renal medicine Flashcards
What are some different renal function tests?
Bloods: FBC, U+Es, bone profile, CRP, HbA1c
Urine: dipstick, protein-creatinine ratio, albumin-creatnine ration, urine culture
Imaging: US KUB
What are some signs on examination of advanced renal disease?
Brown nails
Yellow brown uraemic skin
Uraemic frost from sweat on skin
Hyperreflexia
Pericardial rub
What are some investigations you should do when a patient has hyponatraemia?
- Plasma osmolality: rule out pseudohyponatraemia
- K+ and Mg2+: hypoK and hypoMg can potentiate ADH release
- Urine Na: if <20 then non-renal salt losses, if >40 then SIADH
- TSH and 9am Cortisol
- Calcium, Albumin, Glucose, LFTs
- CT head if suspect SIADH
What are some causes of SIADH?
Malignancy
Meningitis
Subarachnoid haemorraghe
Drugs e.g SSRIs, morphine, amitriptylline
Hypothyroidism
What is the management of hypovolemic and hypervolemic hyponatraemia?
Hypovolaemic: (renal or GI losses of Na) IV fluids 0.9% NaCl at 1-3ml/kg/hr and add K+ if needed
Hypervolaemic: (increased water lowering Na) fluid restrict and consider furosemide
how should you manage acute and chronic hyponatraemia?
Acute and Symptomatic (<48hours)
3% HYPERTONIC SALINE BOLUSES +/- Furosemide)
Chronic and Symptomatic (>48 hours)
If seizures hypertonic saline boluses
Otherwise isotonic saline and furosemide
Chronic and Asymptomatic
Water restriction
Stop offending drug
If dehydrated give water
If fluid overloaded give water restriction, furosemide and Na
When is a patient having Type IV RTA and what are some common causes of this?
Due to issue with distal tubule not being able to respond to aldosterone
- Hyperkalemia
- Hypochloraemic metabolic acidosis
- HTN
Causes: hyporeinaemic hypoaldosteronism, diabetic nephropathy, hypertension, NSAIDs, lupus nephritis
When is long term dialysis started?
When needed to manage the symptoms of renal failure. eGFR usually <10-15. Used as a bridge to transplantation
Inability to control fluid status e.g pulmonary oedema
Inability to control VP
Acid-base or electrolyte abnormalities
Cognitive impairment
What are the different types of peritoneal dialysis?
- Automated PD: Automatic cycler machine at night over 10hours with 10-12L exchanged. Leaves daytime free
- Continuous Ambulatory PD: 4-5 dialysis exchanges a day at regular intervals of 2L.
- Assisted Automated PD: healthcare assistants visit the patient’s home to set up machine for night
what are the disadvantages of peritoneal dialysis
Patient needs to learn technique
Unsuitable if patient has stoma or previous GI surgery
- Risk of peritonitis
- Hernia
Hydrothorax
Leaks
Catheter site infection
Loss of membrane function over time
what are the advantages of haemodialysis?
More efficient form of dialysis
Unit based so support from staff
what are the disadvantages of haemodialysis?
Risk of bleeding due to heparin
Infection
Hypotension
Anaemia
AVF steal syndrome
SVCO from central lines
Time consuming
What are some contraindications for kidney transplantation?
- Active infection or malignancy
Severe heart or lung disease
Reversible renal disease
- Uncontrolled substance abuse
Non-adherance to treatment
- Short life expectancy
How is hyper acute rejection of a renal graft avoided?
Induction of immunosuppression at moment of transplant
Drugs used:
- Methylprednisolone plus one of below
Basiliximab
Thymoglobulin
Alentuzumab
Rituximab
what is the biggest cause of mortality following renal transplant?
CVD
Malignancy
Infections
