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
