Renal Flashcards
Kidney functions and measuring renal function
Removal of waste products Vitamin D activation Regulate pH Regulate water EPO production
Measuring renal function
- eGFR
- U&E - Creatinine, creatinine clearance, urea
- Catheter
- Calcium
- Urine dip
- Albumin:Creatinine ratio - CKD staging
Furosemide
Loop diuretic
Works on NKCC2 transporter in ascending limb
OUT:
- Sodium
- Potassium
- Chloride
- Water
Side effects
- Postural hypotension
- HYPOkalaemia
- HYPOnatraemia
- HYPOchloraemia
- HYPOcalcaemia
Bendroflumethiazide
Works on DCT
Blocks Na+/Cl- symporter
Side effects
- Postural hypotension
- HYPOkalaemia
- HYPOnatraemia
- Gout
Spironolactone
Aldosterone antagonist
Potassium sparing
DCT and collecting duct
Blocks aldosterone
OUT
- Sodium
- Chloride
IN - Potassium
Side effects
- Postural hypotension
- HYPERkalaemia
- Metabolic acidosis
- AKI
Pre-renal AKI
LOW urinary sodium
Hypotension
Dehydration
Haemorrhage
Sepsis
HF
Renal artery stenosis
Renal AKI
HIGH urinary sodium
Urine dip = Protein +++
Acute tubular necrosis
- Most common
- Due to sepsis
Acute interstitial nephritis - White cells on urine dip
Glomerulonephritis
Sepsis
HUS
Rhabdomyolysis
Post-renal AKI
Obstruction
- Stones
- Strictures
- BPH
- Cancer
- Surrounding masses
Nephrotoxic drugs
Pre-renal
- NSAIDs
- ACE-I
Renal
- Penicillin
- Cephalosporins
- Gentamicin
Post-renal - Acetylcholine
AKI risk factors and definition
Age Dehydration Nephrotoxic drugs Contrast Underlying renal disease Diabetes
< 0.5 ml/kg for 6 hours
Creatinine ^ 50% in 7 days
Grading
- 1.5-1.9x baseline
- 2-2.9x baseline
- 3x baseline
eGFR decrease by 25% in 7 days
AKI presentation
Asymptomatic
Oliguria Arrhythmias Confusion Seizures Fluid overload - Oedema
Uraemia
- Vomiting
- Dizziness
- Cognitive impairment
- Asterixis
AKI investigations and management
Urine dip / MC&S
U&E - Urea:Creatinine ratio
Septic screen
USS within 24 hours if cause unknown
Management - Treat cause!
- IV fluids
- Stop nephrotoxic drugs
- Change drugs that are renally excreted - May cause toxicity
- Treat metabolic acidosis - Sodium bicarbonate
- Catheter
Treat hyperkalaemia - Calcium gluconate
- If K > 6.5 or ECG changes
- Risk of tissue necrosis
HYPERkalaemia aetiology and presentation
Rhabdomyolysis AKI / CKD DKA Addison's Tumour lysis syndrome
Drugs
- Spironolactone
- ACE-I
- A2RB
- Heparin
Presentation
- Weakness
- Flaccid paralysis
- Decreased reflexes
HYPERkalaemia investigations and management
Investigations
- U&E
- ECG - TTT - Tall Tented T waves
Management - C BIG K Drop
- Calcium gluconate (If ECG changes or K > 6.5)
- Bicarbonate - Sodium bicarb
- Insulin
- Glucose - Dextrose
- K+ reduction - Salbutamol
- Dialysis
HYPOkalaemia aetiology and presentation
Diarrhoea
Vomiting
Conn’s
DKA treatment - Salbutamol
Drugs
- Furosemide
- Thiazides
Presentation
- Weakness
- Hypotonia
- Muscle pain
HYPOkalaemia investigations and management
U&E
ECG
- Inverted T waves
- ST depression
- Prolonged PR
- U waves
Management - KCl - Sando-K
Pyelonephritis
E.Coli
Klebsiella
Pseudomonas
Proteus
Presentation
- Fever
- Rigors
- Flank pain
- N/V
- Lower UTI symptoms
- Sepsis
Investigations - Sepsis 6!
- USS/CT for abnormalities or stones
- Urine dip / MC&S
Management
- Abx - Cipro
- Severe - IV Cef
PKD
ARPKD - 16,4
ADPKD - 6
Presentation
- Renal symptoms
- Abdo mass - Flank
- Flank pain
- Recurrent UTIs
- Haematuria
- Stones
Associated conditions
- HTN
- SAH
- Mitral valve prolapse
- Liver cysts
Investigations
- USS - Multiple cysts on kidneys
- Screen for SAH
Management
- Treat HTN
- Family screening
Renal cancer
Smoking
Von-Hippel Lindau disease
Clear cell carcinoma - Most common
Transitional cell carcinoma
Presentation
- Painless haematuria
- Loin pain
- Abdo mass
- Weight loss
- Left varicocoele - LTV drains into LRV
- Hepatosplenomegaly
- Mets - Lung (cannonball mets) / Bone
Investigations
- Urine dip / MC&S
- CT + Biopsy
- CXR - Cannonball mets
Management
- Partial / Total nephrectomy
- Chemo/Radio
Haematuria aetiology
Vascular - Coagulopathy
Iatrogenic - Radiotherapy / Catheter
Trauma - Lacerations
Autoimmune - SLE / RA
Infection
- LUTI
- Pyelonephritis
- TB
Neoplasm
- Nephroblastoma - Children - Flank mass
- Renal cell carcinoma - Painless of painful haematuria
- Bladder cancer - Painless haematuria
- Prostate cancer / BPH
Drugs - Penicillin / NSAIDs
Other
- Stones
- Structural abnormalities
- Gynae - Endometriosis
- Renal disease - Glomerulonephritis
Haemolytic uraemic syndrome
E.Coli O157:H7
“Kid went to a farm”
Presentation
- AKI
- Thrombocytopenia
- Microangiopathic haemolytic anaemia
- Gastroenteritis
Investigations
- Urine dip - Haematuria
- Stool sample
- AKI work up
- FBC - Thrombocytopenia + Haemolytic anaemia
Management - Supportive
Nephrotic syndrome aetiology and presentation
Children - Minimal change disease
FSGS
Membranous nephropathy
Cytokine mediated damage to GBM
^ Glomerular permeability
Presentation
- Oedema
- Proteinuria
- Hypoalbuminaemia
Nephrotic syndrome investigations / management / complications
Urine dip - Proteinuria MSU-MCS ACR FBC Clotting Renal biopsy
SLE antibodies
Management
- Chidren / Steroid sensitive - Prednisolone
- Adults / Steroid-resistant - Cyclophosphamide
Complications
- Infections due to loss of IgG
- Thrombophilia
- Hypercholesterolaemia
- AKI
- HTN
Nephritic syndrome
IgA nephropathy Goodpasture's Wegener's PSGN SLE
Presentation
- AKI
- HTN
- Haematuria
Investigations
- Urine dip - Haematuria
- Urinalysis - RBC casts
- ASO titre
- ANA
- ANCA
- Anti-dsDNA
Management - Supportive
- Low salt
- IV Prednisolone
- Diuretics
ACE-I side effects
Hyperkalaemia
Renal impairment
Dry cough - Bradykinin
Postural hypotension
CKD aetiology
Age
DM
PKD
Heart disease
Myeloma
Interstitial disease - TB
Glomerular disease
Smoking
Nephrotoxics - NSAIDs, etc.
CKD complications
Malaise
Uraemia - Itching
Restless leg syndrome
Amenorrhoea
ED
Anaemia
Electrolyte imbalance
Osteoporosis
CKD investigations / findings
Bloods
- Anaemia
- ESR ^ - Myeloma?
- Glucose ^ - DM?
- Hyponatraemia
- Hyperkalaemia
Urine
- Proteinuria
- Haematuria
Other
- Renal USS
- CT
CKD staging and management
- > 90
- 60-90
3a. 45-60
3b. 30-45 - 15-30
- < 15
Management
- Control HTN
- Control DM
- Prevent CVD
- Correct anaemia
- Treat electrolyte imbalance
- RRT
Dialysis indications
Dialysis is AA PUMP
(It’s not, but oh well)
Arrhythmias
AKI/CKD
Potassium ^^^^^
Uraemia
Metabolic acidosis
Pulmonary oedema
Dialysis types
Haemodialysis
- Blood passed over semi-permeable membrane against dialysis fluid
- Requires anticoagulation
- Requires AV fistula
- Hospital or home treatment
- Complications - Infection, hypotension, N/V
Peritoneal dialysis
- Peritoneum used as semi-permeable membrane
- CI in obesity or intestinal disease
- Good for young independent patients
- Complications - Peritonitis, hernia
Renal transplant
Matching
- ABO
- HLA
- Antibody
Advantages
- Prolongs life
- Prevents complications - Anaemia
Risks
- Operative risk - Infection
- Cancer risk - Due to immunosuppression
- Rejection risk
Renal transplant rejection types
Hyperacute - Minutes Wrong ABO
Accelerated - Days - T-cell mediated
Acute cellular - 3 weeks - Steroids
Chronic - Years - Fibrosis
