Renal Med Flashcards
What quantifies an AKI
Rise in creat more than 25micromol in 48 hrs
50% increase in creat in a week
Urine output less than 0.5ml/hr
What are the pre renal causes of AKI
Insufficient blood supply to kidneys
-Dehydration
-Shock- sepsis or blood loss
-HF
What are the renal causes of AKI
Intrinsic kidney disease
-Acute tubular necrosis
-Acute interstitial nephritis
-Haemolytic uraemia syndrome
-Rhabdomyolysis
What are the post renal causes of AKI
Outflow obstruction from kidneys
-Kidney stones
-Tumours
-Strictures/ ureters
-Benign prostatic hyperplasia
-Neurogenic bladder
What is acute tubular necrosis and what are it’s causes
Necrosis of epithelial cells of renal tubules
Most common renal cause of AKI
Caused by hypo perfusion and nephrotoxins (gentamicin or radio contrast)
Muddy brown casts on urinalysis
What is the management of acute tubular necrosis
Prevent by fluids and avoiding nephrotoxins
Treat with IV fluids and hold nephrotoxic drugs, reverse underlying cause/ relieve obstruction
Dialysis if needed
Stop ACE inhibit in AKI as they reduce filtration pressure
What is CKD and how does it present
Reduced kidney function over 3 months, eGFR below 60ml/min and urine:creatinine above 3
Diabetes, HTN, NSAID’s, Lithium,, glomerulonephritis, PKD
Fatigue, pruitis, oedema, HTN, peripheral neuropathy, nausea, pale, foamy urine
What are the scoring systems for CKD
G score- eGFR
G1- >90
G2- 60-89
G3a- 45-59
G3b- 30-44
G4- 15-29
G5- less than 15
A score- albumin:creatinine
A1 under 3
A2 3-30
A3 over 30
What referrals are made in CKD
Work out kidney failure risk equation- 5 yr risk of kidney failure
Refer to specialist if
eGFR less than 30
Urine ACR more than 70
Accelerated progression
5 yr risk over 5%
Uncontrolled HTN
What medications can be given in CKD
ACE inhibitors and statins
Want target BP under 130/80
Give ACE inhibit in
Diabetes + urine ACR over 3
HTN and urine ACR over 30
Anyone with Urine ACR over 70
Monitor serum potassium
SGLT2 inhibitors - Dapagliflozin
Given in diabetes and ACR over 30
Consider in diabetes and ACR 3-30
Non diabetes and ACR over 22.6
How does anaemia of chronic disease happen in CKD and how is it treated
CKD- not as much erythropoietin is made in the kidneys - normocytic anaemia
Treat with iron and erythropoietin
don’t blood transfuse - issues with immune reaction if transplant needed
How does renal bone disease occur in CKD and how is it treated
Reduced phosphate excretion causes high serum phosphate
Low vit D in serum ask kidneys can’t absorb it
Causes a secondary hyperparathyroidism - parathyroid glands secrete PTH in response to low fit d and high phosphate
PTH stimulates osteoclast activity to resorb and increase serum calcium
Causes osteomalacia and osteoclerosis (new bone formation due to osteoblasts but not properly mineralised)
Ruggery jersey spine
Treatment: Low phosphate diet, phosphate binders, active forms of fit D, adequate calcium intake
What is nephritic syndrome
Generic term for inflam of kidneys
Haematuria, oliguria, proteinuria, fluid retention
What is nephrotic syndrome
Basement membrane in glomerulus is permeable and causes proteinuriaa
Proteinuria more than 3g per 24hrs
Low serum albumin
Peripheral oedema
Hypercholesterolaemia
Oedema, frothy urine, predisposes to thrombosis , HTN and high cholesterol
What is the most common cause of nephrotic syndrome in children and in adults
Children- minimal change disease- idiopathic and treated with steroids
Adults- Membranous Neuropathy or local segmental glomerulosclerosis