Renal II Flashcards
Most common cause of AKI
Acute tubular necrosis
Two main causes of ATN
Ischaemia
Nephrotoxins
Examples of cases in which ischaemia occurs causing ATN
Shock
Sepsis
Nephrotoxins which can cause ATN
Aminoglycosides
Myoglobin secondary to rhabdomyolysis
radiocontrast agents
lead
Features of ATN
features of AKI: raised urea, creatinine, potassium
What might be seen on urinalysis in ATN
Muddy brown casts
Mx of ATN
Supportive management
IV fluids
Stop nephrotoxic medications
Treat complications
What is interstitial nephritis
inflammation of the space between cells and tubules (the interstitium) within the kidney.
How does acute interstitial nephritis present
AKI
HTN
Rash
Fever
Eosiniphilia(hypersensitivity reaction)
what causes acute interstitial nephritis
Drugs (e.g. NSAIDS or antibiotics)
Infection
Mx of acute interstitial nephritis
Treat underlying cause
Steroids
How does chronic tubulointerstitial nephritis present
chronic inflammation of the tubules and interstitium. It presents with chronic kidney disease.
What is HUS
Occurs when there is thrombosis in small blood vessels throughout the body. This is usually triggered by a bacterial toxin called the shiga toxin.
HUS triad
Haemolytic anaemia
Acute kidney injury
Low platelet count (thrombocytopenia)
Most common cause of HUS
toxin produced by the bacteria e. coli 0157 called the shiga toxin. Shigella also produces this toxin and can cause HUS
What can increase risk of HUS
Use of antibiotics and anti-motility medications such as loperamide to treat the gastroenteritis
Presentation of HUS
Brief gastroenteritis with bloody diarrhoea
Reduced urine output
Haematuria
Abdominal pain
Lethargy and irritability
Confusion
HTN
Bruising
Mx of HUS
Supportive mx
Antihypertensives
Blood transfusions
Dialysis
Pathophys of type 1 RTA
pathology in the distal tubule. The distal tubule is unable to excrete hydrogen ions.
Causes of RTA 1
genetic SLE Sjogren's Primary biliary cirrhosis Hyperthyroidism Sickle cell disease
Presentation of RTA 1
Failure to thrive in children
Hyperventilation to compensate for the metabolic acidosis
Chronic kidney disease
Bone disease (osteomalacia)
IX - RTA 1
Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)
Rx of RTA 1
Oral bicarbonate
RTA 2 pathophys
Pathology in the proximal tubule. The proximal tubule is unable to reabsorb bicarbonate from the urine into the blood. Excessive bicarbonate is excreted in the urine
Main cause of RTA 2
Fanconi’s syndrome
RTA 2 - IX
Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)
Mx of RTA 2
Oral bicarb
What is RTA 4 caused by
caused by reduced aldosterone
Can be due to adrenal insufficiency, ACE inhibitors/spironolactone or systemic conditions such as SLE/diabetes/HIV
RTA 4 - IX
Hyperkalaemia
High chloride
Metabolic acidosis
Low urinary pH
Mx of RTA 4
Fludrocortisone
Sodium bicarbonate
Treatment of hyperkalaemia may be required
Indications for acute dialysis - AEIOU
A – Acidosis (severe and not responding to treatment)
E – Electrolyte abnormalities (severe and unresponsive hyperkalaemia)
I – Intoxication (overdose of certain medications)
O – Oedema (severe and unresponsive pulmonary oedema)
U – Uraemia symptoms such as seizures or reduced consciousness
Indications for long term dialysis
End stage renal failure (CKD stage 5)
Options for maintenance dialysis
Continuous Ambulatory Peritoneal Dialysis
Automated Peritoneal Dialysis
Haemodialysis
Complications of peritoneal dialysis
Bacterial peritonitis
Peritoneal sclerosis
Weight gain
Psychosocial effects
What does rhabdomyolysis cause release of
Myoglobin (causing myoglobinurea)
Potassium
Phosphate
Creatine kinase
Causes of rhabdomyolysis
Prolonged immobility
Extremely rigorous exercise
Crush injuries
Seizures
signs and symptoms of rhabdomyolysis
Muscle aches and pain Oedema Fatigue Confusion (particularly in elderly frail patients) Red-brown urine
Mx of rhabdomyolysis
IV fluids
IV sodium bicarbonate
IV mannitol (increases GFR)
Manage electrolyte disturbances
What is polycystic kidney disease(PCK)
genetic condition where the kidneys develop multiple fluid-filled cysts
Types of PCK
Autosomal recessive and dominant
Diagnosis of PCK
kidney ultrasound scan and genetic testing
Extra-renal manifestations of PCK
Cerebral aneurysms
Hepatic, splenic, pancreatic, ovarian and prostatic cysts
Cardiac valve disease (mitral regurgitation)
Colonic diverticula
Aortic root dilatation
Complications of PCK
Chronic loin pain Hypertension Cardiovascular disease Gross haematuria Renal stones End-stage renal failure
Mx of PCK
Tolvaptan(slows progression of cysts) Antihypertensives Analgesia Antibiotics Dialysis
Definition of AKI
a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
Diagnosis of amyloidosis
Congo red staining: apple-green birefringence
serum amyloid precursor (SAP) scan
biopsy of skin, rectal mucosa, or abdominal fat
Features of amyloidosis in renal disease
Commonly presents as nephrotic syndrome (e.g. 70% present with proteinuria in AL amyloidosis).
Common in AA amyloidosis (in 80% of cases) & AL amyloidosis, but less likely in ATTR amyloidosis.
Neurological presentation of amyloidosis
Ischaemic stroke
Peripheral & autonomic neuropathy
