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NEPHRO > Renal failure > Flashcards

Renal failure Flashcards

1
Q

Chronic renal failure def

A

Kidney damage
GFR < 60 ml/min in 3 months

Prev Cr > 3 months
Small kidneys on Us
Sclerosis on biopsy

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2
Q

Acute renal failure def

A

Cr 900 micromol/L

Recent Cr normal
Normal size kidneys on U/s
Biopsy not always done- just for an unknown cause

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3
Q

Cause of chronic renal failure

A

VITAMIN C

Vascular: Lupus Nephritis, Malignant HPT
Infection: HIV, HCV, HBV
Inflamation: Reflux nephropathy, Glomerulonephritis
Trauma
Toxins: Analgesic nephropathy
AI: SLE
Metobolic: DM
Idiopathic/Iatrogenic
Neoplams: Amyloid, Meyeloma 
Congenital: ARPKD, ADPKD, medullary cystic, Alport syndrome
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4
Q

Cause of acute renal failure

A

Pre-renal, renal, post renal

Pre-renal: 5HVIBES drugs
Hypovolaemia: Blood loss
Hypoperfusion
HYpotension
Haemorrhage 
Heart failure, MI 
Vomiting and diarrhoea: dehydration
Infection/Sepsis
Burns
Embolism
Surgery, Stenosis
Drugs: NSAIDS, ACE-I, Radiocontrast
Renal: 1 2 MAPEN 5H
primary glomerulonephritis
secondary infection/vasculitis
Moitrin: NSAIDS, cyclosporin
Amphoterican, ATN, AIN
Pre-renal causes
Embolic
Nephrotic syndrome
Haemolysis, Rhabdomyolysis
Hypoxic episode
H2 Blockers
H2 Ions Acidosis
HUS: Hamolytic uraemic syndrome
Post renal (obstruction): 3CPINKS
Cancer, crystels, clots
Prostate path
Infections
Neuropathic bladder
Kidney stones
Stenosis: PUJ, Post uretheral valves
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5
Q

Complications of chronic renal failure

A
  1. Electrolyte abnormalities- > Na, K, PO2 < Ca
  2. Anaemia- < EPO
  3. Uraemis
    Pericarditis
    Gastritis
    Encephalopathy
    Coagulopathy
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6
Q

Complications of acute renal failure

A
  1. Electrolyte abnormalities- > Na, K, PO2 < Ca
  2. Metabolic acidosis
  3. HPT
  4. Fluid Overload
  5. Uraemia:
    Pericarditis
    Gastritis
    Encephalopathy
    Coagulopathy
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7
Q

Presentation of chronic renal failure

A

RESIN 9P

Retinopathy, renal osteodystrophy
Edema, encephalopathy
Skin yellow
Increased bp, infetility, impotenance
Nails brown, N+V
Pruritis
Pallor
Purpura
Pericarditis, cardiomegaly, CAD
Pleural eff
Pulm oedema
Prox myopathy
Prox neuropathy
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8
Q

Presentation of acute renal failure

A 
Dependant on cause:
Pre renal dehydration or fluid overload:
Dehydration
Dry membranes
Thirst
Dizzy
Tachy
< BP
> Cap refill
Fluid over load:
Peripheral oedema
> JVP
Gallop rhythem
HPT
Basal creps

AIN: Rash, arthralgia, fever
Nephritic sx: Proteinuria, Haematuria, oligouria, HPT
Nephrotic sx: Proteinuria, albuminuria, oedema

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9
Q

Csi chronic renal failure

A
  1. U/s: < 10 cm CKD
  2. Biopsy: Sclerosis
  3. Urea and creatinine
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10
Q

Csi acute renal failure

A 
ABCDEU
ABG
Bloods: FBC, culture, U&amp;E, Cr
Catheter
Dipsticks
ECG, Electrolytes
U/S
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11
Q

RX chronic renal failure

A

BEAN:
1. Bp controll: ACE-I or ARB with BBB and CCB
2. EPO and electrolytes: Phosphate binders and EPO
3. Acess lifestyle: < Chol, < W, dont smoke
4. Nutrition: < Protein
5. Specialist care:
Haemodyalisis 12 hrs/weekly
Transplant
Continious ambulatory peritoneal dialysis 4/d everyday

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12
Q

RX acute renal failure

A
  1. Haemodynamic support
  2. Treat cx:
    - Restrict K, NA, PO
    -Treat < Ca if symptomatic
    - > K
    Protect heart: Cagluconate
    Shift K in cells: Actrapid + 50% dextrose, NaCHO3, B2 agonsists
    Eliminate K: Kexelate, Dialysis, > urnine flow
    < Intake: stop supplements and ACE-I
    - Metabolic acidosis: HCO3, Cagluconate
    -HPT rx
    -Fluid overload: Lasix
  3. EM dialysis
    - Unresponsive pulm oedema
    -Unresponsive > K
    -Unresponsive Metabolic acidosis
    Uraemic syndrome
  4. Treat cause
  5. Conservative:
    - Diet: < Na, K, Sufficient calories, no fruits and drinks
    - Input and output chart
    - Visible losses: give back excretion+500 ml
    - Avoid nephrotoxins
    - Avoid > BP
  6. Biopsy if no cause found
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13
Q

Pre-renal vs. renal

A 
pre-renal:
1. ECF contracted: Orthostatic hypotension, > JVP, tachy, signs of dehydration
2. U: Cr 1:10
3. Urine
U-Na <20
Fe-Na <1%
U0osmol > 400
4. Urine normal but> concentration

< Output
>cr&raquo_space;U < GFR
Good response to saline
Normal microscopy and dipsticks

Renal:
1. ECF variable: Contracted, normal, overload
2. U: Cr 1:20
3. < Urine concentration:
U-Na >20
Fe-Na >1%
U0osmol <300
4. Urine: Proteinuria, haematuria, casts
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NEPHRO (13 decks)

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