RENAL&GU Flashcards
What is CKD?
Gradual, irreversible reduced kidney function
Reduced kidney function (eGFR <60) for >3 months
(measured on 2 separate occasions) alongside evidence
of kidney damage (structural abnormalities on USS,
persistent sediment (blood/protein) in urine, history of
renal transplant)
What does the kidney do?
- filter and excrete waste products from the blood
- water and electrolyte balance
- secretes renin (BP control), EPO (RBC production) and Vit D
What is end stage renal failure?
Stage 5 CKD
- insufficient renal function to sustain life
- require haemodialysis
What initial investigations would you do for someone with suspected CKD?
- Serum creatinine and eGFR.
- Early morning urine sample (ACR).
- Urine dipstick test (haematuria)
- Body mass index (BMI), blood pressure, and serum HbA1c and lipid profile (cardiovascular risk factors).
- A renal tract ultrasound if indicated (such as urinary tract stones or obstruction, or a family history of polycystic kidney disease.)
How would you monitor for disease progression in someone with CKD?
- eGFR and urine ACR
- FBC (exclude renal anaemia)
- serum calcium, phosphate, vitamin D, and parathyroid hormone (exclude renal metabolic and bone disorder)
What are the complications of CKD? (7)
- AKI
- HTN/dyslipidaemia
- CVD
- renal anaemia
- renal mineral and bone disorder
- peripheral neuropathy
- pulmonary oedema
Give 5 causes of CKD
- Age
- glomerulonephritis
- infections e.g. HIV/TB
- drugs (NSAIDs, calcineurin inhibitors)
- obstruction (stones/fibrosis)
How might someone with CKD present?
Mostly asymptomatic
- nephrotic/nephritic syndrome
- unexplained haematuria/proteinuria
Give 4 causes of normal anion gap (hyperchloremic) metabolic acidosis
- gastrointestinal bicarbonate loss: diarrhoea, fistula
- renal tubular acidosis
- drugs: e.g. acetazolamide
- Addison’s disease
Give 4 causes of raised anion gap metabolic acidosis
- lactate: shock, hypoxia
- ketones: diabetic ketoacidosis, alcohol
- urate: renal failure
- acid poisoning: salicylates, methanol
What are the stages of hyperkalaemia?
mild: 5.5 - 5.9
mod: 6.0 - 6.4
sev: >6.5 (or ECG changes)
How is hyperkalaemia treated?
mild/mod: stop causative meds, treat underlying cause, calcium resonium
severe:
1. IV calcium gluconate 10%
2. IV soluble insulin with 50ml glucose 50% over 5-15mins
3. nebulised salbutamol
Give 3 ECG findings you would get in hyperkalaemia
- tall, tented T waves
- broad QRS complexes
- loss of P waves
Give 5 possible causes of hyperkalaemia
- renal impairment
- nephrotoxic drugs
- DKA
- Addisons
- metabolic acidosis
Which pH balance does hypokalaemia tend to be associated with?
metabolic alkalosis (H+ is a competitor of K+)
Give 2 causes of hypokalaemia with hypertension
- Cushing’s syndrome
- Conn’s syndrome (primary hyperaldosteronism)
What symptoms might you get with hypokalaemia?
- muscle cramps
- weakness
- arrhythmia
- ILEUS
What ECG changes would you expect to see in someone with hypokalaemia?
U waves
absent T waves
prolonged PR interval
ST depression
How is hypokalaemia managed?
mild = PO K+ supplement
severe (<2.5) = very slow IV infusion
What medication should you check for in patients with hypokalaemia to save them from harm?
DIGOXIN - exacerbates toxicity
Give 3 causes of hypokalaemia without hypertension
- diuretics
- GI loss (e.g. Diarrhoea, vomiting)
- renal tubular acidosis (type 1 and 2**)
Give 4 S&S you might get with hypocalcaemia
- tetany (muscle cramp, twitch, spasm)
- perioral paraesthesia
ECG: prolonged QT interval
Trousseau’s sign - wrist flexion with BP cuff
Chvostek’s sign - tapping over parotid causes face twitch
Give 2 causes of raised ALP plus raised calcium
- bone mets
- hyperparathyroidism
Give 2 causes of raised ALP plus low calcium
- osteomalacia
- renal failure
What is SIADH?
syndrome of inappropriate ADH secretion
- hyponatraemia secondary to the dilutional effects of excessive water retention
What is ADH and where is it produced?
Vasopressin, stimulates water resorption from collecting ducts
- produced in hypothalamus and secreted by posterior pituitary gland
What biochemical/clinical picture do you see in SIADH
euvolaemic hyponatraemia
What would you expect to see on urine osmolality and urine sodium in SIADH?
high urine sodium
high urine osmolality
Give 3 examples of voiding LUTS
(HIS)
Hesitancy
Incomplete emptying (terminal dribble)
Straining to void
Give 3 examples of storage LUTS
Frequency
Urgency
Nocturia
Give 4 causes of proteinuria
1 glomerular disease
2 tubular disease e.g cystic kidney disease
3 overflow in e.g. rhabdomyolysis
4 transient proteinuria in e.g. fever/overexertion
Give 3 main causes of bladder outlet obstruction (in men) and an example for each
1 Bladder outlet obstruction
- prostate enlargement/cancer
2 - Neurogenic
- causa equina/MS/PD
3 - Iatrogenic
- opiates
What is the management for BPH?
- Conservative management
- weight loss/exercise/reduced caffeine - Alpha blockers
- Tamsulosin/doxazosin - 5-alpha reductase inhibitors
- finasteride
How do alpha blockers work and what are side effects?
- decrease small muscle tone
- work IMMEDIATELY
- SE: hypotension, drowsiness, DEPRESSION
How would renal stones present?
- sudden onset UNILATERAL severe colic pain
- haematuria
- no tenderness on palpation
How would you managed someone with renal stones?
1 - A-E
2 - adequate fluid resuscitation
3 - analgesia
4 - most pass without further intervention
How do you manage urge incontinence?
1 - treat underlying cause
2 - conservative
3 - BLADDER TRAINING
4 - anti muscarinic e.g. Oxybutynin
5 - MIRABEGRON (no anticholinergic SE)
6 - topical oestrogen in post menopause
How do you manage stress incontinence?
1 - pelvic floor exercises
2 - conservative
3 - DULOXETINE
4 - surgery
What are indications for acute dialysis?
AEIOU
A - acidosis (refractory)
E - electrolyte disturbance (refractory hyperkalaemia) I - intoxication
O - oedema (severe/unresponsive pulmonary oedema)
U - uraemia symptoms (seizures/decreased conciousness)
How do you treat pyelonephritis?
IV co-amoxiclav
What are indications for doing a renal biopsy?
- unexplained AKI
- suspected glomerulonephritis
- positive nephritic screen
- persistent acute tubular necrosis
- suspected interstitial nephritis
