Speciality: Renal Flashcards
Cranial Diabetes Insipidus
- Causes
- Presentation
- Ix
- Rx
- Idiopathic, post head injury, Pit surgery, craniopharyngioma, DIDMOAD, Hereditary Haemochromotosis.
- Polyuria. Polydipsia
- High plasma osmolality and low urine osmolality
- Water deprivation test - Desmopressin
Nephrogenic Diabetes insipidus
- Causes
- Presentation
- Ix
- Rx
- Genetics, hypercalcaemia, hypokalaemia, drugs (lithium), tubulo-interstitial disease
- Polyuria, Polydipsia
- High plasma osmolality and low urine osmolality, water deprivation test
- Thiazide diuretics and low salt/protein diet.
Alport syndrome
- Causes
- Presentation
- Ix
- Rx
- X linked
- Defect in collagen gene, abnormal GBM. - Microscopic haematuria, renal failure, BL sensorineural deafness, Eye problems.
- Genetic testing, renal biopsy.
- Nil
Daily glucose requirement
- 50-100g/day
- Regardless of weight
Fluid requirements
- water
- Potassium, sodium and chloride
- 25-30/ml/kg/day
- Potassium, Na and CL = 1mmol/kg/day
Metabolic acidosis
- Normal anion gap
- Raised anion gap
- Hyperchloraemic metabolic acidosis; GI bicarb loss due to diarrhoea, renal tubular acidosis, Addison’s disease.
- Lactic acidosis; shock, sepsis and hypoxia.
- Ketones
- Renal failure.
CKD EGFR ranges
Normal = Patients w/ EGFR >60ml/min/1.73m2 with NO markers of renal disease.
CKD1 = EGFR >90ml/min + evidence of kidney disease
CKD 2 = EGFR 60-90ml/min + reduced renal function + evidence of renal disease
CKD 3a = EGFR 45-59ml/min
CKD 3b = EGFR 30-44ml/min
CKD 4 = EGFR 15-29ml/min
CKD 5 (ESRD) = EGFR <15ml/min
Anion gap
(na + k) - (cl + hco3)
AKI
- Causes
- Presentation
- Ix
- Rx
- Pre-renal = Ischaemia, hypovolaemia, renal artery stenosis.
Renal = Glomerulonephritis, Acute tubular necrosis, Rhabdomyolysis, Tumour lysis syndrome.
Post-renal = Kidney stone, BPH.
Risk factors - Emergency surgery, Intraperitoneal surgery, CKD, DM, HF, age, liver disease, nephrotoxic drugs. - Rise in creatinine of 26mmol/L in 48hrs OR 50% rise in 7 days OR fall in urine output.
- Oedema
- Arrhythmia
- Uraemia - U&E
- Urine output. - Stop NSAIDS, aminoglycosides, ACEI, ARB, Diuretics.
- Treat electrolytes issues
- Refer to nephrologist
- Correct underlying cause.
Acute interstitial nephritis
- Causes
- Presentation
- Ix
- Rx
- Drugs - penicillin, rifampicin, NSAID’s, allopurinol, furosemide.
- Systemic disease - SLE, sarcoidosis.
- Infection
- Marked interstitial oedema, and infiltrate between tubules. - Fever
- Rash
- Arthralgia
- Eosinophilia
- Mild renal impairment
- HTN
- Proximity of Sx to drugs. - Urinalysis; sterile pyuria and white cell casts.
- Remove offending agent and support.
Potassium sparing diuretics
- Spironolactone
- Eplerenone
- Amiloride
Hyperkalaemia Management
1) Remove precipitants
2) Stabilise cardiac membrane w/ Calcium Gluconate (doesn’t alter electrolytes)
3) IV insulin/dextrose - moves K intracellularly.
4) Nebulised salbutamol.
5) Calcium resonium removes K from the body. PO or via enema.
6) Diuretics
7) Dialysis
Maintenance fluid requirements in kids
100ml/kg for the 1st 10kg
50ml/kg for the 2nd 10kg
20ml/kg for the remainder.
Haematuria
- Causes
- Presentation
- Ix
- Rx
- Transient haematuria = UTI, periods, exercise, sex.
Constant = Cancer (painless haematuria = bladder Ca until proven otherwise), stones, BPH, prostatitis, Chlamydia. - Can be macro or microscopic
- Urine dip.
- Further Rx = cystoscopy, U&E etc. - Urgent referral = >45 + non-explained visibe haematuria w/o infection OR that persist or recurs following UTI Rx.
Urgent referral = >60 + unexplained nonvisible haematuria + dysuria and raised WCC.
Rhabdomyolysis
- Causes
- Presentation
- Ix
- Rx
- Skeletal muscle is damaged and breaksdown, resulting in myoglobin release.
- Results in AKI.
- Consider in long-lie.
- Prolonged seizure.
- Crush injury
- Statins (especially when prescribed w/ Clarithromycin) - Tea-coloured urine due to myoglobin.
- AKI + CK
- Myoglobinuria
- Elevated phosphate
- Hyperkalaemia
- Metabolic acidosis. - U&E
- CK
- Urinalysis
- ABG - IV fluids to maintain urine output + Supportive care.
Preventing nephrotoxicity due to contrast media.
- IV NACL for 12 hours pre and post procedure.
Nephrotic syndrome Triad
- Proteinuria >3g/24hr
- Hypoalbuminaemia
- Odema
Other features include low total T4 levels.
Nephrotic syndrome Causes
- Minimal change disease
- Membranous GN
- FSGS
- Amyloidosis
- DM
Persistent pyuria + negative urine culture and screen
Renal TB
Goodpasture’s syndrome
- Causes
- Presentation
- Ix
- Rx
- Pulmonary haemorrhage and rapidly progressive glomerulonephritis.
- Anti-GBM against collagen.
- More common in men.
- Associated w/ HLA DR2 - Pulmonary haemorrhage
- Rapidly progressive GN - Renal biopsy - linear IgG deposits along the GBM
- Raised transfer factor due to pulmonary haemorrhages - Plasma exchange
- Steroids
- Cyclophosphamide
Nephritis syndrome causes
- Post strep GN -often GAS URTI
- LSE, Goodpasture’s syn, IgA nephropthy.
Post streptococcal GN
- Causes
- Presentation
- Ix
- Rx
- 1-2 weeks following a URTI.
- Often GAS - strep pyogenes
- Immune complex deposition in the glomeruli (IgG, IgM and C3) - General headaches, malaise
- Haematuria
- Proteinuria
- HTN
- Low C3 - Clinical
- renal biopsy; diffuse proliferative GN
- Neutrophils in the endothelium. - Supportive
- Carries a good prognosis.
Acute tubular necrosis
- Nephrotoxic stimuli; aminoglycosides, contrast media, myoglobin and haemolysis results in necrosis.
- Muddy brown casts
Interstitial Nephritis
- Causes
- Pathology
- presentation
- Ix
- Rx
- Drugs !!! NSAIDs, penicillin, rifampicin
- SLE, Sarcoid
- Infection - Histology, marked oedema and interstitial infiltrate
- Fever, rash, joint pain
- Eosinophilia
- Mild renal impairment
- HTN - Sterile pyuria
- White cell casts
Primary Vs secondary aldosterone’s
- Secondary = high renin
Cause - renal artery stenosis. - Primary = normal renin