renal zero to finals conditions Flashcards
risk factors for AKI
over 65
liver and heart disease
medications such as NSAIDS
sepsis
diabetes
NICE guidelines for AKI
Rise in creatinine of more than 25 micromol/L in 48 hours
Rise in creatinine of more than 50% in 7 days
Urine output of less than 0.5 ml/kg/hour over at least 6 hours
pre-renal causes of AKI
Anything that causes inadequate blood flow
dehydration
shock
heart failure
renal causes of AKI
Due to intrinsic disease-
Acute tubular necrosis
Glomerulonephritis
Acute interstitial nephritis
Haemolytic uraemic syndrome
Rhabdomyolysis
post renal causes of AKI
Obstruction to the outflow
Kidney stones
Tumours (e.g., retroperitoneal, bladder or prostate)
Strictures of the ureters or urethra
Benign prostatic hyperplasia (benign enlarged prostate)
Neurogenic bladder
investigations for AKI
Urinalysis assesses for protein, blood, leucocytes, nitrites and glucose:
treating AKI
IV fluids for dehydration and hypovolaemia
Withhold medications that may worsen the condition
Withhold/adjust medications that may accumulate with reduced renal function (e.g., metformin and opiates)
Relieve the obstruction in a post-renal AKI
Dialysis may be required in severe cases
most common cause of intrinsic kidney disease
acute tubular necrosis
causes of chronic kidney failure
Diabetes
Hypertension
Medications (e.g., NSAIDs or lithium)
Glomerulonephritis
Polycystic kidney disease
signs of CKD
fatigue, pallor, foamy urine (proteinuria)
investigations of CKD
eGFR
proteinuria
haematuria
management of renal bone disease
Low phosphate diet
Phosphate binders
Active forms of vitamin D (alfacalcidol and calcitriol)
Ensuring adequate calcium intake
what is golmerulonephritis
Glomerulonephritis refers to inflammation of the glomeruli in the kidneys. The glomerulus is the first part of the nephron. It filters fluid out of the capillaries and into the renal tubule.
nephritic syndrome
Haematuria
Oliguria (significantly reduced urine output)
Proteinuria (protein in the urine), but less than 3g per 24 hours
Fluid retention
nephrotic syndrome
damage to the basement membrane and become highly permeable and causes proteinuria
signs of nephrotic syndrome
Proteinuria (more than 3g per 24 hours)
Low serum albumin (less than 25g per litre)
Peripheral oedema
Hypercholesterolaemia
most common cause of nephrotic syndrome in children is
minimal change disease
The top causes of nephrotic syndrome in adults are:
Membranous nephropathy
Focal segmental glomerulosclerosis
Case: 2-5 year old with proteinuria, low albumin and oedema
minimal change diserase- nephrotic syndrome
IgA nephropathy
patient in 20s with haematuria
caused by proliferation of mesangial cells ( found in centre of glomerulus and support the capillaries)
membernous nephropathy common nephrotic syndrome
Membranous nephropathy involves deposits of immune complexes in the glomerular basement membrane, causing thickening and malfunctioning of the membrane and proteinuria. Histology shows IgG and complement deposits on the basement membrane.
good pasture syndrome antibodies
anti- GBM
microscopic polyangiitis
MPO- antibodies
granulomatosis with polyangiitis
PR3- antibodies
what is good pastures syndrome
antibodies attack glomerulus on basement membrane causing pulmonary haemorrhage
scale for hyperkalaemia
normal- 3.5-5.3
mild- 5.4-6
moderate- 6.6.5
severe- over 6.5
conditions that cause hyperkalaemia
Acute kidney injury
Chronic kidney disease (stage 4 or 5)
Rhabdomyolysis
Adrenal insufficiency
Tumour lysis syndrome
medications that can cause hyperkalaemia
Aldosterone antagonists
ACE inhibitors
Angiotensin II receptor blockers
NSAIDs
ECG changes in hyperkalaemia
tall peaked T waves
absent p waves
prolonged PR interval
broad QRS complex
treatment for severe hyperkalaemia
insulin- drive insulin from ECF to ICF dextrose infusion- prevent hypo when on insulin
IV calcium gluconate- stabilises cardiac muscle cells
