Renal Flashcards
Why does nephrotic syndrome increase clot formation?
Antithrombin 3 and plasminogen is lost in the urine
Why does nephrotic syndrome increase risk of heart disease?
Liver compensates for loss of proteins buy increasing synthesis of lipids - causes hyperlipidaemia
Why is there an increased infection risk in nephrotic syndrome?
Loss of antibodies in the urine
What would you look for on a blood film that would distinguish AKI from CKD?
Hypocalcaemia - wouldn’t happen in AKI, but would in CKD (vitamin D conversion reduced due to damage, also lost in the urine, vit D regultes calclium - therefore CKD a cause of secondary hyperparathyroidism)
What is diabetes inspidus?
Decreased ADH (brain) or lack of response to ADH (nephrogenic)
Cannot reabsorb water
Presentation: Polyuria and thirst (increasing serum osmolality), dehydration, postural hypotension, +++Na+ (because low water)
What is the role of ADH?
Allows for water reabsorption in the collecting ducts
What is a differential for diabetes inspidus?
Drinking too much water!
What is the cause of cranial diabetes insipidus?
- Hypothalamus does not produce ADH (can be caused by tumours, infections, head injuries, brain surgery / radiotherapy)
What tests would you do for diabetes inspidus?
- Urine osmolality LOW (lots of water not many solutes)
- Water deprivation test –> don’t give water for 8 hours, then give desmopressin (synthetic ADH( and measure urine osmolality again.
Used to distinguish between cranial and nephrogenic.
Cranial - after desmopressin urine becomes less dilute (Can still respond to ADH just have problems making it). In nephrogenic - no response to the ADH as problem with the response to it).
What are the causes of nephrogenic diabetes?
- Lithium - most known cause
- Genetics
- Electrolytes
What medication should be prescribed for those with CKD?
ACEi
ACEi first line for diabetics, not Ca2+ blocker - due to co-existing diabetic nephroptathy
What is the mechanism of action of spironolactone?
Aldosterone antagonist
Adverse effects: hyperkalaemia and gynaecomastia (switch to eplenerone if troublesome)
What type of blood gas distrubance would you see in a patient with diarrhoea?
Metabolic ACIDOSIS
*loosing bicarb in the faeces
What type of. blood gas disturbance would you see in vomitting?
Metabolic alkalosis
Would be loosing H+ in the vomit
What drugs should stopped in AKI?
- NSAIDs
- Antibiotics
- ACE inhibitors
- ARB2’s
- Diuretics
What happens to potassium in AKI?
Shoots up
How would you distinguish between AKI and dehydration?
Both cause a reduced urine output
AKI: creatinine rise
Dehydration: urea (BUN) will rise much more than the creatinine, causing reduced urine output
What would you look for on the bloods of a patient presented with dehydration?
Urea (BUN)
Will be raised
What are the maintenance fluids for a healthy adult?
- 25-30ml/kg/day water
- 1 mmol/kg/day K+, Na+, Cl-
- 50-100g/day glucose
How much potassium does 0.9% saline have in it?
154 mmol Na and Cl
What does hartmaans solution have in it?
Na, Cl, Bicarb, K+
What is the most common cause of nephrotic syndrome in kids?
Minimal change disease
What is the treatment of minimal change disease?
Prednisolone
A man comes in with haemoptysis, fever, and joint pain. Investigations show an AKI. What antibody would you want to test for?
Anti GBM
Signs of lung and kidney problems
Nephritis is usually rapid and progressive - happens within a couple of days
What are antiGBM antibodies against?
Type 4 collagen
List 4 causes of rhabdomyolysis
- After a fall, long lie
- Seizure
- Statin use
- Crush injury
What would you expect to see on the bloods of someone with rhabdomyolysis?
- Myoglobinuria
- Calcium low (myglobin binds calcium)
- Elevated CK
- Hyperkalaemia - why you have to be really careful - ECG
What is the treatment of rhabdomyolysis?
Lots and lots of IV fluids
How can you differentiate between post-strep glomerulonephritis and IgA glomerulonephritis / bergers?
Bergers = URTI in last couple of days
Post-strep = URTI 2-3 weeks ago
What things in the history would point towards Alports syndrome?
- Hearing problems
- Eye problems
- Haematuria
What causes post-strep glomerulonephritis?
Strep pyogenes
What is a commonly recognised caution in those with nephrotic syndrome?
- Increased risk of VTE
Antithrombin 3 is lost in the urine (therefore unnopposed action of thrombin) - Infection rates increased - loose antibodies
- AKI
- Hypovolaemia
- CV complications (increase lipids due to loss of proteins)
What are the symptoms of amyloidosis?
- Progressive weakness and SOB
- Commonly causes loss of renal function and proteinuria
- Hepatosplenomegaly
What is the most common cause of kidney disease?
Diabetic nephropathy
What things would you ask about in a LUTS history?
Frequency
Before stream - incontinence, urgency, trouble starting
During - weak flow, stop and starting of urine, dysuria
Following - dribbling, incomplete emptying
Urine - smelly, frothy, any blood
Fever, loin to groin pain, rigors, generally unwell
Red flag: back pain, weight loss, night sweats
What is the mist common extra-manifestation of PKD?
- Hepatomegaly (cysts form in the liver)
- Most people think berry aneurysms are the most common, however this is not true, but they are a common exam Q to ask about!
What can happen as a result of correcting sodium quickly in someone that has low sodium?
Central pontine myelosis
If you use large volumes of NaCl for fluid resus, what can be a complication?
Hyperchloraemic metabolic acidosis - too much Cl-
What is the triad seen in HUS?
- AKI
- Haemolytic anaemia - fragmented RBC seen on blood film
- Low platelets
What two things should you NOT give people with HUS?
- Molitlity agents e.g. loperamide
- Antibiotics
How long does it take for an AV fistula to mature before use?
6 - 8 weeks
What is the anion gap?
Used to work out whether metabolic acidosis has been caused by :
- Increased acid production / ingestion
- Reduced loss of acid / loss of bicarb (can’t mop up excess acid)
If the anion gap is normal, no extra acid being produced in the body (have situation 2) -
If the anion gap is high, indicates a new acid (such as lactate, ketones, urate, acid posioning), has been produced by the body
How can you tell that there is a renal cause as apposed to pre/post-renal cause on a urine dip?
Raised protien in renal problems - would not see with pre or post
How can you tell the difference between an acute intersitutal nephritis and an acute tubular acidosis?
ACN - inflammatory, therefore involves WBC - raised in the urine
ATA/N = not inflammatory, results in destruction of cells, no WBC (luecocytes) in urine
Glomerulonephritis cause = nephritic - would see lots of blood present in the urine
List some causes of acute interstitual nephritis
- Penicillin containing drugs
Name 4 causes of intrinsic AKI
Glomerulonephritis ATN (Acute tubular necrosis) AIN (Acute intersititual nephritis) Rhabdomyloysis Tumour lysis syndrome
How would you classify AKI?
Pre-renal
Intrinsic
Post-renal
List some of the signs of AKI
- Confused patient (particulrly elederly) - caused by the build up on uraemia, leading to encepalopathy
- Reduced urine output
- Oedema
