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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
Renal causes of AKI
``` Acute tubular necrosis Glomerulonephritis Vasculitis Nephrotoxins Contrast Rhabdomyolysis Interstitial nephritis HUS TTP Malignant HTN Myeloma Goodpasture's sydnrome Lupus ```
26
If you have elevated serum creatinine or reduced eGFR, what do you think?
Is it acute or chronic? Cause? Treatable?
27
What are the symptoms of uremia?
Nausea Vomiting ?
28
Why might someone on chemo have AKI?
Nausea and vomiting
29
If there was a pre-renal cause, what would you expect to see in the urine?
No blood or protein
30
Tubular problem - what would you see in urine?
Minimal blood
31
Glomerular problem - what would you see in urine?
??
32
Investigations
Volume status (for ATN) Urine microscopy and dipstick Imaging ??????????
33
What do you need to urgently manage?
Potassium PO Acidosis ??????????????????
34
What ECG changes would you see with hyperkalemia?
High T waves | broad QRS complexes
35
When do people with end stage chronic kidney disease?
Can be in teenage years due to congenital causes that have been missed, or reflux kidney disease
36
How many stages of CKD are there?
5
37
What increases the risk of death with CKD?
Albuminurea
38
Causes
``` Elderly ApoLone gene? Diabetes Chronic glomerulonephritis Vascular diseases Autosomal dominant polycystic disease ```
39
Investigations for CKD
Identify cause
40
Complications of CKD
cardiovascular complications e.g. heart attack and stroke Calcification
41
Management of CKD
BP control - ACEi/ARB Reduce proteinuria SGLT2 inbhitors
42
Name an ARB and dose used in CKD
Irbesartan 150-300mg
43
Name an SGLT2 inhibitor
Gliflozins
44
What is nephrotic syndrome?
Proteinuria Oedema Hypoalbuminia
45
What counts as proteinuria?
more than 300mg
46
Cystoscopy looks at what?
bladder
47
Proteinuria and enphrotic sydnrome suggest?
Always indicates glomerular pathology
48
Causes of proteinuria
``` Diabetes Amyloid SLE membranous nephrotpathy minimal change glomerula disease and FSGS ```
49
Management
?????????? serum albumin and cholestrol serum creat/eGFR glucose, SLE , virology, myelmoa screen, immunology
50
Management of proteinuria
Control oedema ACEi/ARB Treat the cause Steroids/immunosupression
51
When do you look at the bladder if someone has haematuria?
only do cystoscopy if over 40 years old
52
Painful haematuria
urological cause e.g. stones or cancers
53
Under 40 and no pain
Intrinsic microscopic renal/glomerula cause
54
?????????????
Alport's syndrome | IgA nephropathy

DPD (38 decks)

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