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Genitourinary > Renal pathology > Flashcards

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
Q

Stimuli for PTH secretion

A

Low calcium

High phosphate

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26
Q

Renal failure therapy

A

Prevent it from getting worse
BP control
Control complications

27
Q

Proteinuria

A

Shouldn’t have more than 200 mg protein in urine over 24 hours
Excess of this normally indicates glomerular problem

28
Q

Haematuria

A

Blood in urine
Can be from glomerular disease, tumour or infection
Microscopic or macroscopic

29
Q

What is the protein you would normally find in proteinuria?

A

Albumin

30
Q

Nephrotic syndrome

A

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
Q

Mechanism for oedema

A

Increased albumin excretion
Liver can’t keep up
Reduction in oncotic pressure
Movement of fluid into interstitial space

32
Q

Complications of nephrotic syndrome

A

Increased cholesterol
Thromboembolism
Infection
Malnutrition

33
Q

How to distinguish between two types of renal AKI

A

ATN - generally won’t have proteinuria

Acute glomerulonephritis - generally will have proteinuria

34
Q

Nephritic syndrome

A

Inflammatory type of acute kidney injury

35
Q

Why does BP treatment reduce protein excretion?

A

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
Q

Renal cell carcinoma

A

90% of renal cancers
More common in men, highest incidence in 60s
Genetic component
Smoking

37
Q

Fluid assessment

A

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
Q

What blood test could indicate whether kidney disease is acute or chronic?

A

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
Q

Most AKI is which category?

A

Pre-renal

40
Q

What is the best test of post-renal AKI?

A

Renal ultrasound

41
Q

What does crackles on auscultation indicate?

A

Pulmonary oedema

42
Q

When creatinine is above 600, eGFR is likely to be:

A

Below 10 mL/min

43
Q

4 major signs of CKD

A

Malnutrition
Fluid overload
Rash
Pericardial rub

44
Q

Why does CKD present with a rash?

A

Inability to excrete phosphate makes your skin itchy

45
Q

Pericardial rub

A

So uremic that toxins build up between pericardial layers

Sounds like walking on snow

46
Q

Why is phosphate elevated in CKD?

A

Decreased vitamin D
Decreased gut absorption = low calcium and high phosphate
Body tries to retain calcium so parathyroid hormone increased

47
Q

How big should the kidney be?

A

10-11 cm

Scarring can cause kidney to shrink so small kidney can indicate CKD

48
Q

What is the best BP treatment for CKD?

A

ACE inhibitors or angiotensin receptor blockers

49
Q

Hypotonic fluid

A

Hypotonic solution that pushed fluid into cells and makes them swell up

50
Q

Hypertonic fluid

A

Hypertonic solution that pushes fluid out of cells and makes them shrink

51
Q

Signs of fluid overload

A 
Weight gain
Puffy eyes
Swollen ankles
Increased blood pressure
Breathlessness
52
Q

Signs of dehydration

A

Weight loss
Dry mouth
Low BP
Dizziness

53
Q

When should you not give a patient IV fluid?

A

When they’re drinking enough
When they’re on enteral feeding
When they’re already fluid overloaded

54
Q

When should you give a patient IV fluid?

A

When they’re not drinking

When they’ve lost a lot of fluid

55
Q

Why would a patient need IV fluid?

A

Maintenance
Replace losses
Resuscitation

56
Q

Paediatric fluids

A

4 mL/kg/hr for first 10kg
2 mL/kg/hr for next 10 kg
1 mL/kg/hr for the rest

57
Q

Third spacing

A

Losing fluid to ECF spaces where it can’t be used

Results in ascites and pleural effusion

58
Q

Two types of isotonic fluid

A

0.9% NaCl

Plasmalyte 148

59
Q

Hypotonic fluid

A

5% dextrose
Decreases Na+ and increase H2O
Risk of overcorrection

60
Q

Hyponatraemia

A

Not enough Na+
Can be due to low Na+, but mainly due to excess water
Pseudohyponatraemia common due to lab error

61
Q

Cause of sodium loss

A

GI loss
Hypo-aldosteronism
Sweat (rare)
Diuretics - lose more Na+ than relative H2O

62
Q

Water excess causes

A 
Polydipsia
SIADH
Cirrhosis
Heart failure
Nephrotic syndrome
63
Q

Urine osmolality is normally high in hyponatremia. What’s the exception?

A

Water intoxication

64
Q

Rapid correction of hyponatremia

A

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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