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Final year Medicine > Renal > Flashcards

Renal Flashcards

1
Q

AKI dx

A

Serum creatinine.
NICE: rise in Cr >25micromols/L in 48h
>50% in 7 days
Urine output of <0.5ml/kg/h for > 6h.

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2
Q

Risk factors AKI

A 
Acute infection
surgery
CKD
Heart failure
DM
Liver disease
>65
cognitive impairment
Nephrotoxic meds: NSAIDs, ACEi. 
Contrast dyes.
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3
Q

Causes of AKI

A

Pre renal (most common) - Dehydration, hypotension (shock), e.g. Sepsis, Heart Failure

Renal - glomerulonephritiis, ATN, interstitial nephritis

Post renal - Kidney stones, cancer, ureter/urethral strictures, prostate cancer, BPH

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4
Q

Ix

A

FBC U+E, glucose, clotting, ca, esr
ABG
if unclear GN screen: ASOT, ANA, dsDNA, complement, ANCA, gbm, serum protein electrophoresis. ig. hep b/c

Urine dip: protein, blood, nitrites, leukocytes. glucose
MC+S, chemistry - U+E, pcr, osmolality , BJP

ECG - hyperkalaemia
CXR

USS: obstruction.

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5
Q

Mx

A

A-E. GCS
B pul oedema -sit up , high flow o2.
C fluid status.
Tx Hyperkalaemia, pul oedema, consider dialysis need.

Shock/dehydration

  • Fluid challenge 500ml over 15mins.
  • repeat as necessary
  • aim 20ml/hUO

Cardiac monitor
catheterise - UO
cvp
fluid balance chart

evidence of post renal causes.

hx + ix - acute v chrnoic
Bloods, abg, urine dip MCS chem
ecg
CXR, 
REnal USS

Tx sepsis - blood cultures, empirical abx.

call urology if obstructed depsite atehter.
care with nephrotoxic drugs.

Assess: Hx- acute/chronic.
Fluid status
GU tract obstruction - suprapubic pain, enlarged prostate,

Stop nephrotoxic meds. Stop ACEi, Stop NSAIDs.
Fluids - IV
monitor UO, catheterise. fluid balance, weights. Bp, Fbc,

Prerenal: IV fluids
Post renal: catheter.

Severe: renal specialist
Dialysis.

Complications: 
Hyperkalaemia
Fluid overload
metabolic acidosis
Uraemia.- encephalopathy, pericarditis.
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6
Q

Causes of haematuria

A 
Renal: Congenital PKD
Trauma
Infection (pyelonephritis)
Glomerulonephritis, tubular interstitial nephritis
Neoplasm.

Extrarenal: Trauma (stones, catheter)
Infection (cystitis, prostatitis, urethritis)
Neoplasm (bladder, prostate)
Bleeding diathesis
Drugs (NSAIDs, Frusemide, cipro, cephalosporins).

False + (pophyria, myoglobin)

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7
Q

Glomerulonephritis presentations

A

asymptomatic haematuria
nephrotic syndrome
nephritic syndrome

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8
Q

Causes of glomerulonephritis

A 
Idiopathic
immune (SLE, Goodpastures, vasculitis)
infection (HBV, HCV, strep, HIV)
Drugs: penicillamine
amyloid
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9
Q

Ix glomerulonephritis

A 
Bloods:
FBC U+E ESR
complement
ANA, dsDNA, ANCA, GBM
serum protein electrophoresis, Ig
Infection (ASOT, HBC, HCV serology).

Urine: Dipstick (protein, blood)
Spot PCR
MCS
bence jones protein

Imaging
CXR (inflitrates: goodpastures, wegeners)
Renal USS +/- Biopsy

General mx
Refer nephrologist
Treat HTN (<130/80)

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10
Q

causes of asymptomatic haematuria

A

IgA nephropathy
Thin BM disease
Alports syndrome

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11
Q

Features IgA nephropathy

A 
commonest GN developed world
young males: episodic haematuria after URTI
rapid recovery
increased IgA
can -> nephritic syndrome.

Ix: Biopsy (IgA in mesangium).

Mx: steroids, Cyclophosphamide (if reduced renal function). Tx HTn w ACEi.

Prognosis: 20% ESRF in 20y.

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12
Q

Thin BM disease

A

Autosomal dominant

commonest cause asymptomatic haematuria

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13
Q

Alports syndrome

A 
x linked
Haematuria , proteinuria -> ESRF.
sensoneurinal deafness
retinal flecks
cataracts
female: Haematuria.
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14
Q

Post strep glomerulonephritis (nephritic syndrome)

A 
young child HTN, Haematuria, proteinuria (oedema)
oliguria, progressive renal impairment. 
increased ASOT
decreased C3
1-2 w after strep throat/skin
Biopsy: IgG and c3 deposition
mx: supportive. 
95% recover fully.
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15
Q

Crescentic RPGN

A

can -> ESRF in days.
crescents in BM

Type 1: Anti GBM 5%.
-haematuria, haemoptysis
cxr- infiltrates.
Mx: Plasmapharesis, immunosuppression.

Type 2: Immune complex deposition
-complication of igA, Endocarditis, SLE.

Type 3: Pauci immune
cANCA - GPA (wegeners)
pANCA - eos GPA (churgstrauss), Microscopic PA.

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16
Q

Nephrotic syndrome

A 
Proteinuria >3g/24h
hypoalbuminaemia (<30g/L)
oedema
PCR: >300mg/mmol spot urine sample. 
?high cholesterol

Frothy urine
leg scrotal, facial swelling

Mx: give LMWH if albumin <20
monitor U+E, BP, fluid balance, wt
treat casue
fluid: salt/fluid restrict, furosemid
proteinuria: ACEi
Lipids: statins
vte: tinzaparin.
tx htn

complications:
Infection
VTE
Hyperlipidaemia

17
Q

Minimal change

A

children
URTI
fusion of podocytes EM
tx: steroids

18
Q

Membranous nephropathy

A 
20-30% adult nephrotic syndrome
Asw
Lung,colon,breast cancer
SLE, thyroid
Hep B
Drugs (penicillamine), gold
Biopsy: subepithelial immune complex deposits.
Mx: Immunosuppression
40% spont remission
19
Q

FSGS

A 
Afro caribs
asw VUR, Bergers, SCD, HIV
biopsy focal scarring, igM deposition
mx: steroids,cyclophosphamide.cicliclosporin. 
30-50% ESRF
20
Q

Interstitial nephritis causes

A

Immune hypersensitivity - occurs 4-7 days post drug.

Drugs: NSAIDs
abx- cephs, penicillins, rifampicin, sulfonamide
diuretics - furosemide, thiazide, 
allopurinol
cimetidine
Infections: staph, strep
SLE, sjogrens.
21
Q

sx interstitial nephritis

A

fever, artrhalgia, rash
aki
uveitis

22
Q

ix interstitial nephritis

A

IgE, eosinophils

dip- haem, protein, sterile pyruria.

23
Q

Mx interstitial nephritis

A

Stop drug

pred

24
Q

Cured hypovolaemia, persistent ARF

A

ATN
causes:
-hypovolaemia
-nephrotoxins

25
Q

Nephrotoxins

A 
Drugs
NSAIDs
Antimicrobials :AVASTA
Aminoglycosides
Vancomycin
Aciclovir
Sulphonamides
Tetracyclines
Amphotericin
ACEi
Immunosuppressant (ciclosporin, tacrolimus)
Contrast media
anaesthetic enflurane.
endogenous
haemoglobin
myoglobin
urate
Ig light chaisn
26
Q

Mx Rhabdomyolysis

A

Ix: Dipstick (+hb, -ve RBCs.
Blood: CK, K, Po4, urate.

mx; hyperkalaemia
IV rehydration
CVP monitoring if anuric
IV NaHCO3 -> alkalinise urine.

27
Q

CKD causes

A

Kidney damage >3m

Causes DM, HTN
RAS
GN
PKD
Drugs(analgesic)
Pyelonephritis + VUR
SLE
myeloma
Amyloid
28
Q

Ix CKD

A 
BLoods Hb, U+E, ESR, glucose, hypocalcaemia, hyperphosphataemia, ALP PTH
Imune: ANA, dsDNA, ANCA, GBM, C3/4, Ig, Hep
Film: burr cells
Urine Dip, MC+S, PCR, BJP
Imaging: CXR, AXR, Renal USS, 
Bone xrays
CTKUB
renal biopsy
29
Q

complications of CKD

A 
CRF HEALS
Cardiovascualr
Renal osteodystrophy
Fluid
HTN
Electrolyte disrturbances
Anaemia
Leg restless
Sensory neuropathy
30
Q

Mx CRF

A

General: tx reversible casues
stop nephrotoxic drugs

Lifestyle; exercise, healthy wt, stop smoking, na fluid, phosphate restriction

CV risk: statins, aspirin.
DM

HTN <140/90

Oedema: frusemide

Bone disease: phosphate binders: calcichew
alfacaldidol Vit D analagoues
ca supplements
cinacalcet

Anaemia - EPO

Restless legs: clonazepam

Haemodialysis
Renal transplant

31
Q

Renal transplant

A

Assess virology status
CVD
TB
ABO. HLA

Contrandications:
Active infection
cancer
severe Heart disease, other comorb

Immunosuppression: pre op campath/alemtuzumab

Post op: prednisolone short term.
tacrolimus, ciclo long term

32
Q

Complications of renal transplant

A

Post op: bleeding, graft thrombosis, infection, urine leak

Hyperacute rejectionL ABO-.thrombosis, SIRS.

Acute rejection <6m

  • rising cr. fever, pain.
  • cell mediated response.
  • responsive to immunosuppression.

Chronic rejection:
Interstitial fibrosis, tubular atrophy
gradual increase cr, proteinuria.
not responsive to immunosuppression

Ciclosporin: /tacrolimus toxicity.

immune dysfunction -opportunistic infections.
cancer riskS: SCC, BCC, Lymphoma.

cardiovascular disease - HTN, atherosclerosis.

33
Q

Raised anion gap

A

lactate
DKA
urate (renal failure)
salicylate poisoning

34
Q

normal anion gap metabolic acidosis

A 
bicarbonate loss D+V
fistula
renal tubular acidosis
acetazolamide
addisons
ammoni

Final year Medicine (18 decks)

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