Renal/Urology Flashcards
Prerenal AKI causes
Hypovlaemia
Renal artery stenosis
Renal AKI causes
Glomerulonephritis Acute tubular necorosis Acute interstitial nephritis Rhabdomylosis Tumour lysis syndrome
Post renal AKI causes
Kidney stones
BPH
Diagnosis AKI
Renal US if no identifiable cause
AKI treatment
Assess drugs
Loop diuretics for oedema
Treat hyperkalaemia
Renal replacement therapy indications
Hyperkalaemia
Pulmonary oedema
Uraemia
Drugs to stop in AKI
NSAID except aspirin ACEI ARB Diuretic Aminoglycoside Metformin Digoxin Lithium
AKI diagnostic criteria
Increase creatinine 26 in 48h
or increase >50% in 7d
or oligurea
Staging criteria AKI
1) Creatinine 1.5-1.9x or oliguria >6h
2) Creatinine 2-2.9x or oliguria >12h
3) Creatinine 3x or oliguria >24h
CKD classification
1) GFR > 90 and abnormal U and E/proteinuria
2) 60-90
3) 30-59
4) 15-29
5) <15
Treatment anaemia in CKD
Optimise iron then erythropoitin stimulating agents
Kind of anaemia in CKD
Normochromatic normocytic anaemia
Bone profile in CKD
Decreased calcium
Increased PTH
Increased phosphate
Decreased vit D
Treatment bone disease in CKD
1) Decrease dietary phosphate
2) Phosphate binders and vit D
3) Parathyroidectomy
Treatment CKD hypertension
1) ACEI - rise in creatinine 25% acceptable
2) Furesemide
Treatment proteinuria CKD
1) ACEI if ACR>30
Identify nephrotic syndrome
Triad:
- proteinuria
- hypoalbuminaemia
- oedema
Diseases causing nephrotic syndrome
Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulonephritis
Diseases cause nephritic syndrome
Rapidly progressive glomerulonephritis
IgA nephropathy
Alport syndrome
Diseases causing mix of nephrotic and nephritic syndrome
Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis
Post-strep glomerulonephritis
Most common nephrotic syndrome
Children - minimal change
Adults - focal segmental glomerulosclerosis
Identify hyperacute rejection
Minutes to hours
Needs removed
Identify acute failure
<6m
Asymptomatic worsening renal function
Maybe reversible with steroids
Identify chronic graft failure
> 6m
Recurrence original disease
Identify acute interstitial nephritis
Caused by drugs - antibiotics, NSAID
Allergic type picture
Sterile pyuria and white cell casts on urinalysis
Identify ADPKD
Hypertension Stones CKD Liver cyst Berry aneurysm
Diagnosis ADPKD
Abdominal US
Treatment ADPKD
Tolvaptin
Identify alport syndrome
X linked, childhood presentation
Renal failure
Microscopic haematuria
Bilateral sensorineural deafness
Identify anti-glomerular basement membrane disease (goodpasture)
Pulmonary haemorrhage
Rapidly progressive glomerulonephritis - proteinuria and haematuria
Diagnosis goodpasture
Renal biopsy
Treatment goodpasture
Steroids
Identify focal segmental glomerlunephritis
Linked HIV
Young males
Identify haemolytic uraemic syndrome
Young children classic triad:
- AKI
- haemolytic anaemia
- thrombocytopenia
Treatment haemolytic uraemic syndrome
Suportive, no role antibiotics
Identify henoch schlein purpula
Children Rash on buttocks and extensors Arthritis Abdominal pain Maybe IgA nephropathy
Treatment henoch schlein purpula
Supportive