Renal workbook and key points Flashcards
What are the common causes of AKI
Pre renal: decreased CO (HF or LF), hypovolaemia (bleeding vomiting)
Renal: acute GN, tubular injury (sepsis/nephrotoxins)
Postrenal: bladder outlet obstruction
Investigations for AKI
Urine dip for protein and blood, FBC, Us and Es, LFTs, bone profile, CRP, CK for rhabdomyalosis, USS KUB (bladder outlet obstruction), measure urine output
Initial treatment for AKI
Ensure volume status and perfusion pressure: give IV fluids
How does ADH regulate fluid balance
Synthesised in hypothalamus and released by PP, causes more Na+ and water retention, blood volume increases and urine osmolarity also increases.
Kidney tubules become more permeable, more water can leave the kidney tubule and be reabsorbed into the blood
Fluids for AKI patient with low bp and dehydration but normal Na+ and K+
Isotonic solution- Normal saline 0.9% NaCl
Investigations for CKD staging
EGFR, albumin:creatinine ratio
How does hypertension worsen renal function
HTN causes increased renal perfusion pressure, arteries around the kidney are weakened/narrowed/hardened, and cannot delivery enough blood to the kidney
Common causes of CKD
Diabetes, HTN, GN, PKD, obstructive nephropathy
Clinical examination findings in CKD
Ammonia breath, pallor, cachexia, cognitive impairment, tachypnoea, HTN, volume overload (pulmonary oedema/ascites)
PKD = palpate kidneys, palpate bladder for obstructive uropathy often with prostatic enlargement
Tests to confirm cause of CKD
BP, urinalysis, plasma glucose, ECG
FBC to check for anaemia
Us and Es, serum albumin, urinary albumin, Hep B and C and HIV serology
Renal US, CT, MRI
3 forms of RRT
Peritoneal dialysis, haemodialysis, transplantation
Major complications of RRT
peritoneal- drainage problems, peritonitis
Haemodialysis - infection, cramps
Transplant- rejection/infection/malignancy
Principles of managing end stage renal patients with high PTH levels (mineral bone disease)
Reduce severity of mineral bone disease
Reduce symptoms
Reduce cardiovascular mortality
End stage renal disease with anaemia principles of management
Measure haematinics and replace if deficient, start ESA, Hb100-120 is aim
2 immunosuppressant drugs commonly given after kidney transplant apart from corticosteroids
Calcineurin inhibitors e.g. tacrolimus
Antimetabolites e.g. mycophenolate
Things to monitor after transplant
GFR, CN1, proteinuria, Ca2+ and phosphate, PTH, lipids and glucose. Screen for infections, monitor cardiovascular health, screen for malignancies
Causes of low Na+
Causes of high Na+
Marker of small vessel vasculitis
ANCA
Marker of Goodpastures
Anti-GBM
Marker of auto immune conditions e.g. lupus
ANA/dsDNA high, C3 and C4 low
Marker of myeloma or IgA nephropathy (lymphoproliferative disorders)
Serum immunoglobulins and electrophoresis
Markers of sarcoidosis (impacts lung (would see lymphadenopathy) and kidney)
Serum ACE
Marker of rhabdomyalysis
Creatine kinase
Reasons someone may need dialysis
Drug toxins, acidaemia (profound), hyperkalaemia (refractory: given 3 treatments already), fluid overload and anuric, AKI, pulmonary oedema + anuria
Increased K+ can cause what arrhythmias
Sinus brady, AV block, ventricular ectopics, (peak T waves, flat or absent p, B-road QRS)
Which bottle first when taking bloods
Brown
Commonest causes of nephrotic syndrome
Adults: membranous GN
Kids: minimal change disease (lupus)
Elderly: diabetic nephropathy/myeloma/amyloidosis/membranous GN (lupus)
When is BNP raised
Anything that stretches atrium
Where does vasculitis, membranous GN and minimal change disease affect histologically
Name a drug that can cause fluid overload
Amlodipine CCB
Why do CCBs cause fluid overload
Decrease in arteriolar resistance that goes unmatched in venous circulation
What can you give to patients for itch due to nerve irritation
Gabapentin or Pregablin
