Summary Book Renal Flashcards
DDx of kidney enlargement
Chronic hydronephrosis, renal cell carcinoma, acromegaly, polycystic kidneys, infiltrative = amyloidosis / sarcoidosis / malignancy - lymphoma
Contraindications for renal transplant
Malignant disease (<2years of remission). Severe ILD and lung disease. Active vasculitis. Ongoing sepsis / TB / HIV. Alcohol, smoking, drugs. Severe osteoporosis or uncontrolled diabetes. Over 75 years old. Over 35 BMI. Medication non compliance or physciatric instability.
Complications of calcineurin inhibitors (tacrolimus, cyclosprin)
Tremor, AKI, hypertension, hyperglycemia, hyperkalemia, deranged LFT, gingival hyperplasia, hirsutism, gout, haematological malignancy, SCC, post transplant lymphoproliferative disorder
Complications of sirolimus (mtor inhibitor)
Hyperlipidaemia, proteinuria, infection, ILD, pulmonary effusion, pericardial effusion, DVT
Mycophenolate complications
Nausea, vomiting, diarrhoea, pancytopnea, infections, SCC
Azathioprine complications
Hepatitis, rash, pancreatitis, TPMT levels, SCC
Steroid complications
Diabetes, weight gain, osteoporosis, myopathy, bruising, infections
Define, cause and management of post transplant lymphoproliferative disorder
B cell proliferation becoming lymphoma. EBV status. Reduce immunosuppressants.
Management of renal transplant
- Immunosuppressant- prednisolone/ tacrolimus/ MMF - wean CNI after 6 months. 2. Monitor for signs of pharmacological side effects. 3. If CMV positive then 6 months of valganciclovir. 4. Bactrim for PJP. 5. Annual vaccination and skin checks.
Risk factors for renal transplant
Diabetes, glomerulonephritis, hypertension, SLE, IHD, PVD
Signs of rejection
Fevers, swelling, reduced urine output, flank pain, acute renal impairment
Complications of dialysis
Hypotension, peritonitis, dementia, line infection, social (sexual dysfunction, financial, work)
Pros and cons of haemodialysis and peritoneal dialysis.
Peritoneal dialysis- risk of peritonitis, protein loss, hyperglycemia, not as effective, perforation. HD- less total time, less protein loss, access issues (infections or clots), hypotension, amyloid, anaemia.
Indications for acute dialysis
Uraemia, fluid overload, hyperkalemia, severe metabolic acidosis
Protective and mortality factors for dialysis
Protective- high cholesterol and obesity. Mortality- high phosphate, low albumin, hypertension and diabetes.
Management of CKD complications
- Treat reversible conditions (diabetes, UTI, hypertension, drugs, CCF, dehydration)
- Non pharmacological- fluid restriction, optimise CVS health, transplant work up
- Pharmacological- monitor bone health = calcium and phosphate levels, aneamia, renal osteodystrophy (vit D)
Bicarb can be considered for metabolic acidosis.
ACEi for hypoalbuminaemia and hypertension
Investigations for chronic kidney disease
- Bloods - FBC, UEC, albumin, myoloma screen, vasculitis screen
- GN screen - ANA, ENA, dsDNA, C3+4, ANCA (MPO/PR3), anti GBM antibodies
- Urinalysis- ACR (<30mg/g), casts, blood
- Us or CT KUB
- Biopsy to rule out GN
Risk factors of chronic kidney disease
Diabetes (33%), glomerulonephritis (24%), hypertension (14%), systemic disease (vasculitis, RF, myoloma, infective endocarditis), polycystic kidney disease, reflux nephropathy, drugs
Presentation of chronic renal impairment
Anaemia, ureamia (lethargy, nausea, vomiting, anorexia, fatigue, cramps, confusion), puritis, peripheral neuropathy, pericarditis, nocturia
Compare mechanisms of calcitriol and cinacalcet
Calcitriol (active vit D) lowers PTH levels, which reduces turnover, and increases calcium while decreasing phosphate
Cinacalcet increases sensitivity of calcium sensing receptors of PTH which decreases calcium
Compare definitions and presentation of nephritic and nephrotic
Nephrotic = > 3.5g of protein and low albumin. Presents with oedema, hyperlipidaemia and hypercoagulant
Nephritic = presents with AKI, hypertension, haematuria, proteinuria and pyuria.
