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Renal pathology Flashcards

1
Q

Normal GFR

A

100 mL/min

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2
Q

Signs and symptoms of kidney failure

A 
Vomiting
Loss of appetite
Fatigue and weakness
Changes in urine output
Hypertension
Oedema
Itchy skin
Coldness
Shortness of breath
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3
Q

eGFR

A

Estimates GFR using plasma creatinine

Accurate and accounts for muscle mass

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4
Q

Why do we measure creatinine?

A

It’s a measure of how much waste product your muscles are making and how well your kidneys are excreting it

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5
Q

Normal creatinine levels

A

Normal adult: 60
Child: 20
Muscly adult: 100-120

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6
Q

Acute kidney injury

A

Sudden rapid reduction in GFR
Happens over days or weeks
Usually reversible
70% cases due to non-renal causes

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7
Q

Pre-renal AKI: absolute loss of fluid causes

A

1) Haemorrhage
2) Vomiting and diarrhoea
3) Severe burns

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8
Q

Pre-renal AKI: relative loss of fluid causes

A

1) Distributive shock

2) Congestive heart failure

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9
Q

Main causes of pre-renal failure

A 
Low blood pressure
Dehydration
Shock (septic or cardiogenic)
Severe renal artery stenosis
Haemorrhage
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10
Q

Blood test results in pre-renal AKI

A

Creatinine: high
Potassium: high
Phosphate: high
Calcium: may be low

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11
Q

Treatment of pre-renal AKI

A

Fix underlying problem

  • rehydrate
  • treat bleeding
  • fix heart
  • antibiotics
  • ICU
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12
Q

Acute tubular necrosis

A

Mainly due to pre-renal
Persistent oliguria and renal failure after correction of underlying condition
High creatinine, potassium and phosphate
Low urine output

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13
Q

Treatment of ATN

A

Maintain normal BP
Treat underlying problem
Dialysis later

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14
Q

ATN recovery

A

95% get better

Polyuric phase requires IV fluid until complete recovery

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15
Q

Rapidly progressive glomerulonephritis

A

Acute renal failure due to glomerular disease
Blood and/or protein in urine
Confirm with renal biopsy

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16
Q

Post-renal AKI causes

A

Kidney stones
Tumour
Prostate hypertrophy
Urinary retention

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17
Q

Chronic kidney disease

A 
Over months or years
Gradual decline in renal function
Irreversible
Elevated creatinine and urea
Usually normal urine output
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18
Q

3 main causes of CKD

A

Diabetes
Glomerulonephritis
Hypertension

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19
Q

Cellular changes in CKD

A

Gradual increase in creatinine over time due to underlying disease causes scarring or glomeruli and interstitium, gradually reducing kidney function

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20
Q

Signs and symptoms of CKD

A

Usually none for a long time

Later, hypertension, oedema, pulmonary oedema, raised JVP

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21
Q

CKD stage 2

A

60 - 90 mL/min GFR

Increased PTH

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22
Q

CKD stage 3

A

30 - 59 mL/min GFR

Decreased calcium

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23
Q

CKD stage 4

A 
15 - 29 mL/min GFR
Anaemia
Acidosis
High phosphate
Increased CV risk
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24
Q

CKD stage 5

A

<15 mL/min GFR
End stage renal failure
Uraemia

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25
Stimuli for PTH secretion
Low calcium | High phosphate
26
Renal failure therapy
Prevent it from getting worse BP control Control complications
27
Proteinuria
Shouldn't have more than 200 mg protein in urine over 24 hours Excess of this normally indicates glomerular problem
28
Haematuria
Blood in urine Can be from glomerular disease, tumour or infection Microscopic or macroscopic
29
What is the protein you would normally find in proteinuria?
Albumin
30
Nephrotic syndrome
More than 3.5 g/day urinary protein, low serum albumin and oedema Causes frothy urine, hypercholesterolaemia and blood clots Renal function can be normal or impaired
31
Mechanism for oedema
Increased albumin excretion Liver can't keep up Reduction in oncotic pressure Movement of fluid into interstitial space
32
Complications of nephrotic syndrome
Increased cholesterol Thromboembolism Infection Malnutrition
33
How to distinguish between two types of renal AKI
ATN - generally won't have proteinuria | Acute glomerulonephritis - generally will have proteinuria
34
Nephritic syndrome
Inflammatory type of acute kidney injury
35
Why does BP treatment reduce protein excretion?
Patients with increased BP have increased glomerular hydrostatic pressure, therefore increased glomerular filtration rate and increased proteinuria Therefore blood pressure treatment is a key first line of defence in proteinuria and other glomerular diseases
36
Renal cell carcinoma
90% of renal cancers More common in men, highest incidence in 60s Genetic component Smoking
37
Fluid assessment
Tissue turgor - useful for younger people BP - low could mean dehydration JVP - should be 1-2 cm. ANy higher indicates increased fluid and maybe RHF
38
What blood test could indicate whether kidney disease is acute or chronic?
Haemoglobin because chronic patients tend to be anaemic | RBCs take 120 days to die, so acute kidney failure wouldn't show up as anaemia
39
Most AKI is which category?
Pre-renal
40
What is the best test of post-renal AKI?
Renal ultrasound
41
What does crackles on auscultation indicate?
Pulmonary oedema
42
When creatinine is above 600, eGFR is likely to be:
Below 10 mL/min
43
4 major signs of CKD
Malnutrition Fluid overload Rash Pericardial rub
44
Why does CKD present with a rash?
Inability to excrete phosphate makes your skin itchy
45
Pericardial rub
So uremic that toxins build up between pericardial layers | Sounds like walking on snow
46
Why is phosphate elevated in CKD?
Decreased vitamin D Decreased gut absorption = low calcium and high phosphate Body tries to retain calcium so parathyroid hormone increased
47
How big should the kidney be?
10-11 cm | Scarring can cause kidney to shrink so small kidney can indicate CKD
48
What is the best BP treatment for CKD?
ACE inhibitors or angiotensin receptor blockers
49
Hypotonic fluid
Hypotonic solution that pushed fluid into cells and makes them swell up
50
Hypertonic fluid
Hypertonic solution that pushes fluid out of cells and makes them shrink
51
Signs of fluid overload
``` Weight gain Puffy eyes Swollen ankles Increased blood pressure Breathlessness ```
52
Signs of dehydration
Weight loss Dry mouth Low BP Dizziness
53
When should you not give a patient IV fluid?
When they're drinking enough When they're on enteral feeding When they're already fluid overloaded
54
When should you give a patient IV fluid?
When they're not drinking | When they've lost a lot of fluid
55
Why would a patient need IV fluid?
Maintenance Replace losses Resuscitation
56
Paediatric fluids
4 mL/kg/hr for first 10kg 2 mL/kg/hr for next 10 kg 1 mL/kg/hr for the rest
57
Third spacing
Losing fluid to ECF spaces where it can't be used | Results in ascites and pleural effusion
58
Two types of isotonic fluid
0.9% NaCl | Plasmalyte 148
59
Hypotonic fluid
5% dextrose Decreases Na+ and increase H2O Risk of overcorrection
60
Hyponatraemia
Not enough Na+ Can be due to low Na+, but mainly due to excess water Pseudohyponatraemia common due to lab error
61
Cause of sodium loss
GI loss Hypo-aldosteronism Sweat (rare) Diuretics - lose more Na+ than relative H2O
62
Water excess causes
``` Polydipsia SIADH Cirrhosis Heart failure Nephrotic syndrome ```
63
Urine osmolality is normally high in hyponatremia. What's the exception?
Water intoxication
64
Rapid correction of hyponatremia
Normal brain, intake of water leads to water gain Rapid adaptation leads to loss of Na+, K+ and Cl- Slow adaptation leads to loss of organic osmolytes If not properly corrected at a slow rate here, osmotic demyelination can occur causing brain damage and death

Genitourinary (6 decks)

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