Session 10 Flashcards
What can increase the chance of getting Acute kidney injury?
Diabetes Mellitus
What is pre-renal failure?
Issues with renal perfusion or pump failure eg MI
What are some of the risk factors for Acute Kidney Injury?
Diabetes Mellitus
Infection
Drugs (NSAIDS cause vasocontriction of the afferent arteriole)
Chronic kidney disease
What are some of the markers for Acute Kidney Injury?
Increased K+
Increased Urea
Increased Creatinine
What is Lupus nephritis?
Inflammation of the kidney, especially vasculitis
What do Monomorphic red cells indicate?
Damage to the collecting duct or ureters
What do Red cell casts indicate?
Damage to the Glomerulus
What do Muddy brown granular casts indicate?
Acute nephron necrosis
What are some of the causes of pre renal Acute Kidney Injury?
Volume depletion
Effective volume depletion eg Sepsis
What are some of the causes of post renal Acute Kidney Injury?
Prostatic
Tumours
Kidney stones
What are some of the Intrinsic renal causes of Acute Kidney Injury?
Established acute tubular necrosis due to endogenous toxins
Vascular issues with the small vessels in the Glomerulus
Intrinsic renal interstitial nephritis
How can Acidosis lead to Hyperkalaemia?
H+ will enter the cell due to the high concentration and exchanges for a K+. Therefore the ECF concentration of K+ increases
How do you manage a patient with Acute Kidney Injury?
Fluid replacement, but remember the composition of the fluid and replace electrolytes too
Correct the metaboliic acidosis
Volume overload
Dialysis as a last resort if symptomatic of uraemia (Effecting CNS/CVS) or the hyperkalaemia is not responding to treatment.
What property do red blood cells have that have passed through the Glomerulus?
Dysmorphic red blood cells (Mishaped)
If RBCs are in tact it suggests they are passing into the urine via another route eg malignancy
What are some of the causes of Microscopic haematuria?
Polycystic kidney disease Renal stones Renal tumours (Can be carcinoma or transitional) Glomerular disease Arteriovenous malformations
What are some of the causes of Microalbuminaemia? (Low levels)
Endothelial injury
Glomerular disease
Vascular complications
What can you use as a stable marker to compare protein to?
Creatinine
What are some of the causes of Macroalbuminaemia? (High levels)
Painless = renal cell carcinoma Myoglobinuria (Haem from muscles due to Rhabdomyolysis due to compartment syndrome) Haemaglobinuria (Haemaglobin spills into blood due to malaria, very rare) Glomerular disease (IgA nephropathy. Usually stops when infection is gone) Consumption of food dyes
What are the triad of findings in patients with Nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema (Can be mistaken as cirrhosis or heart failure, but there would not be albumin in the urine for these)
What is Nephrotic syndrome?
Damage/Loss of the podocytes so the Glomerulus is leaky to proteins
What is Anasarca?
Oedema spread throughout the whole body
How do fat bodies occur in the urine?
Casts that are due to hypercholesterolaemia.
Due to Nephrotic syndrome
How can Nephrotic syndrome cause an increased risk of DVTs?
You lose blood clotting factors that normally prevent excessive coagulation so there is an increased risk
What patients are very high risk for bleeding during renal a biopsy?
Renal biopsies have a high risk of bleeding, especially worse in patients who are on Aspirin (must stop for 10 days before biopsy) or warfarin
What are the some of the main causes of Nephrotic syndrome?
FSGS (Focal segmental glomerulosclerosis - scars in glomerulus) Minimal change disease Membranous nephropathy Infections Malignancy
What are some of the main causes of Nephritic syndrome?
Glomerulonephritis
Vasculitis
Lupus
What rash doesn’t blanch?
A vasculitic rash
What can chronic glomerulonephritis cause?
The kidneys to shrink. Because it is low grade, it is usually impossible to palpate them
What biochemical markers are there for chronic glomerulonephritis?
High creatinine
Blood in urine
Protein in urine
How do you treat chronic glomerulonephritis?
Control blood pressure as this means a slower decline for the kidney
Control the HBA1C in Diabetics
Give ACEi to decrease the proteinuria
What are some of the secondary effects of Kidney disease?
Hypocalcaemia as the kidneys activate vitamin D
Hyperkalaemia due to acidosis
