haemodialysis
tunnelled cuffed catheter
AV fistula
tunnelled cuff catheter
subclavian or jugular vein into SVC or right atrium
2 lumens - blood exits and blood enters
dacron cuff provide barrier to infection
which vessels for AV fistula
radio-cephalic
brachio-cephalic
brachio-basilic
examining AV fistula
skin integrity
aneurysms
palpable thrill
machinery murmur
AV fistula complications
aneurysm infection thrombosis stenosis STEAL syndrome high output heart failure
STEAL syndrome
inadequate blood flow distal to AV fistula
distal ischaemia
is it ok to take blood from AV fistula?
NO
matching renal donor
HLA type A, B and C on chromosome 6
what vessels are used in transplant?
external iliac
transplant rejection
hyperacute = remove graft
acute <6 months
chronic
cause of hyperacute rejection
HLA or ABO antibodies
complications related to immunosuppressants
IHD T2DM infections - PCP, CMV, TB Non-hodgkin lymphoma SCC - skin cancer
