Renal Medicine Flashcards
What are the indications for urgent dialysis? [4]
- Uraemic complications ie encephalopathy
- Refractory hyperkalaemia
- . Metabolic acidosis uncontrolled by medical treatment.
- Pulmonary oedema with oliguria.
What ECG changes would you expect to see in hyperkalaemia?
Non-specific changes
- Tall, peaked T waves
- Widened QRS
- Prolonged PR interval
What are risk factors for renal stones?
- dehydration
- hypercalciuria, hyperparathyroidism, hypercalcaemia
- cystinuria
- high dietary oxalate
- high protein diet
- renal tubular acidosis
- medullary sponge kidney, polycystic kidney disease
- beryllium or cadmium exposure
What drugs can lead to the development of renal stones?
Drugs that promote calcium stones: loop diuretics, steroids, acetazolamide, theophylline
-Thiazides can prevent calcium stones (increase distal tubular calcium resorption)
How do renal stones present?
Flank pain
What is the investigation of choice if you suspect renal calculus/stones?
Non-contrast CT scan
How is minimal change disease managed?
- Majority are steroid-responsive
- For steroid resistant case= cyclophosphamide
- Relapse is common
How is an AKI diagnosed?
increase in serum creatinine by 26.5 mol/l within 48 hours,
increase in serum creatinine to 1.5 times baseline
urine volume < 0.5 ml/kg/h for 6 hours
What investigations can help differentiate between prerenal AKI and intrarenal AKI?
Urinary sodium - kidneys hold on to sodium to preserve volume in prerenal AKI
Urine osmolality
BUN: Creatinine ratio
Outline the stages of an AKI
Stage 1: Increase in creatinine 1.5-1.9x baseline + Urine production: < 0.5ml/kg/h for >6 consecutive hours
Stage 2: Increase in creatinine 2.0-2.9x baseline + Urine production: < 0.5ml/kg/h for >12 consecutive hours
Stage 3: Increase in creatinine > 3x baseline + Urine production: < 0.3ml/kg/h for > 24h or anuric for 12h
