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DPD > Renal disease > Flashcards

Renal disease Flashcards

1
Q

Normal GFR for adults and elderly

A

Adults more than 90ml/min

For elderly 60ml/min

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2
Q

Normal creatinine

A

under 110mcmol/L

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3
Q

Normal potassium range

A

3.5-5 mmol/L

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4
Q

What cells are in the glomerulus?

A

Endothelial layer with pores
Glomerular basement membrane
Podocytes

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5
Q

What are the kidney’s functions?

A 
Filtration of waste products
Electrolyte homeostasis
Hormone production (1,25 calcitriol active vitamin D), erythropoetin
Blood pressure control via RAS 
Acid base homeostasis
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6
Q

What is oliguria?

A

Low urine output

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7
Q

Where is creatinine produced? Why is this relevant?

A

Creatinine is made by muscle so can differ in people with different muscle mass

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8
Q

What is the normal GFR

A

120-130ml/min

rate of plasma clearance by kidneys

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9
Q

What radiomarkers can be used to see GFR accurately?

A

EDTA
Iothalamate
Iohexol

expensive
takes 2-4hr
IV injection

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10
Q

Name a better marker of eGFR and explain why it’s better

A

Cystatin - not affected by age, sex or muscle mass

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11
Q

What does the e in GFR stand for?

A

Estimnated

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12
Q

How do they now calculate eGFR?

A

Age + creatinine formula

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13
Q

When can eGFR be inaccurate?

A

AKI

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14
Q

What things can make your urine look red/brown without haematuria?

A

Rhabdomyolysis
Rifampicin
Food dyes/beetroot
Porphyria

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15
Q

How is proteinuria measured?

A

Protein to creatinine ratio or albumin creatinine ratio

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16
Q

Normal PCR

A

20-30

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17
Q

What does acute kidney injury mean?

A

Rapid decline in renal function over a period of hours or days with accumulation of waste products, potentially life threatening metabolic consequences
With our without a change in urine output

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18
Q

What is the numerical definition of AKI (two different)

A

Serum creatinine rise by greater than 26umol/L within 48hrs

OR

Serum creatinine rise 1.5 times the reference range which is known or presumed to have occurred within one week

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19
Q

How is AKI defined with regards to urine output?

A

Urine output of less than 0.5ml/kg for 6 consecutive hours

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20
Q

How many stages of AKI are there?

A

3 stages

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21
Q

Risk factors for AKI

A 
Age >75yrs 
Pre-existing CKD (eGFR<50ml/Kg)
Previous episode of AKI
Debility and dementia
HF
Liver disease
DM
Hypotension
Sepsis
Hypovolaemia
Nephrotoxic drugs 
Continued antihypertensives in hypotension

Acute illness
Major surgery

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22
Q

Name a type of AKI. What is the pathophysiology? What kinds of things lead to this intrinsic AKI?

A

Acute tubular necrosis is an ‘intrinsic AKI’ where hypoperfusion or injury to the epithelial cells causes the basement membrane to detach and malfunction.

Causes:

Sepsis
Low BP
Nephrotoxic drugs

23
Q

Pre-renal causes of AKI

A

Low CO
Hypotension
Renal artery thrombosis

24
Q

Renal causes of AKI

A 
Acute tubular necrosis
Glomerulonephritis
Vasculitis
Nephrotoxins
Contrast
Rhabdomyolysis
Interstitial nephritis
HUS
TTP
Malignant HTN
Myeloma
25
Q

Renal causes of AKI

A 
Acute tubular necrosis
Glomerulonephritis
Vasculitis
Nephrotoxins
Contrast
Rhabdomyolysis
Interstitial nephritis
HUS
TTP
Malignant HTN
Myeloma
Goodpasture's sydnrome
Lupus
26
Q

If you have elevated serum creatinine or reduced eGFR, what do you think?

A

Is it acute or chronic?
Cause?
Treatable?

27
Q

What are the symptoms of uremia?

A

Nausea
Vomiting
?

28
Q

Why might someone on chemo have AKI?

A

Nausea and vomiting

29
Q

If there was a pre-renal cause, what would you expect to see in the urine?

A

No blood or protein

30
Q

Tubular problem - what would you see in urine?

A

Minimal blood

31
Q

Glomerular problem - what would you see in urine?

A

??

32
Q

Investigations

A

Volume status (for ATN)
Urine microscopy and dipstick
Imaging
??????????

33
Q

What do you need to urgently manage?

A

Potassium
PO
Acidosis
??????????????????

34
Q

What ECG changes would you see with hyperkalemia?

A

High T waves

broad QRS complexes

35
Q

When do people with end stage chronic kidney disease?

A

Can be in teenage years due to congenital causes that have been missed, or reflux kidney disease

36
Q

How many stages of CKD are there?

A

5

37
Q

What increases the risk of death with CKD?

A

Albuminurea

38
Q

Causes

A 
Elderly
ApoLone gene?
Diabetes
Chronic glomerulonephritis
Vascular diseases
Autosomal dominant polycystic disease
39
Q

Investigations for CKD

A

Identify cause

40
Q

Complications of CKD

A

cardiovascular complications e.g. heart attack and stroke

Calcification

41
Q

Management of CKD

A

BP control - ACEi/ARB
Reduce proteinuria
SGLT2 inbhitors

42
Q

Name an ARB and dose used in CKD

A

Irbesartan 150-300mg

43
Q

Name an SGLT2 inhibitor

A

Gliflozins

44
Q

What is nephrotic syndrome?

A

Proteinuria
Oedema
Hypoalbuminia

45
Q

What counts as proteinuria?

A

more than 300mg

46
Q

Cystoscopy looks at what?

A

bladder

47
Q

Proteinuria and enphrotic sydnrome suggest?

A

Always indicates glomerular pathology

48
Q

Causes of proteinuria

A 
Diabetes
Amyloid
SLE
membranous nephrotpathy
minimal change glomerula disease and FSGS
49
Q

Management

A

??????????
serum albumin and cholestrol
serum creat/eGFR
glucose, SLE , virology, myelmoa screen, immunology

50
Q

Management of proteinuria

A

Control oedema
ACEi/ARB
Treat the cause
Steroids/immunosupression

51
Q

When do you look at the bladder if someone has haematuria?

A

only do cystoscopy if over 40 years old

52
Q

Painful haematuria

A

urological cause e.g. stones or cancers

53
Q

Under 40 and no pain

A

Intrinsic microscopic renal/glomerula cause

54
Q

?????????????

A

Alport’s syndrome

IgA nephropathy

DPD (38 decks)

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