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