Renal Disorders Flashcards

1
Q

What are the standard definitions of AKI?

A

AKI Stage 1:

Increase ≥26 µmol/L; or by1.5-1.9x the reference sCr <0.5mL/kg/hr, 6-12hr

o AKI Stage 2:

Increase 2.0-2.9x the reference sCr <0.5mL/kg/hr, ≥12hr

o AKI Stage 3:

Increase ≥354 µmol/L; or by ≥3x the reference sCr <0.3mL/kg/hr, ≥24hr

Anuric for ≥12hr

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2
Q

Investigations for AKI?

A

Urine dip -> blood, protein, leucocytes, nitrates, glucose

o Renal USS (only if pyelonephritis or if no identifiable cause)

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3
Q

What is nephrotic syndrome?

Common causes?

A

low albumin, peripheral oedema, proteinuria

minimal change disease

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4
Q

what are some signs and symptoms of nephrotic syndrome?

A

1st = peri-orbital oedema (often misdiagnosed as allergy)

o 2nd = other delayed features of oedema (i.e. peripheral leg swelling), features of underlying diagnosis

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5
Q

investigations for nephrotic syndrome?

A

Urine dipstick testing, urea, U&Es, urine MC&S, urinary sodium

o FBC, ESR, creatinine, albumin

o Complement levels (C3, C4)

o Anti-streptolysin O or anti-DNase B titres (recent streptococcal throat infection)

o HBV, HCV, malaria screen

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6
Q

Management of nephrotic syndrome?

A
  • oral prednisolone (4-6 weeks)
    if steroid sensitive will return to normal
  • renal biopsy if steroids don’t work1
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7
Q

complications of nephrotic syndrome?

A

§ Risk of thrombosis loss of AT-III in the urine à hypercoagulable state

§ Risk of infection loss of immunoglobulin in urine à infection risk (esp. NHS bacteria)

§ Hypercholesterolaemia urinary albumin loss à less oncotic pressure à hepatic cholesterol synthesis

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8
Q

What is the common cause of renal failure?

A

Acute -
Haemolytic Uraemic Syndrome / HUS – low RBC, low platelets and AKI;

Acute tubular necrosis - usually after organ failure

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9
Q

Signs and symptoms of renal failure?

A

Oliguria or anuria Discoloured urine – brown

o Oedema – feet, legs, abdo, weight gain

Fatigue, lethargy, N&V

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10
Q

Investigations for renal failure?

A

Renal Ultrasound

CKD - small kidneys

AKI - large bright kidneys

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11
Q

Management for renal failure?

A

Pre-renal failure
- Fluid replacement /circulatory support is key

Intrinsic renal failure
- monitoring water and electrolyte balance

Post-renal failure
- Requires assessment of the site of obstruction (i.e. PUV, VUJ obstruction, etc.)

o Relief can be achieved by nephrostomy or bladder catheterisation

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12
Q

What is acute glomerulonephritis?

A

inflammation in the glomerulus and other kidney compartments, 1st or 2nd:

minimal change
diffuse (all glomeruli)
focal (some glomeruli)
segmental (parts)

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13
Q

Cause of acute glomerulonephritis?

A

Post-infectious (streptococcus in children) Vasculitis (SLE, ANCA +ve)

o IgA nephropathy (adults, but includes HSP in children) Mesangiocapillary glomerulonephritis

o Goodpasture’s

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14
Q

Signs and symptoms of acute glomerulonephritis?

A

Nephrotic syndrome – low albumin, oedema, proteinuria

o Nephritic syndrome – haematuria, HTN, proteinuria

o Decreased urine output and volume overload / oedema

o Hypertension and seizures

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15
Q

Management of acute glomberulonephritis?

A

minimal change - steroids

focal segmental - steroids, diiuretics, ace inhibitors, immunosuppresive drugs

membranous - supportive, acei and arbs.

correct water and electrolyte imbalances

BP management, dietary advice, lipid lowering therapy.

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16
Q

What is IgA vasculitis?

A

Henoch-Schönlein Purpura - palpable Purpura with joint and abdominal pain, loss of blood and protein in the urine

IgA and IgG complex and deposits in organs activitating complement

17
Q

Signs and symptoms of IgA Vasculitis?

A

Purpuric Rash

Arthlagia

Abdominal Pain

Glomerulonephritis

18
Q

Investigations of IgA Vasculitis?

A

FBC, clotting screen, urine dipstick, U+Es

Urinalysis: RBC, proteinuria, casts, urea, creatinine

Increased IgA, normal coagulation

19
Q

Management of IgA vasculitis?

A

most cases resolve spontaneously within 4 weeks

NSAIDs
Oral prednisolone
IV corticosteroids
Renal transplant - end stage renal disease

20
Q

What is nephroblastoma (Wilm’s tumour)

A

Most common intra-abdominal tumour of childhood (2nd most common cancer of childhood after ALL)

o <5yo (80%) – often 3yo

o 95% unilateral

o 1-2% familial /FHx

· Undifferentiated mesodermal tumour of intermediate cell mass

21
Q

What are signs and symptoms of a Wilm’s tumour?

A

Asymptomatic abdominal mass (MOST COMMON)
- Painless haematuria

o Less common:

  • Abdominal pain Anorexia
  • Anaemia (haemorrhage into mass) Hypertension
22
Q

Investigations of Wilm’s Tumour?

A

Ultrasound
CT/MRI

Stage 1-5:
1 = limited to kidney, completely excisable
2 = not limited to kidney, completely excisable
3 = not limited to kidney, not completely excisable
4 = spread beyond abdomen, haematogenous metastasis
5 = bilateral (each tumour graded separately)

23
Q

Management of Wilm’s Tumour?

A

Nephrectomy + chemotherapy (± radiotherapy prior to surgery if advanced disease)

80% cure rate