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renal - mine > renal diseases > Flashcards

renal diseases Flashcards

1
Q

what is nephrotic syndrome

A

collection of symptoms due to glomerular disease

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2
Q

what are the symptoms of nephrotic syndrome

A

proteinuria
hypoalbuminaemia
oedema
(hyperchloesterolaemia)

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3
Q

what does nephrotic syndrome indicate

A

non-proliferative process affecting podcytes

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4
Q

what is nephritic syndrome

A

signs and symptoms of glomerulonephritis

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5
Q

what does nephritic syndrome indicate

A

proliferative process affecting endothelial cells

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6
Q

what are the symptoms of nephritic syndrome

A 
AKI
oliguria 
haematuria 
hypertension 
active urinary sediments
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7
Q

what is chronic kidney disease

A

abnormal kidney function and/or structure

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8
Q

what are the causes of chronic kidney disease

A

diabetes
hypertension
glomerulonephritis

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9
Q

what are the symptoms of chronic kidney disease

A

anaemia
fatigue/muscle weakness
weight loss
hypertension

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10
Q

what are the symptoms of advanced uraemia found in chronic kidney disease

A

uraemic frost
twitching
conffusion
pericardial rub/effusion

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11
Q

what are the investigations of chronic kidney disease

A 
U&Es
eGFR
creatinine
ACR
GFR:Creatinine
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12
Q

what are the stages of chronic kidney disease

A 
G1 = eGFR >90
G2 = eGFR 60-89
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15
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13
Q

what is the treatment of chronic kidney disease

A 
control BP
lower lipids 
RAAS inhibition 
correct anaemia
lifestyle
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14
Q

what is the BP target in chronic kidney disease

A

<140/90

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15
Q

what is the BP target in chronic kidney disease with diabetes

A

<130/80

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16
Q

what is used to lower lipids in chronic kidney disease

A

statin (atorvastin 20mg)

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17
Q

what is used to control BP in chronic kidney disease

A

ACEI or ARB

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18
Q

what is the target iron levels in chronic kidney disease

A

100-120g/L

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19
Q

what is the iron therapy given in chronic kidney disease

A

venofer or ferinject

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20
Q

what is an acute kidney injury

A

abrupt (<48hrs) reduction on kidney function

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21
Q

what must be done before diagnosis of acute kidney injury

A

fluid resus

exclusion of obstruction

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22
Q

what must be present to be classed as an acute kidney injury

A

serum creatinine >26.4
OR increase in creatinine by 50%
OR reduction in urine output

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23
Q

what medications can cause an acute kidney injury

A

gentamicin
metformin
ACEI/ARBs
trimethoprim

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24
Q

what are the 3 categories of acute kidney injury causes

A

pre-renal
renal
post-renal

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25
Q

summarise the pre-renal causes of acute kidney injury

A

anything that reduces the circulating volume to kidney

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26
Q

give examples of pre-renal causes of acute kidney injury

A

hypovolaemic:

  • haemorrhage
  • volume depletion (D&V, burns)

hypotension:

  • cardiogenic shock (HF)
  • sepsis

renal hypofusion

  • NSAIDs
  • ACEL/ARBSs
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27
Q

summarise renal causes of acute kidney injury

A

inflammation or damage to the kidney cells

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28
Q

give examples of renal causes of acute kidney injury

A

vasculitis
glomerulonephritis
interstitial nephritis
tubular injuries

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29
Q

what could cause a tubular injury in the kidneys

A

ischaemia
gentamicin
contrast
rhadbomyolysis

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30
Q

what could cause interstitial nephritis

A

drugs
infection e.g. TB
sarcoidosis

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31
Q

give examples of post-renal causes of acute kidney injury

A

stones
cancer
strictures
extrinsic pressure

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32
Q

summarise post-renal causes of acute kidney injury

A

obstruction of urine flow causing back pressure

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33
Q

what are the symptoms of a pre-renal acute kidney injury

A

oliguria

acute tubular necrosis

34
Q

what are the symptoms of a renal acute kidney injury

A 
eosinophilia
vascular bruits
non-specific 
 - itch
 - Nausea &amp; vomiting 
 - fluid overload
35
Q

what are the investigations of acute kidney injury

A 
U&amp;Es
FBC 
urinalysis
US/CT 
immunology = vasculitis
36
Q

what is the treatment of post-renal acute kidney injury

A

relieve obstruction

37
Q

what is the treatment of pre-renal acute kidney injury

A

replace fluids

38
Q

what is acute tubular necrosis

A

most common form of acute kidney injury in hospital

39
Q

what is the cause of acute tubular necrosis

A

decreased renal perfusion

40
Q

what is hyperkalaemia, what is it a complication of

A

> 5.5

complication of acute kidney injury

41
Q

what are the investigations of hyperkalaemia

A

ECG

K+ levels

42
Q

what is the treatment of hyperkalaemia

A

10mls 10% calcium gluconate
10 units insulin with 50ml 50% dextrose
salbutamol nebs

43
Q

what is the treatment of chronic hyperkalaemia

A

calcium resonium

44
Q

what is glomerulonephritis

A

immune mediated disease of the kidneys which affects the glomeruli

45
Q

what type of inflammation does glomerulonephritis cause

A

non-infective inflammation

46
Q

what are the symptoms of glomerulonephritis

A 
haematuria
proteinuria 
hypertension
impaired renal function (CDK/AKI)
nephrotic syndrome 
nephritic syndrome
47
Q

what symptoms are caused by damage to the endothelial or mesangial cells

A 
haematuria 
proliferative lesion(s)
48
Q

what symptoms are caused by damage to the podocyte

A

proteinuria

non-proliferative lesion

49
Q

what are the investigations of glomerulonephritis

A

urinalysis
urine microscopy
kidney biopsy

50
Q

how do you quantify proteinuria

A

24hr urine collection

urine protein:creatinine ratio

51
Q

what is the treatment of glomerulonephritis

A 
anti-hypertensives (ACEI/ARBs)
statins
duiretics
diet advice
immunosuppression
52
Q

what is the immunosuppression treatment of glomerulonephritis

A

corticosteriods

azathioprine

53
Q

what is the target BP in glomerulonephritis

A

<130/80

<120/75 if proteinuria is present

54
Q

what are the types of glomerulonephritis (6)

A 
minimal change
focal segmental 
membranous nephropathy 
IgA nephropathy 
rapidly progressive 
membranoproliferative
55
Q

what is the treatment of minimal change glomerulonephritis

A

1st line = oral steroids

2nd line = cyclophosphamside/CSA

56
Q

what would expect on a biopsy of minimal change glomerulonephritis

A

normal

57
Q

can minimal change glomerulonephritis lead to real failure

A

nope

58
Q

what is the most common cause of nephrotic syndrome in children

A

minimal change glomerulonephritis

59
Q

what is the most common cause of nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

60
Q

what are the causes of Focal segmental glomerulosclerosis

A 
primary 
secondary:
 - HIV
 - heroin
 - obesity 
 -  reflux nephropathy
61
Q

what would you expect on biopsy of Focal segmental glomerulosclerosis

A

focal and segmental sclerosis (duh)

62
Q

what is the treatment of Focal segmental glomerulosclerosis

A

steroids

63
Q

what is the 2nd most common cause of nephrotic syndrome in adults

A

Membranous Nephropathy

64
Q

what is the cause of Membranous Nephropathy

A

primary

secondary:
- infections
- SLE
- cancer = lung, colon, melanoma
- drugs

65
Q

what drugs can cause Membranous Nephropathy

A

gold
penicillamine
NSAIDs
captopril

66
Q

what would you expect on biopsy of Membranous Nephropathy

A 
thick membranes (duh)
subepithelial immune complex deposition in basement membrane
67
Q

what is the treatment of Membranous Nephropathy

A

steroids
alkylating agents
B cell monoclonal antibodies

68
Q

what is the most common glomerulonephritis

A

IgA nephropathy

69
Q

what are the symptoms of IgA nephropathy

A

asymtpomatic microhaematuria ± non-nephrotic range proetinuria

70
Q

when do symptoms of IgA nephropathy usually occur

A

after a resp infection

71
Q

what would you expect on biopsy of IgA nephropathy

A

mesangial cell proliferation and expansion

IgA deposits in mesangial (duh)

72
Q

what immune marker would you check for in IgA nephropathy

A

Anti-TTG

73
Q

what is the treatment of IgA nephropathy

A

BP control via ACEI/ARB

74
Q

what would you expect see on membranoproliferative glomerulonephritis under the microscope

A

big lobulated hypercellular glomeruli with thick membranes

75
Q

what does rapidly progressive glomerulonephritis result in

A

rapid deterioration in renal function over days/weeks

76
Q

what is the cause of rapidly progressive glomerulonephritis

A

vasculitis
goodpastures
SLE
HSP

77
Q

what would you expect to see on biopsy of rapidly progressive glomerulonephritis

A

glomerular crescents

78
Q

what is the marker for goodpastures

A

GMB

79
Q

what is the marker for vasculitis

A

ANCA

80
Q

what is the treatment of rapidly progressive glomerulonephritis

A

immunosuppresion
plasmapheresis
dialysis if needed

81
Q

what drugs are used for immunosuppression in rapidly progressive glomerulonephritis

A

steroids = IV methylprednisolone or oral prednisolone

cyclophosphamide/mycopheolate/azathioprine

renal - mine (8 decks)

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