renal and urology Flashcards
what causes AKI?
a rapid deterioration in kidney function
when there is a sudden decrease in glomerular filtration rate
what are the 3 groups causes of AKI?
pre renal
renal
post renal
what causes a pre renal cause of AKI?
when there is reduced perfusion to the kidneys
what are the causes of pre renal AKI?
absolute hypovolaemia
low effective arterial blood volume
anatomical
drug induced
give 3 causes of absolute hypovolaemia
haemorrhage
over diuresis
vomiting and diarrhoea
give 4 causes of low effective arterial blood volume
heart failure
sepsis
cirrhosis
3rd spacing of fluid
give 1 cause of anatomical causes of pre renal AKI
renal artery stenosis
give 3 drugs that can cause pre renal AKI
NSAIDs
ACE inhibitors
diuretics
what causes intra renal AKI?
structural or functional change at the level of the nephron
what are the 2 ways in which intra renal AKI can occur?
independently or as a transformation of pre renal AKI
what is the most common cause of AKI?
acute tubular necrosis
why does acute tubular necrosis occur?
due to iscaemic or toxic injury to cells in the proximal convoluted tubule
what are the 3 things that can cause acute interstitial nephritis?
drug induced
infection induced
immune mediated
what is a nephrotic syndrome?
a non proliferative process affecting podocytes
how does nephrotic syndrome present?
proteinuria >3g / day
oedema
hypoalbuminaemia <30
what is the most common cause of nephrotic syndrome in children?
minimal change disease
what is the most common cause of nephrotic syndrome in adults?
focal segmental glomerulonephritis
what is nephritic syndrome?
a proliferative process affecting endothelial cells
how does nephritic syndrome present?
haematuria
oliguria
hypertension
which 2 things can cause intra-tubular obstruction that can cause intra-renal AKI?
multiple myeloma w/ paraprotein
pigment e.g. rhabdomyolysis
what causes post renal AKI?
obstructive pathology leading to congestion of the kidneys
where can pathology cause post renal AKI?
ureters
bladder
prostate
urethra
external
what can cause a post renal AKI in both kidneys?
obstruction at the level or distal to the bladder
based on the KDIGO criteria what confirms a diagnosis of AKI?
any of the following:
- urine output <0.5ml / kg / hr for 6hrs
- serum creatinine increase 1.5x baseline for 7 days
- serum creatinine increase by 0.3mg / dL in 48hrs
what are the indications for dialysis in AKI?
A - acidosis (pH <7.15)
E - electrolyte imbalance (hyperkalaemia >6.5 mmol)
I - ingested toxins
O - fluid overload
U - uraemia
what are the renal complications of systemic sclerosis treated w/?
ACEi
