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General practice > Renal II > Flashcards

Renal II Flashcards

1
Q

Most common cause of AKI

A

Acute tubular necrosis

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2
Q

Two main causes of ATN

A

Ischaemia

Nephrotoxins

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3
Q

Examples of cases in which ischaemia occurs causing ATN

A

Shock

Sepsis

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4
Q

Nephrotoxins which can cause ATN

A

Aminoglycosides
Myoglobin secondary to rhabdomyolysis
radiocontrast agents
lead

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5
Q

Features of ATN

A

features of AKI: raised urea, creatinine, potassium

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6
Q

What might be seen on urinalysis in ATN

A

Muddy brown casts

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7
Q

Mx of ATN

A

Supportive management
IV fluids
Stop nephrotoxic medications
Treat complications

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8
Q

What is interstitial nephritis

A

inflammation of the space between cells and tubules (the interstitium) within the kidney.

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9
Q

How does acute interstitial nephritis present

A

AKI
HTN

Rash
Fever
Eosiniphilia(hypersensitivity reaction)

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10
Q

what causes acute interstitial nephritis

A

Drugs (e.g. NSAIDS or antibiotics)

Infection

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11
Q

Mx of acute interstitial nephritis

A

Treat underlying cause

Steroids

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12
Q

How does chronic tubulointerstitial nephritis present

A

chronic inflammation of the tubules and interstitium. It presents with chronic kidney disease.

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13
Q

What is HUS

A

Occurs when there is thrombosis in small blood vessels throughout the body. This is usually triggered by a bacterial toxin called the shiga toxin.

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14
Q

HUS triad

A

Haemolytic anaemia
Acute kidney injury
Low platelet count (thrombocytopenia)

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15
Q

Most common cause of HUS

A

toxin produced by the bacteria e. coli 0157 called the shiga toxin. Shigella also produces this toxin and can cause HUS

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16
Q

What can increase risk of HUS

A

Use of antibiotics and anti-motility medications such as loperamide to treat the gastroenteritis

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17
Q

Presentation of HUS

A

Brief gastroenteritis with bloody diarrhoea

Reduced urine output

Haematuria

Abdominal pain

Lethargy and irritability

Confusion

HTN

Bruising

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18
Q

Mx of HUS

A

Supportive mx
Antihypertensives
Blood transfusions
Dialysis

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19
Q

Pathophys of type 1 RTA

A

pathology in the distal tubule. The distal tubule is unable to excrete hydrogen ions.

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20
Q

Causes of RTA 1

A 
genetic 
SLE
Sjogren's 
Primary biliary cirrhosis 
Hyperthyroidism 
Sickle cell disease
21
Q

Presentation of RTA 1

A

Failure to thrive in children
Hyperventilation to compensate for the metabolic acidosis
Chronic kidney disease
Bone disease (osteomalacia)

22
Q

IX - RTA 1

A

Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)

23
Q

Rx of RTA 1

A

Oral bicarbonate

24
Q

RTA 2 pathophys

A

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

25
Q

Main cause of RTA 2

A

Fanconi’s syndrome

26
Q

RTA 2 - IX

A

Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)

27
Q

Mx of RTA 2

A

Oral bicarb

28
Q

What is RTA 4 caused by

A

caused by reduced aldosterone

Can be due to adrenal insufficiency, ACE inhibitors/spironolactone or systemic conditions such as SLE/diabetes/HIV

29
Q

RTA 4 - IX

A

Hyperkalaemia
High chloride
Metabolic acidosis
Low urinary pH

30
Q

Mx of RTA 4

A

Fludrocortisone
Sodium bicarbonate

Treatment of hyperkalaemia may be required

31
Q

Indications for acute dialysis - AEIOU

A

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

32
Q

Indications for long term dialysis

A

End stage renal failure (CKD stage 5)

33
Q

Options for maintenance dialysis

A

Continuous Ambulatory Peritoneal Dialysis
Automated Peritoneal Dialysis
Haemodialysis

34
Q

Complications of peritoneal dialysis

A

Bacterial peritonitis

Peritoneal sclerosis

Weight gain

Psychosocial effects

35
Q

What does rhabdomyolysis cause release of

A

Myoglobin (causing myoglobinurea)
Potassium
Phosphate
Creatine kinase

36
Q

Causes of rhabdomyolysis

A

Prolonged immobility
Extremely rigorous exercise
Crush injuries
Seizures

37
Q

signs and symptoms of rhabdomyolysis

A 
Muscle aches and pain
Oedema
Fatigue
Confusion (particularly in elderly frail patients)
Red-brown urine
38
Q

Mx of rhabdomyolysis

A

IV fluids
IV sodium bicarbonate
IV mannitol (increases GFR)

Manage electrolyte disturbances

39
Q

What is polycystic kidney disease(PCK)

A

genetic condition where the kidneys develop multiple fluid-filled cysts

40
Q

Types of PCK

A

Autosomal recessive and dominant

41
Q

Diagnosis of PCK

A

kidney ultrasound scan and genetic testing

42
Q

Extra-renal manifestations of PCK

A

Cerebral aneurysms
Hepatic, splenic, pancreatic, ovarian and prostatic cysts
Cardiac valve disease (mitral regurgitation)
Colonic diverticula
Aortic root dilatation

43
Q

Complications of PCK

A 
Chronic loin pain
Hypertension
Cardiovascular disease
Gross haematuria 
Renal stones
End-stage renal failure
44
Q

Mx of PCK

A 
Tolvaptan(slows progression of cysts) 
Antihypertensives
Analgesia 
Antibiotics 
Dialysis
45
Q

Definition of AKI

A

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

46
Q

Diagnosis of amyloidosis

A

Congo red staining: apple-green birefringence
serum amyloid precursor (SAP) scan
biopsy of skin, rectal mucosa, or abdominal fat

47
Q

Features of amyloidosis in renal disease

A

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.

48
Q

Neurological presentation of amyloidosis

A

Ischaemic stroke

Peripheral & autonomic neuropathy

General practice (26 decks)

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