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Renal Flashcards

1
Q

What are diabetics annually screened for?

A

Microalbuminuria + urine dip at every appointment

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2
Q

Complications of renal replacement therapy

A 
CVD- MI and stroke
Malnutrition
Renal bone disease
Infection
Malignancy
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3
Q

Cardiac complications in hyperkalaemia

A

ECG changes:
Tall tented T waves, broad QRS, prolonged PR, flat P wave

Arrhythmias:
Asystole, VF

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4
Q

Causes of hypercalcaemia

A 
Hyperparathyroidism
Thiazide diuretics
Malignant disease
Sarcoidosis
Thyrotoxicosis
Vit D intoxication
Cortisol deficiency
Familial hypocalciuric hypercalcaemia 
Acidosis
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5
Q

Pathophysiology of CKD

A

Primary kidney injury:
Diabetes, glomerulonephritis, HTN/reno-vascular disease, pyelonephritis and reflux nephropathy

Nephron loss

Hyperfiltration and hypertrophy of residual nephrons (compensating to maintain GFR), increased glomerular capillary pressure

Sclerosis of hyper-filtering nephrons

Nephrotoxins, decreased perfusion (dehydration, shock), proteinuria, hyperlipidaemia, hyperphospatemia, smoking

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6
Q

Define CKD

A 
Sustained, irreversible decrease in GFR 
<60ml/min/1.73, for >3months
Equations to calculate
OR
Persistent haematuria/proteinuria/structural abnormalities of the kidneys
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7
Q

Define hypocalcaemia

A

<2.1mmol/L

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8
Q

Indications for dialysis in CKD

A

Metabolic acidosis
Hyperkalaemia after 3x rounds of treatment
Anuria/uraemia
BLAST drugs

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9
Q

Define end stage renal disease

A

<15 GFR

Need for renal replacement therapy

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10
Q

Nephritic syndrome

A

Haematuria
Oliguria
Proetinuria
Fluid retention

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11
Q

Most common cause of glomerular pathology and CKD?

A

Diabetic nephropathy

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12
Q

Risk factors for pyelonephritis

A

Female
Structural urological abnormalities
Diabetes

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13
Q

Presentation of pyeloneprhitis

A

High fever and rigors
Loin to groin pain
Dysuria and urinary frequency
Haematuria
Other non-specific symptoms (e.g. vomiting)
Pain on bimanual palpation of renal angle

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14
Q

Investigations of CKD

A

Determine aetiology
Evaluate complications
Bloods (FBC, ESR, U&E, glucose, low Ca, high phosphate, high ALP, high PTH)
Urine (dip, MC&S, albumin:creatinine ratio)
USS kidney (small in CKD) and bladder (obstruction)
Biopsy

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15
Q

3 types of fluid replacement

A

5% glucose:
Method for administering IV water, not bulk blood volume
Only 5% stays in IV space
Distribution as for water

0.9% saline:
Better for resuscitating blood volume
33% stays in IV space
Distribution as for ECF

Colloid:
5% human albumin
Best for resuscitating blood volume in very haemodynamically compromised patient

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16
Q

Metabolic alkalosis characteristics on ABG

A

↑ pH
↑ HCO3-
↑ BE

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17
Q

Causes of metabolic alkalosis

A

Gastrointestinal loss of H+ ions (e.g. vomiting, diarrhoea)

Renal loss of H+ ions (e.g. loop and thiazide diuretics, heart failure, nephrotic syndrome, cirrhosis, Conn’s syndrome)

Iatrogenic (e.g. addition of excess alkali such as milk-alkali syndrome)

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18
Q

Presentation of CKD at different stages

A

1-3
Frequently asymptomatic
Via screening of at risk pts

4-5
Endocrine/metabolic/water/electrolyte disturbances

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19
Q

Prevention of diabetic nephropathy

A

Blood pressure control
Glycaemic control
CVS risk control (stop smoking, reduce cholesterol, consider aspirin)

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20
Q

Define hypercalcaemia

A

> 2.6mmol/L corrected calcium

> 3mmol/L severe

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21
Q

2 mechanisms, their effects and their management of lack of 1,25 vitamin D production in CKD

A

Hypocalaemia:
Causes bone pain
Managed with vit D and calcium supplementation

Raised PTH:
Causes fractures, osteomalacia, ostetitis fibrosa
Managed by phosphate binders, vit D/analogues, calcimimetics, 1-alpha calcitol

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22
Q

Management of UTI

A

Trimethoprim/nitrofurantoin

3 days:
For simple lower urinary tract infection in women

5-10 days:
For women that are immunosuppressed, have abnormal anatomy or impaired kidney function

7 days:
For men, pregnant women or catheter-related

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23
Q

Presentation of lower UTI

A

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Confusion commonly the only symptom in older/frail patients

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24
Q

Bacterial causes of UTI

A 
E. coli
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
Staph saprophyticus
Candida albicans (fungal)
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25
Metabolic acidosis characteristics on ABG
↓ pH ↓ HCO3- ↓ BE
26
Causes of metabolic acidosis
Increased acid production or acid ingestion | Decreased acid excretion or rate of gastrointestinal and renal HCO3– loss
27
Define nephritis
Inflammation of the kidneys Non-specific and not a diagnosis
28
Progression of diabetic nephropathy
``` GFR elevated (glomerular and tubular hypertrophy) Glomerular hyperfiltration (mesangial expansion due to ongoing damage) Microalbuminuria (30-300mg albumin/24hrs) - early warning of renal problems and risk factor for CKD ```
29
Causes of hypertension
``` Essential (95%) - no identifiable cause Secondary (5%) Chronic renal disease Coartication of aorta Endocrine disease (Cushings, conns, phaeochromocytoma, acromegaly Raised ICP Pre-eclampsia Drugs (steroids, COCP, NSAIDs) ```
30
Causes of hypokalaemia
Excessive renal loss: Drugs (thiazides, loop) Endocrine (aldosterone excess) Inherited defects Magnesium deficiency (Na/K/ATPase) Process driving K+ into cells: Acute alkalosis Insulin Thyrotoxicosis GI losses: Diarrhoea Vomiting Low dietary K
31
Cardiac complications in hypercalcaemia
ECG changes: Short QT Arrythmias uncommon
32
Causes of hypocalcaemia
``` Alkalosis Hypoparathyroidism Renal failure Vit D deficiency Malabsorption Acute pancreatitis Rhabdomyolsis Sepsis Low Mg ```
33
Causes of hyponatraemia
Excess intake/water retention: SIADH, drugs, CCF, cirrhosis, CKD/nephrotic syndrome, hypothyroidism, pregnancy Renal Na loss: Diuretics, mineralocorticoid deficiency, tubular disorders, SIADH, cerebral salt wasting Other Na loss: Vomiting, diarrhoea, burns Pseudo-hyponatraemia: Hyperproteinaemia, hyperlipidaemia
34
Define glomerulonephritis
Umbrella term applied to conditions causing inflammation of or around the glomerulus
35
Causes of UTI
Bacteria from faeces Spread through sexual activity Incontinence/hygiene issues Urinary catheters
36
Management of 3 mechanisms of abnormal kidney excretion in CKD
Fluid retention: Leads to HTN Managed by salt and fluid restriction, loop diuretics Potassium retention: Leads to hyperkalaemia (muscle weakness, arrhythmias) Managed with low K diets, correction of acidosis Acid retention: Caused by metabolic acidosis Managed by sodium bicarbonate therapy
37
Management of CKD
Identify and treat reversible causes (relieve obstruction, avoid nephrotoxins) Delay or halt progression of CKD (BP management) Manage CVD risk (lifestyle, BP, lipid and glycaemic control) Diagnose and treat pathologic manifestations of CKD (anaemia, mineral and bone disorders, treat acidosis and oedema, restless legs and cramps)
38
Causes of hyperkalaemia
``` Reduced renal loss: Low GFR K-sparing diuretics Trimethoprim RAAS inhibiting drugs ACE inhibitors Addisons Dietary excess ``` ``` K+ release from cells: Acidosis Tumour lysis Insulin deficiency Depolarising muscle paralysis ```
39
Definition and stages of hypertension
Raised blood pressure in the systemic vascular bed >140/90mmHg Normal <120/<80 Pre-HTN 120-139/80-89 Stage 1 40-159/90-99 Stage 2 >160/>100
40
Define hyponatraemia
<135mmol/L sodium Clinical consequences at <125mmol/L
41
Define pyelonephritis
Infection in the renal pelvis
42
Treatment of hypernatraemia
Stop water loss (antiemetic, stop diuretic, treat diarrhoea) Aim to replace water (orally or 5% glucose)
43
Define hyperkalaemia
>4.7mmol/L Clinical consequences >6moml/L
44
Urethral syndrome
``` Lower urinary tract syndromes: Urinary frequency Urgency Dysuria Suprapubic discomfort ``` With no recognised urinary pathogen/abnormality
45
Define hypokalaemia
<3.5mmol/L potassium
46
Renal consequences of hypertension | hypertensive renal disease
Hyaline arteriosclerosis in renal arterioles Chronic and progressive renal ischaemia Tubular atrophy, intestinal fibrosis and progressive glomerular sclerosis Progressive CKD (small atrophied and fibrosed kidneys) Vicious cycle of worsening HTN and CKD
47
Causes of hypernatraemia
``` Water loss Blunted thirst with age Diabetes insipidus Diabetes mellitus Diuretic use Iatrogenic (excess saline) ```
48
ADH Where does it act? What does it do? What increases/decreases secretion?
Acts on renal collecting ducts Increases permeability to water (aquaporin channels) to increase water absorption ``` Raised secretion: Increase in plasma osmolality, Pain, stress, nausea Drugs Lung and CNS lesions Ectopic pregnancy Decreased plasma volume ``` Decreased secretion: Decrease in plasma osmolality Increase in plasma volume Ethanol
49
Mechanism of metabolic alkalosis
Decreased hydrogen ion concentration Leading to increased bicarbonate Alternatively a direct result of increased bicarbonate concentrations
50
What is CKD associated with?
``` HTN Anaemia Mineral and bone disorders CVS complications More common >65 ```
51
Define cystitis
Inflammation of the bladder Normally caused by UTIs
52
Mechanism, effect and management of lack of erythropoietin production in CKD
Mechanism: Anaemia Effect: Tiredness, LVH Management: Epoetin, iron and ferritin collection
53
UTI in pregnancy increases risk of
Pyelonephritis Premature rupture of membranes Pre-term labour
54
Signs and symptoms of uraemia
CNS: Encephalopathy, fits, twitch or tremor, tiredness Peripheral neuropathy GI: Anorexia (loss of appetite & weight), N&V, colitis, metallic taste, halitosis Resp: Pleuritis, pleural effusion Cardio: Pericarditis Endocrine: Growth retardation, sexual dysfunction Skin: Pruritus, "half-and-half" nails Pro-haemorrhagic uraemia - impaired platelet function
55
Effects of CKD on CVS health
RAAS activation: Leads to LVH Managed by ACE inhibitors, angiotensin receptor blockers, Microinflammation and HTN: Lead to CAD, CHF, arrhythmias Managed by BP control <130/80
56
Investigations of UTI
Urine dip: Nitrites Leukocytes
57
Investigations for pyelonephritis
Urine dip: Bood, protein, leukocyte esterase, nitrite CT USS DMSA scan (recurrent pyelonephritis)
58
Management of diabetic nephropathy
Optimising blood glucose levels and BP ACE inhibitors (even if BP normal)
59
Cardiac complications in hypocalcaemia
ECG changes: Long QT Arrhythmias: VT, heart block
60
Nephrotic syndrome
Peripheral oedema Proteinuria Serum albumin (<25g) Hypercholesterolaemia
61
Chronic pyelonephritis
Recurrent kidney infections Leads to scarring of the renal parenchyma Can result in chronic kidney disease Can result in abscess and/or pus in or around the kidney May be a role for prophylactic antibiotics
62
Management of pyelonephritis
Blood and urinary cultures Broad spectrum antibiotics (e.g. co-amoxiclav) until culture and sensitivities are available Admission if systemically unwell or complicated IV rehydration Analgesia Antipyretics
63
Cardiac complications in hypokalaemia
ECG changes: ST depression, flat T waves, U wave, extra systoles Arrhythmias: AF, SVT, VT
64
Define metabolic acidosis/alkalosis
Imbalance in production of acids or bases and their excretion by the kidneys
65
Common organisms causing pyelonephritis
E. coli most common Klebsiella Enterococcus Pseudomonas
66
Causes of uraemia
Pre-renal: Raised hepatic production of urea Increased renal reabsorption Iatrogenic Renal: Renal failure Post-renal: Urinary outflow obstruction
67
Define hypernatraemia
>145mmol/L sodium Clinical consequences at >155mmol/L
68
What findings are needed to confirm stage 1 or 2 CKD? | other than GFR
Albuminuria Urine sediment abnormalities Electrolyte and other abnormalities due to tubular disorders Histological abnormalities Structural abnormalities detected by imagine History of kidney transplantation
69
Causes of end stage renal disease
Hypertension Diabetes mellitus Glomerulonephritis
70
How does diabetes affect the kidney?
Chronic high level of glucose passing through glomerulus causes scarring Glomerulosclerosis
71
Management of UTI in pregnancy
7 days of antibiotics (even with asymptomatic bacteruria) Urine for culture and sensitivities First line: nitrofurantoin (avoid in 3rd T) Second line: cefalexin or amoxicillin

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